Being a catalyst for change
As we reported in last year’s annual report, in December 2014 Healthwatch Hillingdon and Hillingdon Mind published ‘Listen to Me’, an interim report that highlighted the struggles of children and young people with mental health problems in Hillingdon and the effects these have on them and their families.
We outlined how uncertain funding, a lack of early intervention and fragmented services were compounding issues and called for a joint approach, from all stakeholders, to improve services.
In Hillingdon, ‘Listen to Me’ inspired a renewed commitment to improve services for children experiencing mental health problems.
Hillingdon Clinical Commissioning Group (CCG) and the London Borough of Hillingdon formed a new Children & Young People’s Mental Health and Wellbeing group to oversee improvements to services and started to develop a Joint Social Emotional Wellbeing and Mental Health Strategy 2015-2018. This incorporated a number of the recommendations made in our ‘Listen to Me!’ report.
Nationally, Healthwatch England used the report to directly influence the Government’s Children and Young People’s Mental Health Taskforce, which was undertaking a major review of children’s mental health.
The interim report was published due to the scale of the problem we had found. It was very important that we built on this report and to do so we set out a 5 month intensive programme of engagement with young people, their families and care professionals.
Our ambition was to gain a better understanding of services. We wanted to produce a comprehensive report, which not only gave a rich evidence base of the lived experience of children, young people, parents and carers, but ensured that these experiences influenced and shaped future plans, by offering practical solutions on how services could be improved.
As our engagement continued, we took every opportunity to bring focus upon children’s mental health.
At the Children & Young People’s Mental Health Group we looked for the membership of the group to be expanded, to include schools and the voluntary sector. We maintained a sustained challenge at the Hillingdon CCG Governing Body and the Health and Wellbeing Board. This led to the Hillingdon CCG commissioning Public Health to complete a Children’s Mental Health Needs Assessment, and providing funding for:
- Reducing the waiting list for the Tier 3 CAMHS (Children’s and Young Peoples Mental Health Service)
- Learning Disability CAMHS
- Out-of-Hours CAMHS intervention at Hillingdon’s A&E department
- Perinatal Mental Health Services.
Already prepared to act
The Children and Young People’s Mental Health Taskforce completed their review and in March 2015 published a report called
The Taskforce echoed much of what we had said in our interim report and reinforced the recommendations we had made.
It called for long-term whole system solutions, collective working and the development of clearly defined transformation plans to address the shortfalls in children’s mental health provision.
Due to the Healthwatch Hillingdon work on children and young people’s mental wellbeing, these were steps we had already taken in Hillingdon. Partners were in a position of strength that could now be built upon.
Comprehensive Report In July 2015, pre-empted by a publicity campaign in the local media and the release of a short promotional animation, we published our eagerly awaited second report, ‘Seen & Heard – Why not now?’ The report featured some uncomfortable hard hitting stories, which gave real insight into Hillingdon’s mental health and wellbeing services from the children, young people and their families who have faced the struggles of emotional and mental health. As planned, in addition to containing a rich evidence base, we outlined 10 key principles that formed a ‘blueprint’ for commissioners to provide better support and services in Hillingdon. Transformation Plans Healthwatch Hillingdon had a pivotal role in the formulation of Hillingdon’s Children and Young People’s Mental Health and Wellbeing Transformation Plan. The insight provided by our ‘Seen & Heard – Why not now?’ report, has been an important reference into the experiences of our children, young people and their families and framed much of the contents of the plan. The information in our reports has been referenced in the Children’s Mental Health Needs Assessment completed by Hillingdon’s Public Health team. It was also pleasing to note that Hillingdon was the only borough in North West London t0 complete a needs assessment to inform their transformation plan and this was directly as a result of Healthwatch Hillingdon’s request in our Listen to Me! report for this to be commissioned. Our work was also promoted as an area of best practice by Like Minded, the programme which is looking to transform mental health and wellbeing services across North West London. We continued to collaborate with partners to develop Hillingdon’s transformation plan and in recognition of all our work were invited by the Health and Wellbeing Board to countersign the plan, with the CCG and the Council, before it was submitted to NHS England for approval, as part of a joint North West London plan.
We did not want to see the momentum for change in Hillingdon slow whilst the plan was being assured by NHS England. Being conscious that every region across the country would be looking to recruit specialist CAMHS staff once transformation funding was announced, we formally asked the CCG Governing Body to consider funding the recruitment of CAMHS staff in advance of the announcement. We also raised concerns with them about the slow progress in the development of the pan North West London Eating Disorder Service and asked for firm timelines to be set in delivering this new service.
NHS England announced in November 2015 that North West London had been successful in its bid and Hillingdon was awarded £524,6233, recurrent for 5 years, to deliver the transformation plan.
Delivering The Plan
We continued to work with and challenged partners on the delivery of the transformation plan, to ensure services were being appropriately planned to meet the needs of Hillingdon’s residents and that children and their families/carers are involved in the process.
As before, we took every opportunity to raise the profile of children’s mental health. In December 2015 we presented on our CAMHS work and the ‘Seen & Heard – Why not now?’ report to The Children and Young People’s Mental Health Coalition (CYPMHC) at the Mental Health Foundation. They were very complimentary about our work and specifically admired the Healthwatch role in signing off the Hillingdon Transformation Plan at the Health and Wellbeing Board. Through this presentation we facilitated the CYPMHC attending the Hillingdon Children and Young People’s Mental Health and Wellbeing Board, to inform on the work being carried out in schools by Place2Be. We also presented on our CAMHS work at the National Service Change Conference in March 2016. Facilitated by Healthwatch England and the Leadership Centre, the conference focussed on how the public sector can work together during service change programmes.
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Progress on plan? We acknowledge that progress has been made in the implementation of the plan. Our expectation is high and we have been increasingly frustrated by the speed at which progress is being achieved. New services have commenced for community eating disorder, self harm, crisis and intensive support and challenging behaviour, which will take time to imbed.
We have seen a reduction in waiting times for accessing CAMHS Tier 3, but until we see the implementation of initiatives to offer early help and prevention, system pressures will remain and those young people who do not meet Tier 3 thresholds, will struggle to find support.
Children and Young People have been engaged by partners in redesign and training will commence following the completion of a training needs assessment.
As we had anticipated the recruitment of staff has been a real challenge and with Trusts across the country advertising for professionals, this has also had an adverse effect of staff retention.
Engagement with schools has also proved to be problematic. Especially with the independence of academies.
We understand the challenges involved and appreciate the efforts being taken by partners but it is disappointing that almost all of the work-streams within the plan were RAG rated amber at the end of March 2016.
As work continues into the new financial year, it is recognised by all partners that there are 6 areas which require immediate focus and further development:
- No counselling service for under 13’s
- Recruitment & retention of NHS staff
- School based counselling services
- Raise participation of CYP in redesign
- Increase Tier 2 capacity
- Transition to adult services
Healthwatch Hillingdon’s task will be to continue to monitor, and challenge, the development in these areas and ensure the new services deliver the desired outcomes.
We have come a long way since we sat down with 5 parents nearly 3 years ago and they told us about how Hillingdon’s services were letting their children down.
We know we have more work to do and Healthwatch Hillingdon will certainly not rest until we know the new investment in Hillingdon has improved services, and the mental wellbeing of children in our borough.
Would you like to be involved in this work?