Agenda item

To consider a report on child and adolescent mental health services provided through Oxford Health NHS Foundation Trust, as well as a separate report on the bespoke child and young people’s mental health services funded directly by Wiltshire Council.

Provision Part-Funded Through Oxford Health NHS Foundation Trust

The Executive Place Director for Wiltshire at BaNES, Swindon and Wiltshire (BSW) Integrated Care Board introduced a report about how Wiltshire Council, together with partners, commissioned targeted and specialist CAMHS provided by Oxford Health. The Associate Medical Director at Salisbury Community CAMHS explained that they received referrals to a single point of access (SPA) where families could then be signposted to the relevant services. She highlighted the impact of the services being delivered, noting that they met regularly with young people to hear about their experience of CAHMS. She mentioned that waiting times for services were broadly in line with the national average and was pleased to report that around 50 percent of all children achieved a full recovery, compared to the national averages of between 34 and 44 percent.

The Associate Director at Thames Valley CAMHS also provided an update, stating that had been an increase in the number of mental health referrals for young people since the pandemic, particularly in relation to eating disorders. In response to this, they were in the process of enhancing their Crisis and Resolution Home Treatment Service, so that additional resources were put into treating people in the community. The changes involved working closely with schools and had led to a reduction in the number of admissions to in-patient or residential units. Part of the additional investment had been running a pilot study for young people with eating disorders called Hospital at Home. As part of this study people that had been referred for an in-patient bed were instead being treated at home. Of the 26 young people receiving treatment at home in the past year, in only one case was it necessary to transfer their treatment to hospital. Due to the success of this study, the Hospital at Home programme was being expanded and an equivalent service would also be set up for people with learning disabilities and autism.

During the discussion the following points were made:

• Members thanked the directors for the report and welcomed the inclusion of information about the impact of the services provided.

• It was noted that an Assessment and Liaison Paediatric In-patient with Eating Disorder (ALPINE) model pilot study was being undertaken to reduce the use of tube feeding in treating young people with eating disorders.

• Although the average waiting time for a mental health assessment was nine and a half weeks, the directors clarified that all children referred to the SPA were signposted to the relevant service within 24 hours.

• The Associate Medical Director at Salisbury Community CAMHS noted that they were improving collaboration with partners in the voluntary sector to provide interventions at an earlier stage. She also confirmed that children requiring an emergency appointment would be seen within 24 hours. In addition, work had been undertaken to review recruitment, which had been increasing in recent months.

• The Associate Medical Director also reported that they were working on an equivalent to the Sleepio App, a treatment for insomnia, which they had been running successful trails with.

• When asked about the figure of 96 percent of patients being allocated a hospital bed within their catchment area, it was confirmed that the catchment area for Wiltshire residents was Berkshire, Oxford and Swindon. The nearest CAHMS in-patient centre was Marlborough House in Swindon.

• In response to a question about what was being done to improve mental health provision in schools, the Executive Place Director explained that they were working with their educational colleagues to get their views. Work was also being done at a national level including around the issue of exam stress in schools.

• When asked about why the percentage of Children Looked After in Wiltshire whose emotional wellbeing was a cause for concern was above the national average, the Director of Families and Children’s Services noted that mental health was the most significant issue facing children in Wiltshire and that it had been discussed at a recent transitional safeguarding event.

• The Associate Medical Director explained that 50 percent of young people that had a diagnosable mental health disorder fell below the threshold for having a diagnosable disorder after receiving care via Oxford Health. The support available after receiving care would depend on the level of recovery of each individual patient.

Wiltshire Council Funded Mental Health Services for Children and Young People

The Interim Head of Service for Whole Life Commissioning introduced a report about the impact that the bespoke mental health services, commissioned directly by Wiltshire Council, were having on young people. She noted that the council were reviewing the services that they commissioned to ensure value for money and to avoid duplication of services. As examples, she highlighted two of the current contracts, with Rethink and Bernardos, that were due for renewal over the next couple of years. The interim head of service also explained that they were developing mental health first aid training skills within the council. She felt that the review of commissioned services had been a valuable activity in building their strategy and reported that there was still lots of work to do over the next financial year. Wiltshire Council were keen to work with partners such as Healthwatch Wiltshire and Wiltshire Centre for Independent Living to ensure that the views of young people were considered.

During the discussion points included:

• Members thanked the interim head of service for the update.

• It was noted that a review was ongoing about whether the Primary Mentoring In-house Service was duplicating the Kidscape Rise Transition Programme.

• In response to queries about the statistical discrepancies in paragraph 91 of the report, including in the number of people starting and completing the Rethink service in 2021-22, the interim head of service explained that they would clarify the figures with Rethink and discuss the way in which they provided figures.

• Members noted that they would welcome a detailed statistical analysis of the impact of the Rethink programme. The Director of Procurement and Commissioning reassured the committee that a formal meeting would be held with the provider in November and consideration was being given to alternative options for the contract going forward.

• It was noted that around 9,000 young people in Wiltshire had a diagnosable mental health condition, so reassurance was sought about the level of support that was available. The Director of Procurement and Commissioning explained that the services outlined in the report were part of wider services being offered. The Executive Place Director for Wiltshire at BSW Integrated Care Board reassured the committee that any individual who came through the SPA at Oxford Health would get support and there were not referral thresholds.

• The Interim Head of Service for Whole Life Commissioning noted that lots of work was being carried out as part of the Independent Living Strategy to find suitable accommodation for young people.

• The Director of Procurement and Commissioning offered to ask officers to provide a report on the Parenting Programme funded through the Supported Families Initiative, including information about the outcomes of the STOP Parenting Programme.

• Members observed that they would appreciate further information about the level of need and impact delivered through Bernardo’s Early Mental Health Service, as well as information about the level of service received after the early intervention. The interim head of service noted that they were seeking further information through contract monitoring and said that the contract was due for tender in the forthcoming year.

• Members welcomed the review of the contracts and stated that they would be grateful for further details about clawback agreements within contracts.

• The Director of Procurement and Commissioning noted that they would submit a report to Cabinet before the next tranche of contracts went to tender, outlining the expectations about contractual management arrangements.

• The Cabinet Member for Children’s Services Education and Skills observed that it would be useful to collate all of the information about the mental health services commissioned together to give an overview of the overall demand and provision. The chairman endorsed these comments and stressed the importance of looking at early intervention.

• The Director of Procurement and Commissioning highlighted that there was an ambition to develop a Wiltshire Council strategy for emotional wellbeing to give further direction to the commissioning of services. Conversations were ongoing with health colleagues about whether some of the funding earmarked for CAHMS after 2025 could be directed towards early intervention.

Resolved

1. To thank the Interim Head of Service for Whole Life Commissioning for the report.

2. To express concern about the lack of information on key performance indicators provided by some of the key contractors.

3. For the Children’s Select Committee to scrutinise the expectations of contractors before the next tranche of contracts go out to tender.

4. To receive a report on the Parenting Programme funded through the Supported Families Initiative.