CAMHS Transformation Plan Refresh October Children and Young People s Mental Health and Emotional Wellbeing

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1 CAMHS Transformation Plan Refresh October 2017 Children and Young People s Mental Health and Emotional Wellbeing 1

2 Contents Page 2 - Lambeth Overview Page 3 - South East Sustainability and Transformation Plan (STP) Page 4 - Our Starting Point in Lambeth Page 6 - Progress to date for 2017 and 2018 Page 14 - Transformation and Redesign of the service Page 21 - Challenges in 2017 and 2018 Page 23 - Governance Page 24 South East Sector Collaborative - Areas of progress and development Page 29 Lambeth Areas for Continued Development Page 31 CAMHS Transformation Funding in Lambeth Page 34 Risks and Mitigation Page 35 - Appendices Appendix 1 Young Lambeth Emotional Wellbeing and Mental Health Strategy Appendix 2 Eating Disorder Service Update Appendix 3 South East Sector Workforce Plan Appendix 4 New Models of Care Update Appendix 5 Update on CAMHS Transformation pilot projects Please note The format of the Transformation Plan has changed slightly for the October 2017 Refresh. Updates for October 2017 are highlighted throughout the document 1

3 Following the publication of Future In Mind and the Young Lambeth Emotional Wellbeing and Mental Health Strategy, Lambeth CCG worked with partners to develop a Transformation Plan for our CAMHS services. The annual refresh of the plan is to provide an update based on the learning and progress throughout the 12 months, and to set out the plans for transformation over the next 3 years. The plan is in line with the 5 Year Forward View and our STP. Our original Transformation Plan can be found at Lambeth CAMHS Transformation Plan The Young Lambeth Emotional Wellbeing and Mental Health Strategy can be found at Young Lambeth Emotional Wellbeing and Mental Health Strategy The Transformation Plan is approved by the Children and Maternity Programme Board (CMPB) and through our Cabinet member for Children, Young People and Families. Lambeth Overview The Young Lambeth Emotional Wellbeing and Mental Health (EWMH) Strategy produced in 2015 highlights 5 main priorities and work streams, in line with Future in Mind. The commissioning intentions and actions for Lambeth were developed under the following priority areas: PRIORITY 1: Prevention: Awareness, Knowledge and Training PRIORITY 2: Maximising Resilience and Self Sufficiency PRIORITY 3: Improving Access to Clinical Services PRIORITY 4: Transition: From Birth to Adulthood PRIORITY 5: A Public Mental Health Approach: The wider Environmental Factors The Lambeth Emotional Wellbeing and Mental Health Strategy 2015 and the supporting Transformation Plan set out Lambeth s ambitions and intentions over the next 3 years. The priority areas, identified needs and the required outcomes remain consistent throughout both documents and reflect the areas of need in the Lambeth Joint Strategic Needs Assessment. The Plan is intended as a live document and while Lambeth s horizon continues to change in regard to services for children, and the changes take place within CAMHS provision, the plan will be developed and adapted to reflect this. This plan is to sit alongside the Lambeth Strategy. 2

4 This Plan has been developed in line with the local Sustainability and Transformation Plan (STP) and with the Collaborative Commissioning Plan being developed with neighbouring boroughs for March South East London Sustainability and Transformation Plan (STP) The Sustainability and Transformation Plan (STP) for South East London includes CAMHS as an area of focus for the next 3 years. Lambeth CCG has been involved with the development of the local STP and we ensure that the CAMHS plans are echoed in our local plans for change. The STP states that Transformation Plans are expected to result in a significant reduction in demand for Specialised CAMHS services within the next 3 years. The STP also reflects that current crisis care pathways are under-developed, particularly for children and young people with complex needs and behaviours related to learning disability (LD) and/or Autism and emerging personality disorders. The overall distribution of CAMHS inpatient capacity does not match Regional population needs and young people are being admitted far from their home, or to paediatric or adult beds; the NHS England National CAMHS Service Review aims to redress service deficits by redistributing/realigning beds to meet local needs. The clear expectation is that by 2020 there will be no inappropriate admissions to adult or paediatric beds and patients will be treated in local care pathways. The STP areas of focus are: To promote commissioning of consistent out of hours services for young people particularly to manage crisis and prevent escalation with clear ambition to manage demand effectively at community level and reduce inpatient admissions TCPs with engagement and support of NHS England to oversee consistent delivery of multi-agency pre-admission Care and Treatment Reviews for children and young people with LD, and/or autism to reduce inpatient admissions NHS England Specialised Commissioning Team to work collaboratively with CCG and Local Authority commissioners to design and commission effective community pathways with robust links to local acute inpatient services with ambition to reduce lengths of stay and inappropriate placements reflected in LTP and TCP NHS England Specialised Commissioning Team to continue to work with local commissioners to reflect ambition in LTP/TCP and STP plans to 3

5 - ensure Regional inpatient capacity meets requirements so out of region admissions become the exception - to reduce variation by introducing standardised access and waiting times - adopt consistent models of care based on best practice that reduce the reliance on inpatient care - deliver seamless age-related service transitions - to support the pilots within the New Care Models programme (NWL) These areas of work are covered in the Progress to Date section. The 5 Year Forward View also sets out a number of key improvements for within mental health provision, such as: an increase in psychological/talking therapies improved community care for children and young people care closer to home specialist mental health care within A and E and better crisis care links. Our Starting Point in Lambeth In the Young Lambeth Emotional Wellbeing and Mental Health Strategy, we set out the following outcomes we want to achieve by 2020; Significant increase in anticipated mental health population accessing treatment to 30%. 20% increase in uptake of parenting programmes and parenting support 75% of the children s workforce will have completed emotional wellbeing and mental health training Waiting time targets achieved and maintained. 10 weeks from referral to treatment for the Early Intervention service, 18 weeks from referral to treatment for all other CAMHS services 20% reduction in the number of children & young people accessing hospital based mental health services (inpatient and outpatient) Reductions in presentations to A&E Nationally recognised excellent eating disorder pathway, with reduced waiting times and improved access An established and comprehensive perinatal MH pathway. Increased number of women accessing mental health services Recommendations referencing the wellbeing and mental health of children & young people from the Black Mental Health Programme are fully implemented and evaluated 4

