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NHS England Children & Young Peoples Programmes in Mental Health Dr Jacqueline Cornish NCD for CYP & Transition NHS England Manchester 16 th March 2017

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Page 1: Jacqueline Cornish

NHS England –

Children & Young

Peoples Programmes

in Mental Health

Dr Jacqueline Cornish

NCD for CYP & Transition

NHS England

Manchester

16th March 2017

Page 2: Jacqueline Cornish

www.england.nhs.uk 2

“Children need champions – strong leaders who will advance their interests – at all levels in the NHS.”

- Professor Sir Ian Kennedy, 2010

Page 3: Jacqueline Cornish

www.england.nhs.uk

CYP are embedded in key programmes in

NHS England

Cancer: the

independent taskforce

made recommendations to

NHS England considering

specific needs of children,

teenagers and young

adults

Mental health access and

waits: programme of transformation of

CYP mental health services is underway

Learning disabilities: aim to reduce inpatient

admissions for those with

LD/autism applies to children

and complements EHCP

Urgent & Emergency

Care: children form one of

the ‘lenses’ through which the

proposed new model of care

will be viewed.

Long-term

conditions: the model

of care planning, house of

care model, and recent

resources developed are

mostly applicable to

children and young people

Specialised Commissioning developing leading edge science and

innovation to enable patients with rare

diseases to be treated most effectively

New care models:Aiming to work with interested vanguards, UEC and

acute care collaboration vanguards to support focus

on CYP

NHS England business plan,

2016/17

Genomics: The Genome

project will enable conclusive

diagnosis in some rare

childhood diseases, and allow

treatment to be tailored

Page 4: Jacqueline Cornish

www.england.nhs.uk 4

Improving

quality of care

Developing future

models of care

Promoting

physical and

mental health &

wellbeing

NHS England’s approach

Improving

outcomes

for CYP

Child Health Digital

Strategy

Page 5: Jacqueline Cornish

www.england.nhs.uk

Child Health Digital Strategy - Context

"Develop integrated health

and care statistics"

‘Knowing where every child

is and how healthy they are’

‘Appropriate access to

information for all involved in

the care of children’

Page 6: Jacqueline Cornish

www.england.nhs.uk

Why focus on children’s health and

information?

➢ Public Health England and the NHS Outcomes Framework 2015/16 stress that a focus on

children’s health is essential and that we should be striving to provide the best start in life

possible for our children.

➢ The recent National Maternity Review has highlighted that this begins not just with the

newborn child but with the mother’s experiences in pregnancy and the birth itself.

➢ The importance of ensuring this good start for the future health of children for the

sustainability of the NHS and the economic prosperity of Britain is one of the key themes of

the Five Year Forward View.

➢ We need to redesign information services to support the new emphasis on:

• the importance of early interventions and preventive measures

• integration across different care settings, particularly joining up maternity and

newborn care – Perinatal mental health and early development

• the need to enfranchise children, young people and parents as equal partners in their

care.

➢ We also need to take on the challenges posed by the current organisation of

information services.

Page 7: Jacqueline Cornish

www.england.nhs.uk

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Pro

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ealth

Public

Health

Commissioners

Directors of Public

Health & Children’s

Services

Delivery of Healthy Child

Programme

(All Children)

Delivery of all other care services

(Some Children)

CHIS /

CHRD

CHIS /

CHRD

CHIS /

CHRD

CHIS /

CHRD

CHIS /

CHRDCHIS /

CHRD

School NursingPrimary CareHealth VisitingMidwifery

Education

ServicesVoluntary Services

Mental Health

Services

Emergency &

Acute Services

Justice ServicesSocial ServicesCommunity

ServicesNeonatal Services

Maternity

Information Systems

Screening

Information Systems

Primary Care

Systems

GPESCYP DatasetCAMHs

Dataset

PCHR

90

CHRDs

Research & Policy

Maternity

Dataset

SCR

National Audit

Page 8: Jacqueline Cornish

www.england.nhs.uk

Central data sharing hub(3 to 5 years)

Page 9: Jacqueline Cornish

www.england.nhs.uk 9

“Integrated care is

about joining things up

in order to meet health

needs, and in ways

that make sense to

children and their

families. Therefore it

should make an

important contribution

towards improving

child health”

