Bolton Local Transformation Plan (LTP) Children and Young People's Emotional Health and Wellbeing - Bolton CCG
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Bolton Local Transformation Plan (LTP)
Children and Young People’s Emotional Health
and Wellbeing
2019/20 Refresh
Authors:
Sarah Whitehead, Commissioning Manager, NHS Bolton CCG
Joanne Higham, Head of Strategic Commissioning for Children & Young People, NHS Bolton CCG
Children and Young People’s Emotional Wellbeing and Mental Health
Local Transformation Plan Refresh 2019/20
1. INTRODUCTION
1.1. The Bolton Children and Young People’s Emotional Health and Wellbeing Local
Transformation Plan (LTP) forms part of the overarching Bolton Health and Care Locality
Plan1 which sets out the local vision and aims which directly support the development and
delivery of the Greater Manchester (GM) Devolution programme.
1.2. Mental health difficulties in children and young people are associated with educational
failure, family disruption, disability, offending and antisocial behaviour, placing demands on
social services, schools and the youth justice system. Untreated mental health problems
create distress not only in the children and young people, but also for their families and
carers, continuing into adult life and affecting the next generation. Devolution has enabled
Greater Manchester to collectively respond to the challenges outlined within Future in Mind
(2015) 2and in doing so, make a step change in transforming mental health services for
children and young people living in Greater Manchester.
1.3. Bolton’s LTP has now been in place for four years and is required to be refreshed in order to
describe and reflect on local progress, confirming that funding has been spent in accordance
with the original plan. The refresh provides a high-level overview of the future ambition of
the locality to fully achieve whole system transformation in order to improve outcomes for
children and young people with mental health problems.
1.4. The LTP reflects the strategic vision of Bolton Clinical Commissioning Group (CCG), Bolton
Council, Bolton NHS Foundation Trust (FT), Bolton Community and Voluntary Services,
Bridgewater Community Healthcare NHS FT, Greater Manchester Mental Health NHS FT
(GMMH) and North West Boroughs NHS FT. The plan has been developed with Children
and Young People (CYP) with lived experience of emotional health and wellbeing difficulties
in addition to other key stakeholders such as Bolton Healthwatch who are pinnacle to
system-wide engagement across the Borough. Delivery of the outcomes is only possible with
significant joint working between all these partners and at scale across GM.
1.5. The NSPCC complete a review of all Local Transformation Plans3 with a focus on assessing
the inclusion of therapeutic support/services for children who have experienced abuse and
neglect. The following elements were used to review the LTPs and therefore will be taken
into account for our LTP refresh:
To what extent LTP’s recognise that mental health issues can be attributed to
abuse and neglect
Whether the needs analysis incorporates abused and neglected children
The information contained within each plan relating to existing or proposed
new services for children who have experienced abuse or maltreatment.
1
http://www.boltonccg.nhs.uk/media/3027/bolton-locality-plan.pdf
2
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/414024/
Childrens_Mental_Health.pdf
3
https://www.nspcc.org.uk/globalassets/documents/research-reports/transforming-mental-health-services-
children-experienced-abuse.pdf
Page 1 of 49
1.6. In March 2018, NSPCC released a Local Transformation Plan Toolkit4 which provides
guidance to localities on how to design and deliver mental health services for children who
have been abused. Bolton will use the information provided within the toolkit, in addition to
examples of good practice from 16/17 and 17/18, to enhance the provision across Bolton for
our most vulnerable children and young people.
2. STRATEGIC CONTEXT
2.1. The NHS Operational Planning and Contracting Guidance 2017-2019 5set out the
requirements for CCGs to deliver and implement the Mental Health Five Year Forward
View6. For children and young people, the three requirements include:
By 2020/21, at least 35% of Children and Young People with a diagnosable mental
health condition receive treatment from a NHS-funded community mental health
service.
Commission community eating disorder teams so that 95% of children and young
people receive treatment within four weeks of referral for routine cases; and one
week for urgent cases
Increase access to evidence-based specialist perinatal mental health care, in line
with the requirement to meet 100% of need by 2020/21, and ensure that care is in
line with NICE recommendations
2.2. An overview of Bolton’s current position against the three requirements is detailed below:
At least 35% of Children and Young People with a diagnosable mental health
condition receive treatment from a NHS-funded community mental health
service
2.3. Improving Access to Children and Young People’s (CYP) Community Mental Health Support
and Treatment is a key priority for Greater Manchester (GM) and Nationally. The Five Year
Forward View for Mental Health states that by 2020/21 there will be a significant expansion
in access to high-quality mental health care for children and young people. Nationally this
means that 70,000 more CYP are accessing treatment each year. This equates to almost
4,000 additional CYP in GM being treated over the 2014/15 baseline (applying 2004
prevalence rates).
2.4. In order to model current activity levels the tier 3 population base for 5 – 19 year old have
been taken into consideration.
4
https://www.nspcc.org.uk/globalassets/documents/publications/local-transformation-plans-toolkit.pdf
5
https://www.england.nhs.uk/wp-content/uploads/2016/09/NHS-operational-planning-guidance-201617-
201819.pdf
6
https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf
Page 2 of 49
Figure 1: Children and Young People’s Access Targets from the Five Year Forward View for
Mental Health.
2.5. Below details a snapshot picture of Bolton and Greater Manchester’s progress to delivering
the access target set within the Five Year Forward View for Mental Health. As at October
2018, Bolton were on track to deliver the 2018/19 access target of 32%
Actual Number of Total number of CYP Percentage access
CYP Receiving with a diagnosable rate (2018/19
treatment (YTD) mental health forecast outturn).
condition 2018/19 Target 32%
NHS Bolton CCG 1,470 6,484 32.5%
Greater Manchester 14,605 59,099 35.5%
Figure 2: Total number of Children and Young People receiving treatment as at October
2018 (defined by 2 or more contacts). Source - NHS Digital (MHSDS)
Commission community eating disorder teams so that 95% of children and
young people receive treatment within four weeks of referral for routine
cases; and one week for urgent cases
2.6. Across GM there are currently three community eating disorder services operating out of
four different sites for young people. Work is taking place to ensure all services achieving the
national access and wait time targets by 2020, which current trends would indicate that is on
track, although not currently being achieved.
