Tri Borough Children’s Trust Board - December 2015
Children & Young People’s Mental Health
Transformation Programme Update
This gives an overview of the current delivery of Children’s Mental Health provision in the three
boroughs Hammersmith and Fulham, Kensington and Chelsea and Westminster aligned with the three
Clinical Commissioning Groups; Central London, Hammersmith and Fulham and West London.
This paper outlines the resources/funding available; the staffing and the services provided.
Current Funding
The table below outlines the current funding provided by Health/CCG Local Authority area:
CCG
LA
Hammersmith and £2,010,863
£512,000
Fulham
Kensington
and £2,762,5621
£379,328
Chelsea
Westminster
£1,631,347
£638,420
(Central
London
CCG)
1 Includes 22% for QPP registered young people
Total
£2,522,863
£3,141,890
£2,269,767
Transformation Funding
The table below outlines the new investment coming from the NHS England Transformation Funding
Clinical Commissioning
Group
2015/16
Eating Disorders
2015/16
Transformation
Central London
Hammersmith and Fulham
West London
£91,557
£100,744
£116,621
£229,176
£252,173
£291,914
2016/17
and
recurring funding to
2019/20
£320,732
£352,918
£408,534
These funds are targeted to deliver ‘transformation’ changes, including a dedicated resource for the
development and establishment of a Community Eating Disorder Service. CCG’s are working
collaboratively with the other 5 North West London CCG’s to develop both Transformation Plans and
combined Eating Disorder Services (initially based on our two current providers).
In addition to above there is also the DfE/DoH Schools Link Pilot in Hammersmith and Fulham. This is
funded jointly by NHS England and Hammersmith and Fulham CCG, each contributing a one off
£50,000 to test how to improve working relationships between mental health providers and 10
Hammersmith schools.
Opportunities and Constraints
There is the possibility but absolutely no guarantee of additional Transformation funds in 2016-17.
Local authority CAMHS funding is significantly challenged by the Government austerity targets.
Tri Borough Children’s Trust Board - December 2015
Children & Young People’s Mental Health
Transformation Programme Update
Current Service Model
Currently services are provided through a tiered model, with differentiated services broadly matched
to the needs of young people. This approach has been criticised as confusing and divisive. As a result,
a key transformation objective is to develop a new service design for local mental health services for
young people which improves accessibility, waiting times and capacity.
CAMHS Service
CAMHS provide a specialist service for children and young people up to the age of 18 years
where there is likelihood that the young person has a severe mental health disorder
and/or where symptoms, or distress, and degree of social and/or functional impairment are
severe.
CAMHS services assess and treat children and young people who are experiencing
serious risks to their emotional and psychological wellbeing and development. The current
threshold for referral to specialist CAMHS is that the suspected mental health difficulties are
urgent, persistent, complex or severe.
CAMHS also provides community based services, known as Tier 2, which offer initial assessments, and
treatment, often on a school based model, to young people with less severe symptoms, behaviours or
conditions. Frequently delivered by Primary Mental Health staff, these practitioners work alongside
Early Help or Team Around the Child initiatives.
CAMHS teams are multidisciplinary and consist of consultant child and adolescent
psychiatrists, clinical psychologists, child psychotherapists, systemic family therapists,
clinical nurse specialists and junior doctors from the CAMH training scheme.
The teams also provide a range of therapeutic and psycho-pharmacological interventions,
consultation and liaison with other services including the paediatric liaison, and out of hours services.
Referrals can be made to CAMHS by any professional working with a child, young person or
their family. CAMHS have traditionally been described in 4 'tiers', which have primarily been defined
by how the service is provided. Tier 4 includes highly specialised inpatient CAMH units,
commissioned by NHS England.
Tri Borough Children’s Trust Board - December 2015
Children & Young People’s Mental Health
Transformation Programme Update
Other Support for Mental Health
In NWL we have a number of other providers and services that support our CAMHS teams,
providing community and schools based support for mental health needs.
In addition to the CAMHS described above, other local mental health support includes:
-
Early Intervention in Psychosis services: offering quick identification of the first onset of
a psychotic disorder and appropriate treatment.
Specialist learning disability services
Looked After Children (LAC) services
Youth Offender Team (YOT) services
Public Health services are also commissioned by local authorities focusing on health promotion.
Current Service Staffing Model
Across the three boroughs the core CAMHS service is provided by two NHS providers;
Central and North West London NHS Trust and West London Mental Health Trust.
CNWL provide the services to Kensington and Chelsea and Westminster and West
London provide to Hammersmith and Fulham.
Position
Medical Staff
Central
London CCG
CCG
Westminster LA
7.9
West
London CCG
Kensington and Chelsea
LA and 22% of QPP
population
3.3
1
6.4
1
1.6
3.8
2.6
2.6
3.9
9
4.37
Hammersmith and Fulham
CCG
LA
4
(Consultant
Psychiatrists, SHOs,
Staff Grade)
CNS
Nursing
Play Therapist
Psychotherapists
Family Therapy
Psychologists
Systemic Therapist
CAMHS Practitioner
Support Worker
Social Worker
Art Therapist
AHP
1
2.3
3.17
6.0
5.8
2.6
0.05
(Dietitian, SALT)
OTs
Participation worker
Admin and Managerial
TOTAL
Rate (per 10,000) for
ALL WTE staff
Rate (per 10,000) for
CLINICAL WTE staff
0.5
6.4
32.5
11.83
0.5
5
29.97
7.46
6.6
28.92
8.58
9.32
6.09
6.62
Tri Borough Children’s Trust Board - December 2015
Children & Young People’s Mental Health
Transformation Programme Update
Collaborative & Sovereign - Transformation Programmes
Across North West London LA’s and CCG’s has identified eight priority areas to begin transforming
child and young people’s mental health;
Priority
Needs Assessment
Aims
Needs Assessment to update understanding
of the populations we serve
Supporting Co-production
Supporting service users, carers and
family members to engage with and
co-produce support services.
3
Workforce Development and
Training
Developing training and support for
parents and all professionals in contact
with children and young people to
identify and respond to mental health
needs.
4
Specialist Community Eating
Disorder Service
The development of a Specialist Community
ED service for children and young people to
access in each area
5
Redesigning Pathways-A Tier Free
System
Developing a new model of delivery,
clarifying services, thresholds, transitions to
improve quality, outcomes and use of
resources
6
Enhanced Support for Learning
Disabilities and
Neurodevelopmental Disorders
Develop an enhanced service within each
of the 8 CCGs, streamlining the current
service offering and filling the gaps.
Development of a new 24/7 crisis and urgent
care pathway
1
2
7
8
Crisis and Urgent Care Pathways
Embedding Future in Mind
Continuing and building on existing good
work – to address specific local needs
New ‘Transformation Funding’ for 2015-16 has been allocated across these 8 priority areas.
There is scope for 2016 and beyond the shape future investments in line with emerging local
priorities and results of the needs analysis.