Following concerns raised by the LSCB and Ofsted around the outcomes for vulnerable children in Barking and Dagenham across the health and care system, the Board noted the key findings of a review conducted by the Director of Public Health (DPH) to understand the key challenges facing vulnerable children and young people and their access to services. The full report was presented to the LSCB in November 2019, and which was appended under agenda item 16 following the passing of a resolution to exclude the public and press from the meeting.
The DPH stressed to the Board the need to take collective responsibility to address the issues highlighted in the review, the findings from which highlighted in many ways what was already known and which illustrated that in the case of vulnerable children and young people there are gaps in dealing with such high demand which is posing considerable challenges in workforce recruitment in the context of a highly competitive market, when compared to neighbouring boroughs with less challenging environs.
It was noted that a joint meeting was held earlier today between the CCG and the Council to look at the process of achieving more joined up working through commissioning. This should include looking at ways to encourage the Schools Improvement Partnership to take an active part.
By way of example the Chair commented that themes emerging out of the pilot Thames Locality Board shows that the growth in the local population means more vulnerable families require support, and demonstrates why as a Board it cannot ignore the challenge of dealing with the unprecedented demand in this area whilst at the same time making the ‘space’ to look at new ways of delivering services. In this respect transformation monies could be made available through the CCG to create the capacity to allow this strategic thinking to take place.
This will inevitably include improving data sharing between partners, notwithstanding the implications of GDPR, although as the Chair pointed out this should not be seen as a barrier as in most instances the issues of GDPR can be got around.
In the light of the presentation and following the detailed discussion the Board agreed to:
(i) Consider reviewing current data sharing agreements between the partners to provide relevant individual level data for Child & Adolescent Mental Health Service (CAMHs) and Speech & Language Therapy (SALT). This will improve data-driven planning and delivery of care to achieve maximum impact. By facilitating segmentation, stratification and impact modelling to identify local ‘at-risk’ cohorts and, in turn, the designing of more cost-effective integrated arrangements for targeting interventions to improve care and reducing unwarranted variations in outcomes, and
(ii) Consider the need for an agreed whole system strategic commissioning plan that sets out a clear integrated universal and targeted pathway from Tier 1 to Tier 4 setting out clear thresholds for access. Key considerations include:
· working towards a multi-agency autism service/pathway across early help, education, health and social care;
· putting in place an effective behavioural pathway; and
· better use of specialist resources caught up in Section 75 and multi-disciplinary arrangements including Looked After Children (LAC) and the Community Learning Disability Team in this space. This includes reviewing specialist provision for Looked After Children (LAC) within CAMHs as they need to reach Tier 3 threshold before being seen.
· the challenge sits across both children and adults’ commissioning for example, vulnerable children sit in families with domestic abuse and adults with mental health needs.
(iii) Consider the opportunities created by ‘Place based Care’. For example, where the newly created Primary Care Networks can add value through their development of a Social Prescribing offer to enhance comprehensive universal prevention for children, young people and their families, and
(iv) Recommend that the findings be reviewed to ensure improving outcomes for vulnerable children and safeguarding is at the heart of the transformation of programmes by both the BHR Joint Commissioning Committee and the BHR Children and Young People Transformation Board.