CYP Eating Disorder Waiting time - Urgent (rolling 12 months - quarterly for national &
regional)
Mar-18 Jun-18 Sep-18
ENGLAND 78.9% 74.7% 81.3%
NORTH OF ENGLAND 78.8% 73.5% 81.6%
GREATER MANCHESTER (ICS) 74.5% 81.0% 90.0%
Page 3 of 49
Figure 3: Children and Young People’s Eating Disorder waiting times for urgent
appointments as at Sept 2018 (Source – NHS Digital)
CYP Eating Disorder Waiting time - Routine (rolling 12 months - quarterly for national
& regional)
Mar-18 Jun-18 Sep-18
ENGLAND 79.9% 81.2% 80.2%
NORTH OF ENGLAND 85.7% 84.2% 83.4%
GREATER MANCHESTER (ICS) 80.4% 82.8% 86.6%
Figure 4: Children and Young People’s Eating Disorder waiting times for routine
appointments as at Sept 2018 (Source – NHS Digital)
2.7. Building on learning each service has developed since being established, the GM CEDS
Steering Group working to support the services to deliver care in a more consistent way
across the conurbation. The aim is to amplify aspects of the services that are working well,
and continue to reduce unwarranted variation between the services. Clinical and operational
staff are meeting monthly, along with commissioners and VCSE representatives to further
develop a GM’s CEDS service specification for autumn 2019 in advance of commissioning
intentions being agreed.
Increase access to evidence-based specialist perinatal mental health care, in
line with the requirement to meet 100% of need by 2020/21, and ensure that
care is in line with NICE recommendations
2.8. Future in Mind (2015) published by the Department of Health prioritised the enhancement of
Perinatal Mental Health Service as a key step to promoting, protecting and improving
children and young people’s mental health and wellbeing.
2.9. NHS England has committed to fulfilling the ambition in the Five Year Forward View for
Mental Health so that by 2020/21 there will be increased access to specialist perinatal
mental health support in all areas of England, allowing at least an additional 30,000 women
each year to receive evidence-based treatment, closer to home, when they need it.
3. GREATER MANCHESTER (GM) COLLABORATION
3.1. As the Greater Manchester Health and Social Care Partnership has established it is clear
that a considerable amount of Future in Mind transformation planning and commissioning is
best done to scale across the GM footprint rather only at a single LA/CCG footprint.
3.2. As part of devolution, Greater Manchester made a clear commitment to develop the current
provision of mental health services, working towards parity of esteem. This includes taking
collaborative action in making full use of the targeted Children and Young People’s mental
health investment in localities, clusters and across Greater Manchester; supporting activity
Page 4 of 49
linked to refreshed Local Transformation Plans (LTPs) devised to deliver the ambition set out
in Future in Mind (FIM) . This guidance emphasises the need for joined-up commissioning
and provision. To support this system alignment, a Greater Manchester Future In Minds
Delivery Group has been instigated as a consortium of all 10 x Greater Manchester Clinical
Commissioning Groups (and will include 10 Local Authorities), with representation from the
Strategic Clinical Network, NHS England Specialised Commissioning and Public Health.
3.3. A number of groups oversee and deliver the required changes (with representation from
Bolton CCG and Bolton Council):
• Greater Manchester Children’s and Maternity Commissioning Consortium
• Greater Manchester Future In Mind (FIM) Delivery Group
• Greater Manchester Mental Health Strategy - Children and Young People’s Mental
Health Board
• Association of Directors of Children’s Services (GM Children’s Services Review).
3.4. This collaborative approach across the 10 Local Authority footprints is enabling the sharing
and implementation of good/best practice, development of consistent care pathways and
quality standards, leading to improved quality and equitable services across Greater
Manchester.
3.5. Working together CCGs/LAs are delivering more efficient use of resources by
commissioning and delivering some services at scale. The costs of Specialist CAMH
Services are unlikely to be reduced, but efficiency will improved as a result of an
implementation of THRIVE informed service delivery which will result in increased
throughput. Additional efficiencies will be delivered by reducing the numbers of
professionals involved in complex families for whom managing risk is the primary
support/intervention.
3.6. The announcements of extra funding to transform mental health services contained within
the autumn statement (December 2014) and Budget (March 2015) were designed to help
areas build capacity and capability across the system so that, by 2020/21, they can make
measurable progress towards closing the health and wellbeing gap and securing sustainable
outcomes for children and young people’s mental health.
4. CAMHS WORKFORCE
4.1. In order to sustain delivering increased access and improved outcomes for children and
young people’s (CYP) mental health – as per the national must do - a significant expansion
in the workforce (and associated investment) is required. Following publication of the Five
Year Forward View for Mental Health (FYFVMH) and more recently Stepping Forward to
2020/21: The mental health workforce plan for England (July 2017)7, Greater Manchester
(GM) is required to hold plans how it will grow the mental health workforce to enable us to
deliver the FYFVMH objectives.
4.2. In addition, GM and its localities have recognised the potential risk to effectively delivering
our ambitious children and young people mental health transformation plans are largely
centred on the workforce.
7
https://www.hee.nhs.uk/sites/default/files/documents/Stepping%20forward%20to%20202021%20-
%20The%20mental%20health%20workforce%20plan%20for%20england.pdf
Page 5 of 49
4.3. In response a £1.4 million investment through GM transformation funding has been secured
to ensure a clear strategy and associate plans are in place to mitigate the known risks. The
Greater Manchester Children and Young People’s Emotional Wellbeing and Mental Health
Workforce Strategy has been developed through consultation and engagement with a variety
of stakeholders that included NHS Providers, Clinicians, CCGs and the GM Strategic Clinical
Network – to name a few.
4.4. The scope of the strategy focuses on the specialist element of CYP Mental Health workforce
– CAMHS. Over time and through the work GM transformation funded GM i-Thrive
programme strategic planning will seek to develop strategies for the wider CYP workforce.
The purpose of the strategy is to outline principles and solutions across four key domains: -
Improving supply and retention
Building skills and knowledge
Talent development and system leadership
Improve workforce welfare and wellbeing
4.5. To date all specialist GM NHS CAMHS services have undergone the Self-assessed Skills
Audit Tool (SASAT) to map their existing provision in order that a clear understanding of
both local and GM gaps are understood. The assessment provides full information on staff
numbers including whole time equivalents, skills and capabilities.