6 Outcome monitoring and evaluation framework fully established and routinely informing service improvement Reduction in inequalities through explicit Equalities Objective which start with transition from child to adult mental health services Comprehensive clinical and referral pathways fully embedded for key presenting conditions; conduct disorder, self-harm, first on set psychosis, eating disorders, depression & anxiety (baseline and targets competed in 2015/16) It is our ambition and intention to move from a crisis led model of care to an early identification and prevention focus. We are working towards reducing the number of children and young people who will require access to inpatient treatment, specialist Tier 3 and 4 intervention or attend A and E at crisis point. In the longer term it is our vision to create a more integrated model or alliance between providers from the voluntary and community sector to provide support at an earlier stage. Alongside early intervention programmes around building emotional wellbeing and resilience, we envisage a suite of services and provision at Tiers 1, 2 and 3 for children and young people in Lambeth by Robust pathways from this range of provision into our main CAMHS provider SLaM, Children s Social Care and Early Help team, will enhance the offer available to young people, families and referrers such as schools and GP s. The focus within Year 1 was to: Scope, cost and make recommendations for a comprehensive evidence-based parenting programme, early intervention and prevention programmes Undertake the mapping and scoping of emotional wellbeing and mental health training and skills within the children s workforce Develop a comprehensive eating disorder pathway Undertake a comprehensive review of current CAMHS provision within our clinical services Develop a comprehensive crisis care pathway Effectively implement IAPT Scope and Implement a comprehensive Perinatal Mental Health pathway Scope and identify gaps and needs in support for CYP that have experienced sexual abuse and/or exploitation 5

7 The focus within Year 2 and 3 was to: Complete review and redesign of the Early Help Offer in Lambeth, reflecting true transformation Develop capacity and skills within the Voluntary Community Sector, and share best practice across organisations working on the front line to support young people with emotional wellbeing and mental health Start to commission training and support for schools and the Voluntary Community Sector Progress the Liaison and Diversion work and to develop improvements to health outcomes for young people in the criminal justice system Progress to Date Throughout 2016 and 2017 Lambeth has been working to begin to implement the changes as laid out in our original Transformation Plan. A number of our work streams in Year 1 focussed on the scoping and mapping of current provision and undertaking gap analysis to inform work and change over the next 3 years. Improving Access to Clinical Services Waiting times: The Five Year Forward Plan states that by 2020/21 at least 70,000 more children and young people should have access to high-quality mental health care when they need it. It was our immediate vision for 2015/16 to improve access to clinical services for children and young people in Lambeth, which has been realised through a number of initiatives. The priority for us in Lambeth, as well as nationally, was to reduce waiting times for children and young people to access our clinical services, especially our Early Intervention Service. Our waiting times had reached an average of 50 weeks in 2015 and we had started to work with our mental health trust to develop plans to bring these down to our target of an average 11 weeks. Lambeth has committed an additional 180k per year to the service to initiate our waiting time initiative. The funding provided additional resources and capacity in the Early Intervention team, as well as the Neurodevelopmental Team. We have continued to see a general decrease in the waiting times for the EI service, but continue to monitor this through our London Dataset quarterly reports and regular meetings with our Lambeth service lead. 6

8 Table 1 - Waiting times for Lambeth CAMHs services Child and Adolescent Community Service Lambeth Lambeth CAMHS Early Intervention Lambeth CAMHS Neurodevelopmental Team Lambeth Children Looked After Lambeth Youth Offending Update: The average waiting time of those assessed in Quarter 1 17/18 is now weeks and we are working continually to reduce this. There were 14 cases that are reported to have been waiting in excess of 26.1 weeks for assessment in this quarter. However these cases were ADHD transfer cases which were offered appointments in line with 6 monthly reviews. Three cases were waiting in excess of 39 weeks. Eighteen cases were waiting in excess of 26 weeks for their first treatment in the Child and Adolescent Community Team, these again had a diagnosis of ADHD. Table 2 Current waiting times for assessment for CAMHS LAMBETH Teams 0-4 Weeks Weeks Weeks Weeks Weeks 1Year+ TOTAL Child and Adolescent Community Service Lambeth Lambeth CAMHS Early Intervention Lambeth CAMHS Neurodevelopmental Team Lambeth Children Looked After Lambeth Youth Offending PAIRS (Parent & Infant Relationship Service) 1 1 Grand Total For Looked After Children, in Quarter 1 there were no children or young people waiting in access of 12 weeks for assessment. There were 3 cases transitioned to adult services with evidence of prior planning before their 18 th birthday. All 3 cases identified had a CPA within the 6 month timescale. 7

9 By Quarter 1, 33 cases had been identified as still being seen in CAMHS aged 18 or over as treatment was still being delivered. 21 of these cases had been identified in the Child and Adolescent Community Service, 1 with Early Intervention, 4 with NDT, 1 with CLAMHS and 6 with YOS. CLAMHS discuss their cases within their weekly meeting which has resulted in no new cases being held past the age of 18. This is a system that is being replicated across all of the Lambeth CAMHS Teams. Access The Implementing the Five Year Forward View for Mental Health [NHS England 2016] commits CCGs to increasing the number of children accessing appropriate support by 10% over the life course of the Transformation Plan. Currently 25% of children and young people with diagnosable mental health needs are accessing services. This is expected to be increased to at least 35% as a result of the full implementation of Transformation Plans. The population of young people in Lambeth is approximately 68,000. If 1 in 10 young people are expected to have a mental health illness, this would give an estimate of 6,800 young people. This tells us that to reach our trajectory we should have around 2,040 young people accessing treatment for mental health. Currently only our Mental Health Trust, SLaM, submit data officially for this NHSE set target. However we have a number of wellbeing services supporting young people in Lambeth, funded by the CCG and Local Authority. We will work in 2018 to ensure the data from these services is also captured formally and able to contribute to the overall access targets for Lambeth, via Mental Health Services Dataset (MHSDS). We are working with neighbouring boroughs to review the mental health dataset to ensure it allows capture of these additional access services. As per national requirements, Lambeth CCG is committed to meet increased capacity and to work towards the set trajectory for access to evidence based community mental health provision. Table 3 Lambeth trajectory for access to community mental health provision Year Target (% Increase of CYP accessing CAMHS) Trajectory (No of CYP accessing CAMHS) 16/ ,360 17/ ,496 18/ ,768 19/ ,040 8

10 Outcomes We have worked with our Trust to ensure we are collecting robust data and information on outcomes for young people. Due to severe delays with data, we have only started to receive this in Through the roll out of Improving Access to Psychological Treatment (IAPT) for children and young people across a number of CAMHS services, we have been able to start to gather outcome information and data for how our services are impacting on young people accessing them. Table 4 - No. of patients eligible for paired CGAS, % recorded and % showing improvement by Borough Borough Eligible for Paired CGAS Paired CGAS Paired CGAS% Improved Improved% Croydon % % Lambeth % % Lewisham % % Southwark % % Grand Total % % Table 5 - No. of patients eligible for paired CGAS, % recorded and % showing improvement by Team in Lambeth LAMBETH Teams Eligible for Paired CGAS Paired Paired CGAS% Improved Improved% Child and Adolescent Community Service Lambeth % 76 66% Child and Adolescent Crisis Care Service (Lambeth) % 1 100% Child and Adolescent CWP Programme Lambeth 3 0 0% 0 0% Lambeth CAMHS Early Intervention % 29 60% Lambeth CAMHS Neurodevelopmental Team % 15 44% Lambeth Children Looked After % 12 63% Lambeth Youth Offending % 6 55% PAIRS (Parent & Infant Relationship Service) % 0 0% TOTAL % % Table 6 - Change of CGAS scores over course of treatment for cases closed in quarter LAMBETH Teams Average 1st SCORE Average 2nd SCORE Average DISCHARGE SCORE No of Discharges Child and Adolescent Community Service Lambeth Child and Adolescent Crisis Care Service (Lambeth) 2 Child and Adolescent CWP Programme Lambeth 1 Lambeth CAMHS ACIST 1 Lambeth CAMHS Early Intervention Lambeth CAMHS Neurodevelopmental Team

