Mental Health: Forward Thinking – The Implementation Plan

1. NHS England –
Children & Young
Peoples Programmes
in Mental Health
Dr Jacqueline Cornish
NCD for CYP & Transition
NHS England
Manchester
16th March 2017

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“Children need
champions – strong
leaders who will advance
their interests – at all
levels in the NHS.”
- Professor Sir Ian Kennedy, 2010

3. www.england.nhs.uk
CYP are embedded in key programmes in
NHS England
Cancer: the
independent taskforce
made recommendations to
NHS England considering
specific needs of children,
teenagers and young
adults
Mental health access and
waits: programme of transformation of
CYP mental health services is underway
Learning disabilities:
aim to reduce inpatient
admissions for those with
LD/autism applies to children
and complements EHCP
Urgent & Emergency
Care: children form one of
the ‘lenses’ through which the
proposed new model of care
will be viewed.
Long-term
conditions: the model
of care planning, house of
care model, and recent
resources developed are
mostly applicable to
children and young people
Specialised Commissioning
developing leading edge science and
innovation to enable patients with rare
diseases to be treated most effectively
New care models:
Aiming to work with interested vanguards, UEC and
acute care collaboration vanguards to support focus
on CYP
NHS England business plan,
2016/17
Genomics: The Genome
project will enable conclusive
diagnosis in some rare
childhood diseases, and allow
treatment to be tailored

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Improving
quality of care
Developing future
models of care
Promoting
physical and
mental health &
wellbeing
NHS England’s approach
Improving
outcomes
for CYP
Child Health Digital
Strategy

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Child Health Digital Strategy - Context
"Develop integrated health
and care statistics"
‘Knowing where every child
is and how healthy they are’
‘Appropriate access to
information for all involved in
the care of children’

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Why focus on children’s health and
information?
➢ Public Health England and the NHS Outcomes Framework 2015/16 stress that a focus on
children’s health is essential and that we should be striving to provide the best start in life
possible for our children.
➢ The recent National Maternity Review has highlighted that this begins not just with the
newborn child but with the mother’s experiences in pregnancy and the birth itself.
➢ The importance of ensuring this good start for the future health of children for the
sustainability of the NHS and the economic prosperity of Britain is one of the key themes of
the Five Year Forward View.
➢ We need to redesign information services to support the new emphasis on:
• the importance of early interventions and preventive measures
• integration across different care settings, particularly joining up maternity and
newborn care – Perinatal mental health and early development
• the need to enfranchise children, young people and parents as equal partners in their
care.
➢ We also need to take on the challenges posed by the current organisation of
information services.

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0d 5d 8d 11d 7w 9w 12m 13m 24m 40m 4y 5y
NIPE
Bloodspot
Hearing
NewBabyReview
6-8WeekExam
8/12/16wkImms
12mthReview
12/13mthImms
2/2.5yrIntegReview
3yr4mthImms
4-5yreyesightcheck
SchoolEntryChk
Year6Check
Year8HPV
BoosterImms
Public Health
EnglandPersonalHealthProfessionalHealthPublicHealth Commissioners
Directors of Public
Health & Children’s
Services
Delivery of Healthy Child
Programme
(All Children)
Delivery of all other care services
(Some Children)
CHIS /
CHRD
CHIS /
CHRD
CHIS /
CHRD
CHIS /
CHRD
CHIS /
CHRD
CHIS /
CHRD
School NursingPrimary CareHealth VisitingMidwifery
Education
Services
Voluntary Services
Mental Health
Services
Emergency &
Acute Services
Justice ServicesSocial Services
Community
Services
Neonatal Services
Maternity
Information Systems
Screening
Information Systems
Primary Care
Systems
GPESCYP Dataset
CAMHs
Dataset
PCHR
90
CHRDs
Research & Policy
Maternity
Dataset
SCR
National Audit

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Central data sharing hub
(3 to 5 years)