4.6. Building on the SASAT and in order to meet the requirements and those of the Five Year
Forward View for Mental Health and Stepping Forward to 2020/21: The mental health
workforce plan for England, GM as an STP area has to submitted returns to NHS England
on how we are planning to grow the CAMHS workforce to enable us to deliver increased
access and better outcomes.
Allied Total
CAMHS Workforce Expansion Medical Nursing
Health Clinical
Greater Manchester (100%) 9 65 37 111
Bolton (10.1%) 0.9 6.6 3.7 11.2
Bury (6.5%) 0.6 4.2 2.4 7.2
Heywood, Middleton & Rochdale (8.0%) 0.7 5.2 3 8.9
Manchester (21.1%) 1.9 13.7 7.8 23.4
Oldham (8.1%) 0.7 5.3 3 9
Salford (9.5%) 0.9 6.2 3.5 10.5
Stockport (10.0%) 0.9 6.5 3.7 11.1
Tameside & Glossop (8.3%) 0.7 5.4 3.1 9.2
Trafford (7.4%) 0.7 4.8 2.7 8.2
Wigan (11.0%) 1 7.1 4.1 12.2
TOTAL 9 65 37 111
Figure 5: Greater Manchester CAMHS workforce expansion (2016-2021)
Note: Workforce expansion by service area in Full Time Equivalents (FTE). The numbers
provided are based on Public Health weighted capitation formulas to apportion the nationally
agreed figures across Greater Manchester STP
4.7. The enhancement of an additional 111 CAMHS clinical staff across Greater Manchester,
outlined above, will be supported by Greater Manchester Transformation funded uplift of 39
Page 6 of 49
additional clinical posts working within the Greater Manchester Crisis Care Pathway
(REACH-IN). This combined growth sets an ambitious target to grow the workforce by a total
of 150 clinical posts by 2021; ensuring a comprehensive CAMHS (up to 18yrs) to meet the
population needs
Bolton CAMHS Workforce Trajectory
4.8. Bolton CCG and Bolton CAMHS have been working collaboratively to address the proposed
CAMHS workforce expansion targets. The following tables detail a piece of work undertaken
by Bolton CAMHS in January 2019 to describe the current and expected workforce situation
by the end of the Local Transformation Plan funding in 2020/21.
Year One (18/19)
Role WTE
Allied Health Professional 2.8
Admin & Clerical 1.0
Nursing & Midwifery 1.4
Year Two (19/20)
Role WTE
Medical 0.40
Allied Health Professional 0.50
Admin & Clerical 1.00
Nursing & Midwifery 2.00
Year Three (20/21)
Role WTE
Allied Health Professional 3.00
Admin & Clerical 0.30
Nursing & Midwifery 1.00
Figure 6: CAMHS workforce expansion trajectory from 2018/19 – 2020/21
4.9. Based on the information above, a summary of Bolton’s expected workforce increase is
detailed below:
Role* WTE
Medical 0.90
Nursing & Midwifery 4.90
Allied Health Professionals 7.50
Admin and Clerical 3.10
Total 16.40
Figure 7: Bolton CAMHS expected workforce increase by 2021.
*All roles include the additional workforce from the Community Eating Disorder Service
(CEDS).
Page 7 of 49
5. BOLTON CHILD POPULATION
5.1. Over the next five years Bolton’s total population, currently 283,115, will increase by 7,400
people (2.6%), and by 2027 there will be around 12,800 more people (4.5%) resident in the
Borough. The year 2031 is the first year our population will reach 300,000. This is a notably
slower increase than we see nationally (6.9%) but is similar to the changes predicted for the
Greater Manchester conurbation8.
5.2. In general, over the next ten years Bolton’s pre-school and secondary school populations will
reduce slightly while there will be a small increase in the older teens group. The primary
school cohort will remain fairly stable. Over the next five years the only significant change
will be an increase in the secondary school population9
Population change between 2017 and 2030 for 0-19 year olds
2017 2022 2025 2030
Pre- School (0-4) 19,036 18,977 18,862 18,490
Primary School (5 – 10) 23,339 23,415 23,016 23,022
Secondary School (11 – 15) 17,277 19,474 20,108 19,442
Older Teens (16-19) 13,737 13,717 14,861 15,692
Total 73,389 75,582 76,848 76,647
Figure 8: Bolton’s population change between 2017 and 2030 for 0-19 year olds
5.3. The proportion of BME children is growing at a much faster rate than the adult population.
This means that today 27.5% of Bolton’s children are from BME backgrounds. The ethnic
profile of births has also seen a change in recent years with an increase to mothers born
outside of the UK. Latest official data (2014 births) shows that 25.7% (966) of Bolton’s live
births were to mothers born outside the UK (this is similar to Greater Manchester (25.4%)
and lower than seen nationally (27.8%). Of these, the greatest number were to mothers born
8
ONS (2016) Subnational Population Projections, ONS
9
ONS (2016) Subnational Population Projections, ONS.
Page 8 of 49
in the Middle East and Asia (525), followed by the EU (203), Africa (203), and the New EU
(174)10.
5.4. As at March 2018, there were 615 Looked After Children (LAC) for whom Bolton Council has
responsibility. This is 91 children per 10,000. The Looked After Children figures peaked in
Dec 2017 when there were 630 children in care (93.5 per 10,000) This is an increase from
March 2017 when the numbers were 580 (87 per 10,000 of the population) and is in line with
an upward trend over the past 15 years
5.5. The figure below compares Bolton 2018 data with Bolton and North West 2017 data and
highlights that Bolton has similar numbers of Looked After Children to other local areas (86
per 10,000) but the rates are higher than the national average of 62 per 10,000 children
under 18 years.
Figure 9: North West Comparison for Looked After Children per 10,000 population
5.6. A total of 155 of Bolton Looked After Children (25%) are placed out of area which compared
favourably to the national average of 40% and is a reflection of Bolton’s commitment to
placing children closer to home (see figure below). Bolton CCG retains responsibility for
commissioning and monitoring health services for those children who are out of area.
Figure 10: North West Comparison for the percentage of Looked After Children based out of
Borough
10
The New EU. Joined in 2004: Estonia, Latvia, Lithuania, Czech Republic, Hungary, Poland, Slovakia, Malta,
Cyprus (EU), Cyprus (not otherwise stated), Slovenia, Czechoslovakia not otherwise stated. Joined in 2007:
Bulgaria, Romania. Joined in 2013: Croatia.
