Invitees:

Cllr Phil White, Cabinet Member – Social Services and Early Help;

Susan Cooper, Corporate Director – Social Services and Wellbeing;
Lindsay Harvey, Corporate Director -  Education and Family Support (Interim);
Laura Kinsey, Head of Children’s Social Care;
Nicola Echanis,  Head of Education and Family Support;
Jo Abbott-Davies, Assistant Director of Strategy & Partnerships – ABMU Health Board;

Andrew Davies, Chair of AMBU Health Board;
Mark Wilkinson, Group Manager - Social Services & Wellbeing;
Suzanne Sarjeant, Head of Pencoed Primary;
Kaye King, Wellbeing Officer, Pencoed Primary;
Jeremy Evans, Head of Heronsbridge;
Dr Sylvia Fowler, Heronsbridge;
Lorraine Silver, ALN Casework Manager.

The Scrutiny Officer introduced the report on Child and Adolescent Mental Health Services (CAMHS)

The Committee received a presentation from the Interim Corporate Director Education and Family Support which updated the Committee on:

·         training undertaken by professionals and volunteers to identify and support children and young people with mental health needs;

·         CAMHS support in place for the Youth Offending Service (YOS);

·         links to transitional adult mental health services; and

·         information and data on mental health and emotional wellbeing services delivered in schools.

He informed the Committee of the provision to CAMHS by the Inclusion Service.  He stated that the Youth Offending Service (YOS) is currently without a (statutorily-required) member of staff nominated by the Local Health Board.  He also stated that YOS currently manages 108 young people, many of whom have mental health issues.  Enhanced Case Management Approach (with Health as key partner) is being piloted.  The Inclusion Service ensured ‘the right people provide the right support to the right people at the right time.’  He stated that monthly consultations are held with a consultant child psychiatrist.  There were also referral pathways to primary healthcare services. 

He highlighted links to adult mental health support, where there is transition planning for all young people who have identified mental health needs.  He also highlighted the support provided to CAMHS by the Integrated Family Support Service.  He informed the Committee of the provision of mental health and emotional wellbeing support provided to schools in the County Borough.  He stated that health is responsible for CAMHS provision and funding is devolved directly to ABMU and Cwm Taf.  All schools undertake a significant amount of work supporting pupil wellbeing and mental
health, with provision met from core budgets. 

The Committee referred to the provision of mental health services for young people and questioned whether provision in the Borough is better or worse compared to the national picture.  The Assistant Director of Strategy and Partnerships stated there is a significant issue of recruitment throughout the UK to provide mental health services.  Funding in various parts of Wales has led to staff moving around, creating shortages in other parts of Wales.  She stated that all providers of CAMHS have problems in adhering to Welsh Government targets, with provision to young people at weekends being problematical.  There was currently a full complement of staff in the Bridgend area, but there was insufficient accommodation to offer all services.  The Assistant Director of Strategy and Partnerships informed the Committee that the target of 26 weeks for assessment is being achieved and provision of services locally was not significantly worse, but there was a need for services to improve.  The Committee referred to the shortage of accommodation and questioned whether services could be accommodated in schools.  The Interim Corporate Director Education and Family Support commented there is surplus capacity within schools, but the settings needed to be selective and must meet the needs of young people.  The Head of Education and Family Support informed the Committee that the use of safeguarding hubs was being considered for the provision of services.

The Committee questioned how funding from Welsh Government to support CAMHS was allocated.  The Assistant Director of Strategy and Partnerships informed the Committee that funding from the Welsh Government for CAMHS is allocated to a particular service.  The Welsh Government would also notify ABMU of the availability of further funding to support CAMHS during the year; this approach was problematic as it affected recruitment. 

The Committee questioned the waiting times for young people to be able to access services and the support offered to young people during the interim.  The Assistant Director of Strategy and Partnerships informed the Committee that waiting times in Bridgend are slightly longer and that 50% of referrals do not meet the criteria for CAMHS.  The average time it takes for support to be accessed is 12.5 weeks.  There was now funding in place for a liaison officer who would be the first point of contact and who would determine where best to direct children and young people for support.  A service is also in existence whereby measures are in place to support children and young people in schools as a bridge to CAMHS. 

The Committee commended the work undertaken by schools in putting in place measures to bridge the gap between children and young people who are awaiting assessment from CAMHS or do not meet the referral criteria.  The Committee expressed concern that service provision is reliant on grant funding.  The Committee commented on the need for pupils to be able to know where to go in order to access services.  The Committee also commented that schools provide stability and questioned the mechanisms in place when young people are referred to CAMHS.  The Assistant Director of Strategy and Partnerships informed the Committee that the challenge is to ensure continuity.  There is a case management system which is in place for 7 weeks and the service is already seeing the benefits whereby individuals now have a wider range of options available to them.  It had been made clear to Cwm Taf that Bridgend is not fully staffed, who were now attempting to stabilise the situation by recruiting younger staff.  The Committee questioned what happens after the 7 weeks period has elapsed.  Assistant Director of Strategy and Partnerships commented that the 7 weeks model is a national one, is outcome based and based on what the young person wants to get out of the service, as opposed to the number of times in which they are seen. 

