Children and Young People’s Mental Health and Emotional Wellbeing

In March 2015 the Mental Health Taskforce (co-chaired by NHS England and the Department of Health) published Future in Mind: a report with 49 recommendations for improving children and young people’s mental health and emotional wellbeing. Future in Mind revealed that for 75 per cent of adults with mental health problems these start before the age of 18, yet enough wasn’t been done to help these children and young people early enough. The report outlines the need to move away from the traditional tiered approach to mental health services through a whole system approach, bringing together health, education, social care and the voluntary sector. In February 2016 the Taskforce produced the Five Year Forward View for Mental Health Services which further sets out the vision for all age mental health services. Following the release of Future in Mind, areas were asked to produce Local Transformation Plans (LTPs) which would outline how they would bring about the necessary changes to improve children and young people’s mental health and emotional wellbeing.  These plans were importantly produced at a local level with the valuable input of children and young people themselves.

Progress to date

• Established a local Children & Young People Mental Health Improvement Team which includes dedicated service improvement support, clinical expertise & Local Authority advice
• Established a CAMHS Clinical Experts Group across Cheshire & Merseyside to provide clinical leadership, peer support, problem solving and good practice
• Hosted a number of workshops to help commissioners & clinicians prepare for the transformation of CAMHS & CYP Eating Disorders Services
• Provided support & completed pre-assurance screening of CAMHS Local Transformation Plans
• Supported the local NHS England DCO (Director of Commissioning Operations) in reviewing & assuring all CAMHS Local Transformation Plans
• Worked with the Northern England SCN’s and NHS England’s National Children & Young People’s Mental Health Improvement Team to influence and aid coordination of the national support programme
• Developed an initial assessment for CAMHS data flow system preparedness
• Established a programme of service improvement support for CAMHS transformation in 2016/17

Children and Young People with Autistic Spectrum Disorder (ASD)

In 2011, NICE published guidelines for the recognition, referral and diagnosis of children and young people on the autistic spectrum. NICE recommended that each local area establish co-ordinated multi-disciplinary and multi-agency referral, assessment and diagnostic pathways for children with a suspected Autism Spectrum Disorder (ASD).

In February 2014, the Children & Young People Network established an ASD Special Interest Group (SIG) to review community services for children with ASD and their families in Cheshire and Merseyside. The aims of the SIG were to:

• Identify and map current multi-agency pathways from diagnosis to transition for children and young people with ASD
• Review existing parent support programmes for children and young people aged 11-15 years with ASD
• Develop a process for measuring the experiences of children and young people with ASD and their families.

The SIG’s work programme was originally intended to run for two years until March 2016 but completion was brought forward to March 2015 due to the ongoing changes to national service improvement policy and a need to adapt network priorities. The SIG therefore focused its efforts on developing a referral pathway and wider stakeholders could review and develop parent support programmes, along with processes to measure service user experience. Through its review, the SIG found considerable variation in the availability and quality of referral pathways within Cheshire and Merseyside and it was difficult to establish how far some were meeting NICE guideline recommendations. Parents reported poor access to services and were frustrated and confused with the referral pathway. With a few exceptions, the voluntary sector was largely disengaged from the referral process, mainly due to previous negative experiences such as broken policy promises and raised expectations that were not subsequently met. There was variable but significant pressure on resources and some areas were unable to meet parent expectations or the NICE recommendation. There was however considerable expertise in ASD and a passion across all voluntary, health, education and social care agencies to improve services for children with ASD and their families.

Progress to date

• Established a Cheshire & Merseyside ASD Special Interest Group
• Developed a standard blueprint referral pathway template in line with NICE guidelines recommendations
• Produced an information leaflet for parents and carers, for use at point of referral
• Completed an initial assessment of parents’ priorities during the referral pathway
• Mapping of existent local multi-agency pathways from diagnosis to transition for children & young people with ASD
• Supporting commissioners to improve referral experiences of, and support for, children & young people with ASD and their families
• Supporting parents at the point of referral with preliminary information & signposting
• Informing the future development of a tool for measuring parents’ experience

Children and Young People with Long Term Conditions and supporting them through Transition

Reduction in unplanned emergency admissions and improved experience through Transition for Children and Young People (CYP) living with long term condition including Asthma, Epilepsy and Diabetes was identified as a priority of the North West Coast Children’s Network in 2015/16.

Progress to date

This work continues into 2016/2017 with all acute provider and commissioner organisations across the North West participating in a self-assessment exercise. The self-assessment tool was developed in collaboration with clinical leads/experts from paediatric Asthma, Diabetes and Epilepsy and based on current best practice standards allowing the SCN to undertake a scoping exercise across the region. Gathering this information will enable the SCN team to identify key themes, areas of best practice, barriers, and challenges currently within the system to inform future commissioning and provision of long term conditions and transition services across the North West Coast region.

Improving acute medical and surgical paediatric care

In 2010 the Royal College of Paediatrics and Child Health (RCPCH) published the Facing the Future standards setting out ten key requirements to deliver high quality, safe and sustainable acute general paediatric services.

Facing the Future intended to be live and flexible to changes in the health system and, five years on from the original publication, the RCPCH has conducted a review of the standards.

In addition to revising the original Facing the Future: Standards for Acute General Paediatric Services the RCPCH, RCGP and RCN have worked together to develop a new set of standards in the Facing the Future suite, Facing the Future: Together for Child Health, which apply across the unscheduled care pathway to improve healthcare and outcomes for children

Progress to date

A self-assessment tool was developed based on both the Facing the Future Standards for Acute General Paediatric Services and Together for Child Health.

The self-assessment document was distributed in July 2015 and all eight Providers have completed and RAG rated themselves against the standards.