North West London Clinical Commissioning Groups Children and Young People’s Mental Health and Wellbeing Strategy and Transformation Plan In response to Future in Mind First Published October 2015 Refreshed October 2016 and October 2017 Supported by the Mental Health and Wellbeing Team– The Mental Health and Wellbeing Strategy for North West London
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North West London Clinical Commissioning Groups
Children and Young People’s Mental Health and Wellbeing Strategy and Transformation
Plan
In response to Future in Mind
First Published October 2015 Refreshed October 2016 and October 2017
Supported by the Mental Health and Wellbeing Team– The Mental Health and
Wellbeing Strategy for North West London
2
Declarations of Support
Brent
Name: Councillor Krupesh Hirani Position/Organisation: Lead Member for Adults, Health and Wellbeing - Member for Dudden Hill Ward (Labour) Date:
Name: Sarah Basham Position/Organisation: Brent CCG Mental Health GP Lead Date:
Central London
Name: Cllr Heather Acton
Position/Organisation: Deputy Chair Health and Well-being Board Date: 30.10.17
Name: Jules Martin
Position/Organisation: Managing Director NHS Central London CCG Date 30.10.17
Ealing
Name: Dr Mohini Parmar Position/Organisation: CHAIR, NHS EALING CCG Date:
Name: Cllr Julian Bell Position/Organisation: Leader, London Borough of Ealing; Chair, Ealing Health & Well-being Board Date:
Hammersmith and Fulham
Name: Cllr Ben Coleman
Position/Organisation: Chair Health and Well-being Board.
Date:
Name: Janet Cree
Position/Organisation: Managing Director, NHS Hammersmith and Fulham CCG
Date:
Harrow
Name: Chris Spencer
Position/Organisation: Corporate Director of People Services Harrow Council
Date:
Name: Paul Jenkins
Position/Organisation: Chair Date: 31.10.17
3
Hillingdon
Name: Dr Ian Goodman Position/Organisation: Chair
Date: 17.10.17
Name: Position/Organisation: Health and Wellbeing Board Endorsement Agreed via Email Date: 17.10.17
Hounslow
Name: Mary Clegg
Position/Organisation: Managing Director Hounslow CCG Date: 24.10.17
Name: Councillor Steve Curran
Position/Organisation: Leader of Hounslow Council and Chair of Hounslow Health & Wellbeing Board Date: 24.10.17
West London
Name: Cllr Charles Williams
Position/Organisation: : Chair of Health and Wellbeing Board for Kensington and Chelsea
Date:
Name: Louise Proctor
Position/Organisation: Managing Director, NHS West London CCG Date: 30.10.17
4
Table of Contents
1.0
Executive Summary
Page 5
2.0
Supporting Improved Mental Health In NW London
Page 6
3.0
Understanding Local Need
Page 8
4.0
Service Provision
Page 15
5.0
Our Shared Priorities
Page 17
5.1 Priority 1: Waiting Times Page 18
5.2 Priority 2: Community Eating Disorder Service Page 23
5.3 Priority 3: Redesigning the System Page 29
5.4 Priority 4: Vulnerable Groups Page 36
5.5 Priority 5: Crisis and Urgent Care Page 44
6.0
Emerging Local and National Initiatives
Page 49
7.0
Enablers
Page 51
Enabler 1: Coproduction Page 51
Enabler2: Work Force and Training Page 52
8.0
Equalities
Page 56
9.0
Governance and Risk
Page 57
5
1.0 Refresh 2017/18 Executive Summary
This document is a refresh of the 2015 and 2016 North West London (NW London)
Children and Young People’s (CYP) Mental Health and Wellbeing Strategy and
Transformation Plan. The plan provides detailed assurance to local and national
stakeholders we are working in partnership across health, local authorities,
education, the third sector and criminal justice system to provide high quality
intervention and support to CYP who require mental health and emotional wellbeing
services. The Transformation Plan is a core component, of the North West London
Sustainability Plan (STP) 1 which sets out the vision to support the local population to
be well and live well. Key to achieving this vision is to deliver fundamental
improvements for CYP. The transformation plan forms the basis of the overarching
CYP NW London STP Transformation Programme.
Since the publication of the original plan in 2015 we have made significant progress
towards our defined aim of promoting emotional wellbeing and ensuring that children
and young people, who experience mental health issues, have timely access to high
quality intervention and support. A number of new services and quality improvement
initiatives have been successfully implemented including a Community Eating
Disorder Service, an Out of Hours Crisis Service and a range of local school’s mental
health prevention and early intervention programmes.
