Agenda item

Anne Coyle (Corporate Director of Children’s Services); Ansaf Azhar (Corporate Director of Public Health & Community Safety); Daniel Leveson (BOB ICB Place Director, Oxfordshire); Caroline Kelly (Lead Commissioner- Start Well, Oxfordshire Health, Education and Social Care Joint Commissioning across Oxfordshire County Council and the BOB ICB); Donna Husband (Head of Public Health Programmes – Start Well, Public Health & Community Safety Directorate, Oxfordshire County Council); have been invited to present a report with a progress update on Children and Young People’s Emotional Wellbeing and Mental Health.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Anne Coyle (Corporate Director of Children’s Services); Ansaf Azhar (Corporate Director of Public Health & Community Safety); Daniel Leveson (BOB ICB Place Director, Oxfordshire); Caroline Kelly (Lead Commissioner- Start Well, Oxfordshire Health, Education and Social Care Joint Commissioning across Oxfordshire County Council and the BOB ICB); Donna Husband (Head of Public Health Programmes – Start Well, Public Health & Community Safety Directorate, Oxfordshire County Council); had been invited to present a report with a progress update on Children and Young People’s Emotional Wellbeing and Mental Health.

It was highlighted that this item had come to HOSC previously in 2022, where the Committee recommended for urgent prioritisation of funding to support the Children’s Emotional Wellbeing and Mental Health Strategy. This item was therefore an update on the effectiveness of the Strategy and its deliverability in the context of children’s emotional wellbeing and mental health services overall.

The Director of Public Health informed the Committee that this was a system-wide strategy that was launched over 12 months ago, with a view to how there could be improvements to the emotional wellbeing and mental health of Oxfordshire’s young people. It was highlighted that the strategy partly aimed to improve the mental wellbeing of children in a manner that prevented young residents from having to be on CAMHS waiting lists to begin with. Alongside the Children’s directorate, Public Health had conducted a needs assessment to look at the underlying need within the County with respect to children’s emotional wellbeing and mental health. It was explained to the Committee that it was in this context that the strategy was formulated. The strategy contained four key principles which were:

1.    Providing early help and creating supportive environments.

2.    Developing a confident workforce.

3.    Ensuring positive transitions.

4.    Improving access.

The Lead Commissioner for Start Well outlined that there was a digital offer which was currently being tendered, with bids having been received for the new service which was due to start in April 2024. An analysis of the parent course offer was conducted, as well as the use of support groups to understand what was already available, what was working well, and to receive feedback from parents and carers to understand what else could be undertaken in the digital space. There was also work with schools to understand how they operate to support children and young people with their wellbeing and resilience; looking at various frameworks including the I-THRIVE model. The system’s dashboard had also been developed to understand the initiatives that were being worked on now and whether they were making a difference to children, young people, and their families.

The Head of Public Health Programmes for Start Well outlined that Oxfordshire MIND had been commissioned to deliver all-ages Mental Health and Suicide Prevention Training. Training is also very much needs-led in its focus and nature. More bespoke training may also be delivered by the system if that is identified within local communities.

It was also explained to the Committee that in terms of the transitions approach, very focused workshops across system partners had taken place to feed into wider decisions as to whether there would be development of an all-age mental health service with colleagues in Adult Services.

The Committee were informed about the imperative for wider collaborative work within the system for improving the mental wellbeing of children, young people, and their families. Intervention needed to occur at an early stage for services to be effective. Some of the progress in this area included the following:

Ø  Delivering a joint initiative between Early Years and Public Health to target speech and language communication to children before they went to school.

Ø  The Oxfordshire Inclusive Economy Partnership had developed a Charter for employers to demonstrate support for and commitment to making Oxfordshire a fairer and more inclusive place to live and work.

Ø  There were also broader initiatives that occurred in the grassroots of local communities that would inevitably impact on the betterment of the wellbeing of families.

Furthermore, some opportunities as well as constraints were highlighted to the Committee. Some constraints included:

Ø  Increased needs and access for mental health support and services.

Ø  Recruitment challenges for the local community CAMHS.

Ø  Significant financial challenges across the integrated care system.

In terms of opportunities, the Committee were informed that there was a service transformation as well as an improvement in partnership and integrated working.  Some examples of this included; a newly commissioned integrated 0-19 years public health service; an Emotionally School Based Avoidance Project; and a CAMHS Thames Valley Link Project. Additionally, there was also a strong commitment to responding to the recent Ofsted/CQC SEND inspection outcomes.

