Agenda item

10:10

A presentation and reports on Emotional Wellbeing of Children and CAMHS (Child and Adolescent Mental Health Service).

The Committee is RECOMMENDED to endorse the new strategic partnership approach to support children and young people’s emotional wellbeing and mental health in Oxfordshire.

The Committee received

·         a report, as requested, summarising the work completed to date on the development of a shared strategic approach to children and young people’s emotional wellbeing and mental health in Oxfordshire;

·         a presentation on the Emotional Wellbeing of Children and CAMHS (Child and Adolescent Mental Health Service)

·         a briefing paper providing the background information and data.

The presentation was given by Tehmeena Ajmal, Interim Executive Managing Director for Mental Health, Learning Disability and Autism, Oxford Health and Caroline Kelly, Lead Commissioner, OCC / OCCG.

Councillor Liz Brighouse, Cabinet Member for Children, Education and Young People’s Services added that the Children’s Trust Board was also discussing these issues.  She believed that the safest place for a child was in school.  However, the education system was fragmented now with only one maintained secondary school in the county.  Many neuro-diverse young people were not achieving their entitlement of hours in school due to reduced timetables, exclusions, isolation and other reasons.

Tehmeena Ajmal noted that staff were tired after a couple of very difficult years and more staff were needed.  She outlined a number of areas being looked at:

·         the Neuro-developmental conditions pathway where assessment, treatment and support are all offered.

·         the provision of more services online – some young people prefer it and it offers an opportunity to spread the staff base.

·         working with the voluntary sector on in-reach into schools.

·         examining if the outcomes-based contracts for services to 18-65 year olds could be expanded to 16-25 years olds where the offer is not quite right yet.

The Chair noted the tight timeline for engagement and asked if they were satisfied that the stakeholder group included the best possible representation.  Caroline Kelly responded that there had already been engagement on the needs.  They were working with the Council’s engagement team and the list of possible initiatives will go to a stakeholder group to make recommendations.

Caroline Kelly added that the timescales were indicative and they can delay if they feel they need to in order to get sufficient engagement.  The Health & Wellbeing Board had prioritised this strategy to be implemented this year.  She noted that the voluntary and community sector was developing some really innovative services and Oxfordshire was also able to learn through the Integrated Care System what was working in Buckinghamshire and Berkshire.

Asked about additional funding for mental health teams in schools, Caroline Kelly confirmed that additional transformation funding from NHS England was available and that work was in-train on expanding the offer.

Dan Knowles, CEO, Oxfordshire Mind, highlighted some areas in need of focus and investment:

·         the length of wait for an autism assessment

·         the comorbidity of mental health and autism

·         the way in which the pandemic had emphasised inequalities.

He noted that funding for mental health services in Oxfordshire has historically been below average and this was an issue in need of scrutiny.  The voluntary sector shared the same workforce issues as the statutory services.  What the sector does well was in providing non-clinical, person-centred, strengths-based, community-focussed recovery programmes.

Dan Knowles added that Oxfordshire Mind had communications with 13,000 people per year – about 20% of whom were young people or parents.  They were interested to talk about how that resource could be used to benefit young people.  There were also active discussions in train around cooperation between third sector organisations to break down silos.

Councillor David Turner asked if support was still being provided to young carers as Cabinet agreed some years ago.  Caroline Kelly responded that support was provided through social work teams but they had identified a gap in relation to the provision of respite which they were looking to remedy.

Barbara Shaw asked what was being done to reduce waiting times for children with autism and ADHD which were having an enormous impact on schools.  She noted that the proportion of children accepted with neuro-developmental conditions was less than half the number in 2019/20 and asked why.

Tehmeena Ajmal responded that she was concerned that many people were under the impression that they had to get a diagnosis to access support but this was not the case.  However, it was correct to say that the current system was not working.  There had been three workshops under the Integrated Care Board to discuss what could be done better.