The 2017 Transformation Plan switches focus from individual service improvement
and implementation to whole systems redesign with the remodelling of the entire
children and young people’s emotional health and wellbeing service delivery
framework together with the implementation of a fully integrated 24-hour crisis service
and reconfiguration of services aimed at vulnerable groups such as young people
involved in the criminal justice system and those with Autistic Spectrum Disorder
(ASD) and Learning Disabilities (LD).
The ambition of our transformation programme is to ensure by 2021 every child and
young person in NW London can access appropriate needs based, person centred
mental health and emotional wellbeing support that significantly improves outcomes.
The transformation programme is underpinned by key enablers; workforce
development and assessment of local need. At the heart of the programme is
coproduction ensuring the needs, wishes and preferences of children, young people
and their families and carers are central to the design and development of all
pathways and services. In line with the ambition of Future In Mind2, our vision is
provide high quality, equitable intervention that achieves the same outcomes no
matter where in the system help is sought.
1
NW London Sustainability and Transformation Plan November 2016 https://www.healthiernorthwestlondon.nhs.uk/sites/nhsnwlondon/files/documents/nwl_stp_october_submission_summary_v01.pdf 2 Future in Mind DoH/NHSE 2015
2.0 Supporting Improved Mental Health and Wellbeing for Children and Young People in North West London
In February 2015 eight NW London
CCGs launched ‘Like Minded’ – the NW
London strategy for mental health and
wellbeing. As part of this strategy all eight
CCG’s pledged to work together to
deliver the ambition of Future in Mind2. A
joint Transformation Plan was developed
for NW London that defines shared
priorities and describes initiatives
implemented locally.
Although collaboration is at the core of how we work, we recognise that each borough has individual needs and infrastructure. For clarity we are not proposing that there is any cross-subsidisation across NW London. The funding outlined in this plan is ear-marked for each CCG, and will be invested in the children and young people in each locality.
The Transformation programme is a unique opportunity to design a new system
which, by 2021 will look radically different from our starting point in 2015. There are
many clear benefits to working in partnership to address our mental health priorities
across NW London. These include:
- Having a clearer picture of emotional and mental health needs across NW
London giving us a richer understanding of the demands on services, the
challenges faced, and the areas in which we can benefit from working together.
- Developing economies of scale allowing us to pool resources, jointly invest in
project management, commissioning of needs assessments, and buying of
services such as communication campaigns.
- Sharing of learning from the many different initiatives and high quality services
implemented in each area.
- Reducing duplication and promoting efficient working and business practices.
- Delivering equitable service provision and access across NW London ensuring
that CYP receive high quality mental health care and support, irrespective of
which borough they live in.
- Collaborative working to develop consistent pathways and services that deliver
Self-harm is also more common amongst young people with mental health needs.
Among 11-16 year olds, over a quarter of those with emotional disorders and around
a fifth of those with conduct or hyperkinetic disorders or depression said that they had
tried to harm themselves5.
In NW London rates for CYP admitted to hospital because of self-harm are
significantly lower than the English average for all 8 CCG’s (Table 5) with either no
trend or a decreasing trend noted in 2015/164.
4Public Health England Fingertips 2015: https://fingertips.phe.org.uk/profile-group/mental-
health/profile/cypmh/data#page/1/gid/1938133090/pat/120/ati/153/are/E38000020 5ONS (2005). Mental Health of Children and Young People in Great Britain. Accessed at
England rate in 2015/16= 60; London rate in 2015/16= 51 (per 10,000 children under 18 years)
% of LAC
where there
is cause for
concern in
2015/16
44.7 25.7 20.9 40.7 32.8 43.2 31.4 27 33.3
England rate in 2015/16= 37.8%; London rate in 2015/16= 32.9%
Children with Special Educational Needs Children with special educational needs may be at higher risk
of developing emotional and mental health issues. Across NWL, the percentage of
school aged children with special education needs, including autistic spectrum
disorders, ranges widely as demonstrated in the Table 7.
4 Public Health England Fingertips 2015: https://fingertips.phe.org.uk/profile-group/mental-
health/profile/cypmh/data#page/1/gid/1938133090/pat/120/ati/153/are/E38000020 6 National Statistics September 2016 Children looked after in England including adoption:
2015 to 2016 Local authority tables: SFR41/2016- Table LAA1 https://www.gov.uk/government/statistics/children-looked-after-in-england-including-adoption-2015-to-2016
Rates in Hammersmith and Fulham, Hounslow and Westminster are higher than both
the English and London average. The percentage of children with autism known to
schools is slightly higher in Hammersmith and Fulham and Hillingdon. The
percentage of children with a learning disability is lower than the English and National
average across NW London.
Table 7: Children with Special Education Needs 4,7
Criminal Justice and Mental Health
Rates for first time entry to the youth justice system across NW London are shown
Table 8 below. First time entrants into the criminal justice system are significantly
higher than the London average in Hammersmith and Fulham, Brent, Ealing
Hounslow and Kensington and Chelsea and all NWL boroughs have rates above the
national average.