The Committee referred to how the report cited the significance of the BOB Integrated Care Partnership in the context of this strategy. It was enquired as to the contributions that the ICP and its various member organisations had actually made toward the strategy and its effectiveness. It was highlighted to the Committee that this was indeed a systemwide strategy, and the BOB ICB Place Director for Oxfordshire referred to how the Director of Public Health, alongside the Executive Director for People Transformation and Performance were all members of the Place-Based Partnership. It was also explained that a joint commissioning team was in place, which was an indication of joint working between the County Council and the NHS. The Committee were also informed that the partnership working was indeed effective and conducive towards good collaborative work. The Director of Public Health also explained that a task group was formed to help identify and involve all relevant partners in the strategy.

In regard to a query relating to the role of Cabinet Members/elected officials in the context of the strategy, the Public Health Director specified that Cabinet Members had an opportunity to comment on the strategy at the Health and Wellbeing Board. The Cabinet Member for Children’s Services added that it was clear that elected members were involved, but that there was also an academisation of most secondary schools, where the regional schools director had more control over these schools than the County Council had. Since 1991 Local authorities also had little control over the budgets of schools, although the Council could influence how schools utilised funding where possible and necessary.

The Committee referred to how the report highlighted a commitment to addressing gaps in emotional wellbeing services for children and young people. It was queried as to how this process of identifying gaps was carried out, and if there were any gaps that had been identified. The Director of Public Health responded that there were a number of themes that were identified including transitions as well as the digital offer. Workforce was another area that was identified.

The Committee referred to how at-risk children were discussed when the item previously came to HOSC in 2022, and enquired as to whether there was an explicit list of various vulnerable groups, taking into account the NHS CORE20plus 5. The Head of Public Health Programmes (Start Well) explained that there was universal provision in place, but also explained that there were various other strands of work around the Council and the wider system, looking at families through the lens of vulnerabilities. An example of this was how the suicide prevention work was partly related to areas of deprivation. The utilisation of data from the Joint Strategic Needs Assessment (JSNA) would help inform and determine where vulnerabilities existed within the population. The Committee emphasised the importance of transparency and urged that the process of vulnerabilities was simplified and made as understandable and explicit as possible for residents. The Director of Children’s services also added that part of the system wide learning and training was about getting everybody on the same page with regards to identifying and supporting vulnerable groups. The Committee were also informed that there was no single way in which children’s needs would be met; and the strategy sought to create opportunities across the board in order that Children and Young People could access services in different ways and at different times that were suitable to them.

The Committee queried whether the digital offer would be produced in a manner that took into account the views of children and their families. It was responded that prior to going out to tender, market testing was undertaken to gather feedback on what the most popular apps would be. Children and Young People could not be part of the evaluation panel due to legal processes around procurement not enabling this.

The Committee then enquired as to what the pathway was for moving from digital and non-clinical intervention towards more clinical interventions for children that may require this. It was responded that children can be referred to CAMHS at any stage. There was no prerequisite to have support online before being allowed to access CAMHS. Even whilst receiving CAMHS services children could also continue to utilise the app. The app constituted an outlet for children and young people to express their views and feelings and to gain peer support. The Committee was also informed that the app was moderated to flag any concerns to statutory services if there was any indication that there was a child at risk who required additional support.

The Committee queried whether there were specific avenues of funding made available for the purposes of delivering this strategy, and whether the current sources of funding were adequate. It was also asked as to whether measures will be taken to explore even further funding. The ICB Place Director for Oxfordshire stated that the system was doing the best that it could to operate effectively within the funding allocations that it currently had, and that services were working thoroughly and extensively to meet the need. There had been additional investment in mental health services over the last few years through the mental health investment standard that had been used in priority areas. The Director of Children’s Services added that it was vital that children and young people were heard, and that using a preventative agenda was also an important element of avoiding an escalation to a heavily intense clinical approach.

The Committee highlighted the importance of consistent and effective workforce recruitment and retention for the delivery of any strategy of this nature, and enquired as to how it would be ensured that there was an adequacy of workforce.