11 Lambeth Children Looked After Lambeth Youth Offending PAIRS (Parent & Infant Relationship Service) 15 TOTAL 232 Currently our robust outcome data recorded is from our mental health Trust. We are working with our colleagues in the voluntary and community sector to ensure the gathered outcome data from the commissioned and non-commissioned projects is counted. We will need to work with them to see how this data around access numbers and outcomes can contribute to the wider Lambeth access and trajectory data going forward with NHSE. We do not want to lose this rich data and information just because it is not from within the larger mental health Trusts. Eating Disorder Service: We have seen the embedding of the community Eating Disorder Service and the implementation of a direct advice line for professionals. Through a piece of partnership working with our mental health trust SLaM and neighbouring boroughs of Southwark, Lewisham and Croydon, the advice line was funded and launched in February This was in response to feedback from schools and GP s around accessing the eating disorder service and requiring advice for individual young people and their work to support them. One of our highest area of Tier 4 specialist service/outpatient spend was for the eating disorder service and provision, hopefully leading to the reduction of inpatient placements required for Lambeth children and young people. Appendix 1 gives the full update report on the Eating Disorder service. Table 7 Waiting Time Targets for 16/17 and 17/ / /18 Waiting Time Target Achieved % (Target Achieved / Total number of Referrals) Referral Type Q1* Q2* Q3* Q4 Q1 Q2 Q3 Q4 Apr- Jun July- Sep Oct- Dec Jan-Mar Apr- Jun July- Sep Oct- Dec Jan- Mar Emergency < 1 day N/A N/A N/A N/A N/A 100% (1/1) 10

12 Urgent < 7 days Routine < 28 days % Accepted (Total accepted/ Received) 40% (2/5) Shortest: 1 Longest: 12 38% (19/50) Shortest: 6 Longest: % (55/59) 63.6% (7/11) Shortest: 3 Longest: % (6/49) Shortest: 7 Longest: % (60/66) 100% (4/4) Shortest: 5 Longest: % (41/52) Shortest: 3 Longest: % (56/59) 100% (7/7) Shortest: 3 Longest: % (55/67) Shortest: 8 Longest: % (74/78) 100% (5/5) Shortest: 3 Longest: % (46/57) Shortest: 9 Longest: % (62/66) 100% (7/7) Shortest: 1 Longest: % (49/53) Shortest: 3 Longest: 42 (wanted appt in Sept) 88.2% (60/68) Average / Quarter = 92.7% (367/396) Table 8 Numbers of referrals to Eating Disorder Service by borough from April September 2017 Referrals CCG Received Accepted % accepted NHS BEXLEY CCG % NHS BROMLEY CCG % NHS CROYDON CCG % NHS GREENWICH CCG % NHS LAMBETH CCG % NHS LEWISHAM CCG % NHS SOUTHWARK CCG % Grand Total % The service was cited as a national example of best practice in the NHSE commissioning guidance. In line with the model, the service is very accessible. Young people and carers have been able to selfrefer via either a dedicated telephone line or an online form on their website. The service appears to be making good progress towards meeting the waiting times standards. Q waiting time figures were: Routine 92.5%, Urgent 100% and Emergency 100%. The service is planning to become members of the Quality Network for Community CAMHS - Eating Disorders in 2018, and in line with the Network's recommendations will seek accreditation in

13 CAMHS Service Reviews and SPOA: September 2016 saw the start of our CAMHS service reviews in Lambeth. The aim of the review was to better understand the current provision in Lambeth, to ensure the services are meeting expectations and standards, to look at activity levels, to review resourcing and capacity and identify areas of good practice, learning and improvement. Completion of the review has helped us to identify gaps in provision, reorganise current team structures where needed and better allocate resource. The review will also inform the future allocation of transformation funding and spend beyond 19/20. Service reviews were completed in Summer A report was taken to the Children and Maternity Programme Board (CMPB) and to Senior CAMHS staff through performance monitoring and Transformation meetings. The reviews have been useful for the service leads and staff as well as commissioners, working together to review the service and delivery, and we have received positive feedback. We had also gathered the views of partners and referrers to identify key areas of improvement in each of the CAMHS teams. Following the review of CAMHS services progresses, the feasibility and effectiveness of a Single Point of Access (SPOA) will be evaluated as well as the key links and pathways between voluntary and community sector and statutory services. CAMHS services need to be embedded as a key aspect of the Early Help Offer as well as the provision for Tier 3 and above. The outcome of the reviews will be a pivotal step in understanding how to best transform CAMHS provision in Lambeth on a wider scale to meet presenting need with a very real focus on Early Intervention, Tier 2 support and pathways such as crisis care, transitions and ADHD. Appendix 3 shows the summary report of the Service Reviews. Crisis Care: For our crisis care provision, we are confident that we will realise a 10% reduction in children and young people presenting in crisis by With the addition of 2 x Band 7 nurses within the Lambeth CAMHS team, working closely with the Emergency department and our Paediatric Liaison Service, we have added integrated capacity. We will continue to work closely with our South East Commissioners to ensure a robust and constant response to crisis care. We are working alongside SLaM, Lewisham, Croydon and Southwark to develop a plan for robust and consistent provision across the boroughs, responding to local need. 12

14 In 2016 (month 3) Lambeth received a one off non recurrent payment of 215k earmarked for eating disorder and/or crisis care. This was allocated to the Tier 4 outpatient treatment delivered by our main CAMHS provider SLaM. This work mainly includes treatment for Eating Disorders, as well as Obsessive Compulsive Disorder, and Dialectic Behavioural Therapy. By ensuring children and young people have access to the most effective treatment locally, we aim to improve outcomes for young people within just one treatment episode, and reduce the need for inpatient provision and repeat access. Lambeth continues to work with colleagues across the SE Sector and SLaM to deliver a robust and consistent crisis care pathway wherever possible for young people. CAMHS Transformation Projects: In 2016 and 2017 Lambeth CCG ran a competitive bidding process for emotional wellbeing projects and programmes to pilot these in the borough and look at outcomes for children and young people. The learning from these projects will be incorporated into the wider development of emotional wellbeing and early help services over 2017 and 18. The projects include: Working with young carers including 1-1 support sessions, creative and practical workshops and weekly courses 1-1 support and counselling provision for young people experiencing and witnessing domestic abuse and violence 1-1 support and counselling for young people involved in gangs and/or gang affiliated Support for children and families through Welcare and Home start 1-1 and group support for young people from the LGBT community, and support and awareness going into schools and colleges These projects, along with the wider work around the voluntary community sector and Early Help, will inform service design and provision over the next few years. Transitions: Transitioning to adult services is challenging for complex cases and or diagnoses. The Mental Health Trust provider SLaM deliver both Children and Adolescent Mental Health Services (CAMHS) and Adult Mental Health services and are working with Lambeth partners to ensure transition protocols are fully embedded and this will continue to be a focus of development for joint commissioning arrangements. 13