Page 9 of 495.7. As at March 2018, there were 230 children and young people placed within Bolton by other
authorities of whom health organisations have a duty to provide care11
5.8. Between 2016 and 2017, 187 children have received a Child Sexual Exploitation (CSE)
service; this is an 8% decrease on the previous year. 10% of the young people who received
a service were male; this is a 6% decrease on 2016 but remains percentage points higher
than the 2014 baseline.
5.9. Bolton’s 2018 – 2020 Strategy12 for Child Sexual Exploitation was endorsed by Bolton
Safeguarding Children’s Board and aims to:
Reduce the likelihood of children becoming victims of child sexual exploitation
Ensure action is taken to safeguard children at risk of sexual exploitation
Target, disrupt and prosecute the perpetrators of child sexual exploitation
5.10. Further information can be found in Bolton Safeguarding Children Board’s (BSCB) Annual
Report 2016 – 2017 (Appendix 1). An updated report will be published by March 2019
5.11. As at January 2018, a total of 24,347 children were classed as living in poverty in Bolton13
5.12. At the end of March 2018, Bolton had 3439 open Early Help Assessments (EHA), of which,
1898 EHAs started in the year and equates to 281 per 10,000 children
5.13. 265 children were the subject of a Children Protection Plan:
50% of Child Protection Plans are in place to reduce the risk of harm from neglect
34% of Child Protection Plans are in place to address emotional abuse
6.4% of Child Protection Plans are in place to address physical abuse
5.6% of Child Protection Plans are in place to address sexual abuse
3.8% of Child Protection Plans are in place for multiple reasons
6. NEEDS ASSESSMENT AND ACTIVITY ASSUMPTIONS
6.1 Within Bolton approximately 15,050 young people (aged 5 – 19 years old) may be eligible for
CAMHS services at tiers 1 and 2 (services for more common (less severe) mental health
needs). This is a very inclusive figure which covers children and young people accessing
mental health support in mainstream services (e.g. school nurses) and may include children
with emotional distress but below the threshold for a diagnosable disorder.
6.2 It is anticipated that at any one time around 80-90% of the total population of children and
young people will fall into the needs-based grouping of thriving (based on Green et al (2005).
In order to model the EHWB activity this assumption has been applied to the population of
Bolton;
11
Source – Bolton Council noting this figure is reliant on notifications from other local authorities
12
http://boltonsafeguardingchildren.org.uk/wp-content/uploads/2018/04/Child-Sexual-Exploitation-Strategy-
2018.pdf
13
https://mss.carto.com/viz/064da52a-2edc-4b7b-a709-f3697a5928b0/public_map
Page 10 of 49Objective 2018/19 2019/20 2020/21
80% of the needs based group is thriving and 64% 72% 80%
would benefit from EHWB support only.
Bolton Activity Projections 9,632 10,836 12,040
6.3 There are 4,400 Children and young people (aged 5 – 16) in Bolton who are eligible to be
seen by a NHS funded community mental health provider. Greater Manchester Mental
Health NHS Foundation Trust (GMMH) in partnership with North West Boroughs Healthcare
NHS Foundation Trust (NWB) provide Bolton’s community mental health service for children
and young people aged up to 18 years. A further 1,990 16-19 year olds suffer from a
common mental health problem. Within Bolton there are three community mental health
providers Bolton CAMHS (0 – 18 year olds), IAPT (16 – 18 year olds) and Early Intervention
in Psychosis 14 years old +.
6.4 The Five Year Forward View for Mental Health states that by 2020/21 there will be a
significant expansion in access to high-quality mental health care for children and young
people14. At least 70,000 additional children and young people each year will receive
evidence-based treatment – representing an increase in access to NHS-funded community
services to meet the needs of at least 35% of those with diagnosable mental health
conditions.
6.5 CAMHS activity for 2017/18 averaged at 942 CYP per month and currently averages at 1986
per month based on 8 months of data for 18/19*.
Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Total 2016/17
1091 951 929 874 845 877 956 1086 913 963 966 1072 11523
CAMHS Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Total 2017/18
Activity 774 973 961 944 797 892 991 994 846 1050 949 1141 11312
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Total 2018/19 (Incomplete)
1460 1823 2053 2309 1858 1944 2141 2302 15890
Figure 11: Bolton CAMHS activity per month for 2016, 2017 and 2018.
* Data from April 2018 onwards details the total number of contacts and includes multiple contacts
with the same individual
6.6 The Did Not Attend (DNA) rate for 17/18 new CAMHS appointments averaged at 4.6% which
was a significant improvement from 16/17. DNA rates for 16/17, 17/18 and Year to Date for
2018/19 are below the national average DNA rate.
Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Average 2016/17
Did Not
8.5% 4.0% 5.7% 5.8% 8.0% 8.9% 5.0% 7.1% 3.4% 3.6% 2.6% 5.6% 5.7%
Attend
Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Average 2017/18
(DNA) -
4.1% 5.3% 4.0% 5.0% 4.9% 2.9% 8.7% 5.0% 5.8% 2.5% 3.5% 3.0% 4.6%
New
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Average 2018/19 (Incomplete)
Appts
6.0% 2.8% 3.9% 4.8% 6.2% 3.7% 2.3% 3.0% 4.1%
Figure 12: % of appointments which resulted in a Did Not Attend outcome for 2016, 2017
and 2018.
6.7 The introduction of a text-based appointment reminder service continues to benefit children
and young people who are supported by CAMHS. Approximately 95% of children and young
people are signed up to this automated service.
14
https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf
Page 11 of 496.8 Additional work needs to be undertaken to further clarify and develop whole-system
pathways. The work plan for 19/20 includes:
Continue to monitor data to ensure that CAMHS referrals are appropriate and that
children and young people access IAPT and Early Intervention in Psychosis (EIP)
age appropriate services.
