1. ‘Are we listening?’ Sabina Hafesji Regulatory Policy Officer (mental health)
Are you really listening?
Review of children and young people’s mental health services
#WeAreListening

2. CQC’s purpose and role
We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve
Register
Monitor and inspect
Use legal powers
Speak independently
Encourage improvement
People have a right to expect safe, good care from their health and social care services
Strategy Slides - 24 May MASTER

3. Inspecting Children’s Health and Safeguarding
Inspection of children’s health and safeguarding as part of CQC’s regulatory activity in:
Acute and Community Health services (also specialist mental health service inspections – CAMHS)
Primary medical Services and Integrated care
Specialist Children’s Inspections under our Review powers
Children Looked After and Safeguarding Inspections
Joint Targeted Area Inspection programme
Special Educational Needs and Disability Inspection programme

4. Mental health inspections
Child and adolescent mental health wards
Child and adolescent mental health services (CAMHS) may assess and treat children and young people as an inpatient in hospital. This may be when community-based services cannot meet their needs safely and effectively because of their level of risk and/or complexity and where they need 24-hour nursing and medical care.
Specialist community mental health services for children and young people
Specialist community child and adolescent mental health services (CAMHS) provide assessment, advice and treatment for children and young people with severe and complex mental health problems. They also provide support and advice to their families or carers. Services are usually multi-disciplinary teams of mental health professionals providing a range of interventions in the community, working with schools, social care, charities, voluntary and community groups.

5. Our core work in Children and Young people’s mental health
Current Core Service rating for all NHS trusts and independent hospitals
Child and adolescent mental health wards (60)
Specialist community mental health services for children and young people (67)
24 January 2018

6. Children and young people’s mental health
Mental health problems affect approximately 1 in 10 children and young people
But estimates suggest only 25% to 35% of children and young people who need support for their mental health can access services
Our phase one report highlighted that 50% of children and young people that are referred to CAMHS are not accepted for treatment
#WeAreListening
Sources: NHS England, Five Year Forward View for Mental Health: One Year on, 2017 | Department of Health and Social Care, Future in Mind, 2015 | NHS Benchmarking Network, CAMHS Benchmarking, 2016

7. Jen’s story
Jen’s school noticed that she was showing signs of mental health problems. The school referred Jen to the specialist child and adolescent mental health (CAMHS) service. A few months later, a local authority social worker also became
involved in supporting Jen’s family, and adult mental health services started helping Jen’s dad.
Extract from: Are we listening?, Care Quality Commission, March 2018
#WeAreListening

8. The journey January 2017 - Review commissioned by the Prime Minister
October 2017 – CQC published Phase One based on existing evidence
New fieldwork from 10 areas across England
March Phase Two report published
#WeAreListening

9. https://www.youtube.com/watch?v=jEIYxPpVNS w&feature=youtu.be
What we found
w&feature=youtu.be

10. #WeAreListening

11. A complex system with many players
Local players
National players
Schools
GPs
Specialist CAMHS services
Local ‘early help’ services that support families to address problems early on
Voluntary and Independent bodies
Emergency Department staff
Social workers
Police and youth justice service
Housing providers
Department of Health and Social Care
Department for Education
Ministry of Housing, Communities and Local Government
Department for Work and Pensions
Home Office
Ministry of Justice, the Ministry of Defence
HM Treasury
Regional players
Sustainability and Transformation Partnerships (STPs)
Clinical Commissioning Groups (CCGs)
Local authority commissioners
Health and Wellbeing Boards
Integrated Care Systems
#WeAreListening

12. How did we collect our findings?
Fieldwork across 10 local areas in England
Direct engagement with children and young people
We spoke to over 1,300 people across the system including mental health professionals and children and young people
Tracked how children and young people moved through the system
#WeAreListening

13. A system under pressure
Signs and symptoms of a system under pressure
Significant gaps in provision
High eligibility criteria
Staff shortages
“I waited 18 months to get the help I need” – Young Person
Pressure on the system
#WeAreListening

14. Person-centred care is key to overcoming barriers
‘despite the system, not because of it’
‘Where there was a conflict in policy and procedure between partner organisations, staff would place the young person at the centre of the discussion and focus on finding the solution’ CQC Reviewer
#WeAreListening

15. Enfield – case study example
Role of the school
CAMHS referral
Involvement of social care/local authority
Working with the family
Regular joint meetings
Third sector/charity involvement
Continuation of support

16. Southwark – case study examples
COORDINATED CARE
Proactive GP
Case coordinator
Family support
Help in the local area
Communication
A WHOLE-SCHOOL APPROACH TO PROMOTING WELLBEING - Cobourg Primary School in Southwark in South London
Pilot on wellbeing - whole-school approach
Working with SLAM
Techniques for managing feelings and behaviour
Working with parents

17. Recommendations: local and regional
A shared local ‘offer’ from Health and Wellbeing Boards
Commissioners must demand better data
Commissioners and providers must draw on evidence and good practice to drive local improvement
Regional:
STPs and Integrated care systems must collaborate beyond the boundaries of health and social care

18. Recommendations: national
The Secretary of State for Health and Social Care should drive joint action across government with an inter-ministerial group on mental health
We welcome the National Audit Office’s value for money study on children’s and young people’s mental health across the system
Government, employers and schools to ensure everyone working with children and young people are trained to promote good mental health
Ofsted should recognise and assess schools’ role in supporting children and young peoples mental health

19. What are we doing next?
To focus on mental health in the next Joint Targeted Area Inspection (JTAI).
To strengthen our focus on children and young people’s mental health with Ofsted through our SEND programme
To report on the progress of our recommendations in 2019/2020.
#WeAreListening

20. If you’d like to hear more…
#WeAreListening
@CareQualityComm
#WeAreListening

21. Thank you www.cqc.org.uk enquiries@cqc.org.uk @CareQualityComm
Generic ASC deck (June Final)