15 Within the contract with our provider, a national CQUIN (Commissioning for Quality, and Innovation) called Transitions out of Children and Young People Mental Health Services is being implemented across the boroughs serviced by the two main mental health Trusts delivering services to children and young people. Commissioners are working together across the Sustainability and Transformation Plan (STP) area in South East London to achieve effective transitions from CAMHS to adult mental health services, primary care and social care with a key focus on children and young people with complex or challenging circumstances with for example a learning disability, autism and children looked after. In Lambeth we are also working with CAMHS Quality and Performance colleagues to hold workshops with key partners such as GPs and voluntary community sector, to inform the pathway development and CQUIN. Forensic CAMHS: NHSE have committed significant resource to the development of a Community Forensic CAMHS service (to include Secure Estate Outreach). This will operate as a Tier 3.5 service and aims to prevent admission to mental health inpatient units, including medium & secure estate, and psychiatric intensive care units (PICUs). The service will provide clinical consultation, clinical assessments and short term interventions to this highly vulnerable cohort. SEL commissioners continue to input into the development of the service, to ensure it meets the needs of our local communities and links effectively with existing care pathways. The service is expected to start in the Spring Perinatal: Following initial scoping and review on community support and provision for perinatal mental health in 2016, the next step is to organise a multi-agency and provider meeting to scope out the gaps and best practice in the wider system. There is a keen desire across our LEAP partners, and adult commissioning colleagues to progress this work over the next 6 months. Transformation and Redesign of the system A key aim and measure within Future in Mind and our Transformation Plans is to increase access to support for young people, whilst reducing the demand on specialist treatment. Therefore it is crucial that we improve our offer at an early stage of intervention, or at a tier 1 and 2 level. 14

16 In December 2017 Lambeth will be launching its Children and Young People s Plan (CYP Plan). This is the first multi-agency children s plan in Lambeth in a number of years and it signals a change and the agreement for partners to work together in a more coordinated approach to bring about better outcomes for children, young people and families. Our vision is to truly transform how the provision and support in the borough is accessible and available for young people, and for there to be choice and variety in interventions. A high number of young people in Lambeth do not have a diagnosable mental health disorder and therefore would not meet the threshold for our existing CAMHS services, but do require support and advice around emotional wellbeing and mental health. We must ensure we are providing the correct level of service at the right time for the right young people. We are encouraging the collaborative approach to emotional wellbeing and to supporting young people and creating understanding that CAMHS is a wider system, rather than just centred on medical services. It is key that we work in partnership with services to ensure an integrated offer for young people and families in Lambeth. We will be working closely with partners such as the Black Thrive Partnership, Children and Young People s Health Partnership (CYPHP). The CYP Plan sets out the key programmes and workstreams for : In Lambeth we are looking at wider than just mental health, and re-evaluating what Early Help actually means to our young people and families. It made sense to look at the system as a whole to ensure the emotional wellbeing and resilience of our young people is improved and supported. However this will not dilute the key themes and outcomes from our Mental Health and Emotional Wellbeing Strategy and the actions we need to take to implement this effectively. Lambeth partners and commissioning colleagues are working together to redesign the Early help Offer for children, young people and families. In Lambeth provision has often been silo d and via a number of different commissioning streams and funding. We need to ensure the offer is clear and accessible for children and young people, and coordinated to avoid gaps in service. 15

17 We plan to align the programmes above to ensure the Early Help offer in Lambeth is provided for 0-19 year olds, and up to 25 for young people with complex needs or disabilities. The offer will be aligned closely to the existing Children s Social care services and interventions available. We have a number of work streams and elements to the redesign, and need to ensure we are bringing the wider children s workforce along with us in the vision. We cannot guarantee funding for the CAMHS Transformation in the long term, therefore we must ensure our plans for change are sustainable. Therefore we are working to make changes that are embedded in the wider system, and develop new delivery models and whole family working, to create long term and effective improvements. 16

18 Expanding and Coordinating Provision: The Lambeth Public Health Joint Strategic Needs Assessment (JSNA) was refreshed in The key issues are detailed below, looking across health, youth at risk, early years etc. these are the key priority areas and risk factors that we need to be aware of when targeting our early help offer. We are also working with the equalities commission and their findings to ensure we are reaching the correct target groups. We also work closely with the Black Thrive Partnership in Lambeth, ensuring that young black males in particular are supported to address their wellbeing and mental health issues, and ensuring they are supported to reach their potential. Lambeth Young People s Campaign: By the end of the year, in line with the release of our CYP Plan, we will be launching our Lambeth Made Campaign. This campaign will help to promote a child friendly Lambeth to help our young people to thrive and achieve in the borough, through learning, community engagement, work and personal goals. The campaign will also help to encourage community trading how young people and families can support each other and build resilience and self-management by helping and sharing skills across the community and networks. Engagement and Workforce Development: In 2016 we held a number of workshops and events to facilitate networking, promote a partnership approach to emotional wellbeing delivery, and to encourage co-production and collaboration. This has been a key step towards building positive relationships with our community and VCS partners 17