Develop whole system pathways for Anxiety, Depression, Self-Harm and ADHD
Continue to implemented the recommendations from the Thematic review of young
suicides in Bolton
7. GOVERNANCE
7.1 The governance structure to oversee the implementation of the CYP Emotional Health and
Wellbeing transformation plan has recently been strengthened to include the wider children’s
agenda. The LTP transformation will now be driven through the Emotional Health and
Wellbeing Transformation Steering Group comprising of representatives from partners,
stakeholders, provider, parents and young people from across the locality. This group will
support the development and provide oversight with scrutiny to those schemes identified to
deliver the CAMHS Transformation Plan. This group meets on a monthly basis and feeds
directly to the newly developed Integrated Children and Families Steering Group with reports
submitted to the Mental Health Strategy and Planning Group.
Figure 13: Bolton’s governance structure for children and young people’s mental health
7.2 The Integrated Children and Families Strategic Group (formerly Children’s and Maternity
Strategy and Planning Group) also meet on a monthly basis with senior representation from
the whole system including commissioning, NHS providers, Voluntary and Community
Page 12 of 49Sector, Children’s Social Care, Education and parents, and feeds directly into the Bolton
System Accountability Meeting.
7.3 The overarching outcome for the Integrated Children and Families Strategic Group is:
“Giving our children the best possible start in life, so that they have every chance to
succeed and be happy”
7.4 Key objectives of the Strategic group include, but are not limited to:
To ensure fair and equitable access to services
To ensure clinical sustainability
To ensure services are focused on early intervention and prevention
Commissioning and delivery of high quality, evidence-based services and
interventions
Developing sustainable and consistent service provision
Providing care closer to home where clinically and financially possible
Streamlining pathways to ensure seamless delivery of care and positive patient
experience
Working with patients and the public to co-produce future service models to meet
the needs of the Bolton population
Support financial sustainability
Feed into the wider Greater Manchester and Bolton transformation work
programmes
7.5 The Bolton System Accountability Meeting comprises of chief executives and senior
representatives from Bolton health and care organisations. The role of this meeting is to
provide system oversight of finance, performance and outcomes in order to drive the
changes through to the Health and Wellbeing Board. This framework of oversight and
scrutiny continues the theme of continuous improvement by leadership members from each
organisation providing the transparency and governance at each stage through to Health
and Wellbeing Board.
7.6 Appropriate Governance documentation including clear terms of reference, risk registers,
action logs and reporting templates are in place to support the continued scrutiny of this
work programme ensuring that the focus on outcomes for children and young people
remains a key priority.
7.7 Bolton’s refreshed LTP has been further strengthened by its continued commitment to the
alignment governance and transparency processes detailed within the Greater Manchester
(GM) Mental Health Strategy15. This GM Strategy forms part of the GM shared Health and
Social Care Partnership (HSCP) which is derived from the 10 GM CCG’s and Councils and
is strengthened further by representatives from NHS England Specialised Commissioning
and Public Health.
7.8 The Greater Manchester strategy focuses on:
Prevention - with an understanding that improving child and parental mental health and
wellbeing is key to the overall future health and wellbeing of our communities.
15
https://www.greatermanchester-
ca.gov.uk/downloads/file/161/greater_manchester_mental_health_strategy
Page 13 of 49 Access – improving our ability to reach all the people who need care and to support
them to access timely and evidence-based treatment.
Integration - many people with mental health problems also have physical problems.
These can lead to significantly poorer health outcomes and reduced quality of life.
Through the strategy we will aim to achieving parity between mental health and physical
illness.
Sustainability - In order to effect change for the long term the strategy will build on
evidence from the innovations which have proven to have impact either in Greater
Manchester or elsewhere, to challenge the way we plan and invest in mental health
7.9 Bolton is committed to inclusion both at a local level with our Bolton partners but similarly
within the shared values of the framework of the GM HSCP Health and Wellbeing Strategy
who have incorporated a whole system approach to meeting the individual needs of each
member of the GM community; with the mental health needs of children having key priorities.
7.10 We will collaborate with GM’s other local transformation partnerships to further develop and
implement a single performance and outcomes framework. The planned GM framework will
draw from the best practice already developed by local transformation partnerships, and will
be informed and shaped by the voices of children and young people. (Patient reported
outcome measures).
7.11 The GM outcomes framework and overall work programme will also be informed by learning
from the children and young persons’ IAPT programme and through continued work with
local transformation partnerships to peer review and challenge implementation progress,
spending and impact of transformation ambitions.
8. CHILDREN AND YOUNG PEOPLE INVOLVMENT AND ENGAGEMENT
8.1 Bolton continues to be committed to the involvement and engagement of children, young
people and their families in the development and implementation of the transformation work
plans that form our LTP. Engagement with Children, Young People, Parents/Carers and
Stakeholders forms the basis of our need for change, development and continuous
improvement.
8.2 Recognising that further work was required in our approach to engagement with children and
young people we have listened and been active in our commitment to further develop this
area of the work programme. This has included, for example, commissioned engagement
projects through our Voluntary Sector Providers to engage children and young people who
experience mental health difficulties to actively “tell us”, through a variety of methods.
8.3 During its initial stages, the CAMHS transformation plan was co-produced as a result of the
Building Health Partnerships programme which ran during 14/15 – 15/16. Four events were
held during this period and representation was sought from:
Children and young people with lived experience of mental health services
Bolton VCSE
Local authority
CCG
NHS providers
8.4 The action plans from the Building Health Partnerships were presented to Bolton’s Youth
Council who prioritised the actions which were then transposed to the Bolton’s LTP.
Page 14 of 498.5 Children and young people continue to be central to our engagement process; ensuring we
have a robust transformation plan; we have led on a number of projects including:
Procurement of a new CAMHS provider for Bolton with a young person
representative on the panel
Thrive small investments allocated by children and young people
Development of an Anti-stigma campaign
Development of a mobile app which supports action planning with CAMHS
Describing the vision of the new CAMHS pathways through a variety of forums
One young person has been filmed explaining his involvement with Building Health
Partnerships and this film was showcased on the Building Health Partnerships
national roadshow during 16/17.
Children and young people have contributed to the development of an investment
panel to review ideas and innovations from a range of voluntary sector organisations
and supported agreement for funding of small investment opportunities aimed at
improving outcomes for children, young people and their families across the borough
8.6 We have also and continue to sought evidence from our partner agencies about how Bolton
children and young people view our services; Bolton Young Voices group based at Bolton
CAMHS meet regularly and their opinions are shared with the CAMHS Steering Group
through the CAMHS Participation Lead.