Table 8: First time entrants to youth justice system aged 10-174
4
Public Health England Fingertips 2014/17: https://fingertips.phe.org.uk/profile-group/mental-health/profile/cypmh/data#page/1/gid/1938133090/pat/120/ati/153/are/E38000020 7 National Statistics, Special educational needs in England: January 2017Local authority
The QNCC-ED standards provide the basis for the annual review process and are
used by member services to benchmark themselves nationally against peers. Both
WLMHT and CNWL have registered with the network. CNWL have had their peer
review and are awaiting the outcome. WLMHT are in the process of working towards
accreditation and are awaiting their peer review.
Feedback from some of our young people who have used the service.
5.1.5 Next Steps
2017/18
Evaluation, review and refinement. Developing a joint quality improvement
action plan looking to enhance service provision including self-referral, 7 days
and after hour clinics and home visits.
Streamlining the referral process, especially for GP’s in some areas
Defining a robust communication plan to ensure CYP, parents and carers and
other key referrers (i.e. GPs) are aware of any agreed changes.
Ensuring both CNWL and WLMHT are compliant to The Quality Network for
Community Eating Disorder services for children and young people (QNCC-
ED) standards and have been formally reviewed.
2018/19
Key decisions regarding testing the market to be made.
Business as usual monitoring
North West London Eating
Disorder Service
They pay attention to what you say
Very easily accessible with self-referral system, no delays. Frequent appointments tailored to need, reducing and increasing frequency depending on level of input required. Able to talk to our therapist on phone when need extra help. Everyone we have dealt with has been caring and professional.
Everyone is so supportive and you feel really safe. You can come here with anything as it is a non-judgmental service. You are reassured that you're not the only person going through this.
I feel more listened to and heard than previous places
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65.3 Priority Three: Redesigning the System
5.3.1 Funding
2015/16 2016/17 2017/18
Central £60,000 £207,045 £91,630
West £88,000 £244,509 £90,000
H&F £56,000 £189,026 £80,000
Ealing £206,700 £328,765 £290,960
Hounslow £127,930 £246,902 £142,056
Hillingdon £120,000 £140,000 £140,000
Harrow £170,000 £270,000 £270,000
Brent £154,468 £166,000 £112,000
5.3.2 Road Map
5.3.3 The Ambition
We have high aspirations for children and young people’s emotional wellbeing and
mental health provision in NW London. Our ambition is to provide high quality,
equitable intervention which achieves the same outcomes no matter where in in the
system help is accessed. We believe that fundamental for success is: -
1. Children, young people, their families and carers are at the heart of
developing NW London services;
2. Every child and young person in NW London has access to local help and
support that promotes emotional wellbeing and builds resilience;
3. When mental health issues do arise, early help and intervention in schools
and local communities can be easily accessed, building confidence and
supporting self-management;
4. We have an easy to navigate system in place delivered by joined up services
which are multi-agency;
5. Flexible intervention and support offered is sensitive to individual needs and
reflects the wishes and preferences of the child, young person as well as their
families and carers.
30
6. There is a holistic approach to intervention enabling children and young
people to access appropriate support no matter where in the system they
access care;
7. Children and young people can access intervention which reflects their
changing needs and supports them transition into adult services;
8. Children and young people who require health based care have timely access
to evidence based intervention with clear outcomes and treatment goals;
9. Support options are available for children and young people with complex
needs but for whom health based interventions are not suitable;
10. We have a flexible and adaptable workforce with the right skills to deliver high
quality, sustainable services;
11. Our aims and objectives are progressive and adapted to meet changing local
needs such as the Grenfell Fire national disaster and align to other evolving
national and local directives and programmes such as NHSE specification,
Transforming Care Programme (TCP), New Models of Care (NMoC) and
Thrive London the Mayor’s city wide mental health programme.
The anticipated benefits of implementing the programme:
Better health and wellbeing for our children and young people
Improvements in physical, mental, social, emotional and educational
wellbeing, leading to improved quality of life and resilience;
Children and young people receive holistic, proactive and well-coordinated
support in the least intensive setting;
A wide variety of help and intervention is available, tailored to the needs,
wishes and preferences of the individual child or young person.
Transformed quality of care delivery
Professionals are supported to deliver effective coordinated care across
organisational boundaries;
There is an ethos of continuous improvement and responsiveness to the
changing needs of the population;
Clarity of process and support structures enables staff to feel more confident
in carrying out timely and supported transfers and transitions;
Clarity on roles and responsibilities leading to effective joint shared
responsibility for the welfare of children and young people;
There are clear pathways in place to support seamless transition to adult
services.
