Download - 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%
Population aged 0-17 years
10.3% estimated 5-16 year olds
with mental health condition
Data Source: ONS 2013, 2015 LTPs and Local JSNAs All Icons made by Freepik from www.flaticon.com
23 CCGs
21.3%
Population aged 0-17 years
9.8% estimated 5-16 year olds
with mental health condition
11 CCGs
20.2%
Population aged 0-17 years
9.5% estimated 5-16 year olds
with mental health condition
10 CCGs
22.9%
Population aged 0-17 years
7.7% estimated 5-16 year olds
with mental health condition
9 CCGs
19.7%
Population aged 0-17 years
9.6% estimated 5-16 year olds
with mental health condition
12 CCGs
20.0%
Population aged 0-17 years
10.8% estimated 5-16 year olds
with mental health condition
21 CCGs
21.1%
Population aged 0-17 years
10.1% estimated 5-16 year olds
with mental health condition
21 CCGs
21.4%
Population aged 0-17 years
10.3% estimated 5-16 year olds
with mental health condition
19 CCGs
21.5%
Population aged 0-17 years
9.3% estimated 5-16 year olds
with mental health condition
20 CCGs
20.8%
Population aged 0-17 years
9.6% estimated 5-16 year olds
with mental health condition
32 CCGs
22.6%
Population aged 0-17 years
11.0% estimated 5-16 year olds
with mental health condition
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]