Meeting documents

To consider a report by the Transformation Programme Lead for the Adult and Community Services Forward Together Programme (attached).

The Committee considered a report by the Transformation Programme Lead for the Adult and Community Services Forward Together Programme following an Inquiry Day held on 13 July 2018.

Councillor David Walsh, who chaired the Inquiry Day, explained how the initial focus on Child and Adolescent Mental Health Services (CAMHS) had been widened to incorporate lower level support and mental wellbeing.  Invitations had been sent to around 80 organisations with 40 people attending on the day.  The event had begun with a compelling account by a young person regarding her experience of being unwell and needing the support of mental health services to recover.  This had been helpful in setting the context for the day which was structured around the 4 elements of the "Thrive Model" for mental health.

A presentation was given by the Senior Commissioning Manager (Mental Health) - NHS Dorset Clinical Commissioning Group (CCG) and the Assistant Director, Commissioning and Partnerships, Dorset County Council (DCC) that set the context and importance of the Thrive Model and the challenges ahead.  These were described as follows:-

1.    Getting advice: building and promoting resilience, self-help, advice and signposting for children going through temporary difficulties, and sitting below NHS mental health services.

The challenges were around the range of different offers across the county, services disappearing due to lack of funding leading to changes in service delivery; adequate confidence and skills in the workforce in dealing with mental health issues; capacity in other services, lack of understanding of CAMHS, recovery education model and whole school approaches to mental health, for example, physical activity to support wellbeing.

2.    Evidence based support: ie getting on the right pathway on diagnosis of a condition including CAMHS, social services and other different types of therapy.

The challenges in this area included workforce understanding of wider CAMHS services, inappropriate referrals, signposting to other services, developing the offer for children's emotional health and wellbeing within schools following the recent Government Green Paper.

3.   Getting more help in the community or in hospital.

Challenges were around children having treatment outside Dorset, a lack of tier 4 beds for acutely unwell young people (which was a national problem,) out of hours CAMHS services and supported housing and care packages at the time they were needed.

4.   Getting risk - more complex support

The challenges included increasing workforce skills particularly for self- harming, multi-agency risk plans with shared responsibility and accountability and joint commissioning between the CCG and other partners to refocus services around the Thrive Model.

The Committee was provided with an update on how activity across the County sat alongside the local transformation plan which had been refreshed in October 2018 and now described the Thrive Model in a much clearer way, including the challenges and opportunities.  The new care models would enable a more joined up approach to commissioning and providing adequate pathways.

The Thrive Model was the perfect conduit to shape further services so that NHS expertise was accessed much earlier as outlined in the recent government Green Paper.   A business case for additional investment would be submitted to the CCG to enable this work to continue and re-shape the offer for children.

In response to a question about the current lack of continuous packages of care or consistency of staff, it was explained that the ambition to join up commissioning would greatly assist with currently disjointed care package arrangements.  A workforce culture shift would also be required to build confidence in staff in dealing with mental health issues.  It would be important that all agencies took responsibility and did not immediately step away from a patient once a referral had been made to another agency. 

Councillors highlighted the need to identify children with mental health issues from primary school age, and that although there were instances where training was given for newly qualified teachers (NQTs) in some schools, it was not known whether this was taking place consistently across all Dorset schools.  It was confirmed that this could be further investigated, although the Local Authority did not have a great deal of influence in this area.

Members were informed that work was taking place around emotional literacy for young people and different interventions, such as the "I can problem solve" programme that had resulted in a large impact on children in both emotional literacy and academic achievement.  The SEND reforms also assisted in addressing this area.

The Local Transformation Plan (LTP) advocated a whole school approach to mental health issues arising from adverse childhood experience due to poor situations at home or other issues that formed a pre-curser to mental health problems.

Members asked whether school exclusion pupils were included and were informed that a monthly multi-disciplinary meeting was convened to discuss the reasons behind exclusions.  A whole family approach to support was also provided in the flash courses and the longevity and skills of the assessor was a key factor in getting to know the family circumstances with wraparound services for parents and carers.

Councillor Walsh outlined the recommendations contained in the report that had been developed as a result of the Inquiry Day.  Members discussed how one of the recommendations in relation to engaging young people on an on-going basis could be achieved, in particular, with members of the Youth Parliament and youth workers.

The Assistant Director - Commissioning & Partnerships advised that she would be able to facilitate a conversation with members of the Youth Parliament about opportunities for engagement so that this could be built into their workplan for next year. 

Resolved

That the set of recommendations outlined in the report be agreed and circulated to key Dorset organisations as appropriate.

Reason for Recommendation

The Committee supported the County Council's aim to help Dorset's citizens to remain safe, healthy and independent.