8.7 A comprehensive consultation of Bolton CAMHS took place during 2016 by our partner
Healthwatch Bolton; who identified themes for improvement which have formed the basis of
our refresh of the Local Transformation Plan. Bolton CVS were commissioned to facilitate
engagement with the community and voluntary sector in Bolton and spoke to a range of
partners including groups working with young people with experience of mental health
services to inform the new CAMHS Model.
8.8 In 2017, Healthwatch Bolton also produced an engagement report on Young Carers in order
to provide an insight into their day to day lives and the challenges they face16. Following this,
two events were organised in January 2018 for Young Carers Awareness Day to showcase
the engagement work, celebrate the support that Young Carers offer in Bolton and to
encourage key stakeholders to work together to improve the emotional health and wellbeing
support for Young Carers. This work is driven by the Young Carers Partnership Group which
reports into Bolton’s Carers Partnership Board.
8.9 Through the development of robust engagement processes, aligned reporting and joined up
governance processes the outcomes of Bolton children and young people’s remain a key
strategic priority. The increasing level of quality monitoring processes and systems which
both recognise and affect change such as ROM (routine outcome measurement) which is
embedded within CAMHS quality monitoring and reporting, continues to reflect the vision of
constant quality that Bolton continues to strive for.
8.10 Whilst we have incorporated schools and colleges within our engagement for CAMHS re-
design and re-development we recognise that active engagement within schools, colleges
and early learning establishments is a process of continuous engagement, review reflection
an change in order that we can support the emotional wellbeing needs and children and
16
http://healthwatchbolton.co.uk/wp-content/plugins/download-
attachments/includes/download.php?id=1654
Page 15 of 49young people alongside children and young people who may have these needs alongside
mental health needs.
8.11 In December 2018, a collaborative CYP Emotional Health and Wellbeing Stakeholder
Engagement Event was delivered by Bolton CCG, Greater Manchester Mental Health
Foundation Trust and North West Boroughs Foundation Trust. This event was based around
Thrive Principles and aimed to provide an opportunity for all staff across Health, Social Care
and Education to understand the strategic landscape around Children and Young People’s
Mental Health. A key piece of feedback from the CAMHS re-procurement was that
stakeholders did not know what provision was available across Bolton to support the
emotional health and wellbeing of children and young people; therefore, the event aimed to
showcase a variety of organisations who are funded through Bolton’s Local Transformation
Plan. Further information can be found on page 31.
8.12 The Greater Manchester Health and Social Care Partnership (GMHSCP) have agreed to an
overarching engagement framework which makes the commitment to securing expertise by
experience into each of the Greater Manchester (GM) based programmes.
8.13 In February 2018 the Youth Combined Authority (YCA) was established; the YCA is part of
the Greater Manchester Governance structure and gives young people under the age of 18
years, the opportunity to shape, influence and scrutinise Greater Manchester’s practice,
policy and plans. The YCA is made up of two representatives from each of the ten Local
Authority Youth Councils and two representatives from each of ten additional selected
organisations from across Greater Manchester all of whom are committed to youth voice and
social action. The YCA is supported by the Mayor’s office and co-ordinated by Youth Focus
North West.
8.14 The YCA has elected a Health Working Group made up of members of the YCA and
additional interested young people from the constituent groups and localities. The priority
theme of the YCA Health Working Group is Mental Health with the following work streams:
Stigma, challenging perceptions and raising awareness
Quality, making services young people friendly, both those provided within the NHS
and other agencies.
Training for professionals and young people on supporting young people (i.e. Mental
Health First Aid training) within the NHS and other agencies.
Spreading good services across Greater Manchester and addressing the postcode
lottery.
8.15 Children and Young People from January 2019 are represented as members of Greater
Manchester Children and Young People’s Mental Health Board (GMCYPMH Board, which
seeks to support the young people’s priorities as far as possible through coproduction
principles.
8.16 Members of the GMYCA and the Health Working Group will consider the needs of the
diverse nature of young people and consider accessible methods to gather views of young
people who may not feel comfortable in a meeting environment by:
Identifying stakeholders and people who have contact with young people; youth
workers, organisations
Use the information gained from their host organisations and by speaking to other
young people
Page 16 of 49 Conducting surveys and focus groups
Keep young people updated via the GMYCA Communications Strategy
Social media
Use a range of different platforms to spread information, because not all young
people use social media
Twitter – live chat hashtags
Link in with Health-watch champions
Presentations in schools and colleges
8.17 In addition work and training has been initiated to improve shared decision making by
empowering young people voice’s in their own treatment decisions about their individual
mental health and care and treatment. Shared decision making is a central element of the
GM i-Thrive programme.
9. BOLTON AMBITION
9.1 Bolton is committed to the needs of all children and young people and notably those who
may experience mental health difficulties; we have considered our original Local
Transformation Plan and in light of the views of our children, young people and their
supporters and we have recognised the further development required. There is a clear
expectation that through the delivery of our LTP, we will achieve a significant expansion of
provision and access to high quality mental health and wellbeing support for our children and
young people and those who care for them. This means we must put them at the very heart
of all that we do and remain focused on ensuring better outcomes, experiences and delivery
of services that meet their needs.
9.2 As described above, we are working in a collaborative, integrated system that has and
continues to require a comprehensive system wide approach. The key to delivery of the
Bolton Vision 17to significantly improve outcomes with a far greater emphasis (including
investment) in prevention and earlier intervention. This programme of system change will
continue be delivered through a phased approach that addresses whole scale system
changes and the development of a culture which encourages sustainability. We also
acknowledge that this approach holds a number of challenges and as such we are aligning,
driving and supporting changes at a Greater Manchester level.
9.3 We have worked with our colleagues in GM Crisis Care Partnership steering group and have
been committed to making the necessary changes to how we support young people and
children with mental health needs experiencing crisis. The developments in the Rapid
Assessment, Interface and Discharge (RAID) process are one area that Bolton has sought to
be committed and offer leadership. Bolton was integral to the development of a new On Call
Mental Health Liaison Service for children and young people (previously CAMHS on call);
ensuring that safe crisis care is provided for Bolton children and those in Greater
Manchester irrespective of what day, time of day or place that the child or young person
presents in crisis.
9.4 Through Bolton’s whole service audit and refresh along with its commitment to a Greater
Manchester vision for children and young people with mental health need; Bolton is
committed to ensuring that the services we commission seek to empower and strengthen the
experiences of Bolton children. Ensuring that Bolton children and young people have a
positive experience of childhood and develop a strong sense of person, resilience and
wellbeing.
