Local Transformation Plans Review

www.england.nhs.uk

Children & Young People

Mental Health Services

Local Transformation Plans Review 2015

March 2016

Abi Childs & Rahul Agarwal NEL Healthcare Consulting

Introduction

• NEL Healthcare Consulting, part of NEL CSU, is working with NHS

England and other partners to carry out an analysis of the children

and young people’s Local Transformation Plans

• The analysis will review the plans and supporting documents from a

quantitative and qualitative perspective

• The 2015 LTPs outlined how organisations would work together to

improve services for children and young people with mental heath

problems across the whole care pathway

• The LTPs are the richest source of information available to date on

the state of children and young people’s mental health across the

country. They gave an overview of current and future planned

performance against the priorities set out in Future in Mind

• The analysis will enable NHS England and its partners to use data to

inform its decision making, share learnings across the country and

inform policy development on key areas moving forward

• The analysis focused only on the evidence contained in the LTPs and

their supporting documents

Contents

Introduction

Methodology

SCN map

Summary of data

analysis

Summary of KPIs

Summary of

qualitative analysis

Extraction methodology

3

Local Transformation

plans and Background Documents

CAMHS Assurance

Data Collection Templates

High Level Summary Templates

Self Assessment Checklists

Summarise Information

Develop Insight

1Collect Data

1100+ Documents from

123 LTP Areas

2 Synthesise

Information

3 Summarise

Information

7 Qualitative Themes 1. CYP Participation

2. Whole system

engagement

3. Promotion, Prevention and

Early intervention

4. Vulnerable CYP groups

5. Outcome monitoring

6. Eating disorders

7. Workforce

4 Data Areas - Expenditure

- Workforce data

- Activity data

- Prevalence

- Also looked at

Transformation

KPIs

Data

Analysis Qualitative

Review

Present Data Summary

Provide Report on each

theme

Develop

Recommendations

Introduction Clinical Network Regions

4

North England

Yorkshire & Humber

East Midlands

East of England

South East

Thames Valley

West Midlands

South West

Wessex

London

Cheshire & Merseyside

West Midlands

South West

Thames Valley Wessex London South East

East of England

East Midlands

Yorkshire & Humber

Northern England Manchester, Lancashire and

Cumbria

20 CCGs

22.5%

Population aged 0-17 years

10.2% estimated 5-16 year olds

with mental health condition

12 CCGs

20.7%




Data Source: ONS 2013, 2015 LTPs and Local JSNAs All Icons made by Freepik from www.flaticon.com

23 CCGs

21.3%




11 CCGs

20.2%




10 CCGs

22.9%




9 CCGs

19.7%




12 CCGs

20.0%




21 CCGs

21.1%




21 CCGs

21.4%




19 CCGs

21.5%




20 CCGs

20.8%




32 CCGs

22.6%




This is a map of the Clinical

Network (CN) regions which

are used for the analysis in

this report

Summary of Data Analysis Expenditure

£273m Approx annual

NHSE Inpatient

spend on CYPMH

14/15

£628m Approx annual spend on

CYPMH 14/15 by CCGs

and Local Authorities

46% 38% 16%

CCG NHSE LA

£78 England Annual

CCG Average

£2,721k

England

Annual LA

Average

£949k

Approx Total Community and Inpatient CYPMH

Expenditure 14/15

Approx CYPMH Community and Inpatient

Expenditure by funding source %

Approx Average Expenditure on community and

inpatient services per CYP

Average annual CYPMH expenditure per CCG

and LA

* Population segments used are 0-17 years general population based on latest available ONS data

** Community services in relation to referrals and workforce refers to Tier 3 or Tier 2/3 depending on the data provided by the local CYPMH system.

*** Community and Inpatient services in relation to expenditure includes Tier 2/3 and also NHSE spend on in-patient services (Tier 4)

Summary of Data Analysis Referrals and Workforce

6

Approx annual total CYPMH Community

Services Referrals 14/15

Approx total annual CYP accepted vs referred

into community services per general population

1000 0-17 year olds

Approximate England Average Community

Expenditure per Referral

£2,338

270K 198K

Total

Referrals

Total

Referrals

Accepted

18/24

Approx CYPMH staff in community services per

1000 0-17 year olds

Clinical

0.7

WTE

Admin

0.2

WTE

* Population segments used are 0-17 years general population based on latest available ONS data

** Community services in relation to referrals and workforce refers to Tier 3 or Tier 2/3 depending on the data provided by the local CYPMH system.