Sustainability of Services
The most effective use of available resources delivering sustainable services;
Unnecessary hospital admissions are avoided;
Correct balance of resource and skills across all settings of care;
Integrated care through multi-disciplinary teams with skills and disciplines to
deliver flexible, more responsive and more creative treatment;
Organisational clarity on strategic aims and purpose: joint shared
responsibility for the welfare of children and young people.
31
5.3.4 Our Progress
A primary concern amongst many CYP, their families and carers as well as and
professionals who are trying to provide help and support is navigating a fragmented
complex system with no clarity on what help is available and how that help can be
accessed. Although numerous local initiatives have been implemented in each
borough that provide early intervention, expand access and improve the quality of the
support and treatment offered, a systematic approach has not been undertaken. To
help us identify gaps and help us focus our resources, the AFC carried out a needs
assessment which identified several gaps. The gaps are set out in Table 19 below
Each Local Authority publishes a local offer on their website which highlights both
health and non-health based services available locally. Details of each local offer are
outlined in each annex.
Table 20: Gaps Identified by AFC Needs Assessment
Resilience and Self-Management
No strategic coordination of prevention & promotion resources available at borough, NW London and pan-London level making help and support difficult to navigate.
Early Intervention, support and sign posting
An uncoordinated approach to offering advice and support;
No central information point;
Lack of dissemination to professionals (health, education, social care, third sector), young people, parents and carer on where they can access general help and support;
Lack of digital interventions to support self-management and build resilience.
Specialist Evidence based Treatment
Lack of interagency coordination and integration;
Siloed approach to CAMHS provision;
High treatment thresholds that are barriers to obtaining support;
Long waiting times with limited interim support solutions offered;
No step-up step-down approach in the community;
Inflexible traditional model of care offered;
Lack of early intervention for Learning Disabilities (LD) and Neurological Disorders (ND).
Interagency support and Intervention
No consistent approach to targeting vulnerable groups not who are not engaged;
No joint agency working or joint plans developed.
In addition to clarifying local need in terms of emotional wellbeing and mental health,
new approach and ways of working were recommended. Central to this concept was
the adoption of THRIVE as a mechanism to supporting implementation in NW
Five Year Forward View Mental Health https://www.england.nhs.uk/wp-content/uploads /2016/02/Mental-Health-Taskforce-FYFV-final.pdf. 12
Mental Health Crisis Concordat
http://www.crisiscareconcordat.org.uk/ 13
Mental Health Crisis Care for Children and Young People Healthy London Partnership 2016 https://www.myhealth.london.nhs.uk/sites/default/files/Improving%20care%20for%20children%20and%20young%20people%20with%20mental%20health%20crisis%20in%20London.pdf
Aligning to other national and local work programmes with interdependencies
including the New Models of Care Programme (NMoC) and TCP, our aim is to
provide easily accessible, integrated 24/7 support and intervention for CYP in crisis.
Our aim is to:
1. Improve access to care: ensuring CYP who live in NW London can access high quality emergency care and support 24/7;
2. Reduce avoidable admission to hospital: preventing inappropriate hospital admissions (paediatrics, adult MHU and Tier 4 CAMHS) and linking children to appropriate intensive community support services;
3. Providing timely care enabling CYP who live in NW London to access timely emergency care and support 24/7 with minimal waiting times;
4. Introducing a step-up step down approach to enable CYP to access the right help at the right time in the right location;
5. Improving experience of CYP by supporting access to needs-based seamless care and signposting to applicable longer-term support and intervention based on their individual wishes and preferences;
6. Provide multi-agency joined up care delivered across organisational boundaries;
7. Align to the London health based places of safety initiative being carried out by the Healthy London Partnership;
8. Ensure all CYP have a safety and coping plan in place.
The anticipated benefits of implementing the programmes:
There will be a reduction in unnecessary hospital admission to CAMHS beds
and the use of adult and paediatric beds will be avoided;
There is a viable alternative to inpatient care;
CYP can access care closer to home;
There will be a coordinated approach across health, justice, social care and
education;
Pathways will align and support successful delivery to the NMoC Programme
in NW London;
The experience of CYP in crisis will improve;
There will be a reduction in A&E attendances.
46
5.5.4 Progress
Out of Hours and Crisis Care
For NW London, the essential first step in developing consistent infrastructure to
deliver integrated 24/7 was the implementation of Out of Hours crisis service. In April
2016 funding was allocated to CNWL and WLMHT to develop and implement an out
of hours’ crisis pilot service across NW London. The pilot aimed to bring parity of
esteem of CYP presenting with mental health issues in Accident and Emergency
Units (A&E’S) during OOH. The services enabled CYP up to the age of 18 in crisis to
be assessed and supported by CAMHS qualified nurses in a timely manner. All CYP
who present in crisis in A&E, urgent Care Centres (UCC), in S136 suites and when
an emergency admission is sought are assessed. In 2016/17 over 800 CYP
accessed the service.