17
http://boltonvision.org.uk/
Page 17 of 499.5 Bolton has sought to eliminate the boundaries and challenges that the current mental health
service tiered care service model has embedded, This current tiered care systems has at
times restricted and limited the ability of a child or young person being seen by the most
appropriate person or service; at the most appropriate time or suitable place.
9.6 Bolton has adopted the THRIVE Model of developing an emotional well-being and mental
health service for children, young people and those who care for them that is supported by
locality wrap around service.
Figure 14: Thrive model of emotional health and wellbeing
9.7 The THRIVE framework18 was developed through research by the Anna Freud National
Centre for Children and Families and Tavistock and Portman NHS Foundation Trust as the
basis of their redesign approach to establishing a system to support CAMHS transformation;
and is embedded in the NW North West (NW) Strategic Commissioning Network (SCN)
which we are committed to.
9.8 The THRIVE Model will replace the tiered model of care and support with a comprehensive
therapeutic model which aims to be reflective of need and reactive to a child or young
persons need in Bolton as summarised below;
THRIVING – Global Emotional Health and Wellbeing (EHW) sessions within community
venues. Developing specific tailored EHW packages for the most vulnerable within the
community for example BME, Not in Education Employment and Training, youth
offenders and Looked After Children. To support this work it is anticipated that 15 – 20
% of specialist nurse/consultant support would be required.
GETTING ADVICE (COPING) - Prevention services across 7 days accessible through a
range of mediums and in a range of settings including the utilisation of the voluntary
sector youth clubs. One off low level intervention and signposting to other services.
GETTING HELP - Early Intervention and improved and timely access to support for a
young person in distress. Aimed at reducing risk and enhancing early interventions. This
evidence based approach will be underpinned by enhanced training and support for
multi-agency teams who may be first responders or who are already engaged with the
young person. Training will be via utilisation of MindEd within group sessions supported
18
http://www.implementingthrive.org/about-us/the-thrive-framework/
Page 18 of 49by CAMHS professionals, supervision will be accessed via CAMHS and adult mental
health voluntary sector providers.
GETTING MORE HELP – Access to specialist services for example Eating Disorder.
Follow up and prevention of future crises through effective multi-agency care planning,
improved access to evidence informed interventions and increased delivery of help in
community settings including a young person’s home.
GETTING RISK (INTENSIVE) SUPPORT – A flexible crisis response with access to risk
assessment, advice and support 24:7 from a confident and well trained multi-agency
workforce with access to appropriate hospital and community based places of safety
and/or intensive home treatment teams who can support young people in crisis in their
own homes.
9.9 We will use the THRIVE framework to develop an emotional well-being and mental health
offer for children, young people and those who care for them that is supported by locality
wraparound services and provision that seeks to prevent a journey of escalation and/or
increasing severity and complexity
10. THE BOLTON JOURNEY – 2018/19
10.1 Utilising the local transformation funding, Bolton has made progress and invested in
expanding the capacity of CAMHS to ensure appropriate access for CYP in a timely manner.
In addition, investment and service development have commenced within our community
and voluntary sector provision as well as early help and intervention within other settings
such as schools. A summary of the main work stream areas from 2018/19 is detailed below.
2018/19
Emotional Health and Wellbeing Training
10.2 Our partnership, like all across Greater Manchester, is continuing to promote the MindEd e-
learning platform as a training resource for the whole workforce. MindEd is an educational
resource for children, families and professional produce by the Royal College of
Psychiatrists website19: MindEd has been included in the approved training programme for
Bolton local authority funded schools. This approved training programme will also be shared
with independent schools within Bolton.
10.3 Plans are to be developed to commence the systematic roll out of the MindEd tool to all
children’s services in Bolton by utilising Local authority and voluntary sector links. A
continuous rolling training programme will be developed to ensure that skills are kept up to
date and that training needs are being met.
10.4 Bolton continues to progress the development of a mental health competency framework for
all staff working with children and young people. The aim of this will be to ensure that all
organisations can identify the level of training required for each staff group and also know
where to access the training. The competency framework will allow us to identify gaps in
training provision and assist with collaborative working across Bolton to commission new
training opportunities.
10.5 Due to the enormity of a full CYP Mental Health training framework, Bolton’s Children and
Young People’s Emotional Health and Wellbeing Transformation Group have agreed the
following training priorities:
19
https://www.minded.org.uk/
Page 19 of 49 Suicide Prevention and Self Harm
Adverse Childhood Experiences (ACEs) – Trauma aware and Trauma informed
Wider workforce training on Children and Young People’s Mental Health
10.6 Within our Workforce Development Work Stream, assumptions have been made on the
demand within Bolton. The resulting local workforce plans will be fed into Bolton's Strategic
workforce group via the Integrated Children and Families Strategic Group. The workforce
development programme is currently being developed which includes
Develop and enhance the skills and knowledge of Bolton’s community voluntary
sector workforce
Promoting CAMHS and assisting in the recruitment and retention of staff
Promoting the CYP IAPT model and recruiting a wider community workforce
Development of an all age liaison psychiatry model
Feeding into the wider GM workforce development
Development of a GM IThrive hub.
10.7 Bolton have utilised the following Greater Manchester Training initiatives to support the local
workforce:
GM i-THRIVE Training Academy
o 6 staff members attended the Shared Decision Making training which took place
in January 2019.
Transforming Care for Children and Young People
o Greater Manchester have been chosen to become an accelerator site for
Transforming Care for Children and Young People.
o As a result GM has been allocated some money from NHSE to support
implementation of the Transforming Care model and one of the key aspects of
this is embedding a risk support model for CYP with LD and autism in every
locality
o A total of 20 staff have signed up to this training across Health, Social Care and
Education
Children and Young People – Increasing Access to Psychological Therapies
10.8 The Children and Young People’s Improving Access to Psychological Therapies programme
(CYP-IAPT) is a change programme for existing services delivering CYP mental health care.
It aims to improve outcomes and experience of care for children, young people and their
families by increasing access to effective services and evidence-based therapies through
system-wide service improvements.