- Wolfe et al, 2016

Integrated Care

Page 10: Jacqueline Cornish

www.england.nhs.uk

NHS England’s activity in 2016/17 is set out

in these three broad themes

10

Theme Work to be progressed in 2016/17

Improving and integrating

physical and mental health

and wellbeing

Transformation of CYP Mental Health services

Reducing childhood obesity

Improving care for CYP with long-term conditions e.g. Epilepsy, Asthma,

Diabetes, Complex Disabilities & End of Life Care

Improving student physical and mental health outcomes

Improving quality of

services

Service reviews of neonatal critical care, paediatric general surgery and

paediatric intensive are – led by specialised commissioning

Improving care for children with complex needs, including learning disability

and autism with greater personalisation of care through the Integrated

Personalised Commissioning Programme

Improving the child death process – simplifying procedures, and establishing a

national database for better identification of modifiable factors in deaths and

trends

Improving Transition from paediatric to adult services

Developing future models of

care

Working to develop New Models of Integrated Care for CYP, opportunities

through the creation of STPs, the Integration Collaborative and

Commissioners Forum

Support to the development of pilots to improve decision making around CYP inNHS 111 services.

Page 11: Jacqueline Cornish

www.england.nhs.uk 11

Long Term Conditions

• Improved Outcomes

• Integrated Mental and Physical Health

• Transition to Adulthood

• Student Health

National Paediatric

Asthma Collaborative

Page 12: Jacqueline Cornish

www.england.nhs.uk

Childhood Obesity – co-existent MH

12

Page 13: Jacqueline Cornish

www.england.nhs.uk

CYP Mental Health

13

The report makes a

series of

recommendations:

Maximise mental

health and wellbeing

throughout childhood

Page 14: Jacqueline Cornish

www.england.nhs.uk

Common themes

14

CYP Mental HealthFuture in Mind & Five Year Forward View

• Promoting resilience, prevention

and early intervention.

• Improving access to effective

support.

• Care for the most vulnerable.

• Accountability and transparency.

• Developing the workforce.

• Promoting good mental health

and preventing poor mental

health.

• A 7 day NHS – right care, right

time, right quality.

• Complex need services nationally

from 2016.

• ‘Hard-wiring’ mental health across

the NHS.

Page 15: Jacqueline Cornish

www.england.nhs.uk

Future In Mind and the FYFV for Mental Health

By 2020, for people of all ages we want to see:

Publications Gateway

Ref. No. 03250

And for children and young people specifically:

Improved crisis care for all ages: right place, right time, close to home

Improved transparency, leadership and accountability across whole system

More visible and accessible support

Improved public awareness less fear, stigma and discrimination

Timely access to clinically effectivesupport

More evidence based, outcome-focused treatments

Better use of data and information across the network

Professionals who work with children and young people trained in child development and mental health

Model built around the needs of children and young people, and a move away from the ‘tiers’ model

Improved access for parents to evidence-based programmes of intervention and support

A better offer for the most vulnerable children and young people

Page 16: Jacqueline Cornish

www.england.nhs.uk

Key issues

Access Waiting times Vulnerable

groupsTransition

Economics of investment Infrastructure/resources Systems

£78 Average spend per

child 0-17 yrs

6.6%CYPMH as proportion

of MH spend (2012/13)

Not enough is being spent

The high cost of getting it wrong

The low cost of investing early

YP with a MH problem are…• 8x more likely to have contact with YJS

• Twice as likely to be claiming benefits

Group CBT

£229

Unit cost

£7,252

Total lifetime benefit

Number of 5-16 yr

olds with a

diagnosable MH

condition per 1,000 in

England.

1020.7

Number of WTE

CYPMH clinical

workforce per 1,000

0-17 yr olds in

England.

Low workforce capacity

Long waiting times

Average maximum wait

for first appointment

(NHS benchmarking)

High numbers of referrals

Approx increase in

referrals last four years

referrals 14/15

44%

26

weeks

Tiered

system

0-25s

Thrive

Step care

modelsIntegrated

pathways

Varied

approaches

Various

commissioners

CCGs LAs

NHSE Schools

MoJ

Page 17: Jacqueline Cornish

www.england.nhs.uk

Contributing to the 2020 vision

At least 70,000 more CYP receiving swift and appropriate access to care each year

Completed national roll-out of CYP IAPT programme with at least 3,400 more staff in existing services trained to improve access to evidence based treatments

1,700 additional new staff to support improved access to evidence based treatments

Evidence based community eating disorder services for CYP across the country95% of those in need of eating disorder services seen within 1 week for urgent cases & 4 weeks for routine cases.