The key aims of the CAMHS OOH service are to:
Enable access to specialist child and adolescent mental health services from
first contact;
Improve the experience for CYP in crisis to ensure the right decisions can be
made regarding initial care and treatment required;
Support access to specialist CAMHS advice for GP’s, Accident & Emergency
staff, paediatricians, police, emergency duty teams, young people and
families;
Provide integrated care with seamless and timely pathways into community
CAMHS;
Provide education and training to a variety of staffing groups;
Provide support to those seeking emergency inpatient care out of hours;
Implement a safety and coping plan.
Table 26: Staffing of THE OOH Service
8
Table 27: Operational Hours
8 Data provided by CNWL and WLMHT
West London Mental Health Trust Central and North West London NHS Trust
Nursing 1x Band 8a 4.29 WTE, 2x7 Band 7 WTE.
Nursing 2xBand 7
West London Mental Health Trust Central and North West London NHS Trust
4:30 to 9am Monday to Friday
24hrs on Saturday
Sunday and Bank Holidays)
4pm to 7am Monday to Friday
24/7 Saturday, Sunday and Bank holidays
47
Table 28: OOH Service 1st
April 2016 to 31st
March 2017
Evaluation
Evaluation of the OOH took place in September 2016 with further evaluation in July
2017. As well as formal evaluation, the service was reviewed by Rethink Young
Champions in three boroughs (Hammersmith and Fulham, West London and Central
London. The report is in development and will be formally shared in November 2017.
878 CYP have accessed the service. The vast majority of cases assessed were for
self-harm, suicidal ideation and overdose. Although the services successfully met the
general aims and were very well received by CYP, their parents and carers, the
evaluation of the OOH service identified several challenges:
Difficulty recruiting staff on this shift pattern leading to over reliance on agency
staff;
Challenges with capacity due to delivering services over a large geographical
area leading to reliance on existing staff such as Psychiatric Liaison Services
to review CYP within contacted timescales;
Fragmented service provision with out of hours not linked to in hour’s crisis
services;
Robust data capture systems were not in place;
Health focussed with limited social care input;
Capacity to support training of A&E staff limited in some areas;
Ability to fully support other colleagues i.e. police, paramedics limited due to
capacity;
Intensive community service focussed on reducing unnecessary admission
not in place in all areas.
To address these challenges additional funding was allocated in April 2017 to provide
a fully integrated 24/7 CYP Crisis Service across NW London. The service will be
delivered by CNWL and WLMHT who are working in partnership to develop
pathways. Although the service delivery model will vary from borough to borough due
to differing local infrastructure, the pathway will be consistent across NW London and
CYP will experience the same high-quality care and outcomes no matter where they
access care.
The 2 year pilot is linked to the New Models of Care Programme (NMoC - outlined on
page 49) and will provide intensive community intervention to prevent unnecessary
hospital admission and facilitate early discharge. Savings from NMoC will be also be
invested in crisis and community services. The service is expected to go live in late
2017. Pathway development and recruitment is underway.
Central London
West London
H’don Brent H’w H&F Ealing H’slow TOTAL NWL
Assessments 40 80 123 117 102
84 ( 4
WLMHT 80
CNWL)
170 (91
WLMHT and 79 CNWL)
162 (WLMHT 158 and 4 CNWL) 878
48
The new service will be a stepping stone to our longer term vision for a fully
integrated crisis and home treatment team. Developing this service is a crucial
component of redesigning the system.
Feedback from some of our young people who have used the service.
5.4.5 Our Next Steps
2017/18
Fully mobilise the new pilot 24/7 Crisis Service
Plan for future developments including integrated multi-agency intensive
community services
Complete OOH Evaluation
Develop a dashboard with key outcomes to be monitored.
2018/19
Make key decisions regarding testing the market and commissioning third
sector providers to deliver elements of the programme.
Evaluation
2019/20
Business as usual and or procurement and mobilisation based on 2018/19
decisions.
Thanks I needed help now I can go home
North West London Out of Hours Crisis
Service
I found it very useful because she gave me good advice and spoke to me calmly and nicely.
Kind and helpful
It helps a lot and its nice talking to them because they give good advice on what you need help or support
49
6. Emerging National and Local Initiatives
6.1.1 Collaborative Commissioning: National Commissioning for Quality and
Innovation (CQUIN) Transitions
National data indicates that transitions between children’s (CAMHS) and adult mental
health services (AMHS) for young people at the age of 18 are frequently poorly
managed and 25% -50% of young people under 25 years disengage. The CQUIN
aims to:
Incentivise improvements to the experience and outcomes for young people
as they transition out of Children and Young People’s Mental Health Services
(CYPMHS);
Improve joint working across service boundaries.
