Agenda item

(To receive a report from Kevin Johnson, Programme Manager – Children’s Integrated Commissioning, which enables the Committee to consider and comment on a report seeking to establish a new single Section 75 commissioning arrangement for children and young people’s mental health services from September 2022 , which is being presented to the Executive for a decision on 05 April 2022)

(NOTE: Councillor C Mathews wished it to be noted that he was a Governor at Lincolnshire Partnership Foundation Trust)

Consideration was given to a report by the Programme Manager – Children’s Integrated Commissioning on the establishment of a new single Section 75 commissioning arrangement for children and young people’s mental health services from September 2022, which was being presented to the Executive for a decision on 05 April 2022. In addition to the report, the following was reported:

·       The recommendations had been supported by the Children’s Executive Departmental Leadership Team, Lincolnshire School’s Forum, the Council’s Commissioning and Commercial Board, the Lincolnshire Partnership Foundation Trust, the Clinical Commissioning Group, and the Joint Commissioning Overview Group.

·       The recommendations sought to transform children and young people (CYP) mental health services, establish a new single Section 75 commissioning arrangement for children and young people’s mental health services from September 2022, and approve the Council’s investments in CYP mental health services.

·       The same amount of funding of £724,589 was committed to Children and Adolescent Mental Health Services to deliver the Council’s statutory duties.

·       Significant pressures upon the High Needs Block of the Designated Schools Grant meant that the Council needed to taper funds and increase investments in this area in order to maintain its statutory duties.

·       Other options for the transformation had been considered, but the recommended model demonstrated that it minimised waste from duplicated services and offered a more flexible approach that suited the particular circumstances of a rural county.

·       Work was underway to evaluate the long-term impacts of the pandemic on service use.

In response to questions raised by the Committee, the following points were confirmed:

• The current generation of children and young people were considered to have worse mental health outcomes compared to previous generations due to a variety of factors such as social media, pressures of modern life, and family lifestyles, along with the impact of the Covid-19 pandemic. Prior to the pandemic, the number of referrals to specialist mental health services for Lincolnshire children and young people were reducing but referrals were now on the increase. There would be a need to reassess how mental health services for children and young people were structured to respond more effectively to those changing needs and ensure if referrals continue to be higher that increased demand could be met.
• The Lincolnshire Clinical Commissioning Group (CCG) supported recommendations in principle at the Joint Commissioning Overview Group on 24 February 2022 to offset the phased diversion of £1m funding from Healthy Minds Lincolnshire back into the High Needs Block of the Designated Schools Grant with its own investment, so that there would be no overall reduction in funding. The CCG also supported recommendations for additional investment into Child and Adolescent Mental Health Services (CAMHS).
• In relation to staffing pressures from the increase in referrals, Lincolnshire Partnership NHS Foundation Trust (LPFT), which was rated outstanding for its mental health services for children and young people, was developing plans for its own in-house workforce/training programme to bring previously untapped resources into the specialist mental health services workforce, such as new psychology graduates. Children’s Services was working closely with LPFT and the University of Lincoln to maximise these opportunities across the wider workforce. In addition, a national programme had been introduced in relation to psychological therapy to provide additional training for staff in those emotional wellbeing and mental health frontline services.
• Lincolnshire currently had four Mental Health Support Teams (MHST) available through schools which would increase to eight by 2024, covering about 50% of the county. The MHSTs were a nationally prescribed model and each MHST had to consist of four education mental health practitioners. In Lincolnshire these also consist of two senior clinical leads. The MHSTs had to undertake a year of training which was nationally prescribed. There were a range of universities across the country which bid to NHS England to run the training programmes. After the year of training for the current MHSTs, there was then a year of embedding that training into practice, and so it was not until the third year that the MHSTs would be fully embedded. There were three core mandatory functions for MHSTs which were around direct intervention work with children and young people, supporting the senior mental health lead in each education setting, and supporting access into more specialist services. The Council was challenging NHS England in relation to the strict criteria that each team had to cover around 8000 children and young people as for a rural county like Lincolnshire with smaller schools, this would mean each team covering approximately 24 or more schools to reach the 8000 criteria. For future MHSTs, the criteria had been reduced to 7000 children and young people, but this was still not ideal for Lincolnshire due to its rurality.
• The two Section 75 agreements currently in place with CAMHS and Healthy Minds Lincolnshire were well managed, and the contract managers worked closely together. The proposal for one Section 75 agreement would not incur additional costs but would enable better use of the financial resources available across the system and avoid duplication, and for services to work much more seamlessly together as children and young people moved across those services. Having the services under one agreement would enable a more streamline approach and better communications across the different services, and for both workforce and financial resources to be moved more fluidly across services, depending on where the demand was. The new MHSTs would provide emotional wellbeing and mental health support in schools and colleges and as Healthy Minds Lincolnshire already provided similar support, there was need to consider how to avoid duplication with the MHSTs and maximise the resources available.
• In addition to Healthy Minds Lincolnshire, CAMHS and MHSTs, there were a number of other early intervention services available for school age children such as the Behaviour Outreach Support Service which supports children at risk of exclusion and the Early Help team which has trained officers to support children’s emotional wellbeing. A lot of work was being undertaken in conjunction with Public Health to try to understand the emotional and mental health needs of children and young people in Lincolnshire, and with schools to help them support children and young people to talk about their anxieties and differentiate between normal anxieties such as exam stress and those anxieties which require additional support.
• Improving transition arrangements from children and young people mental health services to adult mental health services was a priority in the NHS long term plan. There were transition arrangements in place, but as the commissioning arrangements moved from Children’s Services to Adult Services, there would be different eligibility criteria and therefore not all young people would move into adult mental health services. This was being considered as part of the review of children and young people’s mental health services where the Children’s Services commissioning team was working with the adult mental health transformation team on all age pathway options. In addition, the LPFT’s Mental Health, Learning Disability and Autism Board would also be looking at how to improve these pathways to ensure children and young people continue to receive the services they need as they move into adult mental health services.
• Parents and carers were a key factor in supporting children and young people with their emotional wellbeing and mental health. Funding for support for parents and carers was complex due to the different services involved but these services worked together in an integrated and co-ordinated way.  Healthy Minds Lincolnshire and the MHSTs provide workshops for parents and carers to support their children and young people at home with their emotional wellbeing and mental health concerns and provide strategies and tips to replicate at home. Some of the workshops were aimed at specific groups of parents and carers who needed support around similar concerns. Pre-recorded workshops or video clips were developed during the pandemic to support professionals, parents and carers, and young people.
• A Section 75 agreement was an agreement that the Council could enter into under the NHS Act 2006 to work in partnership with a NHS body and which allowed the Council to delegate functions to the NHS body to deliver on the Council’s behalf. There were robust monitoring arrangements in place including regular partnership board meetings, where the contractor submitted their quarterly performance information for monitoring, and operational meetings were also held throughout the year.

The Committee requested a further update be brought to a future meeting on children and young people mental health services and the outcomes from the review.

RESOLVED:

1.      That the recommendations to the Executive, as set out within the report, be supported;

2.      That a summary of the comments made be passed on to the Executive as part of its consideration of this item.

3.      That an update be brought to a future meeting on children and young people mental health services and the outcomes from the review.