Letter - Minister's for HSS and CE to HSS Scrutiny Panel re Mental Health Services - 7 March 2022

19-21 Broad Street | St Helier Jersey | JE2 3RR

Deputy Mary Le Hegarat

Chair

Health and Social Security Scrutiny Panel

By email only 7 March 2022

Dear Chair,

Follow up review of Mental Health Services

Thank you for your letter of 1st March posing several follow up questions from our public hearing on 25th February. Please see the below responses and do not hesitate to come back to us if you require any further information.

Funding / Government Plan

1. The Panel notes that the Government Plan allocated £1.75m of funding to the CAMHS Service Redesign' in 2022. Please can you advise what proportion of this funding has been spent so far?

As of 28th February 2022, a total of £150k has been spent against the CAMHS Service Redesign'. This will steadily increase over the next few months as the new roles are appointed to. The funding for 2022 is a part-year effect, allowing for time required to recruit to 33 new posts. Recruitment has begun, with interviews being held in early March. Agency staff have been employed on temporary contracts to enable the redesigned services to become operational. These staff will be stepped down once the permanent roles are appointed to.

1. Please can you set out the priorities under the CAMHS Service Redesign 2022' project and which of these have so far received funding?

The following priorities have all received funding:

• Kooth online counselling and support 11-25 years (commissioned service)

• Development of the Eating Disorder Pathway and key positions such as dietician and eating disorder specialist nurse being recruited to.

• Set up of the Duty and Assessment Team with a single front door via the Children and Families Hub

• Recruitment of Early Intervention Service Manager to start to build and develop the service

• Design and development of additional posts in specialist CAMHS

• Quality and Assurance Function created with key posts recruited to

• Wellbeing drop-in service on a Saturday 10am-6pm- partnership Youth Service and CAMHS

• Additional third-party contracts e.g., autism assessments. Mind Jersey

• Governance and commissioning arrangements agreed

2. Will any of the CAMHS Service Redesign funding include provision for a dedicated psychiatric resource for Looked After Children?

There will be an expansion of child psychiatry positions in the redesigned service which will increase support for looked after children. In addition, there will be a specific consultant psychologist employed for looked after children and their carers.

i. If so, when will this be introduced?

Recruitment is underway and initial interviews have occurred for the psychologist position. We are in discussions regarding recruiting child psychiatrist posts including utilising specialist recruitment companies and a specific campaign for these positions as they are notoriously difficult to recruit to.

2. The Government Plan has provided funding for the Children's Heath Recovery Plan' which reaches across health, social care, education and the voluntary sector to progress a number of initiatives. Please can you provide us with some details about CAMHS's involvement in those projects?

The initial model development and strategy work which started at the end of 2019 identified all areas of redesign that were required across both wellbeing and mental health to improve outcomes for children, young people, and families. The initial CAMHS business case identified the early intervention work, duty and assessment, specialist CAMHS services and the interfaces with schools and the wider community. It was recognised in this initial business case that further work was required specifically with HCS around specific areas of need including specialist crisis and inpatient support, transition arrangements, perinatal pathway, allied health professional interface, and services to support those with a neurodevelopmental disorder, including the medical input required from paediatricians and child psychiatrists. This led to the second business case developed a year later – the Childrens Health Recovery Plan. This was developed with significant input from CAMHS and other wider stakeholders. The detailed specification for these activities is currently in development with services expected to be implemented over the lifetime of the business case.

1. If these are significant projects for CAMHS, please can you clarify the route of the funding and where responsibility lies – as in the Government Plan this project is listed under the expenditure for Health and Community Services?