The CQUIN involves, at least 6 months before transitioning:
1. Joint meeting to plan;
2. Jointly agreed transition plan with personal transition goals;
3. A named and contactable transition key worker
4. A case note audit to assess the extent of Joint-Agency Transition Planning;
5. A survey of young people’s transition experiences ahead of the point of
As part of the development of the workforce development and training strategy, clear
plans will be developed to specify how the expansion in the workforce will be
achieved.
Table 31: Workforce Expansion CWP and RTT
Capacity Building in the Wider Workforce To deliver the ambition of the NW London CYP Mental Health and Wellbeing
Transformation Plan, it is essential children and young people can access the right
help and support at the right time. Developing new ways of working, utilising
alternative pathways and up skilling generalist staffing groups will be a key
component to support us ensure timely access to intervention. This will include being
able to access non-specialist care much earlier and in an environment which meets
the individual needs of CYP. It is therefore recognised those who have a relationship
with children, both in a professional and non-professional context can effectively
provide support and signpost to appropriate local services. Applicable staff include: -
Local authority staff
Parents and carers
Education staff
GP and primary care staff
General health staff (school nurses, health visiting teams and allied
health professionals)
Children centre staff
Voluntary sector
Community programmes and youth services,
Drug and Alcohol services
Staff Brent
Central London
Ealing H&F Harrow H’don H’slow West London
Total NW London
RTT 0 0 0 0 0 0 0 0 0 CWP 0 4 0 4 0 0 4 4 0
55
Across NW London a significant number of programmes are already in place and are
outlined in each annex. Going forward we will be developing a work force strategy to
redesign the system.
7.2.3 Next Steps 2017/18
Establish our plan in partnership with our Local Workforce Action Board
In tandem with developing our new service delivery model, develop our Education and Training Strategy for the wider workforce.
Define workforce training needs required to implement new ways of working and deliver evidence -based care
Map training available and identify gaps.
Scope available providers – working with HEE and HENWL, professional bodies and procure providers
2018/19
Evaluate strategies implemented
56
8.0 Equality and Health Inequalities Historically we have had relatively good local intelligence on the needs of our
communities and have worked collaboratively to address local inequality and target
hard to reach population. We have worked in collaboration with our public health
colleagues to develop our plans and updated and changed our approach to address
unexpected or new needs such as the significant emotional and mental health
support and intervention required by our families affected by the Grenfell Tower Fire.
We have an asset based approach building on the numerous resources within our
communities to build resilience across our population.
To engage our population, we have worked in partnership with a variety of community
groups (with Health Watch, schools via the Healthy Schools Partnership, local youth
groups, third sector agencies and current service providers’ user groups). We do
however recognise that wider input is required to ensure we have a representative
view of our local population and support our existing coproduction plans.
Across NWL we undertake an Equalities Impact Assessment when we initiate large
change programmes. At this stage in the programme we have completed the
screening phase of this process which provides a structure to address firstly who our
changes will impact and any gaps in our plans.
57
9.0 Governance and Risks The Steering Group supporting the development of this plan has brought together the
key representatives from the eight CCGs – as well as tasking the leads to engage
locally with the wider teams not represented at the table. The Steering Group reports
formally to the NWL Mental Health and Wellbeing Transformation Board – which is
accountable to its constituent CCGs and Health and Wellbeing Boards. The Board is
multi-agency and has oversight of the entirety of mental health and wellbeing
strategic development across NW London.
We have also formed (or re-started) 3 dedicated multi-agency implementation groups
and support groups to aid the development and delivery of projects
WLMHT Implementation Group which includes associated CCGs: Ealing,
Hammersmith & Fulham and Hounslow
CNWL Implementation Group which includes associated CCGs: Brent,
Central London, Harrow, Hillingdon and West London
Clinician to Clinician forum aimed at engaging staff from across the system to
embed clinical quality.
As well as reporting to the Steering Group, these groups have a clear link to local
governance structures.
58
Our over-arching governance model links the NWL Mental Health and Wellbeing
Strategy with the 8 NWL CCGs and Local Authorities, with clear governance and
reporting to ensure shared ownership of delivery of our transformation plans (as
shown below).
In developing our plans – and in ensuring we continue to work collaboratively across
North West London - we have a clear governance structure at the NWL level. We
also know that transformation happens at the local level and much of our plans will be
delivered locally. Each CCG has a clear structure for engaging different agencies in
delivering change – these ensure connections to local decision making bodes in
CCGs and Local Authorities as well as the right links to wider children’s work and
mental health developments:
The Transformation Board at a NWL level has NHS England representation providing
a clear link to specialist commissioning and Health in Justice teams.
