Agenda item

To note the update following the presentation of the Southwark Joint Review of Emotional Wellbeing and CAMHS Services and to comment and agree the proposals outlined in the report for inclusion in the implementation plan and subsequent progress reporting to the Board.

The Board heard from Genette Laws, Director of Commissioning, Southwark Council, Kirsten Watters, Consultant in Public Health and Sam Hepplewhite, Director of Integrated Commissioning, NHS Southwark CCG.

Genette Laws emphasised that it was important to have a clear and shared definition of what had been agreed at the November 2018 health and wellbeing board meeting in respect of the 100% target of meeting the needs of children and young people experiencing mental health issues.  She informed the board that the definition was that we will take a whole system approach and aspire to improve outcomes and care for every child and young person, regardless of the level of need, or severity.  In terms of what this meant, Genette Laws referred the board members to the Thrive model that was contained in the agenda. It showed that whilst there were some excellent specialist services in Southwark, what was needed was more early intervention and prevention and that the partners should be seeking to do reduce the stigma, build resilience, and involve children and young people and their families as part of finding solutions so that they are producing for themselves how they take their needs forward.

Genette Laws stressed that wellbeing needed to be everyone's business and that the workforce beyond health and social care should be looked at also.  Particular reference was made to schools because that was where children and young people spend most of their time, but also other places that young people go to such as leisure services.  She advised that consideration needed to be given as to how to broaden out support for the workforce to be able to support young people.  In terms of action, Genette Laws advised that a working group had been established dedicated to early intervention / prevention which was being lead by Kirsten Watters, Consultant in Public Health, Children and Adults Services.

Genette Laws reported on four key areas of focus:

·  Open access drop-in services - A number of exemplars had been visited (the visits are summarised in the appendices to the report).

·  More support for schools - this was being focused on and led by the £2 million pounds investment from the council in terms of supporting mental health in schools. The lead member through the member officer policy unit was conducting a survey to understand what was already available in schools, some of the good practices that existed and where there were areas that needed further support/review so that the best could be made from the £2 million pounds that was available. 

·  Providing more support for parents and families - there were a number of good services already available for example, the parent and communities team, who work in some very small neighbourhoods across the borough.  Consideration needed to be given as to how this work could be harnessed to further support parents who know their children best to be able to support them.

·  Digital self help – The council had recently commissioned as a borough an 18 month pilot online counselling service (Kooth), this service was available across the whole of Southeast London.  Whilst commissioned at scale, thought had been given to how it would be delivered locally.  There were a series of workshops on the horizon to focus on how to really take early intervention and prevention forward.

Kirsten Watters reported on other areas of work that had taken plan.  She informed the board that Public Health had been leading a number of programmes of work, detailed below:

·  A review of self harm case notes had been undertaken and SLaM were looking in more depth at self harm, as this was a key issue of which there was little evidence and understanding of at the present time. An Annual Public Health report had been produced on the emotional health and wellbeing of adolescence (the annual public health report had been circulated with the agenda for information).  The report looked at some key themes around emotional health and wellbeing, particularly, in terms of loneliness, parenting, and relationships. 

·  A new specialist registrar with an expert interest in public health, mental health had been appointed.  They would be scoping out what is meant by good mental health and emotional wellbeing, both in adults and young people, and looking at how to measure this in terms of feeling good, but also functioning well in terms of school readiness, attendance, etc.

·  A new joint strategic needs assessment on what public health, mental health and wellbeing is, across all age groups had been finalised.  This supported the young people's emotional health and wellbeing needs assessment which had been previously presented to the board.

Kirsten Watters also informed the board that her team had been looking at developing a scorecard approach to measure progress so that they knew they were on the right track and also doing well. A key task of the group leading on early intervention and prevention would be to bring this all together, making it coherent and meaningful for professionals and for communities and families, and to enable progress to be tracked.

Sam Hepplewhite explained to the board that this was one of the joint team working arrangements between the CCG and the council and that there was a strategic context to it which linked to the conversations around Partnership Southwark. Sam Hepplewhite further explained that whilst the working arrangements were not at a stage of full integration (level 3) one plan, one budget, they had done things slightly different this year, in that they had started to align planning and spend with the council and had aligned their investment into mental health services with the investment of the council so that there was no duplication, resulting in the Southwark pound being used in the most appropriate way.  Two of examples of this were investment around CAMHS and perinatal health.

Points raised in the discussion.

The importance of being mindful of language used when discussing mental health with young people.  Through discussions held at the Southwark Serious Youth Violence panel, mental health came up as one of the big issues for young people but also the stigma around ‘mental health’.

A question was raised around co-production with parents as well as with young people and also about supporting and upskilling the wider workforce across the whole health and care system, including the police, schools, and the council.  Genette Laws reported that work with parents and families was being undertaken by experts in engagement who already have forums available such as the active communities network who bring families together from where the family is based.  The approach to consultation was also changing, moving away from the traditional tick box exercise towards engaging more in dialogue.

With regard to upskilling the workforce, Genette Laws informed the meeting that they were not yet at the point of having plan in terms of how training will be undertaken, however the forum for where discussions on this will take place had been identified.  The children and young people’s commissioning development group had been repurposed into the Southwark’s children and young people’s partnership. It was no longer focused on commissioners and included providers that were wider than health and care.  This forum would enable conversations about appropriate levels of training.  Genette Laws stressed that they did not want a one size fits all approach and that there was a need to be proportionate about what the different members of the workforce will need in order to be able to either support someone or have enough information to direct someone to the right place.

Cassie Buchanan informed the board that the peer review programme referred to in the report appendix was already taking place in Southwark and that the programme set up to build capacity in schools already existed in Southwark, it was titled ‘leading a mentally healthy school’ and was being led by London South Teaching School Alliance. The programme had been co-developed by John Ivans who leads the hospital school at the Maudsley and practitioners in schools.  Cassie Buchanan advised the board that the programme would greatly benefit from further input from health. She also informed the board that instead of being consulted, schools wanted to be given permission to lead on this work themselves and be supported in co-developing something that sits within education, rather than feeding into a work stream.

RESOLVED:

1.  That the report be noted as an update following the presentation of the Southwark Joint Review of Emotional Wellbeing and CAMHS Services.

2.  That the proposals outlined in the report be agreed as part of the implementation plan and subsequent progress reporting to the Board.