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“Integrated care is
about joining things up
in order to meet health
needs, and in ways
that make sense to
children and their
families. Therefore it
should make an
important contribution
towards improving
child health”
- Wolfe et al, 2016
Integrated Care

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NHS England’s activity in 2016/17 is set out
in these three broad themes
10
Theme Work to be progressed in 2016/17
Improving and integrating
physical and mental health
and wellbeing
Transformation of CYP Mental Health services
Reducing childhood obesity
Improving care for CYP with long-term conditions e.g. Epilepsy, Asthma,
Diabetes, Complex Disabilities & End of Life Care
Improving student physical and mental health outcomes
Improving quality of
services
Service reviews of neonatal critical care, paediatric general surgery and
paediatric intensive are – led by specialised commissioning
Improving care for children with complex needs, including learning disability
and autism with greater personalisation of care through the Integrated
Personalised Commissioning Programme
Improving the child death process – simplifying procedures, and establishing a
national database for better identification of modifiable factors in deaths and
trends
Improving Transition from paediatric to adult services
Developing future models of
care
Working to develop New Models of Integrated Care for CYP, opportunities
through the creation of STPs, the Integration Collaborative and
Commissioners Forum
Support to the development of pilots to improve decision making around CYP in

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Long Term Conditions
• Improved Outcomes
• Integrated Mental and Physical Health
• Transition to Adulthood
• Student Health
National Paediatric
Asthma Collaborative

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Childhood Obesity – co-existent MH
12

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CYP Mental Health
13
The report makes a
series of
recommendations:
Maximise mental
health and wellbeing
throughout childhood

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Common themes
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CYP Mental Health
Future in Mind & Five Year Forward View
• Promoting resilience, prevention
and early intervention.
• Improving access to effective
support.
• Care for the most vulnerable.
• Accountability and transparency.
• Developing the workforce.
• Promoting good mental health
and preventing poor mental
health.
• A 7 day NHS – right care, right
time, right quality.
• Complex need services nationally
from 2016.
• ‘Hard-wiring’ mental health across
the NHS.

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Future In Mind and the FYFV for Mental Health
By 2020, for people of all ages we want to see:
Publications Gateway
Ref. No. 03250
And for children and young people specifically:
Improved crisis care for
all ages: right place, right
time, close to home
Improved transparency,
leadership and
accountability across
whole system
More visible and
accessible support
Improved public
awareness less fear,
stigma and
discrimination
Timely access to
clinically effective
support
More evidence based,
outcome-focused
treatments
Better use of data and
information across the
network
Professionals who work with
children and young people
trained in child development
and mental health
Model built around the needs
of children and young people,
and a move away from the
‘tiers’ model
Improved access for parents
to evidence-based
programmes of intervention
and support
A better offer for the most
vulnerable children and
young people

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Key issues
Access Waiting times Vulnerable
groups
Transition
Economics of investment Infrastructure/resources Systems
£78 Average spend per
child 0-17 yrs
6.6%
CYPMH as proportion
of MH spend (2012/13)
Not enough is being spent
The high cost of getting it wrong
The low cost of investing early
YP with a MH problem are…
• 8x more likely to have contact with YJS
• Twice as likely to be claiming benefits
Group CBT
£229
Unit cost
£7,252
Total lifetime benefit
Number of 5-16 yr
olds with a
diagnosable MH
condition per 1,000 in
England.
102
0.7
Number of WTE
CYPMH clinical
workforce per 1,000
0-17 yr olds in
England.
Low workforce capacity
Long waiting times
Average maximum wait
for first appointment
(NHS benchmarking)
High numbers of referrals
Approx increase in
referrals last four years
referrals 14/15
44%
26
weeks
Tiered
system
0-25s
Thrive
Step care
models
Integrated
pathways
Varied
approaches
Various
commissioners
CCGs LAs
NHSE Schools
MoJ