Further to our over-arching governance arrangements, the governance structures of
each CCG are outlined in detail below.
Children and Young People’s Transformation Plan
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RISK MANAGEMENT As NWL transformation programme progresses, we will continue to re-evaluate our risks. Our current risks are outlined in the table below:
RISK REGISTER
Description Impact
Inherent Risk
Rating Avoidance / Mitigation
Residual Risk
Rating
R1
There is a risk of wider context of funding reductions to CCGs and Local Authority
This will have an effect on activity and resource for transforming mental health services for children and young people.
16 The NW London CYP Mental Health and Wellbeing Service Delivery Framework will be developed in partnership therefore financial risk will be shared across the system and optimising financial benefits and savings.
12
R2
There is a risk that sufficient workforce is not available to meet the new roles (volume and skills/ capability) within the new service delivery framework.
Full implementation may not be possible and cost and quality improvements will not be fully achieved.
16 A workforce strategy is in development which sets out the plans to ensure the wider CYP workforce have the right skills to deliver the right intervention at the right time. We are aligning to National HEE education and training directives and implementing designated initiatives across NW London.
9
R4
A lack of good quality data is available
We will be unable to demonstrate the cost and quality impact new services and new ways of working will bring
12 Development of a dashboard to demonstrate current activity levels and allow for monitoring of impact of the new service delivery framework.
6
R5
Limited financial modelling has been undertaken and costing are estimates.
Difficult to ascertain if we are obtaining value for money and ensure long term financially sustainable services.
12 Robust business plan and costing model being developed.
6
R6
Limited buy in, capacity and engagement from other agencies e.g. education and local authority.
Difficulty developing, new ways of working and new pathways
12 Development of a communication and engagement strategy to ensure wider sector are aware of benefits and risks of the change
9
R7
There is a risk that the CYP programme is not aligned to other work programmes e.g. NHSE Forensic Crisis Service
This could lead to duplication and a disjointed approach to NW London transformation
9 Structures implemented to ensure information sharing and alignment
6
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ANNEX A: Brent CCG (attached as a separate document) ANNEX B: Central London CCG (attached as a separate document) ANNEX C: Ealing CCG (attached as a separate document) ANNEX D: Hammersmith and Fulham CCG (attached as a separate document) ANNEX E: Harrow CCG (attached as a separate document) ANNEX F: Hillingdon CCG (attached as a separate document) ANNEX G: Hounslow CCG (attached as a separate document) ANNEX H: West London CCG (attached as a separate document)
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ANNEX I – Engagement Log
In the development of this plan we have consulted widely with our Children and Young people, their parents and carers, our and key partners across schools, social care and health teams. Evidence can be supplied on request. The table describes the key groups and populations we have actively engaged with – however at a local level our developments have been informed by on-going discussions with a far greater range of people.
Brent CCG
Central London CCG
Ealing CCG
Hammersmith & Fulham CCG
Harrow CCG
Hillingdon CCG
Hounslow CCG
West London CCG
NHS England Specialised Commissioning (CAMHS)
NHS England Mental Health Team
Brent Council
Westminster City Council
The Royal Borough of Kensington and Chelsea
The London Borough of Hammersmith and Fulham
Ealing Council
Harrow Council
The London Borough of Hillingdon
The London Borough of Hounslow
Healthwatch Brent
Healthwatch Central London
Healthwatch Ealing
Healthwatch Hammersmith and Fulham
Healthwatch Harrow
Healthwatch Hillingdon
Healthwatch West London
Central and North West London Mental Health Trust
West London Mental Health Trust
Health Education North West London
Youth Justice Teams
Healthy Schools Partnerships
Rethink Young People
Imperial College Healthcare NHS Trust
Central London Community Healthcare NHS Trust
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ANNEX J – Glossary of Terms
ADHD Attention deficit hyperactivity disorder
A group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness.
ASD Autistic spectrum disorders
A condition that affects social interaction, communication, interests, and behaviour.
CAMHS Child and adolescent mental health services
Services that work with children and young people who have difficulties with their emotional or behavioural wellbeing.
CBT Cognitive behavioural therapy
A talking therapy that can help you manage your problems by changing the way you think and behave.
CCG Clinical commissioning group
Groups of local GPs and other health professionals who commission most of the hospital and community NHS services in the local areas for which they are responsible. Commissioning involves deciding what services are needed and ensuring that they are provided.
CLCCG Central London clinical commissioning group
The clinical commissioning group responsible for commissioning health care services for the residents of the borough of Westminster (excluding the areas of Queens Park and Paddington).
CNWL Central and North West London NHS Foundation Trust
An NHS provider of mental health, sexual health, physical health, addictions, eating disorder and learning disability services.
