Agenda item

Update from Coventry and Warwickshire Partnership Trust (CWPT)

The Joint Overview and Scrutiny Committee will receive an update from the Coventry and Warwickshire Partnership Trust.

Minutes:

CWPT had provided two reports to the joint overview and scrutiny committee. These updated on the RISE children and young people emotional wellbeing and specialist mental health service and Autism waiting times.

 

Chris Evans presented the first report, which gave an overview of the strategic response to the independent review of the crisis offer in Coventry and Warwickshire. The report included the four system recommendations coming from the review and stated the need for a system response. Sections of the report focussed on the following areas:

 

  • Whole system transformation and leadership
  • Building the preventative offer and development of a trauma informed system
  • Enhancing the current crisis service
  • Continued development of the offer to support the restoration and strategic aims
  • Further service transformation to support the strategic aims.

 

Questions and comments were submitted with responses provided as indicated:

 

  • Councillor Marian Humphreys asked a series of questions about:
    • The process to identify children with behavioural problems and those who were disruptive at times impacting on other children.
    • Where there had not been a formal diagnosis the referral to services for advice and length of time before referral to a consultant.
    • The timeframe for parents to receive advice and support, independent of the school.
    • When an Integrated Personal Commissioning (IPC) arrangement should be put in place. From recent case work, there was a need for more training and capacity within schools.
  • Michelle Rudd responded with an outline of the collaborative service offer through RISE, working with families and teachers. A key aspect was the cause of disruptive behaviour, with anxiety sometimes being a cause. There was collaboration with headteachers, the County Council’s teams, family support and families. The impact of Covid was stated and examples given of the workshops which had continued. Councillor Humphreys spoke of the timescales before services were commenced and the lost education. A need to look at how schools responded. Michelle Rudd gave context on the number of schools across Warwickshire, and an outline of the mental health in schools programme, which was being rolled out. There had been considerable success from the earlier phases of this initiative, with the north of Warwickshire, Nuneaton and Bedworth being the next area.
  • Councillor Brett Beetham referred to the appointment of the data quality officer and asked about their initial findings and impact on waiting lists. On the CWPT website, there was not a clear list of the Autism Spectrum Disorder (ASD) services provided and it would be helpful to have a list of the services.
  • Helen Stephenson responded to the question on data quality. Patient records were being migrated to a new clinical system, which could identify errors or duplication of cases. The data quality officer’s role included ensuring the patient lists were as accurate as possible to avoid duplication. The provision of a comprehensive ASD list was being developed and would be published via the CWPT website in due course.
  • Councillor Penny-Anne O’Donnell sought further information about patients with anxiety linked to additional undiagnosed learning needs and the links to the SEND inclusion change programme.

 

Helen Stephenson then presented the second of the CWPT reports to give an update on Autism waiting times. This comprised background on the identified system challenges for Autism waiting times which predated Covid and had been exacerbated due to the pandemic. It referenced the SEND inspection in July 2021, the key areas of improvement required and resultant written statement of action (WSOA). Additional non-recurrent funding of £1.5 million was being allocated to provide further capacity to tackle some of the assessment backlog. Key points were drawn out, including the level of referrals to the service, which was approximately double that commissioned. The pathways had been redesigned and to meet service needs, a business case for additional capacity had been submitted to the Clinical Commissioning Group (CCG). The report concluded with details of the actions taken to review the assessment and triage processes. Additional diagnostic assessment capacity had been sourced including through external providers. In terms of current commissioning, this was based on a prevalence rate of 1% of the population, but the estimated prevalence rate was 3% locally and up to 4% nationally.

 