The Committee asked whether CAMHS is preventing young people from having support via Social Services.  The Assistant Director of Strategy and Partnerships stated that it was about early intervention.  The Corporate Director Social Services and Wellbeing informed the Committee of a complex picture, whereby some children have very complex needs.  Social Services have links with health to ensure gaps in provision are minimised. 

The Committee referred to the high turnover of staff and questioned is there any monitoring in place when young people who have gained the trust of staff subsequently do not return after their allocated consultant has left their post.  The Assistant Director of Strategy and Partnerships stated monitoring does take place, although not necessarily when staff leave.  The Head of Education and Family Support informed the Committee of the work undertaken by the planning group whereby it was looking why children are being referred and where they go when they do not meet the CAMHS criteria.  The Head of Children’s Social Care informed the Committee that the child’s journey is looked at and where they receive support.  The Corporate Director Social Services and Wellbeing informed the Committee that there is a large turnover of children’s social workers, however a concerted effort had been made to recruit staff and a number of initiatives are being developed aimed at retention.  The Committee questioned whether social work staff receive exit interviews.  The Corporate Director Social Services and Wellbeing confirmed that exit interviews are conducted with staff, which had shown a variety of reasons for staff leaving.  She stated that children’s social services have been inspected and there is an action plan in place.  She commented on the importance of senior management being visible and that the Directorate has 21 newly qualified social workers which she had met and commended them for their enthusiasm and commitment.  She stated that newly qualified staff have a mentor, a reduced caseload, a training plan and a professional practice portfolio.  She informed the Committee that she would be meeting with the new recruits in 6 months and confirmed there were no vacancies at present.              

The Committee asked whether schools and police could be linked to the WCCIS computer system.  The Corporate Director Social Services and Wellbeing informed the Committee of the progress being made with WCCIS, which would see systems being integrated.  To date, 11 local authorities and 1 health board had signed up to WCCIS.  She also informed the Committee that joint teams are co-located and that the Multi-Agency safeguard Hub had been set up in virtual format at present.  The Head of Children’s Social Care stated there is parity across schools, with strong support for schools from the Inclusion Service and the Education Psychology Service.  There is also a ‘Team Bridgend’ ethos and strong linkages with the Central South Consortium and plans are in place for a Festival of Learning.  The Chair of ABMU commended the work of BCBC for being the pathfinder in rolling out WCCIS across the Western Bay region and commented that the pace of the roll out needs to increase.  He also welcomed the approach undertaken by this Committee in wishing to scrutinise CAMHS and was pleased a whole system and innovative approach was being taken by all agencies.  He also thanked officers for arranging a broad range of invitees which had participated in the meeting.    

The Committee questioned what type of counselling support is available to young people.  The Head of Education and Family Support informed the Committee that a great deal of counselling type activity is also delivered by the third sector.  She also stated that the CAMHS planning group is putting together a directory of services.  In the absence of a dedicated wellbeing officer being in post, there had been support from the Western Bay region and some limited support was available from the Youth Offending Service.  The Assistant Director of Strategy and Partnerships commented that further support from the YOS would be counter-productive as staff would become de-skilled.  It was important that the right support is committed as there was no spare capacity within the YOS when staff sickness occurs. 

The Committee questioned whether teachers are trained in counselling and whether all primary schools in the Borough receive support.  The Interim Corporate Director Education and Family Support informed the Committee that a number of teachers had been trained as part of their continuing professional development.  The ALN Casework Manager informed the Committee that a great deal of emotional and wellbeing training is delivered to staff and schools in the Borough had been among the first in Wales to have ELSA training, which is designed to build capacity in schools to support the emotional needs of pupils.  All the Borough’s schools have at least one member of staff who is ELSA trained.  ELSA is not dependent on grant funding and is sustainable and resilience is being developed alongside other preventative models to support mental health needs.  Training had been introduced in Adverse Childhood Experiences and is being piloted in 3 schools within the Borough, whereby all school staff receive training in emotional needs. 

The Committee referred to the proposed transfer of services from Cwm Taf to ABMU and questioned the impact on CAMHS waiting times.  The Assistant Director of Strategy and Partnerships informed the Committee that ABMU would not be taking all CAMHS services, but would be taking back primary care CAMHS services.  She stated that staff would transfer under the TUPE arrangements.  The ABMU did not want to unpick arrangements due to the proposals to change health board boundaries which affect Bridgend.  She stated that there had been a spike in referrals for part 1 assessments and a liaison post would be created in order to assist in bringing referrals down. 

