Agenda item

15.1     Jessica Britton, Deputy Chief Delivery & Strategy Officer and Director of Strategic Commissioning NHS Sussex, introduced the report, which provides information about the mental health transformation programme, the work of mental health support teams and neurodevelopment pathways in East Sussex. She highlighted significant increased demand for services in the neurodevelopment pathway, and a change in patterns for the support needed by children and young people.

15.2     The Committee noted that approximately 60,000 children in East Sussex have a diagnosable mental health condition, representing a 66% increase since 2021, and asked what is being done to expand mental health support teams in schools to support these young people, and whether the establishment of i-Rock hubs is being considered in other areas in the county.

15.3     Jessica Britton responded that mental health support teams were part of a national programme for ensuring equal access to mental health services, and the system identified the schools enrolled according to where support was most needed. The system was working with schools to maintain the 65% coverage, but there was to be no further investment in those teams for the time being, as the system was working to ensure the goals of the mental health teams were aligned with early help and support set out in the mental health transformation programme. It was a core priority for the system to ensure a holistic approach to support for children and young people, before increasing support to 100% coverage. The system was exploring the expansion of i-Rock hubs and access to early help.

15.4     Lizzie Izzard, Head of Children and Young People Mental Health Commissioning NHS Sussex, added that i-Rock was viewed as core part of the mental health transformation programme, providing quick advice and support for access to services. She explained the expansion of this across East Sussex would need to consider how it can best support children and young people in local areas, as it may not be suited to all of them, but would be used to develop the core offer. The service was intended to be preventative, so that children’s immediate needs could be met without them escalating, but the ICB is mindful not to medicalise all children while offering them support.

15.5     The Committee expressed concern that the waiting time for neurodevelopmental pathways is 645 days and asked how this was being addressed.

15.6     Jessica Britton confirmed that this waiting time is longer than it should be, but that this was also a national issue being investigated by a national taskforce. Teams in the system had been working to develop a model to triage young people, to signpost residents to support, and the system was working with schools to expand available support while children waited for an assessment. This was developed in partnership with professionals, schools, the VCSE sector and children and young people with experience of the pathway. It was expected that a new assessment model will be finalised by June 2026, to work to reduce that waiting list.

15.6     John Child, Chief Operating Officer SPFT, responded that the transformation of CAHMS services included the early help support offer, to make sure that services were being as productive as possible while providing similar outcomes in different areas. The Trust had developed neurodevelopmental assessment hubs, containing neurodevelopment assessment teams, which contain specialists in different neurodivergences, in order to make best use of resources and ensure best outcomes. Previously, assessments had been carried out by CAHMS specialists, so these hubs were to make the best use of resources to carry out the assessments.

15.7     Anna Moriarty, Associate Clinical Director for CAHMS SPFT, added that the Trust has developed a support-whilst-waiting offer, to help families to access support from the community, VCSE sector and education without a diagnosis.

15.8     The Committee asked what barriers there are to accelerating and improving access to services for patients, including the expansion of i-Rock hubs.

15.9     John Child noted that constraints on resources in the NHS and local government mean that the trust has a gap between demand and resources. Thousands of young people have been referred to the neurodevelopmental pathway, but due to resource constraints the trust did not have the clinical capacity to see patients in the neurodevelopmental pathway within a reasonable timeframe.

15.10   The Committee asked how school environments impact on demand for CAHMS.

15.11   Lizzie Izzard assured the Committee that the neurodevelopmental programme and mental health support teams in schools have been working with ESCC to support children. However, the school environment often is not tailored to neurodiverse children, particularly children with autism, so the ICB have been working with schools through the Partnerships for Inclusion of Neurodiversity in Schools (PINS) programme to develop learning environments that are supportive of children with SEND.

15.12   Jessica Britton added that many children are referred to the pathway through schools, and the mental health schools’ team and PINS are a large part of supporting that.

15.13   The Committee noted that initial assessments happen within 28 days and asked what the qualifications of staff conducting assessments are.

15.14   Lizzie Izzard confirmed that all assessments are completed by professionals with mental health qualifications, from the multi-disciplinary teams. Support workers may join an assessment but would always be accompanied by a qualified professional and would not carry out an assessment independently.

15.15   The Committee asked how children are referred internally to the pathway.

15.16   John Child clarified that internal referrals are where a clinician within the pathway has identified that a patient needs a treatment from a specialist, and external referrals are where children are referred to the pathway from outside, such as from their GP or school.