19 and bringing them into the CAMHS provision. From these workshops emerged areas of need, gaps in provision, and ideas for improvement. We then ran the procurement exercise for organisations to bid in for non-recurrent funding for new and innovative projects addressing emotional wellbeing at this wider level. We hope to embed a number of the effective services producing good outcomes within our overall CAMHS and Early Help offer over the next 3 years. A piece of direct engagement work was also undertaken with young people and young adults across the borough in 2017, looking at what mental health means to them. We commissioned an experienced youth worker to interview individuals and groups a total of 40 young people - from a number of our identified vulnerable groups such as Looked After Children, BME communities, young offenders and the LGBTQ community. Findings from the interviews, group sessions and subsequent report will not only inform the transformation of CAMHS provision and how we target them, but also feed into our communications and awareness raising work. We have continued to work closely with the community and organisations and this has been a key aspect of co-producing our CYP Plan. With transformation funding we have been able to have the support of an experience Early Help and redesign professional who has led on this area of work and made huge strides into building relationships and best practice within our wider services. We held numerous sessions with children and young people, parents and families, and professionals in the borough to gain their input around what we can do better for young people in Lambeth, how we can work better together, what our key joint outcomes should be from the Plan and who we need to involve. This year, we held 3 large workshop sessions with over 150 voluntary and community sector members. The positive and inspiring sessions received great feedback and were the catalyst for a large networking forum and a Whatsapp group to share funding opportunities and best practice. The workshops focussed on three key ideas Building Capacity, Sustainability and Funding Bids and Opportunities. With increasing cuts to the public purse we will become more reliant on the voluntary and community sector and local orgnaistions to support our young peoples and families. We are not able to commission projects and services to meet every need, or every young people, so we must work together effectively to target our funding where is most effective, and work cleverly with partners to provide to fill any gaps. With additional funding in 17/18 from NHSE Lambeth has been able to recruit to 4 wellbeing practitioners as part of the Wellbeing Service in CAMHS. This service will be working as a bridge 18

20 between SLaM and community organisations, schools, and youth hubs and networks, to deliver brief intervention to young people who do not reach the Tier 3 threshold of CAMHS services. We will be working with Healthwatch Lambeth to engage with young people around our early help offer, both to pull together already undertaken research in the area of mental health and to work with our project group to engage young people s views and input. Schools: We have worked closely with local partnerships such as the Children and Young People Health Partnership (CYPHP) to build our training, prevention and early intervention offer. We have jointly commissioned prevention programmes within schools across Lambeth and Southwark, to train and up skill staff in Emotional Resilience and self-sufficiency tools for young people. This was in response to a mapping exercise undertaken in Lambeth last year identifying the needs of children and young people and the support and provision schools were commissioning or delivering in house. We jointly commissioned the training with schools and partners input and attendance during the procurement planning and tender interviews and panels. The training has had a positive start with over 20 schools already either signed up to receive training, completed the initial needs assessments with the children in the school or already having completed training with the provider. This is across both primary and secondary Lambeth schools and the provider is also planning to add to the offer Mental Health First Aid training. The CCG and Local Authority have jointly funded a Healthy Schools and Wellbeing Coordinator for 12 months. This post holder has a vast amount of experience working with schools in Lambeth and has a positive and influential relationship with them. This post will be able to support schools in their delivery of PSHE, training, and advice around commissioning in schools. This will give schools a direct link to a wealth of knowledge around services available to them in Lambeth, pathways and referral routes into targeted support and wider awareness programmes and training. As part of our redesign and transformation, we are redesigning our School Nursing service. This has given us the opportunity to review the current service, to look at where the focus is and what support is offered to schools. The new model will be more aligned to our locality model and approach and will focus again on health improvement advice and awareness, signposting and support with referrals and safeguarding. We are working collaboratively with the current provider GSTT to ensure we are reflecting need and commissioning a robust and effective service to achieve their best outcomes for our children and young people. 19

21 Youth at Risk: Lambeth Local Authority has launched a partnership strategy for Youth at Risk, along with a multiagency action plan. The cross overs between mental health and wellbeing and young people at risk are evident and our CYP Plan is aligned to the Risk strategy. We have begun to look at what training needs and opportunities are out there, and need to be offered, to our wider children s workforce around this agenda. The Youth at Risk Strategy for Lambeth focusses on gangs, county lines, Child Sexual Exploitation (CSE), preventing extremism, and youth violence. The CCG and health partners have been leading on a number of strands of the strategy and plan including prevention and intervention, coordinating our emotional wellbeing support offer with partners from YOS, Police, Community Safety, Social Care and voluntary community organisations. With funding from NHSE at the end of 2016/17 we were able to commission Trauma Training to over 20 local participants, following feedback at community events as to what would be most beneficial when working with young people on the front line. The 3 day training course was attended by voluntary and community sector professionals and received incredible feedback; we will be running the course again in the next few months and hope to find funding to commission another run. With liaison and Diversion funding we have been able to develop a post specifically working in police stations to identify and engage young people coming into the criminal justice system. This post is now being recruited to by our Mental Health Trust and will assess young people either at the police station or when appointments can be given following the contact with the CJS. The post will sit alongside the police, the Youth Offending Service, our Early Help team and health partners. Additional planning is currently taking place around positive activities within the YOS, to support those already engaged with the service with their health and emotional wellbeing, as well as diverting young people at an earlier stage. We will work with the YOS team and partners to ensure we are sighted on and involved with the data collected and outcomes measured for young people in criminal justice, where they relate to health and mental health. The CAMHS Commissioner is a member of the Youth Justice Board and the Youth at Risk Strategy Group in Lambeth and contributes to the outcome measures wherever possible. They also attend the YOS Health Group quarterly. We are also working with commissioning colleagues to align our transformation plans with the Parenting Strategy for Lambeth and the development of parenting wellbeing and resilience programmes delivered in the community and through children s centres. 20

22 In Lambeth the LEAP and CYPHP programmes are currently running to improve health and social outcomes for children and young people. We continue to embed the learning from these initiatives and the effective services into future provision, both across CAMHS and the wider social system. We are working pan-london and with our local paediatricians and Sexual Abuse \Referral Centre The Havens to ensure we have a robust pathway for young people experiencing rape, sexual abuse, physical abuse and sexual exploitation. We will ensure the paediatricians responding to new cases are skilled, supported and can signpost to the relevant longer term support services, and will ensure there is therapeutic support in place for brief intervention or counselling. Lambeth is working with Lewisham and Southwark on a pilot for an advocacy post supporting young people who have experience sexual abuse, to help to navigate the system including accessing support, and any criminal justice system involvement. It is difficult to predict exactly how services and provision will look by Our vision and aim is to ensure young people have access to support and interventions, and treatment at the earliest stage possible, and to achieve the best outcomes around their emotional wellbeing and mental health. It is Lambeth s ideal to see a reduction in the need for crisis care and intense treatment, and an increase in self-resilience, coping and management, and access to early and robust brief intervention. The success of this will be evidenced through measured outcomes, numbers around access, a higher spend on prevention, early intervention and less spend required on crisis care and inpatient treatment. Challenges in 2016 and 2017 The main challenges to date have been with recruitment of clinical staff within our clinical services. The delays in recruitment have affected delivery start dates and allocation of funding. In 2017 we managed to fully recruit to our transformation funded posts including 2 x Band 7 crisis care nurses and a Band 8a Prescribing Nurse for the ADHD service. For 2017/18 and 2019/20 CCGs and Local Authorities are having to submit savings proposals to aid their financial recovery. It is challenging to secure the continuing funding of CAMHS services and keep the transformation funding ring-fenced for future years. Staffing challenges within the Commissioning Team also led to a number of delays within our delivery, especially the delayed start of the CAMHS service reviews and workforce skills development scoping work. Funding for the CAMHS Transformation Manager post was lost 21