Vicky Norman, Service Manager, Oxford Health, added that they had a very good relationship with an online provider Healios and were agreeing another contract with them.  Digital services had allowed them to provide 10,000 more appointments in the first year of the pandemic.  There was more group work and one of the most popular groups was advising parents on how to help their children.  There was a focus on how to provide support for people on the waiting list.

Jules Francis-Sinclair, Oxfordshire Parent Carers Forum, emphasised that they were very supportive of the good work by CAMHS when children get access the service.  She believed that there were problems around communications and managing expectations that can be improved.  There was often a lack of continuity with the loss of long-standing clinicians.

OPCF had a new survey which had just closed.  They had some feedback that some links sent to parents when they accessed the service were not relevant, particularly for children with SEND.  One had to be mindful too of the capacity of parents to deal with so many links.  There was a need for more specialised support around self-injurious behaviour and school avoidance and refusal which can lead to more demands later if not dealt with.

The Committee heard an audio recording of the experiences of an 18-year-old woman who had attended sessions at the Mental Wealth Academy which she found very useful in developing strategies to cope better.  She had found the CAMHS service frustrating because she had three different clinicians due to illness or leaving the service.

Councillor Damian Haywood asked for more detail on prevention – if Public Health or GP services were involved.  Caroline Kelly responded that the strategy was being co-written between Children’s Services and Public Health.  The aim was that all professionals, in schools, nurseries etc would be trained in mental health to support children with emotional difficulties.  NHS England were supporting a range of initiatives.

Ansaf Azhar, Director of Public Health, added that the needs assessment being carried out was also looking to understand the causes.  Some conditions cannot be prevented but some can and in some cases conditions can be managed in existing settings such as schools.  It was important not just to consider the situation for children but also for the families.

Ansaf Azhar also stressed the importance of having evaluation and lesson-learning built into the strategy to show the impact of the collaborative approach.

Councillor Nathan Ley noted that the figure of a 77% increase in mental health treatment was a national figure and asked if the statistic for Oxfordshire was available.  He also asked what the target was for reducing CAMHS waiting times.

Officers responded that the figures for Oxfordshire would come out with the strategy.  The target was four weeks and that is being achieved for urgent cases but the service was well outside that for non-urgent.

Dr Alan Cohen noted that mental health services were doing very good work but had been historically under-funded in this county and asked what was being done to identify new funding.

Diane Hedges, Deputy Chief Executive, Oxfordshire Clinical Commissioning Group, stated that the BOB-ICB (Buckinghamshire, Oxfordshire, Berkshire West Integrated Care Board) was examining what was being done in each area.  Bucks and Berkshire West had already decided on greater investment in mental health services.  The situation for Oxfordshire was that there was no doubt investment was needed but currently, to do that, funds would have to be diverted from some other service.

The Chair stated that the Committee would clearly support prioritising resources for mental health and that there should be parity of esteem between mental and physical health services.

Councillor Freddie van Mierlo asked officers what they would do if they had double the budget, if the extra money allocated in the Council’s budget for 2022/23 would allow them expand services and for more information on geographic inequalities in the county.

Tehmeena Ajmal responded that, regardless of the money available, there were staffing issues that could not be easily overcome.  The best way forward was to build on the partnerships between social care, health and the voluntary sector as well as learning from what works in other parts of the country.

Caroline Kelly added that the feedback from focus groups was that young people want more digital services, to be anonymous and more support in schools.  Regarding geographic inequalities, services across the county were being mapped out to identify any gaps.

Councillor Brighouse noted that this all sat within the SEND review and its whole-system approach and was being worked into an overall strategy.  She said that there was a real need for more trauma support.  The positive was that we had great people working throughout the system and she welcomed the appointments of Matthew Taylor to lead the NHS and Javed Khan as Chair Designate of BOB-ICB.

The Chair thanked all the contributors to the reports and discussion.  It was clear that the committee was very concerned at the sheer level of need facing services.  They would be more reassured if the funding could be identified to provide the expanded services.  She asked all the partners to reflect on the timescales involved in collaboration plans.