In order to deliver the improvements in access to effective care for at least 70,000 children
and young people, CCGs and provider organisations will need to continue increasing the
skills of existing staff and develop a new workforce, embedding the CYP IAPT principles and
ways of working across teams
Page 20 of 49Below demonstrates Bolton’s CYP-IAPT contribution since 2016. Bolton have met the 20/21
CYP-IAPT target of 9.4
Figure 15: Bolton’s CYP-IAPT contribution
5–19 Children and Young People’s Integrated Health and Wellbeing Service
10.9 The 5–19 Children and Young People’s Integrated Health and Wellbeing Service provided
by Bridgewater Community Healthcare NHS Foundation Trust and commissioned through
Public Health has been operational since December 2015 and brings together a range of
teams to deliver a cohesive package of care for children and young people in Bolton.
10.10 The service provides the following support teams to children and young people within
Bolton:
School Nursing
Immunisation and Vaccinations
Healthy Schools
Looked after Children & Safeguarding
Family Health Lifestyle
360˚ Young People and Families Substance Misuse
The Parallel
10.11 The 5-19 service will continue to develop a programme of work promoting emotional
wellbeing through the school-aged years working alongside Children and Young People to
identify and support those with emotional and mental health difficulties with clear referral
process to CAMHS where appropriate. The key areas of this developing work include;
Processes, support and training to identify any mental or emotional health issues and
develop appropriate Brief Interventions and onward referral as required.
Development of training for Children and Young People focusing on improving
emotional Wellbeing, resilience and survival of life events and access to appropriate
emotional/mental health support.
Further enhance provision of emotional/mental health support in Educational Settings
for those Children and Young People identified as ‘thriving’ ‘getting advice’ and
‘getting help’ under the Thrive model, but not requiring a referral to the CAMHS
service.
10.12 CAMHS nurses have also been recruited to provide school support with mental health
education and training and providing a link into the specialist CAMHS service. It is
anticipated that these nurses will also provide support to staff who deal with the most
vulnerable children for example Looked after Children, pupils referred to the pupil referral
unit (PRU) and excluded children.
10.13 As part of a fully integrated Children’s Health and Wellbeing Service, the 5-19 service
commissioned through Public Health went out for procurement in September 2018. A
collaborative service specification based upon Thrive principles was developed between
Bolton Council and Bolton CCG with wider multi-agency contribution to ensure whole-system
emotional health and wellbeing pathways are further strengthened.
Page 21 of 4910.14 The contract for the 0 – 19 Integrated Children’s Health and Wellbeing Service was awarded
in January 2019, with service transfer set to take place in April 2019.
GM Children and Young People’s Crisis Care Pathway - REACH-IN
10.15 Bolton CCG have and continue to be actively involved in the GM Crisis Care pathway
20
development programme around access to 24:7 Mental Health provision and 7 Day
Community Provision for Children and Young People (CYP).
A Greater Manchester Transformation Fund £ 13.3m proposal was approved in December
2017, which held the vision to develop a GM-wide whole system crisis care pathway which
will provide a high quality and timely response to young people in crisis and their families,
accessible across 7 days. The pathway will be fully inclusive, have open access, be holistic
and multi-agency and provide a timely and proportionate response based on need.
In 2018/19, extensive work was undertaken to begin to operationalise the model, engaging
with partners across GM, recruiting staff and designing clinical pathways and protocols.
For 2019/20, the overarching aim is to launch of all elements of the pathway, completing
recruitment and beginning to accept referrals. By the end of this financial year, Rapid
Response Teams will be available 24/7 across GM, reducing demand on A&E and
community CAMHS and improving the experience of young people and their families.
As a key partner we will continue to support this vital work as it progresses. For further
information please go to: https://www.penninecare.nhs.uk/gmccp/
Figure 16: The components of GM Crisis Care Pathway for Children and Young People
20
https://www.penninecare.nhs.uk/gmccp/
Page 22 of 4910.16 To deliver this priority, a whole system approach is required that includes bringing together
commissioning, simplifies the provider system, includes involvement from the independent
and third sector and holds children and young people and those who care for them at the
heart of change. This whole system change has already started and will continue into
2017/18.
All Age Mental Health Liaison Service (Formerly Rapid Assessment Interface
Discharge (RAID))
10.17 As of 9th April 2018, Bolton were the first locality in Greater Manchester to go live with an All
Age Mental Health Liaison service to assess and support Children and Young People under
the age of 16 who present to Bolton Children’s A&E department in mental health crisis.
10.18 Bolton All Age Mental Health Liaison Service, delivered by Greater Manchester Mental
Health NHS FT will also undertake initial assessments on the Paediatric Wards at Royal
Bolton Hospital when it has not been possible to undertake the assessment in the A&E
department.
10.19 The table below shows the total number of assessments which took place for children and
young people aged 16 and under presenting at A&E in mental health crisis
Number of Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Total
completed RAID
assessments for 16
20 29 26 28 12 20 26 37 198
years and under
Figure 17: Total number of RAID assessments taking place for children aged 16 and under
10.20 Bolton continues to support the rollout of All Age Mental Health Liaison across Greater
Manchester including the development of a set of GM standards to ensure consistency of
provision across each of the 10 localities.
Greater Manchester Tier 4 (inpatient) CAMHS
10.21 The NHS England National Commissioning Committee approved the delegated
responsibility of CAMHS Tier 4 General Adolescents (GA) and Eating Disorders (ED)
Services to the devolved Greater Manchester Health and Social Care Partnership
(GMHSCP) Chief Officer.
10.22 This enables Greater Manchester (GM) the ability to make key decisions around specialised
Child Adolescence Mental Health Services (CAMHS) that will deliver cohesive pathways
across the full spectrum of general mental health and eating disorders. Also enable creative
solutions to service design to be pursued – in keeping with the national direction for
specialised mental health services.
10.23 In this context, the GM delegated responsibility of CAMHS Tier 4 GA and ED commenced on
1st April 2018 and work is being undertaken to develop clear commissioning objectives that
maximises the effectiveness of the GM New Care Model and the efficiencies within the areas
of responsibility.
10.24 In support the GM CYP Crisis Care Pathway – REACH-IN pathway aims to dramatically
improve the overall experience and outcomes for children and young people in crisis with
mental health issues, along with those who care for and work with them. The work includes a
new Tier 4 Assessment centre for managing referrals into specialist CAMHS inpatient bed.
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