  • Councillor O’Donnell reiterated her questions above, also asking about the financial implications of the short-term measures reported to address the backlog and arrangements for the longer-term. It was questioned how the revised service arrangements would improve the experience for families needing to access the service.
  • Helen Stephenson provided further information on the triage arrangements from the diagnostic clinicians and referral to external providers. The appointment of an assistant psychologist post meant that appointee could undertake this triage role, providing additional diagnostic capacity. In response to the questions on patients with anxiety linked to additional undiagnosed learning needs, within Warwickshire there were 311 children aged 0-5 years waiting for a diagnosis. Context was provided on the numbers of referrals being received each month, which was significantly higher than the service commissioned. All endeavours were being made to provide efficient assessment given the known impacts on a child’s education.
  • Councillor O’Donnell’s main concern was about funding for the service. There was an absence of figures and detail was needed on timelines too. The aim was to support children, not necessarily to get a full diagnosis. A point on ensuring school staff were upskilled to identify signals at an early stage and provide support. She questioned if this would reduce the ringfenced Education and Healthcare Plan (EHCP) support but see more funding for general support.
  • Helen Stephenson reiterated that a joint business case for significant additional resource would be considered by the CCG later in the day, to tackle the current backlog and provide recurrent funding for the future. Chris Evans spoke about anxiety issues which were experienced by all young people, but when they reached a threshold this did cause difficulties. The online Dimensions Tool enabled young people to access support at an early stage. Some people may need a formal diagnosis, whilst for others, a range of issues could contribute to their anxieties. CWPT continued to support schools on addressing anxiety in young people. Empowering and enabling the young person and their family was also raised.
  • Councillor Kerridge asked about the reporting arrangements and how members could access this information. He used examples of lost days at school, and through disruption. It was suggested that this question be taken under an item later on the agenda.
  • Councillor Kerridge asked about having ‘one point of contact’ to make it easier for people to access services.
  • Chris Evans responded explaining the ways people could access services via the navigation hub, or through a freephone crisis line, which was provided at all times. Moving forwards there was an overarching strategy to signpost people to other appropriate services including those provided by the community and voluntary sector. The key aim was to provide a package of support for each child. 
  • Michelle Rudd expanded on the Rise service. An assurance was provided of the support in place to ‘hold’ families and the young person, with access to clinicians and specialist staff throughout their journey. Given the complexity of the services provided, it was not possible for a single person to undertake this role, but CWPT ensured that people were kept informed where they were on their journey and linked to the appropriate professionals.
  • Councillor Kerridge wanted to ensure that people could easily make contact with the correct service.  It was acknowledged that there were a range of support structures. Reference to the communications structures in place, through schools, organisations like Dear Life and corresponding links from the CWPT and county council websites. Including councillors in the communications would be helpful. Other points around the social media presence, the system-wide digital offer, which was anonymous, provided support and the young person could escalate themselves. During the discussion, a Google search had identified all the relevant contact details.
  • Councillor Jo Barker responded to the last point that during a time of crisis, people may not necessarily know the right words to use for such an internet search. She asked about the number of extra ASD assessments that would be provided from the additional resource allocation. The non-recurrent funding had been split across several areas. It should result in 60 extra diagnostic appointments per month, at a cost of £1800 per assessment. There would be an extra 30 psychology / psychiatry assessments per month, subject to external provider capacity.
  • Councillor Barker questioned if more children could be seen and more could be achieved through use of lower-level interventions. Helen Stephenson advised that there were only a few specialists able to undertake the diagnostic assessments. Ashock Roy agreed it was logical to meet needs earlier on the pathway. He spoke of the number of referrals as people sought a diagnosis to enable access to help. A need to break this cycle and some assessments may be overly long or complex. Anxious children should not need to wait for a diagnosis to get support.
  • Councillor Barbara Brown sought more information about school or multi-disciplinary staff development and training as this was critical to achieving the strategies. She asked whether such training would be optional for schools. Intervention at an earlier stage in the classroom may avoid the need for escalation. Chris Evans responded on the various agencies which interacted with children and the need for a partnership approach between education and health. There needed to be a specialist mental health lead within schools and not to add this to someone’s existing duties. He spoke of the comprehensive twelve-month training programme which had been planned, but delayed due to the pandemic and commissioning difficulties. This was still the aspiration and would link to the mental health in schools teams of CWPT. He outlined the current service offer and the work to join up the various teams to share intelligence. It was recognised that early detection and intervention were really important. He also touched on the system-led dashboard where CWPT was ahead of many other partnership trusts. Further intelligence from this dashboard would be provided going forwards. There was recognition of the challenges being faced by schools.
  • In response to a question from Councillor Marian Humphreys, it was confirmed that no resources had been vired from treatment to provide additional diagnosis. However, these services were underfunded, which contributed to the current delays in treatment. The additional funding identified was for both the Coventry and Warwickshire areas.
  • Councillor Humphreys spoke of the need to have more than one trained special educational needs coordinator (SENCO) to provide adequate cover. This point was acknowledged, and work took place with schools to look at providing bespoke and appropriate cover.
  • Councillor Barker commented on the range of people in schools with experience of the issues being discussed. Specialist health resources needed to be targeted on those with significant need. A need to determine the respective roles of professionals in dealing with each case. Dr Sharon Binyon provided clarity on the multi-agency approach to many of the areas discussed, using the appropriate people. Sometimes diagnosis was not the correct outcome and identifying support needs was more important. For Autism cases sometimes a diagnosis was required by parts of the system, to enable support to be provided. The strategy for Autism would be discussed under a later agenda item.
  • Councillor Barker considered that as with other mental health issues, the Autism pathway could similarly be undertaken by a range of professionals.

 

The Chair thanked the CWPT representatives for their attendance. He provided a summation of the key points discussed, including the service need being double that commissioned presently, asking how this framework was established, and aspects for the county council. There was a need to review the various pathways including diagnostics.  He referred to the inspection review and new SEND member panel, suggesting a further recommendation for a dialogue with that panel on the WSOA amongst other areas. The points on early intervention and assessments needed to be explored further with CWPT. It was suggested that a report back be provided within six months.

 

 

Resolved

 

  1. That the Joint Overview and Scrutiny Committee receives the updates from the Coventry and Warwickshire Partnership Trust (CWPT).

 

  1. That CWPT is asked to contribute to the work of the SEND member panel.

 

That a report back on progress with the areas outlined above be provided to both the Children and Young People and Adult Social Care and Health Overview and Scrutiny Committees.

Supporting documents: