Agenda item

To receive a report on the review and refresh of the Transformational Plan developed in 2015 as part of the LLR Better Care Together Programme.  There was a national requirement to refresh the plan to reflect the progress that had been made in 2015.

Chris West, Director of Nursing and Quality West Leicestershire and East Leicestershire and Rutland CCGs and Tim O’Neill, Director of People, Rutland County Council will be present at the meeting to present the report.

The Board received a report on the review and a refresh of the Transformational Plan developed in 2015 as part of the LLR Better Care Together Programme.  There was a national requirement to refresh the plan to reflect the progress that had been made in 2015.

Chris West, Director of Nursing and Quality West Leicestershire and East Leicestershire and Rutland CCGs and Tim O’Neill, Director of People, Rutland County Council presented the report and answered Members questions.

The 6 core work schemes in the Plan were:-

·         Improve Resilience.

·         Enhance Early Help.

·         Improve access to specialist Children and Adolescent Mental Health Services (CAMHS).

·         Enhance the Community Eating Disorder Service.

·         Develop a Children’s Crisis and Home Treatment Service.

·         Workforce development.

In presenting the report it was noted that:-

a)         Phase 1 of improving resilience was underway and 11 out of 24 schools in city were currently involved in the work stream.  The procurement process was underway and it was envisaged that the 3 year contract would be up and running in July 2017.

b)         CAMHS access had improved and the service was now meeting the 13 weeks’ target for assessments to be carried out.

c)         The service for eating disorders was now available 24 hours and 7 days a week and was running fully.

d)         The crisis and home treatment service had started but was as yet not fully operational.  Staff had been recruited and the service was moving into new premises with an on line direct phone line service at the end of February 2017.

e)         The workforce development work-stream had concentrated on identifying the training needs of the staff that were already in place and the development of staff moving forward.  This was currently at the assessment stage and some non-recurrent funds were being used to fund training resources packages for staff.

f)          The steering group overseeing the process had encouraged members to see that the 6 work-streams were connected to each other and good progress had been made.  Parts of the procurement process had been both complex and challenging but there had been good engagement and support across the partnership in the city.  The challenge moving into next financial year would be to gather the data to assess the impact of the work that had been put in place.

g)         The procurement for early health had gone ahead as planned but it had not been possible to secure a provider that met the required needs across the LLR.  It was accepted that the plan did not fully reflect the work that had already been done in the city around early health.

h)        The next refresh to the Plan would be a more comprehensive explanation of all of the work under each of the work-streams and an assessment of how it was making a difference for children. 

Members of the Board commented that:-

a)         Prior to the publication of the refresh, it should reflect the terminology used in the city so that all agencies understood that there was a local response as well as an overall response in the county.

b)         The efforts being made to strengthen early resilience were particularly welcome.  The Children’s Trust in the city had undertaken a great deal of work in looking at improving the earliest possible stages to engage with young people to help them develop ways of improving their own mental health and support each other.  It had also looked at additional support staff may need in supporting children to ensure that the right services were in place; so that young people and their families had access at the earliest possible point.  This was in response to previous evidence that had shown that some young people in the city had previously not been supported until they were in crisis.  The impact of this upon the person and their family, in terms of recovery, had been significant.  The measures being put in place could have huge benefits in making a difference to young people. 

c)         Improvement in early health in the city had been fast moving as part of the improvement journey and this could be easily be aligned to the work on early health in the Transformation Plan.  The three directors of children’s services in the LLR had been working closely to align processes so that it made sense to the whole partnership and not just an individual organisation within the LLR. 

The Chair referred to the 11 indicators on the dashboard and stated that 10 of these were precise measures.  He felt the 11^th indicator for service user feedback and patient satisfaction surveys should be seen as being of equal importance in relation to the other 10 indicators.  He felt that what young people said about their experiences of being able to access, or not access, services and their perception of their own health and wellbeing was fundamental to understanding how young people perceived their own health and their ability to seek support at the right point.  Although it was laudable to reduce A&E and high level referrals; it was equally important to address other issues which were of concern to young people, such as cyber bullying and on- line harassment.

In response, the Director of People, Rutland County Council stated that a pilot initiative in Rutland supported this view and agreed that feedback and patient experience should be central to the plan.

The Chief Executive of LPT welcomed the investment that had been made to get the crisis team up and running and the investment of resources to improve access.   A year ago, 250 children had been waiting more than 13 weeks for an initial assessment but now no one was waiting more than the 13 week target period.  However, there was still an unsustainable rise in referrals; averaging a 9% year on year increase and there were still significant numbers of cases waiting between the assessment stage and the subsequent treatment programmes and this needed to be addressed.

The Director of People, Rutland County Council stated that there was a desire to get treatment services in operation as soon as possible and it was not envisaged that the procurement process would be lengthy.

The Chair commented that the Plan only referred to funding for 2015/16 but not for current or future years.  As it would take 4-5 years to get resilience within the Plan, it was difficult to plan with any certainty when future funding was unknown.  In response the Director of People, Rutland County Council echoed these views and shared concerns that the Department of Health’s policy of providing yearly funding was not ideal.

In response to a comment by the Police and Crime Commissioner, the Director of People, Rutland County Council stated that whilst the police service had been engaged during the wider planning aspects of the Plan, there would be more specific involvement by Police Officers in the initiatives that were now in place.

AGREED:

1)         That the Board support the publication of the refreshed Plan for 2016/17, subject to the extra information in relation to the early health initiatives and terminology used in the City and the financial information for 2017/18, being included.

2)         The Board expressed concerns at the annual funding arrangements by the Department of Health which made long term planning uncertain.