Agenda item

5.1  Members gave consideration to a joint briefing from ELFT and NELFT on What we are doing to improve access, outcomes, experience and equity for children, young people and young adults (0-25s)

5.2  The Chair welcomed:

Paul Calaminus (PC), Chief Executive, ELFT

Jacqui van Rossom (JV), Chief Executive, NELFT

who took Members through the presentation. PC explained that Services were planned and delivered in partnership with others (education, social care, VCS) and he highlighted the work on developing core therapy services, eating disorders service and the various crisis services.

5.3  The Chair stated that a public question has been received.  Malcolm Alexander (Board Member, Healthwatch Hackney) asked the following:

Will NHS NEL give a commitment in their strategy to take action to prevent patients in a mental health crisis from ever having to wait more than 4 hours from decision to admit to admission to a mental health bed.

Will they also give a commitment to the prevention of young people and children being sent outside their home borough for mental health crisis care?

5.4  In response to MA’s question on out-of-borough placements, PC stated that there were 4 units for young people from NEL and NCL and they were being treated in local CAMHS units. These were not borough specific.  There were 2 units in NEL which allowed young people to be treated closer to their families. He detailed development plans and described the huge impact the pandemic had on children and young people’s mental health causing a spike in demand. NEL was spending more proportionately than is nationally allocated for CYP but the demand graph was stark and there was further to go to meet the need in the population. He described the co-production approach to supporting the 18-25 age group and the benefits of the Advantage Mentoring Programme in NEL.

5.5  In response to MAs question on mental health delays in A&E, PC stated that they wished to return to a position where they always have an emergency bed available for everyone who was deemed to require it. There was an issue about the increased acuity of the presentations partly as a result of the pandemic and this had contributed to the recent spike but they were working hard to achieve the targets and timescales they had set for themselves here.

5.6  The Chair asked what was the waiting time for assessments.  PC replied that for routine cases it was 21-22 days.

5.7  Cllr Brewer expressed concern about these waiting times and asked about the workforce challenge of securing more psychiatrists. PC explained that for the long term they were maximising their number of training places and optimising career pathways and in the shorter term developing new types of extended nursing and therapy roles who would be able to take on some of the workload. They were also developing Peer Support roles and working more with people with lived experience of therapies which was having great results for in patient services.  Keeping and growing CAMHS staff was a challenge and they were working across the CAMHS collaboratives and workstreams to create more jobs with career development potential. There was also work being done on developing short term roles in Digital areas of support.

5.8  The Chair asked about delays in assessment times at designated ‘Places of Safety’ such as the Homerton and he asked if young people have a separate care pathway. PC confirmed that they did.  He added that the key challenges were long duration of stays and people having to be sent outside London and the focus was on getting those back. Those who require beds are currently getting them but some young people, at transition stage for example, can be affected by this current blockages.

5.9  The Chair asked whether ELFT had the opportunity to flex their existing estate.  PC explained that one of the advantages of working within a Collaborative was that they can flex demand across 4 units across NEL and NCL. This creates more capacity and a more advanced Home Treatment Offer to be made available.  JV advised that the cohort being discussed here was a very complex one with many comorbidities e.g. eating disorders etc, and so the solutions needed will be more challenging to provide.  She added that beds for these more complex cases do not sit within the local Collaborative’s allocation. It wasn’t that we don’t have the capacity within our general adolescent units but it’s rather that presentations are more complex and, if for example they are Looked After Children, they will have to be placed within NEL.

5.10  Cllr Adams asked about IAPT and early intervention in psychosis. PC detailed the services and that there is specific age-tailored support for 18-25 year olds with anxiety, depression and psychosis. They go to the Community Mental Health Team services which are generic.  In Newham, Tower Hamlets and Waltham Forest they have to work more with CMH Teams to develop age specific services. He added that those services see few in their 20s. He concluded that an ongoing task is to develop general CMH Teams connected to GPs and those services need to be better able to speak to the younger cohorts.

5.11  Cllr Deakin asked how many young people were currently being supported via the Alternative At Home service and about plans on enhancing Mental Health support in schools and the risks and challenges involved. PC undertook to provide the data.  He added that the teams are quite intensive, typically 15-20 patients and they deliberately work with those on the cusp of hospital services.  The work to expand into schools is a national programme and they do not cover all schools so there has to be a selection.

ACTION:

PC to provide data on the numbers supported via the Alternative At Home service.

5.12  Cllr Sweden asked how confident officers were that A&E backup across NEL was adequate and whether S136 scenarios also applied to young people. PC replied that they did. On work with police, he highlighted a particular project with the City of London where there is a dedicated Street Triage Team with mental health professionals and the Police on the streets at night.  This has really helped and they are talking to the Met Police on possibly expanding it. They do a lot of work with the Met on S136 cases and Police have access to Crisis Line Mental Health services so they can be called in quickly and a plan can be put in place. As regards support at A&E, there are a range of home services and intensive support to help people out of A&E. He reminded Members that A&E is not the main route for mental health crisis presentations or admissions to hospital; the majority come via crisis services, crisis lines or are known to services already.  Referring to the chart in the report he stated that it was clear there was a gap between prevalence and demand and funding the capacity needed to bridge that gap would always be a challenge.

5.13  The Chair thanked the officers for the quality of their presentation and their thoughtful work on these complex issues.  On the A&E beds issue he stated that they would endeavour to keep an eye on this at Hackney’s HOSC and get an update for a future meeting if necessary and will revisit to see if the injection of capacity has been having a positive impact..

RESOLVED:

That the report and discussion be noted.