*** Community and Inpatient services in relation to expenditure includes Tier 2/3 and also NHSE spend on in-patient services (Tier 4)

Summary of Data Analysis KPIs and Most common transformation priorities

7

• The graph below presents the most commonly used Transformation KPIs that LTP areas will use for monitoring progress of

their transformation funding

• As a result it is a good basis to view what the most common themes are for transformation funding at a high level.

• Eating Disorders is the most common theme and 15% of all KPIs, which is of no surprise as there is a separate funding

stream for it. School & Education, Crisis, Digital & Technology projects and General Vulnerable groups are the next most

common and make up almost 25% of the total KPIs

• It should be noted that these percentages relate only to the number of total KPIs and do not represent overall monetary

amounts dedicated to these areas. Additionally, the information collected here was only from the Transformation KPI trackers

and as a result does not mean that LTP areas are not addressing these areas in other ways outlined in their LTPs

77

16

16

21

22

22

29

34

54

60

60

74

84

93

100

134

156

179

200

218

286

Other

Primary care

Thrive Model implementation

Voluntary organisations initiatives

CYPMH Workforce initiatives

Peer support & Mentoring

Specialist services initiatives (Tier 3)

Family & Carers initiatives

Perinatal initiatives

Transformation plan implementation project…

Engagement, co-production and communication…

Whole System Enhancement initiatives

Monitoring & Reporting projects including audit and…

LD/ASD/ADHD

Digital & Technology projects

School & Education programmes

Universal initiatives incl PH, Prevention and Promotion

Crisis and Liaison (including OOH)

Vulnerable groups incl LAC, CSE and YOT

Improving Access incl CYP IAPT and SPOA initiatives

Eating disorders

Total

number

of KPIs

“Other” includes:

• Transition & Discharge

• Early Intervention

• Self-help

• Home (treatment)

• Neurodevelopmental

• Psychosis

• Inpatient / tier 4

Summary of Data Analysis Most Common KPIs

8

The following sets some examples of interesting KPIs within the KPI themes (excluding

eating disorders)

Please note that there were variations in terms of wording used for similar KPIs. The most common or clear wording has been used above.

• Improved appropriate referrals to CAMHS

• All schools and colleges to have a named mental health & wellbeing lead

• Improvement in classroom learning & emotional resilience

• Increased awareness & access of mental health services

• Increased training & confidence in managing mental health issues

• Development of digital apps/e-material to improve self-care, resilience & CAMHS offer

• Integrated care pathways & outcomes through IT

• Meeting minimum dataset requirements & outcomes monitoring

• Use of online counselling

• CYP able to access support & interact with consultants/clinicians virtually

• Number of CYP accessing appropriate interventions as part of a coordinated package

• Increased number of CYP reaching appropriate level of development

• Number of early help assessments

• Develop vulnerable CYP outcome measure

• Improved access for hard to reach groups

School & education Digital & technology KPIs Vulnerable Groups KPIs 1 2 3

Summary of Qualitative Review

9

• This visual shows a comparison of the total average score for the theme

• The score is based on how much evidence LTPs nationally presented on current or future plans for each sub theme

• When reading this graph, it should be noted that this information is based off the content from LTPs of varying degrees of

quality

• The absence of a theme in a plan does not necessarily indicate a problem – for example, some areas may not have put in

details regarding Eating Disorder plans if they were already delivering a NICE compliant service

Eating Disorders Summary

10

• The majority of the focus for eating disorders is on waiting times and

improving access with 35% of the KPIs relating to eating disorders

covering these two topics

• Most areas are making plans around developing a community

eating disorders service with a trajectory towards achieving a fully

compliant service by 2020

• Early detection and intervention was also a primary focus for eating

disorders

• Increasing workforce capacity and training was noted as important

in achieving a compliant service

• Where services are already compliant, the funds are being spent on

both enhancing the existing eating disorders service and on crisis

and self-harm

Key facts

16% of LTP areas

state they are compliant

with the new eating

disorders guidance

84% of LTP areas are

making plans on how to

become compliant

93% of LTP areas are

delivering eating disorder

services with other areas

Specific Vulnerable Groups Summary

11

• Areas employed a variety of different methods to ensure an integrated service was in place and services

were delivered in a multi-agency way. This included embedding mental health practitioners in

