The Chairman will allow members of the public to ask a question or make a statement about any matter on the agenda for this meeting. These questions may be taken during the meeting, when the relevant agenda item is considered, at the Chairman’s discretion.
Questions were received for agenda items and these were heard at the time the Committee considered that agenda item. Where the questioner was not able to ask the question in person the question/s were read aloud by the Council’s Monitoring Officer.
Item 6 – Hospital Admission for Self-harm in Somerset
Somerset Parent Carer Forum ask:
In your report you highlight that there is a view that “you have to attempt suicide to get treatment”. At the forum we are sad to confirm this is the view held by many families due to their own experience or what they hear from other families. We are regularly told by families that they have been referred to CAMHS but that the referral has been unsuccessful, and they have been given no other advice other than you don’t meet the threshold. What plan do you have to address this?
Self harm is clearly a sign of emotional distress, but not necessarily mental illness, the DPH annual report focuses of the high number of children presenting at A&E with self harm and then being admitted. However, we believe that the solution is in intervening earlier and teaching children about positive coping skills (many of which are already being used by children which we know from the HWB survey) and also ensuring support is available beyond the borders of specialist services. The comments about accessibility made in the report were also followed by a recognition that many people refer to CAMHS because they are not aware of other services that might in fact meet the needs of the child more appropriately.
The problem in our view is not with CAMHS but with the system as a whole. This report wanted to highlight the fact that mental health needs to be everybody’s business and we need support of the Forum to help us find ways to meet these needs. On a practical note one thing we have done since the report is to bring together service providers of early intervention mental health services for children and young people. Forty organisations came together and there are now plans to produce details of those services in an easily accessible place for parents and to look at ways they can work better together.
Somerset Parent Carer Forum ask:
Another area of concern is the families that have children who are self-harming, are being told that because the child is autistic they do not have mental health needs and children are being discharged from CAMHS because they are awaiting an ADOS. Does the data collected allow Somerset to have a clear understand of the links between self-harming, Autism and mental health needs so as to commission the needed support for this group?
No I am afraid the data is only collected at a high level and so there is no other medical information attached to this data. I think we should feed this information into the CAMHS commissioning group, which my colleague from the CCG James Slater leads . Issues of diagnoses and on-going mental health problems related to self-harming behaviour were not in scope for any condition. The on-going multiagency (CCG and SCC PH and educational psychology) work around self-harm prevention will be inclusive but any information the Forum has to illustrate how self-harming behaviour is different in relation to children and young people with autism would be welcome.
Somerset Parent Carer Forum ask:
Pages 23-25 highlights the use of schools to support children and young people’s mental health needs. The forum has recently completed a project for NHS England collecting case studies of families who have experienced tier 4 CAMHS services. One of the things that came from that is that schools were unable to implement the recommendations from CAMHS constantly due to capacity. This lead to an escalation which resulted in admissions. How realistic is it that all schools will be able to implement the framework and how are you going to avoid a postcode lottery resulting in some schools not doing so?
Excellent questions, which I think is in 2 parts, there is a tiny proportion of Somerset children who require support at the highest level of specialist support (less than 100) this service is commissioned by NHS E and again I suggest we feed back this information through the CAMSH commissioning group to NHE E, as we know frm children living with a whole range of conditions frm asthma, diabetes and cerebral palsy, a school care plan that is deliverable is so important to enabling them to be at school, make friends and learn – as every other child has the right to do, a recommendation of the suicide review of CYP was that chilkdrne in receipt of CAMHS had a school care plan – to enable the school to manage risk in an informed way
The Somerset Wellbeing Framework is about a whole school approach to mental health and was developed in consultation with schools, young people and CYP practitioners over an 18 month period. It aspires to change the culture of schools and embed an ethos where mental health is regarded as everyone’s business. Inevitably a culture change of this kind will take time to happen but already we can see that this work resonates with schools, the framework was launched in June 2018 and already 41 schools are actively working through the Wellbeing Audit tool with many more registered on the website and using the information and resources to support staff development.
We are conscious that capacity is and will remain an issue with schools being able to manage what they do to educate children and young people alongside actively promoting wellbeing. We have therefore designed the framework to include Pillars of Wellbeing that underpin good mental health with themes that schools recognise as being part of their everyday provision; building a sense of belonging, positive relationships and healthy lifestyles. These areas are fundamental to wellbeing and education so fit well with what schools already offer.
Alongside this, schools are being supported by the Schools Health and Resilience Education Team (SHARE) who providing dedicated Mental Health support at a universal level across all 39 secondary and middle schools over a three year period. The team are working to the framework delivering wellbeing-based activities for staff, parents and young people. Alongside this, the school nurse team are taking an active role in supporting emotional health and wellbeing through the delivery of school-based clinics and as active members of school Wellbeing Action Groups.
To further support schools to adopt a whole school approach to wellbeing and mental health, SCC Public Health is providing a range of training opportunities accessible to all schools. These include a programme of PSHE CPD delivered by an organisation called LIFEbeat and bitesize specialist mental health sessions around topics such as self-harm, eating disorders and bereavement and loss. There is also further Mental Health First Aid on offer and plans to cascade training to parents through a combination of parent workshops and webinars.
The expectation is not to create CAMHS provision in schools but to develop an environment where staff and pupils understand and are able to promote positive mental health and can provide support and early intervention activities at school level. Further government investment (Green Paper) is expected within the next 2 years that will enable greater capacity and leadership in mental health. The Somerset Wellbeing Framework is laying down the foundations for this.