Additionally, the Committee referred to how the voluntary sector, Primary Care Networks (PCNs), as well as BOB ICB were recruiting new roles, and queried how confident the system was that it had all professionals identified as part of the whole system regardless of where and who was employing or providing these workers. The BOB ICB Oxfordshire Place Director explained that workforce remained a challenge within the system. The Director of children’s services referred to the SEND Local Area Partnership inspection, and outlined that a lot was learned from the inspection and its outcome. The inspection had motivated the reaching out to partners to create an integrated response, and there was an understanding that partners were all working toward the same goals, but doing things slightly differently. The Committee then emphasised that given that workforce in this context would be dealing with children with mental health or emotional wellbeing challenges, it was vital that such staff should also receive adequate support for their own wellbeing; it was then queried as to what support structures were in place to support staff wellbeing. The BOB ICB Place Director clarified that every NHS organisation had a comprehensive health and wellbeing offer. The Committee were informed that there were complexities around this, including how job roles could be framed with regards to career prospects and progression opportunities. The cost-of-living crisis was also cited as having an impact. The Director of Children’s Services referred to staff support sessions, and how there was support for staff that was accessible. The Cabinet Member for Children’s services added that from a school’s point of view, Oxfordshire County Council was one of the few authorities that had retained a joint committee where there was regular communication with trade unions.

The Committee sought confirmation as to whether teacher training for autism/ADHD had become mandatory, and queried the level of uptake for this training. It was also raised as to whether such training was ongoing as opposed to being provided on a one-off basis. It was responded that schools were offered training by the Anna Freud Centre, and that this was heavily publicised in schools last year. There was also a push from the Department of Education to increase the uptake of this training from the Anna Freud.

The Committee referred to the recent CQC/Ofsted report, which highlighted some systemic challenges around children's Special Educational Needs & Disabilities (SEND) provision, and enquired as to how the inspection’s outcome would further inform and influence the priorities and actions undertaken as part of this strategy. It was explained that the inspection’s outcome constituted a core element of considerations of how improve the emotional wellbeing and mental health of children with SEND.

The Committee referred to how the report cited a commitment to reviewing the strategy’s deliverability, and queried the ways in which there would be adequate and frequent reviewing of the progress made on delivering the priorities of the strategy. It was also asked as to whether there was a single standardised measure across the system that could be utilised across all settings. It was responded that it would be too complex to have a single measure, and that there were various metrics that were measured, although efforts were made to bring that information together where possible. The importance of having qualitative narratives was also highlighted to the Committee. The BOB ICB Place Director outlined that it was also in the context of the Health and Wellbeing Strategy where the system examined overall impacts on overall aspects around life stages including the start well, live well, and age well initiatives taken by the system.

The Committee emphasised the importance of awareness and navigation of the emotional wellbeing services available for children, and queried whether there were any tools in place through which the system was supporting navigation at both the neighbourhood and Place/County levels. The Head of Public Health Programmes (Start Well) responded that PCNs were commissioning some work from Oxfordshire MIND in relation to emotion-based school avoidance, and such commissioning was predicated on the local needs within local communities. The Chair highlighted that it was crucial for all relevant workers within the system and the neighbourhood levels to be aware of other relevant workers and services that may be available for residents. The Committee was informed that there was work on enhancing Social Prescribing, and that there were a number of officers whose key role was to promote the Social Prescribing Approach.

The Committee AGREED to make the following recommendations:

1.    To work on developing explicit and comprehensive navigation tools for improving communication and referral for services at the neighbourhood level and within communities. It is recommended that piloting such navigation tools in specific communities may be a point of consideration.

2.    To ensure adequate co-production with children and their families as part of continuing efforts to deliver the strategy, including considerations of how children and families can be placed at the heart of commissioning. It is also recommended for an early review with the users of the digital offer once this becomes available.

3.    To continue to explore and secure specific and sustainable sources of funding for the Strategy to be effectively delivered in the long-run.

4.    To ensure that Children and Young People and their families continue to receive support that is specifically tailored toward their needs. It is recommended that a Needs-Based Approach is explicitly adopted, as opposed to a purely Diagnosis-Based Approach. This could allow for early intervention to be initiated as soon as possible.

5.    That consideration is given to the use of a simple and evidence-based standardised evaluation measure, that is suitable across all services that are working on Children’s mental health in community settings.

The Committee also AGREED to the following Action:

1.    To receive a briefing on the use of technology in the context of Children’s Emotional Wellbeing and Mental Health Services in the near future.