23 and the significant cuts and savings proposals across both the Local Authority and CCG prevent us from filling vacant posts. The issue of delayed data continues to be a significant challenge in Lambeth. Issues with staff change over and new systems being embedded within our Trust have led to severe delays in data and performance reports. This combined with capacity issues has led to less scrutiny of the data and numbers being possible on a regular basis. We have been informed now that data will be more robust with new systems in place at the Trust. NHSE informed CCG s of additional recurrent and non-recurrent funding between October and December 2016 from the 25m national allocation. Although the allocated funding is a positive, the last minute nature of the allocation and criteria has often made it difficult to embed this within our plans and allocate accordingly. This has led to work having to be undertaken very quickly and less robustly and requiring a great deal of partner input at short notice. With the key aim of the CAMHS transformation work being the increase of access to services for children and young people, whilst reducing the demand on specialist and inpatient treatment, we continue to be faced with the financial challenge of current increasing spend for the CCGs for Tier 4 specialist services. With an initial increase in specialist spend at a local level over the next few years, we are hoping to see a decrease in repeat admissions and repeat episodes in treatment. Especially in light of the New Models of Care work taking place locally and nationally around Tier 4 provision. It is challenging to be able to allocate funding at a prevention and early intervention level, with the understanding that this has greater impact on children and young people, whilst maintaining budgets for higher level and crisis care. The funding of Wellbeing Practitioners by Health Education England is positive however the CCG is expected to pick up the costs of the salaries of the practitioners from Year 2. The Transforming Care agenda continues to be a high priority for us locally and nationally, however Lambeth has real concerns around the financial and quality aspects of this. We are working to ensure young people are not entering inpatient treatment wherever possible, or leaving back into the community as soon as possible, however there needs to be the appropriate and affordable placements for these young people in the community. If we are supporting young people to come home and access community support, this can be achieved more easily with fast track services and multi-agency input and planning. However where we are placing young people (usually those at risk or with high level 22

24 challenging behaviour) in residential placements, these come at extremely high costs and the standard and quality does not always reflect this. The time needed to be able to follow up on these young people and actions for professionals is demanding and requires specific capacity. We continue to challenge the aspect of appropriate and fair financial allocation with NHSE colleagues, however do not have any timescales for when the financial savings made at national level may be allocated to support CCG s and Trusts at a local level to be able to properly and effectively make these improvements to the system and to young people. Governance Formal governance and oversight of the Transformation Plan and our work around mental health is in place via the CCG Governing Body, The Health and Wellbeing Board, The Children and Maternity Programme Board, and the YOS Management Board in Lambeth. These groups contain a wide range of our key partners at both a senior management and executive level, including the Children s Clinical Lead and Cabinet Member. The quarterly CAMHS Joint Commissioning Group ensures input and understanding at a more operational level and is one of the mechanisms in which our Cabinet Member contributes to this area of work. The Transformation Plan has been taken to additional forums and networks to engage with key partners for example the SENCO s forum, Local Care Network and Locality GP meetings. 23

25 It is the Children and Maternity Programme Boards role to scrutinise and challenge plans and findings around mental health and transformation, and to ensure plans are reflective of need in the borough. The board includes: Clinical Lead for Children and Young People, Cabinet Member for Children and Young People, CAMHS Lead Commissioner, Director of Commissioning and Improvement, Assistant Director of Integrated Commissioning, Children s lead for Primary Care, CCG Quality and Assurance Lead, Designated Nurse for Safeguarding Children, and the CCG Board Nurse for Children and Maternity. Our Eating Disorder Service is also a member of the Quality Assurance Network to ensure best practice and transparency. South East Sector Collaborative - Areas of progress and development We are committed to working with our neighbouring boroughs to ensure a coordinated approach and therefore a better service for children and young people. Lambeth has facilitated south east sector meetings with SLaM, NHS England, and Lewisham, Croydon and Southwark quarterly and commissioners continue to meet on a regular basis to tackle key areas of work together. Our commissioning intentions for CAMHS have been aligned with other South East boroughs who commission SLaM to ensure this approach continues. All of the borough s commissioning intentions include the high level intention of a 32% increase in access to CAMHS provision by Eating Disorder Service Lambeth will continue to work with the south east boroughs and SLaM to develop the eating disorder service. We are fortunate to have a service that is regarded highly as best practice and has effective outcomes with young people. Please see Appendix 2 for a detailed update of the Eating Disorder Service. Crisis Care Provision Please see page 12 and page 27. We will build on our crisis care provision across Lambeth and the south east to ensure we have a full service for children and young people. We are working to develop the crisis care telephone line within adult s service to include CAMHS or signpost to CAMHS, and looking at how to compliment the Paediatric Liaison Service in Lambeth and Southwark. Service provision in this area needs to be out of normal office hours and may need to be provided in different locations to the other CAMHS services. We will be working with clinical leads within SLaM to develop an appropriate and effective model. Transforming Care In Lambeth we have updated our core contract with SLaM to include the development of At Risk registers for learning disabilities. We are currently working with our adult commissioning colleagues to develop this locally and will look to Croydon and Southwark for learning. These areas are further 24

26 along the process and we will work together to ensure there is a systematic approach across boroughs. We are already seeing an increase in the number of children and young people within the LD/Autism cohort who suffer a mental health episode or are showing behavioural difficulties and may require inpatient support or treatment. We are undertaking Care Treatment Reviews and working closely with NHS England to ensure wherever possible more appropriate treatment is sought and provided in the community, and families are supported to support their child. Child Sexual Abuse and Exploitation (CSA/E) This area of development continues to be a priority within our transformation work and local focus. In Lambeth we have worked with the Local Authority and partners to develop and launch a CSE and CSA strategy and a Youth at Risk Strategy and Plan. In Year 1 we commissioned scoping and mapping work with the NSPCC to look at prevalence and gaps in provision. In 2017 we are working together with Southwark and Lewisham to look at evidence based provision, perhaps in the form of a virtual child hub and a third sector specialist service offering therapeutic support and counselling. Lambeth and Lewisham have been very involved with the South East and pan London work taking place around the Child House model. Unfortunately due to central funding issues, the identified area of Croydon will now not be piloting a Child House. We are currently working pan-london again to finalise a contract for advocacy support for young people who have experienced sexual abuse. We are also working with our lead and designated doctor and nurse to develop a child hub and pathway for young people experiencing sexual abuse, especially historical. We have worked with Lewisham and Southwark to fund an advocacy post, and Lambeth has allocated a small amount of funding for therapeutic support and are identifying the best pathway and provider for this provision, hopefully with neighbouring boroughs. In the South East, we also need to ensure we are meeting the emotional and mental health needs of unaccompanied asylum seeking children which is an emerging issue for our area. CYP Improving Access to Psychological Therapies (IAPT) CYP-IAPT is a national qualification focused on the emotional wellbeing and mental health sectors. It sets out approaches to supporting children and young people through measurable outcomes. There is a number of staff within Lambeth CAMHS services trained in IAPT. This has previously been funded by NHS England however from 2017/2018 each CCG will be required to contribute to the cost of the CYP-IAPT programme of training. The national context for the workforce development is: To build capacity and capability across the system so that by 2020, 70,000 more children and young people can be offered an evidenced based intervention. Train 3400 existing staff in an evidence based intervention Train 1700 NEW staff in evidence based interventions 25

