To consider the findings of the scrutiny task and finish group and to recommend the report to the executive for consideration.

The chairman noted that Councillor Powell would be leaving Herefordshire in the near future and thanked him for his work and contributions to the committee. 

Councillor Powell, as chair of the task and finish group, presented the report. In his opening comments he noted the quality and passion of people who met with members of the task and finish group, and who demonstrated an overwhelming desire to improve services.    He thanked the membership of the task and finish group for their hard work and dedication and also the officers who supported the work of the group.

Special acknowledgement was made of the wellbeing ambassadors who were clearly proud of their work, and should be commended and supported to continue and develop their role.

The following points of the report were highlighted:

·         the work was commissioned in order to establish whether or not there could be confidence in meeting corporate aims with regard to the health and wellbeing of children and young people in Herefordshire

·         a lot of research was undertaken by the group and although the strategies and structures seemed complex they appeared to be working well and plans were being realised

·         the findings of the group identified a number of areas listed in the report as recommendations for further attention to consolidate and strengthen service provision across its spectrum

Members of the task and finish group made the following additional comments:

·         a consistent message from people interviewed was that of the importance of early intervention

·         the good work happening in schools could be greatly assisted by a toolkit and greater clarity in supporting mental health needs. The excellent practice within some schools should be shared with others in order to support pastoral care without taking the focus off the curriculum.

·         There needed to be consistency and co-ordination of the support and resources available for schools

·         Participation in further scrutiny activity regarding perinatal services and care of under 5s was supported

A member emphasised that it was essential to maintain consistency within services in order to support young people.  He added that the safeguarding process also played a role in communicating within the referral process if there were mental health needs not being addressed that were impacting on welfare.

A member commented that commissioners should note the experiences of young people being referred and prescribed treatment by their GPs.  He commented further on the prevalence of attention deficit hyperactivity disorder (ADHD) and that there needed to be more awareness of this. In response the task and finish chair commented that there was a need to be clearer about clinical definitions and diagnoses and about record-keeping. He noted that professionals were clearly committed to getting this right and this would contribute to improved outcomes.

A member noted the learning from this report and commented that it highlighted issues that might not be common knowledge such as tier 4 inpatient arrangements. She spoke in support of a number of points in the report including the deeper reach and reviewing the upper age limit, arrangements for transition to adults’ services, reviewing the Linden Centre arrangements, offering peer support between school, and synergies with public health.  The member also pointed out that there were services users from out of the county extended to those who did not have a Herefordshire GP but who attended schools within the county.  The member commented further that when looking at the drop-off rate through the tiers, it was important to ensure that there was distinction between progression through tiers and new diagnoses.

The report was commended by another member who noted that nationally this was a big subject being talked about much more openly by young people.   He highlighted the need to understand the psychology of social media as it could be used to a much more positive effect.   The council could play a part in helping other organisations and young entrepreneurs getting their message out there to raise awareness of issues such as bullying and mental health.  He reminded members that the CLD Trust was having an open day on 10 May from 4-6pm. 

The task and finish chair added that the wellbeing ambassadors were also holding an event on 8 May and emphasised the value of working with them and support them to have a stronger voice.  He added that it was clear in discussions with the wellbeing ambassadors that they did not feel that they had sufficient feedback about any proposals they put forward. These young people were doing some excellent work and it was important to continue to support their work and ensure ongoing communication. 

The vice-chairman thanked the task and finish group for the thorough report. He noted the information gathered from schools that were visited and hoped that the good practice could be shared to ensure more consistency. He noted the role of school governors in highlighting these issues and sharing the good practice.

In answer to a question from the vice-chairman regarding use of the pupil premium for wellbeing support, the interim director for children’s wellbeing explained that some schools were using their budgets to support emotional wellbeing so there could be clearer direction for schools on this.  He added that it was important to ensure that the focus was on giving children a great start in life and there were examples of how the pupil premium was being used which could be shared.

Representatives from 2gether NHS Foundation Trust were invited to comment on the report.  The following points were made in response:

·         The environment of the Linden Centre was known about and options were being considered in conjunction with Wye Valley NHS Trust. In the meantime, the matter had been escalated as far as possible at this time and it remained on the risk register

·         The report was welcomed and timely.  It challenges getting the service right for young people and the trust wished to offer assurance that it was important to deliver services well. Members were welcomed to join the trust’s membership scheme to help address stigma of mental health   

·         The report also highlighted the experiences of practitioners and the complexities of the tiers which was not always clear for service users to understand. Caseload information showed that the demand for tier 3 intervention was being met although the range of support needed go across the spectrum

·         Relationships with young people and their families were positive and there was good working with CLD to make service access and movement between tiers easier as required

·         The choice and partnership approach (CAPA) to treatment helped to manage casework and to reduce the number of weeks waiting. It was acknowledged that this could appear mechanical, however it had produced good results around waiting times, although there was work to do around improving the experience for service users

·         It was acknowledged that it was complicated to access tier 4 services; of an estimated 30 admissions there were in fact 16. There were steps to avoid admissions where possible in recognition of the difficulties travelling to services and the trust was working hard to contain people within their communities.  The crisis care concordant would help to take this forward reduce possibility of moving to tier 4 services with admissions for only the very complex conditions 

·         With regard to referrals being rejected, the perception of this was understood although referrals were accepted or rejected in line with the CAPA system and 70% of referrals were accepted. However, the situation also reflected the complexity of the tier system.  The trust works to actively engage in signposting to services and work to ensure no young person was left unsupported

A member pointed out the importance of focusing on tiers 1 and 2 to reduce the demands on tiers 3 and 4.

In response the task and finish chair welcomed the comments and hoped that the work could continue.

The chairman moved that the recommendations as set out in the task and finish report (appendix 1) be accepted. Members agreed unanimously.

A member commented that the recommendations needed to be taken forward and not moved to the ‘too difficult’ pile.

The interim director for children’s wellbeing commented that this was a useful piece of work which now had to go through due process, but that it was a priority of the children and young peoples’ plan. 

Members expressed thanks to Cllr Powell and commented that he would be missed. 

RESOLVED

THAT:

(a)           The report be agreed, in particular the recommendations, for submission to the executive; and

(b)          the cabinet’s response to the review, including an action plan, be reported to the committee after due consideration by the executive.