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Contributing to the 2020 vision
At least 70,000 more CYP receiving swift and appropriate access to care each year
Completed national roll-out of CYP IAPT programme with at least 3,400 more staff in
existing services trained to improve access to evidence based treatments
1,700 additional new staff to support improved access to evidence based treatments
Evidence based community eating disorder services for CYP across the country
95% of those in need of eating disorder services seen within 1 week for urgent cases & 4
weeks for routine cases.
Improved access to and use of inpatient care, having the right number and geographical
distribution of beds to match local demand with capacity, and leading to an overall
reduction in bed usage.
Improved crisis care for all ages, including investing in places of safety
By 2020 there will be system-wide transformation of the local offer to children and
young people underway, with LTPs embedding Future in Mind principles and fully
integrated into STPs across the country:

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NHS England – CYP MH Delivery Plan
• Supporting Transformation – refresh LTP’s to STP’s,
pilot currencies, data, dashboard metrics
• Workforce development – HEE, CYP IAPT coverage to
100% by 2018
• Generic CYP MH Pathway – 1st point of contact,
scheduled care, intensive interventions
• Eating Disorders – community ED teams, extend
pathway to include in-oatients
• Crisis Care – 24/7 emergency response pathway
• Specialised (Collaborative – CCG’s) Commissioning
• Vulnerable groups – forensic CYPH MH complex
needs pathway, Health and Justice Collaborative
Commissioning Networks, personal budgets for LAC

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Prime Minister’s announcement Jan 2017
• Green paper - DfE, DH with a focus on Prevention
• More for schools
• Mental Health First Aid in schools
• Peer Support
• RCTs
• Extension of training offer for single points of access
• Understanding what works in schools settings
• CQC and Ofsted review
• Digital
• ‘Think Ahead’ Social Worker programme

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CYP MH Schools Link Pilot Objectives
In Summer 2015
NHS England and
Department for
Education jointly
funded (£3 million)
22 pilot sites (27
CCGs and 255
schools) to test the
named lead
approach within
CYP MH services
and schools and to
trial a joint training
programme.
Develop ways to improve joint working between school settings
and CYP mental health services
Understand the development and maintenance of effective
local referral routes
Test the concept of a lead contact in schools and CYP mental
health services
Understand how training and joint working can improve
identification of mental health and well-being issues.
Test whether improved knowledge of the system improve timely
referrals to appropriate services delivering children and young
people’s mental health care

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CYP MH Schools Link Pilot -
Methodology
Workshop training sessions aimed to:
• develop a shared view of the strengths and limitations and capabilities and
capacities of education and mental health professionals
• develop knowledge of resources to support the mental health of children and
young people
• make more effective use of existing resources
• improve joint working between education and mental health professionals
The workshops used case studies and covered content around depression, anxiety,
school approaches to fostering resilience and the use of outcome measures.
The aim: long term, sustainable and locally-owned collaboration between schools
and CAMHS.
The Method: CCGs nominated a named lead responsible as overall point of
contact; NHS CAMHS and schools also nominated named leads to develop joint
working models. Training was delivered by the Anna Freud Centre using the
CASCADE model which was specially designed for the pilots.

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CYP MH Schools Link Evaluation
Methodology: incorporated survey research, research observations
and qualitative case studies in a sample of 10 areas and place
between September 2015 and 2016.
Variety of models tested during the pilot programme. Main areas of
variation included:
• named individual mental health worker
• regular in-school presence
• group or 1-2-1 work with children and young people
• engagement of wider CYPMHS professionals
No single model emerged as being most effective: approaches
tailored to local needs and circumstances.

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Key Findings of the Evaluation
Uptake of evidence-based interventions and common
outcome measures featured less prominently.
Clear evidence of a contribution towards improvements
in the frequency and quality of communication between
schools and NHS CYPMHS in many areas.
Corresponding perceived improvements to the quality
and consistency of referrals, without a corresponding
net increase in total referrals across the pilot.
Very promising early signs of changes to whole school
policies, resources and staffing within pilot schools.

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“It is easier to
build strong
children than
to repair
broken men.”
- Frederick Douglass,
1818 - 1895

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