15.17   The Committee raised feedback from residents that some parents were unhappy with their children being discharged from treatment and asked how carers and families are engaged prior to discharge from treatment.

15.18   Anna Moriarty noted that CAHMS and SPFT offered episodic care, which centres on goal-based outcomes. The trust aimed to have conversations about the limitations of their service early on with families to ensure that goals are obtainable, and this formed part of ensuring that all care offered is working towards a goal to ensure best use of resources. This less routine and systematic support would be utilised in the new clinical model, and support would be reviewed if patients were not making progress towards them.

15.19   The Committee asked if there are any figures available from before 2022 and whether the NHS has received any negative feedback about the neurodevelopmental pathway.

15.20   John Child confirmed that the earliest available inclusion data was from after 2022, as previously data for CAHMS and the neurodevelopmental pathway were grouped together. These were separated in 2022 to better understand the scale of demand for different assessments.

15.21   Anna Moriarty responded that the trust welcomes constructive feedback, and though the themes of qualitative feedback have not been provided in the report, the quantitative data provided indicates that the responses are mostly positive. The trust have been working with a limited data set so far but have started to issue QR code feedback forms to raise the response rate.

15.22   The Committee asked what work mental health support teams were doing in schools, and if there was a larger programme to help students understand anxiety and develop resilience.

15.23   Lizzie Izzard clarified that MHSTs are a national programme following a national model. As set by NHS England, MHSTs consist of four educational mental health practitioners. The first year a team is established, those four practitioners are in training at university and entering the mental health workforce, overseen by a manager and clinical supervision. One team covered approximately 8,500 students across a cluster of schools, as set by NHS England, and the roll out was planned to target areas of most need, with an aim to have full coverage of Sussex by 2030. She added that a whole school approach would be needed to effectively support students, and the teams were working with schools to train staff who work with children daily, to ensure that they were equipped to centre students’ emotional and mental health in educational settings.

15.24   The Committee asked, if there is one team per 8,500 pupils, whether they are able to support all students that need support and whether the support offer covers colleges too.

15.25   Lizzie Izzard responded that the ICB are using their teams to meet need the best they can, including outreach work to schools to identify where the most need is. Where this need has been identified, the MHSTs offer one-to-one support for students that need it most. This is set out in the wider national programme to reach 100% coverage by 2030, but other services like CAMHS and i-Rock are still available to deliver support. The service supported children up to age 18, including further education and colleges. John Child added that schools also commission their own mental health initiatives and internal support for students.

15.26   The Committee asked what will happen for children requiring in-patient care following the announced temporary closure of the Chalkhill unit.

15.27   John Child responded that Chalkhill is a general adolescent in-patient unit and that children requiring more specialist admissions – such as psychiatric intensive care or eating disorder admission – access inpatient care outside the local area. The decision to close Chalkhill was made over a planned period of time (3 months), so as not to disrupt continuity of care for the young people in the unit. He clarified that the closure was due to sustained improvements to the unit not having been made, key clinical roles being vacant and the need to ensure that care remains safe, especially as there had a shift in care needed, toward children with much higher needs, more complex emotional needs, and neurodiversity. He confirmed that SPFT will undertake a programme of work which will include a review of the clinical model to ensure it meets the needs of children and young people, skill mix and facilities to support patient needs, recruitment to key clinical roles and an opportunity to improve the environment of the building. He stressed that this was a temporary closure, and it was the Trust’s full intention for the centre to reopen. He confirmed that young people would not be admitted to adult inpatient facilities and that the approach to bed finding via the Provider Collaborative would not change.

15.28   The Committee asked when it was expected that there would be long term improvement in young people’s mental health services that residents expect to see.

15.29   John Child answered that there were significant ongoing changes in the NHS, and public services were operating under tight financial constraints. The trust were working to improve early intervention and prevention services, to keep children in schools and reduce impact on families. This was particularly important in the context of neurodevelopmental challenges, to prevent escalation and greater cost later on. That is not to disregard current complex needs, but prevention will ease pressures for the future.

15.30   Anna Moriarty added that the THRIVE framework, which enabled partners to give residents the knowledge of what help is available, was key to helping young people to access support as soon as possible. This was a large part of early intervention, but also following up with further specialist support as soon as possible was necessary to prevent escalating need.

15.31   The Committee RESOLVED to:

1)    Note the report; and

2)    Schedule a progress report on neighbourhood mental health support teams to a future meeting.