teams, putting in place bespoke pathways for vulnerable groups, using a Consultation and Liaison

model or using a Lead Professional Approach to manage care

• LAC was the most commonly cited vulnerable group with a variety of measures being developed to

deliver an integrated service with evidence-based interventions at the core. Services for LAC are often

provided by a joint CYP MH and social care team and where this does not exist areas are planning to

integrate these teams to provide a joined up service for LAC

• In terms of youth justice, embedding mental health practitioners within teams was the most common

method of delivery but areas are looking at enhancing elements of the service, such as providing street

triage and developing workforce training

• For CYP with complex needs, the focus is mainly on CYP with learning disabilities and improving

neurodevelopmental pathways. The voluntary sector is recognised as important in providing a

wraparound service as well as supporting universal services to support this group

• CSE was referenced as a priority with areas beginning to explore the best ways to tackle this. Improving

awareness and prevention were cited as key alongside multi-agency working

• LTPs referenced crisis as being important with most areas using their crisis care concordat plans as

the focus for improving services

• Improving transitions was referenced as a key priority with a number of areas considering extending the

service from 0-25 years or creating a flexible service based on need rather than age

Vulnerable Groups Summary Key Facts

12

The graph below presents the % of LTP areas that evidenced current or future plans for particular key vulnerable groups.

85% 77% 76% 71% 69% 58%

Looked After

Children or Care

Leavers

CYP in crisis CYP with

complex needs

CYP known to

the youth

justice system

CYP in

transition

CYP at risk

of child sexual

exploitation

30% 25% 10% 2%

Referenced 5

vulnerable group

categories

Referenced 6

vulnerable group

categories

Referenced 4

vulnerable

group

categories

Referenced 2

vulnerable

group

categories

Referenced 3

vulnerable group

categories

Referenced 1

vulnerable group

categories

10% 25%

Wholes Systems Summary

13

• Areas use a multitude of different techniques to deliver a whole systems approach to CYP MH services.

There is particularly strong collaboration with local authorities, education, YOS and the voluntary

sector

• ALL areas referenced developing decision making boards, committees or oversight groups

• Almost all areas referenced wider collaboration. Several areas referenced influence from the

community (GPs, Patient or Parent forums, Youth Councils and Healthwatch) and most referenced

varying degrees of engagement with community providers (Education, Public Health, SEND, LAC

groups, Young Carers, Police, Third Sector)

• Over half of local areas evidence current or plans to deliver co-located services

Whole Systems Summary Key Facts

14

The graph below presents the % of LTP areas that evidenced current or future plans for engagement for

different organisations groups in the whole system.

Evidence in LTPs

CYP Participation Summary

15

• All areas evidenced CYP engagement using a multitude of different techniques to gather CYP

feedback informing transformation and service re-design. The most common methods included larger

engagement event days, smaller focus groups and interviews, online surveys, CYP stakeholder reference

groups and working with voluntary sector collaboratively on CYP engagement

• The majority of areas also evidenced engagement with parents and carers, in particular through setting

up focus groups, parent and carer reference groups and surveys

• The majority of areas evidenced some form of collecting CYP voice indirectly to inform commissioning

and improve the delivery of services. A third of areas evidenced more innovative direct methods

including young person panels, involving youth parliaments or councils and young commissioners

programmes, Young Inspectors, Young People MH Charters and Young Advisors

• LTP areas acknowledge needing future development of CYP and parent/carers co-production with half

evidencing it in their LTPs as a future generic objective or vision

• Half of the LTP areas recognise the transformation plan is a “living” document and will develop and

monitor it through future CYP engagement as transformation is implemented. A third of areas are

developing engagement/communications strategies or investing in participation leads to assist with this

• There was more widespread use of digital media and events to boost awareness on what current

and future services are and were almost always co-produced with CYP

CYP Participation Summary Key Facts

16

The graph below presents the % of LTP areas that evidenced current or future plans in each participation

sub theme category

Evidence in LTPs

Next Steps

17

Qualitative thematic

reviews still to complete:

• Promotion, prevention and

early intervention

• Outcomes

• Workforce

Final pack to be produced

comprising of:

• Recommendations

• Continuous learning

framework

• Next steps

1 2

Contact details

18

If you have any questions, please contact NEL Healthcare

Consulting:

Abi Childs, [email protected]

Rahul Agarwal, [email protected]

mailto:[email protected]

mailto:[email protected]