The Committee questioned the training and counselling given to Worry Warriors.  The Wellbeing Officer of Pencoed Primary stated that a number of children have concerns with approaching teachers directly and steps had been put in place so that they can approach their peers with their concerns who will then approach the Wellbeing Officer and relay those concerns. A worry box had also been introduced whereby pupils will write their concerns on a slip of paper which would then be addressed by the Wellbeing Officer.  There were steps in place to address issues quickly with teachers and pupils.  The Head of Heronsbridge School informed the Committee of the difficulty encountered in special schools in distinguishing bullying with interpretation and negative interactions. 

The Committee referred to the pressures on schools with having to buy-in services and questioned whether support could be given to young people at with education psychologists at an earlier stage in avoid a referral to CAMHS.  The Head of Education and Family Support informed the Committee of the excellent support given to young people by education psychologists and that there is a well-developed suite of intervention.  The ALN Casework Manager stated that there was always a need for more education psychologists and she stressed the importance of young people being supported by those who know them best.  Schools are supported through ELSA and drop-in services and there is a graduated response to enable schools to buy in services where needed.  The Committee questioned whether joint working with education psychologists had been pursued with the Vale of Glamorgan Council.  The Head of Education and Family Support stated that this proposal was not progressed as there would be no mutual benefit with this arrangement. 

The Committee referred to school budgets being tight and questioned how additional resource is funded.  The ALN Casework Manager stated that if schools require additional resource they would have the opportunity to do that. 

The Committee questioned whether a demand pattern analysis had been undertaken on causation in order to have a greater understanding of the problems and the need for support to young people and to assist with ongoing early and preventative work in this area.  The Committee considered that linkages need to be made with strategies like the Corporate Plan and Local Development Plan in order to plan and design services.  The Interim Corporate Director Education and Family Support commented on the importance of analysis and this would be considered at the next meeting of the planning group.  The Cabinet Member Wellbeing and Future Generations commented that discussions also take place with the police on this issue.       

The Committee requested that it be provided with benchmarking data of AMBU, Cardiff and Vale and Cwm Taf Health Boards in relation to their performance for their residents in relation to CAMHS. 

The Committee questioned why some schools receive support services whilst others do not.  The Head of Education and Family Support stated there is a specific approach at Heronsbridge School, but the Directorate provides support to all schools through the services provided by the team led by the Group Manager Integrated Working and Family Support.  The Group Manager Integrated Working and Family Support stated that 400 young people had school based counselling.  Two schools receive funding for counselling through grant and 7 school based counsellors are managed by the hub.  The Wellbeing Officer of Pencoed Primary informed the Committee that support to pupils is very supported by the Head and the needs of the child must come first.  The Head of Heronsbridge stated that it was the role of the Head to know their pupils and their families.  There was a need to ensure that services are maintained and funding is diverted to meet need. 

The Assistant Director of Strategy and Partnerships informed the Committee that the new model of CAMHS would be different as Cwm Taf would be both provider and commissioner. 

Conclusions   

The Committee noted the issues in ABMU regarding the lack of accommodation and facilities to undertake consultation with children and young people and Members therefore recommend that AMBU look for suitable space within the Borough schools or within the safeguarding hubs, two of which are located within the communities making them very accessible to the public.      

Members commended the schools on the work they are putting in place to bridge the gap between the children and young people who are either awaiting assessment from CAMHS or that do not hit the CAMHS referral criteria, although the Committee recommend that consistency of services across all schools should be provided.             

With reference to the ongoing research into where children and young people go when they do not hit the criteria for CAMHS and the imminent production of a comprehensive directory of services available for those children, Members ask to receive when the information is readily available.  The Committee also recommend that the directory be rolled out to schools, police and parents.

The Committee understand that the Council are currently signed up to Community Care Information Solutions (CCIS) - a software solution that enables health and social care work better together –  which will also be taken up by AMBU in 2018.  Members recommend that the database should also include access and input from Schools and Police.

Members recommended that the planning group look to carry out a demand pattern analysis – detailing age groups, demographics etc. - to try and determine why children and young people in the Borough are being referred for CAMHS and to assist with ongoing early and preventative work in this area.  The Committee further recommend that when this meeting takes place to discuss this proposal further, that Police are also invited to participate.

The Committee requested the following additional information

In relation to the high turnover of staff within AMBU,  Members have asked to receive the amount of children who were undergoing treatment who did not return after their allocated consultant was no longer in post.

Members have asked to receive the recently collated benchmarking data of AMBU, Cardiff and Vale and Cwm Taf Health Boards in relation to their performance for their residents in relation to CAMHS.