Update on the Local Transformation Plan Year Four refresh for approval - Becky Hale
It was reported that five-year transformation funding was made available to clinical commissioning groups operating within Local Transformation Plan (LTP) areas. For the Coventry and Warwickshire LTP area, funding of £1.7m was allocated per year across the area.
Details were provided of the governance arrangements and NHS England required each LTP area to submit an annual refresh of their local plan, with an expectation that health and wellbeing boards were sighted on the refreshed plan and acted as one of the signatories to the document. The report included an appendix on the Coventry and Warwickshire year four refresh of the CAMHS Local Transformation. It detailed the progress, set out priorities for year five along with a detailed action plan.
Year two of the LTP coincided with the start of the new Warwickshire Children and Young People’s Emotional Well-being and Mental Health service for 0-25 year olds, known as Rise. The new service had a two-year implementation period which ended in August 2019. The service was now in year three of the contract and this LTP detailed the progress made. In July 2019, the LTP’s priorities had been reviewed to reflect progress made, and ensure they aligned with national guidance.
Whilst there had been great progress in several areas including the reduction in waiting times for specialist services and services for children in crisis, there had been several areas of slippage with the Rise implementation plan. These areas of slippage had been incorporated into the draft priorities and action plan. The draft priorities for 2019/20 were reported.
There were concerns about the waiting times for ASD and autism which were up to three years. This was a recognised issue and a number of areas of work were ongoing, including the development of an all age autism strategy. It was not just about diagnosis and of importance was the support available for the child or young person, their families and schools. This would require a multi-agency approach. Referral rates for the area were far higher than would be expected for comparative areas.
Russell Hardy emphasised these concerns, asking what workforce would be needed to get the waiting lists to an acceptable standard. There were recognised staffing challenges within the NHS generally and in this area specifically. He noted the hard work being undertaken by staff. It was viewed that there was insufficient detail on workforce in the document and that this issue should be ‘called out’ by the Board. Mr Hardy added that the board had a role to recognise challenges and provide support. By making Warwickshire an attractive place to work it could help to address the current workforce challenges.
Officers explained that the report had been compiled to respond to NHS key lines of enquiry and more detail could be provided on workforce. The provider, CWPT was undertaking work on demand for services, clinical capacity and the gap between them. There was a particular capacity issue for autism. The Chair added that such an assessment of staffing challenges would be useful for all health services.
Dame Stella Manzie, the CWPT representative felt it would be helpful to add the level of detail requested on workforce to other relevant documents including the HWBS. Simon Gilby, Chief Executive of CWPT stated the need for a collective approach. There was a workforce shortage nationally of some clinicians, but it was important not to confuse workforce challenges with some of the decisions made previously on priorities. This collective challenge was particularly relevant for the autism services, where there was much still to do.
The report was praised as giving a complete overview of the services. However, there was a challenge in regard to the data on children in crisis. This made a link between reductions in tier four admissions being direct evidence of better care, which could not be assumed and it could be due to a variety of factors. There was a higher number of patients presenting in crisis at A&E so there was a need to take care when drawing conclusions and a whole system approach was required. There was praise for some of the informal approaches being put in place.
Officers assured that there had been close working with the UHCW crisis and home treatment teams as well as seeking to take a preventative approach to avoid readmissions. It was noted that the data was from 2018/19 and the funding for the new approach was only put in place late in that financial year.
It was questioned how this work connected to the refreshed HWBS given the themes around children and mental health and wellbeing. The HWBS would be a contributor and there was an aim to align all relevant strategies which related to children’s emotional and mental health and wellbeing. The impact of workforce challenges was acknowledged. In some areas there were recruitment difficulties and in other areas an aging workforce.
There were reported improvements in the lived experiences of service users. Further detail was sought on how this was checked and if there was confidence in the direction of travel. Officers replied that the Rise service was outcome focussed. There were a variety of measures including feedback from the service users and performance reports. Endeavours were being made to improve how the data was triangulated with a greater emphasis on the lived experience of service users, their families and also those assessed as not requiring the service.
The cross-border arrangements were discussed. Some children and young people may be located in a Warwickshire school, but their GP practice was located in a neighbouring area. An outline was given of the community offer, which was based on the school location and therapy routes, which were based on the GP location, but there were reciprocal arrangements. From experience a local member was aware of somedifficulties for parents.
At the outset of the Rise programme, there were concerns about inequalities across the area in terms of waiting times. Reassurance was sought that the previous disparities had been addressed.
That the Health and Wellbeing Board:
1. Endorses the Coventry and Warwickshire Child and Adolescent Mental Health Services (CAMHS) Local Transformation Plan refresh for year four.
2. Notes that a refreshed CAMHS Local Transformation Plan for year five is likely to require sign off from the Warwickshire Health and Wellbeing Board in October 2020.