Improved access to and use of inpatient care, having the right number and geographical distribution of beds to match local demand with capacity, and leading to an overall reduction in bed usage.

Improved crisis care for all ages, including investing in places of safety

By 2020 there will be system-wide transformation of the local offer to children and young people underway, with LTPs embedding Future in Mind principles and fully integrated into STPs across the country:

Page 18: Jacqueline Cornish

www.england.nhs.uk

NHS England – CYP MH Delivery Plan

• Supporting Transformation – refresh LTP’s to STP’s, pilot currencies, data, dashboard metrics

• Workforce development – HEE, CYP IAPT coverage to 100% by 2018

• Generic CYP MH Pathway – 1st point of contact, scheduled care, intensive interventions

• Eating Disorders – community ED teams, extend pathway to include in-oatients

• Crisis Care – 24/7 emergency response pathway

• Specialised (Collaborative – CCG’s) Commissioning

• Vulnerable groups – forensic CYPH MH complex needs pathway, Health and Justice Collaborative Commissioning Networks, personal budgets for LAC

Page 19: Jacqueline Cornish

www.england.nhs.uk

Prime Minister’s announcement Jan 2017

• Green paper - DfE, DH with a focus on Prevention

• More for schools

• Mental Health First Aid in schools

• Peer Support

• RCTs

• Extension of training offer for single points of access

• Understanding what works in schools settings

• CQC and Ofsted review

• Digital

• ‘Think Ahead’ Social Worker programme

Page 20: Jacqueline Cornish

www.england.nhs.uk

CYP MH Schools Link Pilot Objectives

In Summer 2015

NHS England and

Department for

Education jointly

funded (£3 million)

22 pilot sites (27

CCGs and 255

schools) to test the

named lead

approach within

CYP MH services

and schools and to

trial a joint training

programme.

Develop ways to improve joint working between school settings

and CYP mental health services

Understand the development and maintenance of effective

local referral routes

Test the concept of a lead contact in schools and CYP mental

health services

Understand how training and joint working can improve

identification of mental health and well-being issues.

Test whether improved knowledge of the system improve timely

referrals to appropriate services delivering children and young

people’s mental health care

Page 21: Jacqueline Cornish

www.england.nhs.uk

CYP MH Schools Link Pilot -

Methodology

Workshop training sessions aimed to:

• develop a shared view of the strengths and limitations and capabilities and

capacities of education and mental health professionals

• develop knowledge of resources to support the mental health of children and

young people

• make more effective use of existing resources

• improve joint working between education and mental health professionals

The workshops used case studies and covered content around depression, anxiety,

school approaches to fostering resilience and the use of outcome measures.

The aim: long term, sustainable and locally-owned collaboration between schools

and CAMHS.

The Method: CCGs nominated a named lead responsible as overall point of

contact; NHS CAMHS and schools also nominated named leads to develop joint

working models. Training was delivered by the Anna Freud Centre using the

CASCADE model which was specially designed for the pilots.

Page 22: Jacqueline Cornish

www.england.nhs.uk

CYP MH Schools Link Evaluation

Methodology: incorporated survey research, research observations and qualitative case studies in a sample of 10 areas and place between September 2015 and 2016.

Variety of models tested during the pilot programme. Main areas of variation included:

• named individual mental health worker

• regular in-school presence

• group or 1-2-1 work with children and young people

• engagement of wider CYPMHS professionals

No single model emerged as being most effective: approaches tailored to local needs and circumstances.

Page 23: Jacqueline Cornish

www.england.nhs.uk

Key Findings of the Evaluation

Uptake of evidence-based interventions and common

outcome measures featured less prominently.

Clear evidence of a contribution towards improvements

in the frequency and quality of communication between

schools and NHS CYPMHS in many areas.

Corresponding perceived improvements to the quality

and consistency of referrals, without a corresponding

net increase in total referrals across the pilot.

Very promising early signs of changes to whole school

policies, resources and staffing within pilot schools.

Page 24: Jacqueline Cornish

www.england.nhs.uk 24

“It is easier to

build strong

children than

to repair

broken men.”

- Frederick Douglass,

1818 - 1895

Page 25: Jacqueline Cornish

www.england.nhs.uk 25