CORC CAMHS outcome research consortium
A group of mental health providers, schools, service users and researchers to work together to develop and improve the effective and routine use of outcome measures in work with children and young people (and their families and carers) who experience mental health and emotional wellbeing difficulties.
CQUIN Commissioning for quality and innovation
A payment framework that enables commissioners to reward excellence, by linking a proportion of healthcare providers' income to the achievement of local quality improvement goals.
CYP IAPT
Children and young people’s increasing access to psychological therapies
A service transformation programme delivered by NHS England that aims to improve existing child and adolescent mental health services working in the
community.
DBT Dialectical behaviour therapy
A type of talking therapy based on cognitive behavioural therapy (CBT) that has been adapted to meet the particular needs of people who experience emotions very intensely.
DfE Department for Education
The government department responsible for education and children’s services in England.
ED Eating disorder A mental health condition characterised by an abnormal attitude towards food that causes someone to change their eating habits and behaviour. The most common eating disorders are anorexia nervosa, bulimia, and binge eating disorders.
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ESCAN Ealing service for children with additional needs
A joint initiative between Ealing Primary Care Trust and Ealing Council, working towards a single point of information with improved access to referral, assessment and appropriate interventions for children and young people with disabilities in the borough.
Future in Mind
The Department of Health’s policy on promoting, protecting and improving our children and young people’s mental health
The policy makes a number of proposals the government wishes to see by 2020 including tackling stigma and improving attitudes to mental illness, introducing more access and waiting time standards for services, establishing ‘one stop shop’ support services in the community and improving access for children and young people who are particularly vulnerable.
GP/s General Practitioner/s Doctors who deal with a whole range of health problems and provide health education, offer advice on smoking and diet, run clinics, give vaccinations and carry out simple surgical operations.
H&F Hammersmith and Fulham
The London borough of Hammersmith and Fulham.
JSNA Joint strategic needs assessment
A process by which local authorities, clinical commissioning groups, and other public sector partners jointly describe the current and future health and wellbeing needs of its local population and identify priorities for action.
LA Local authority An administrative body in local government responsible for providing a range of services for local residents including children and family services and health and adult social care.
LAC Looked after children A child who is accommodated (which means that the council is looking after them with the agreement, at the request or in the absence of their parents) or subject to a Care Order made by the Family Courts.
LD Learning disability A reduced intellectual ability and difficulty with everyday activities – for example household tasks, socialising or managing money – which affects someone for their whole life.
Like Minded
The mental health and wellbeing strategy for North West London
A strategy that encourages working in partnership to look at how we can deliver excellent, joined up services that improve the quality of life for individuals, families and communities who experience mental health issues.
MDT Multidisciplinary team A team of professionals with different qualifications and experience who work together to provide a total package of care.
ND Neurodevelopmental disorder
Disorder that can affect children and young people's development, including their intellectual, motor, communication, behaviour and / or social development. The most common
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neurodevelopmental disorders are attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD).
NHS National Health Service
The universal healthcare system in the United Kingdom.
NHSE National Health Service England
The leadership organisation of the National Health Service (NHS) in England. They set the priorities and direction of the NHS and encourage and inform the national debate to improve health and care.
NICE National institute for health care and excellence
A non-departmental public body, accountable to but independent of government that provides national guidance and advice to improve health and social care.
NWL North West London The north west region of London that includes the London boroughs of Brent, Ealing, Hammersmith and Fulham, Harrow, Hillingdon, Hounslow, Kensington and Chelsea and Westminster.
OOH Out of hours Outside of normal business hours of 9am to 5pm Monday to Friday.
ROMS Reported outcome measures
Measures that provide a means of gaining an insight into the way patients perceive their health and the impact that treatments or adjustments to lifestyle have on their quality of life.
SAFE Situational awareness for everyone
A two year programme led by the Royal College of Paediatrics and Child Health which, in partnership with 12 hospitals, is developing and trialling a suite of quality improvement techniques.
SEND Special educational needs and disabilities
Learning difficulties or disabilities that make it harder for them to learn than most children and young people of the same age.
TAMHS Targeted mental health in schools
A national project to transform the way that mental health support is delivered to children aged 5 to 13, to improve their mental well-being and tackle problems more quickly
WLCCG West London clinical commissioning group
The clinical commissioning group responsible for commissioning health care services for the residents of the boroughs of Kensington and Chelsea and the Queens Park and Paddington areas of Westminster.
WLMHT West London mental health NHS trust
An NHS provider of mental health services for a range of conditions or illnesses affecting people’s psychological wellbeing.
WTE Whole time equivalent A unit that indicates the workload of a full time employed person.
YOT Youth offending team Teams of professionals that work with young people that get into trouble with the law, are arrested, or taken to court, and help them stay away from crime.