27 Incorporate workforce development plans in refreshed Local Transformation Plans (October 2016) CCGs are expected to increasingly invest in the mental health workforce using year-on-year uplift in baseline allocations of Transformation Plan funding. In Lambeth we decided to take the Psychological Wellbeing Practitioner (PWP) approach to training staff in CYP-IAPT. We intended to build on our current IAPT offer and bid for 4 PWP practitioners which enables us to link effectively with the GP localities and communities within Lambeth. It is our ambition to place 1 of our PWP s in each of the localities based in the community. IAPT would then be linked to local GP practices, which would be aligned to local schools enabling interventions to be delivered within the primary care setting reducing stigma and promoting a more flexible approach to care as the PWP could be contracted to work evening and weekends. This model mirrors CYP PPI engagement feedback which stated services should be located close to school and home whilst being flexible and easily accessible. This fits with a model of care that is proactive, intervenes early and underpinned with clinical and evidence based interventions. It is key for us in Lambeth that our children s workforce is skilled and confident in working with young people and bringing about change and positive outcomes. Our aim is for the access to IAPT in community settings to help to decrease the level of need for Tier 3 intense intervention and therefore lower the cost attributed has now seen the introduction of an Emotional Wellbeing service within Lambeth CAMHS a new service working at a Tier 2/3 level bridging the gap between community and voluntary provision and services and CAMHS within the Trust. This has been a greatly welcomed addition from CAMHS and is due to the additional IAPT funding from NHSE this year for wellbeing practitioners. This team of Band 4 newly qualified PWP practitioners are working with lower level referrals/rejected referrals and delivering brief interventions. This works to prevent rejected referrals being passed back to referrers with no signposting or support and can provide the critical short intervention often needed by these young people to prevent the issues becoming worse, and requiring higher level and more intense intervention at a later date. A concern regarding this is that the NHSE funding for the wellbeing practitioners is for 2017/18 only. For 18/19 the funding is reduced by 50% and then stopped completely in 19/20. Lambeth are unlikely to be able to pick up these additional costs of 4 full time staff, not just in light of savings that have to be made, so are working with the Trust to find additional funding sources to ensure this pivotal service can continue. 26

28 Collaborative Commissioning There is continuing collaboration between Lambeth and NHS England (NHSE) Specialised Commissioning; we have been involved in the review of NHS England Specialised CAMHS (Tier 4) in London as part of Transforming Specialised Services in London (TSSL) programme and as such the case for change to look at how we can improve the model of care to provide the right care, at the right time, and in the right place. We have also started the discussions locally, within the Sustainability and Transformation Plan (STP) area and NHSE around transforming care for CYP in the Justice system. Lambeth commissioners have been directly involved in the Our Healthier South East London Partnership/STP work and have regular discussions with NHSE specialised commissioning in regard to South East sector and borough specific work. CAMHS services are provided across the spectrum of care settings with some of the most complex and/or high risk cases requiring admission to specialised (T4) inpatient care. There is the expectation that Local Transformation Plans lead to a significant reduction in demand for Specialised CAMHS services within the next 5 years. Community crisis care pathways that can provide robust and sustainable alternatives to inpatient care are under-developed particularly for children and young people with complex needs and behaviours related to learning disability (LD) and/or Autism and emerging personality disorders. The overall distribution of CAMHS inpatient capacity does not match Regional population needs and young people are being admitted far from their home, or to paediatric or adult beds; the NHS England National CAMHS Service Review aims to redress service deficits by redistributing/realigning beds to meet local needs, the clear expectation is that by 2020 there will be no inappropriate admissions to adult or paediatric beds and patients will be treated in local care pathways. New Models of Care As part of the SEL STP CAMHS Collaborative Commissioning Arrangements, commissioners have been working with SLaM when reviewing Tier 4 inpatient and outpatient across SE London. A wider piece of work is being undertaken across South London, as part of the New Models of Care (NMC) Programme, which aims to create consistency of care across all acute hospital settings across the area. NHS England have accepted the submission for the South London Mental Health and Community Partnership for CAMHS Wave 2. The partnership is made up of three provider organisations, South West London and St. George s Mental Health NHS Trust, Oxleas NHS Foundation Trust, and South London and Maudsley NHS Foundation Trust. Operation of the New Models of Care began on 1 st October 2017, with the partnership taking responsibility for a ~ 20m Tier 4 CAMHS commissioning budget and working closely with NHS England. As part of the New Models of Care process, the lead Trust, SLaM has signed a contract variation that devolves appropriate commissioning responsibility from NHS England for the CAMHS Tier 4 budget. The partnership has also agreed a management agreement with NHS England region team that sets out how we will work together to ensure effective management for the delegated budget and monitor quality and performance of Tier 4 services that support South London patients. The scope of the budget is all Tier 4 services commissioned by NHS England specialised commissioning for residents of the 12 south London CCGs, except for children s inpatient services, 27

29 deaf services, medium and low secure inpatients and specialised services for Transforming Care patients. Tier 4 services are characterised by a number of challenges with the key ones being; availability of alternatives to inpatient facilities due to capacity and accessibility of community based services, access to inpatient facilities within South London, rising need for Tier 4 inpatient facilities creating budgetary pressures, and that inpatient facilities can sometimes exacerbate situations leading to poor outcomes and contributes to rising costs. During 16/17, roughly 65% of adolescent inpatient bed days for South London CAMHS patients were provided outside South London, with the average distance from home being 73 miles. Our aim is to reduce the total number of adolescent and eating disorder bed days by 25% and half the average distance from home by 2019/20. Lambeth commissioner is supporting SLaM around this area of work. The aim is to have2 new Children s HDU beds on one site, taking the number of beds to 10, and 2 family accommodations. There will be 2 PICU beds opening in February 2018 for adolescents, with additional coming later in the year. Another site has 11 beds this site has shortened treatment length and increased use of the day support and treatment. This has already allowed for a higher number of young people to be seen, and also completing treatment as an inpatient. Acceptance for Wave 2 was based on a business case, which seeks to build upon the core CCG Tier 3 commissioned contracts by extending hours and increasing community service capacity in services that will impact upon reducing referrals and shortening inpatient stays, reducing need for inpatients. The community services the partnership has identified for investment are; Crisis Care, Dialectic Behaviour Therapy and Eating Disorders. We will also integrate NHS England Case Management and operational Bed Management to better manage all south London patients in inpatient facilities and seek opportunities to repatriate patients from outside South London. The key timescales for the work are to establish integrated case and bed management by December 2017 and that the investment to strengthen the offer from existing community services will be in place between January March A key priority is also to reiterate the criteria for admission to Tier 4 psychiatric inpatient provision, which are qualitatively different to those for a children s social care or educational residential placement. At this developmental stage, the partnership wishes to engage with and work with CCG and Local Authority commissioners to develop a consistent service approach and expand evidence-based community services for the benefit of patients and their families. To support this, we will be undertaking a baseline exercise across South London, including Tier 3 services as well as validating Tier 4 baseline data from NHS England. An update as of January 2018 is attached as Appendix 4. 28