The CAMHS business case (Government Plan- 2021-2024 GP21-CSP1-1-06) was led by CYPES and the responsibility sits with this department, it was agreed funding would commence in 2022. The available funds are £1.75m in 2022, £2m in 2023, and £2.25m in 2024 recurring. Due to the use of co-production and the way the model was developed, this business case looks at the entire system so includes support delivered by several CYPES (Children's Young People and Education Services) departments such as those delivered by the newly developed Health and Wellbeing service and wider partners such as schools, early help, the inclusion service etc. The investment summarises:

• Early intervention services for children of all ages

• Duty and Assessment

• Improving and refocusing the current service as a specialist service

• Improving quality and performance management

It also includes those services developed in the community and contracted services such as Kooth, autism assessments and training delivery, e.g., "Who's in Charge." (Support for Child to parent Violence)

The Children's Heath Recovery Plan is listed under expenditure for Health and Community Services in the 2022-2025 Government Plan, the detail of which is described in question 2 above. The responsibility for the delivery of the majority of these services sits with HCS, though there is some current discussion, particularly around the neurodevelopmental assessment and support offer and the home treatment team relating to the interface with CYPES services.  

2. What are the Governance arrangements for any joint working?

Governance is being managed by the joint HCS and CYPES Governance and Oversight Group (GOG) with reporting through to executives in CYPES and HCS. More recently work has taken place to develop the governance arrangements further. A meeting with revamped terms of reference is occurring in the coming weeks.

Ministerial Responsibility

3. The political oversight responsibility for CAMHS sits with the Assistant Minister for Children and Education. Deputy Pointon - how often do you get the opportunity to attend the Council of Ministers as Assistant Minister?

Assistant Ministers do not routinely attend Council of Ministers meetings. I have attended on a few occasions when items related to my delegated responsibility are discussed.

a. What has been your priority and focus for CAMHS since this responsibility has transferred to you?

My priority and focus have been to give political oversight and leadership of improvements across the whole service. As a member of the Panel when the original review was completed, I came into this Assistant Minister role well aware of the issues identified and the need for improvement.

I have overseen:

• A significant reduction in waiting times

• The launch of the Children and Young People Emotional Wellbeing and Mental Health Strategy

• Successful increase in funding and increased staffing

• Successful negotiation to ensure that CAMHS is not part of the new Government HQ and will instead be housed in a building and location that is conducive to the needs of the children, young people and dedicated staff.

4. What has been the Minister and Assistant Minister's involvement in the Children and Young People's Emotional Wellbeing and Mental Health strategy?

I was regularly briefed throughout the development, consultation and subsequent launch of the strategy and consider it an excellent example of co-production with meaningful engagement with a wide range of stakeholders.

How do you [each] see it as part of a whole system approach?

We both agree that the strategy provides a holistic whole system approach to improve the emotional wellbeing and mental health for all children and young people. It is clear from the 16 actions listed in the strategy that it encompasses broad ranging change that will have a positive impact from birth to adulthood, for government services and partner agencies, those who need support and those who deliver it:

1. Training, so everyone understands good mental health and wellbeing and how to help children and young people stay well and resilient.
2. Have support for people becoming parents and help them feel well and have strong bonds with their babies.
3. Develop mental health ambassadors across the Island.
4. Help professionals be aware of risks to people's mental health like adverse childhood experiences (ACEs) so they can think about wider support to help children, young people, and their families.
5. A wellbeing helpline.
6. Information, advice and support at the Children and Families Hub.
7. A young person's drop in café where they can learn about wellbeing and mental health, what they can do to stay well and where to go to get support.
8. Drop-in sessions on different topics that promote wellbeing such as physical activity, eating and sleeping well.
9. More support and therapies available including, support for the whole family, creative therapies, and online support.
10. More support for issues like eating disorders, long-term health conditions and disabilities, or for those that are care experienced.
11. More locations and increase the hours that some services are open, like running Saturday afternoon clinics and out of hours services.
12. Improved services for young people who struggle as they become adults or who are caring for a parent.
13. We will promote children, young people and families being actively involved in their care
14. We will collect information and evidence, so we know how and where services have helped.
15. We will set up a Strategic Advisory Panel (SAP) that includes young people, parents, professionals, and people working in the community.
16. We will agree a set of standards and reporting for services that are easy to understand and available for anyone to read.

Yours sincerely,

Deputy Scott Wickenden   Deputy Trevor Pointon

Minister for Children and Education   Assistant Minister for Children and Education