30 Lambeth Areas for Continued Development: Transforming CAMHS medical provision In Year 2 we will see the completion of the CAMHS service reviews and will have gained a full understanding of the current pathways, treatment options, service structures, and routes of access. This will be the key tool for the transformation of Lambeth provision. We will be able to identify clearer routes of access for self-referral, and referral from GP s and schools. We aim to improve communication between the voluntary and community sector, statutory services and SLaM to ensure a smoother and more robust treatment journey for young people. We will continue to focus on the key areas of need as identified in our Lambeth needs assessment and the upcoming children s Joint Strategic Needs Assessment, such as transition periods, transforming care, learning disabilities, behavioural disorders, ADHD and autism pathways, BME groups, and asylum seeking children. The Lambeth mental health core contract has been amended to include the regular reporting of outcomes to the CCG and CAMHS commissioners. Outcomes from CGAS have not been routinely provided as part of performance monitoring and are a key measure of impact of treatment and service provision. School Collaboration A key area for us to develop is our direct work with schools and bringing them in as commissioning partners. Schools are a key partner in delivering emotional wellbeing to young people and the CYPHP emotional resilience programme will be an effective facilitator in this process. We want to help to change the school ethos around embedding emotional resilience and self-sufficiency into children and young people from a young age. Children need practical coping skills and mechanisms to deal with issues and to understand who to speak to when they need help. We are looking to develop the links between our medical CAMHS service and schools by having school champions and link workers in place. We will work with school staff and our CAMHS workers to ensure two way communication is improved and CAMHS services are providing advice and guidance to schools wherever a child does not meet the threshold for provision or therapies. We are also planning to work with the Lambeth Youth Council to co-produce their project ideas for raising awareness of mental health in schools and to break down the stigma of talking about it. We will be looking at the PSHE content and delivery and key messages that we can develop for school staff. We are also joint funding with the council an Emotional Wellbeing and Healthy Schools Coordinator to provide the key contact and liaison between ourselves as commissioners and schools. Workforce Development and Training Our Year 1 and 2 plans included undertaking scoping work to look at the current level of training and skills within the young people s workforce around emotional wellbeing and mental health across Lambeth. We will initially focus on the skillset of social workers, schools, GP s and health visitors and identify good practice and effective training with the aim of rolling out a programme of training and 29

31 awareness. We will work with partners to ensure the identified provision is effective, feasible and will bring the best outcomes for children and young people accessing these services and support. Unfortunately due to capacity we were unable to do a full scoping exercise, however a vast amount of work has been undertaken with the voluntary and community sector regarding skills, knowledge and pathways and access to training. A key risk to our CAMHS workforce is the lack of suitably trained staff available for vacancies within the Trusts and heavy demand across the SE Sector and wider. This has been evident across the SE Sector boroughs and shows through delayed recruitment and retention. SLaM as our mental health Trust are working with staff closely around retention, satisfaction and appropriate supportive management. Appendix 1 details the STP approach to workforce development. Embedding local schemes such as LEAP and CYPHP The projects within the Lambeth Early Action Partnership (LEAP) that have a synergy with the transformation of CAMHS will be further explored and built into our local offer. We will continue to work in partnerships with the Children and Young People Health Partnership (CYPHP) in a number of areas including the health and wellbeing of Looked After Children, those with long term conditions, and the delivery of the emotional resilience training programme in schools across Lambeth and Southwark. There are financial implications on embedding this work within the CCG budget and Lambeth will be looking over the next year at whether the outcomes and impact is strong enough and evidenced for these work areas to be mainstreamed within Lambeth. Digital Technology and Communication In Lambeth we are keen to improve our use of digital technology to promote services and access for children and young people, and to signpost those to help and support when needed. We are looking at evidence based approaches and will be working with young people and colleagues within youth engagement, communications, and the community sector to take this forward. We are developing a communications plan for children and young people and intend to work with young people as well as our Co-production Group to take this work forward. The communication plan includes national campaigns to link in with and promote locally, as well as working with Lambeth young people to develop local initiatives and approaches relating to local need and communities. We will promote nationally recognised digital tools locally such as NHS Go and the Health A-Z, but will also learn from our neighbouring boroughs who have invested in their own digital projects in this area of work. Detail of Previous Spend In previous years, the focus of CAMHS spend has been on Tier 3 and 4 provision for treatment within our CAMHS services. 30

32 2015/16: Total budget for Tiers 1-3 CAMHS Total budget for Tier 4 OP Total budget for Tier 4 IP TOTAL CAMHS Budget 3.667m 574k (200k overspent against allocated budget) 1m (approx) 5.241m Of the 3.667m spent on Tiers 1-3 this consisted mainly of the block contract with our mental health trust ( 2.5m). It also included money for additional wellbeing services such as substance misuse, autism and early help led by the local authority. The levels of activity were summarized in the Strategy as below: The Young Lambeth Emotional Wellbeing and Mental Health Strategy sets out our current spend per child in Lambeth, as of 2015/16. Although there is limited data, the national average cost per contact with tier 1-3 (Community) CAMHS is a relatively crude benchmark and shows an average median cost of 240 per contact across 65 participating organisations. To calculate the average cost per contact in Lambeth, we looked at the 2267 young people seen by Lambeth CAMHS Tiers 1-3 in 2015/16 and used the national average of 6 sessions/contacts per patient giving us per contact, which is just above the national average. However, when we looked at spend per head compared with the neighbouring boroughs of Southwark, Lewisham and Croydon, Lambeth was investing approx. 25% less per head than Lewisham and Southwark, with Lambeth spending 48 per head compared with neighbouring boroughs both spending 61 per head. CAMHS Transformation Funding in Lambeth Our aim in Lambeth is to transform our provision for children and young people requiring support around their mental health and emotional wellbeing. We know based on national assumptions that 10% of the population have a diagnosable mental health need or issue, of which approximately 20% are currently accessing support or treatment. Our aim nationally is to increase this number to 35%. 31