Item 7 - 2015-2020 Somerset Local Transformation Plan for Children and Young People Emotional Health & Wellbeing
Somerset Parent Carer Forum ask
Point 15 in the report highlights the development of the overarching & integrated Health & Social Care Strategy for Somerset (Fit for My Future). From attending the events around the county, we can see that Mental health needs are being looked at separate to the children and maternity work stream. How are you going to ensure that the mental health needs of children and young people do not get lost/loss priority within this approach?
Point 19 - You highlight the extensive local consultation and engagement in the past. Please can you clarify when this took place, how many people were involved and the type of responders e.g. organisations, children, parent etc?
We are working very closely with colleagues to ensure that that the mental health needs of children and young people do not get lost or loss priority. It is acknowledged that the LTP is a plan which (in its initial iteration) pre-dated the Somerset CYPP 2016-2019; and also that effective partnership working requires joint planning & commissioning. Therefore, Somerset CCG has committed to conducting this review in partnership using existing partnership arrangements. Somerset CCG is an active member of the Somerset Children’s Trust (SCT) & in 2018 the SCT Chair is the CCG Director of Quality & Safety (also SCCG Lead Director for Children). SCT’s work programme - set out in the Somerset Children and Young People’s Plan (CYPP) - includes a programme for Improving Emotional Health & Wellbeing (EHWB). This programme board will oversee & deliver the review and ensure it is embedded into the next iteration of the CYPP. Also, as a continuation of strategic planning and development of health & social care in Somerset begun by the Sustainability & Transformation Plan, work has commenced on an integrated Health & Care (H&C) Strategy, called “Fit for My Future”. This work will encompass CYP MH/LD albeit through two overlapping workstreams, each with a service development collaborative: children & maternity; and mental health & learning disabilities. Therefore, a key challenge for the review work will be to ensure that the LTP’s achievements, aspirations and legacies are incorporated into future plans for services in Somerset by the FFMF strategy and its governing structures.
Regarding local consultation and engagement the LTP has benefited from extensive local consultation & engagement through its lifespan, and this is acknowledged by NHS England. As such, the refresh builds on sound foundations. The Children’s Trust has recently conducted an extensive programme of engagement in preparation for the next iteration of the Somerset CYPP. The refresh & review will both be informed by the findings of that work. Similarly, the Fit for My Future programme has conducted an extensive programme of engagement, by which the review will be informed.
The Programme Board includes a range of partner representatives, including a member of the Scrutiny Committee and a representative of the Parent Carer Forum and this helps to ensure a cross section of views are heard.
Regarding out of area placements Somerset CCG delegates the management of out-of-area placements to its Provider, Somerset Partnership FT (SPFT). This is intended to promote clinically-led decision-making & management of these complex cases.
As at 30/11/2018, there were 14 Somerset children & young people under the care of a Tier 4 CAMHS or LD service. Of this 14, 13 were out-of-county. The Providers are in different locations in England, the furthest away being in Staffordshire.
To put this number in context, the SPFT CAMHS caseload (Tier 3, Community Eating Disorders Service & Enhanced Outreach Service) is c1,200 children & young people. In other words, the vast majority of Somerset children & young people receiving CAMHS treatment are receiving it in-county from the local provider.
Recent investments in CAMHS in Eating Disorders & Enhanced Outreach (crisis resolution & home treatment) have enabled local treatment of cohorts of children & young people who (a few years ago) would have been treated out-of-county. These services are sometimes referred to as “Tier 3.5”, largely because they include options for local in-patient treatment.
The “tiering” model currently in use predicts for Somerset a Tier 4 population of about 60 children & young people. Looking at this Tier 4 case-load and the caseloads & waiting-times of Tier 3.5 CEDS & EOT, we are relatively confident that (at this level) the clinical need is being met. In relation to that part of the question about support offered to parents, families & carers, further information has been requested.
Item 8 – SEND Update
Somerset Parent Carer Forum ask:
Please can you clarify when the Autism Education Trust (AET) training to mainstream schools will be rolled out. Will it include academies early years settings and colleges? Will the basic level also been given to transport escorts to ensure a constancy for children and young people?
We often have parents asking for information about the bases and special schools and there is still an element of mystery around what each one does. Will the capital work to increase spaces also included work to ensure the offer is clearly communicated with local families?
AET training for schools will be available from March this year, with bookings currently being taken. This training will be available to all education settings, including early years and FE colleges on a traded basis. Tier 1 training is recommended for all and would be suitable for all school based staff. The Autism and Communication Advisory Service will also adapt and deliver training for travel escorts. There are a number of useful resources which are available free on-line: https://www.autismeducationtrust.org.uk/ Schools and parents are able to download Autism Standards and Guidance for free using this link.
Work has been undertaken to clarify the offer from Special Schools and this information is available. A Service Level Agreement (SLA) for those schools who currently have an Autism Resource Base on their schools site is currently under review and plans are to have these finalised by the end of February 2019. This will ensure clarity around the offer from the Autism Bases. If your child is in the process of obtaining an EHCP, or identifying a suitable placement, the SEND Casework Team will consult with settings which are appropriate to meet their needs and provisions that you wish to be consulted.
Paediatrics and CAMHS have weekly triage meetingsAutistic children with MH needs will be seen by CAMHS; at the same time many ASD children with behavioural/emotional needs should have intervention from ASD and behavioural services.
It is also important for all children to have intervention for behavioural & emotional difficulties from appropriate tier services.
Cassandra Davies asks:
Why is it that the local area needs assessment has not incorporated those?
who are learning disabled and/or are autistic and display behaviour that may
Guidance around these services is specified under NICE Guidance NG93
and is not currently commissioned by Somerset CCG.
Those who experience these needs are the most likely to have complex
support needs in terms of education and mental health.
These young people are not having their needs identified in the strategic
needs assessment and therefore not as part of the statutory assessment
This is a legal issue and means that these young people are experiencing
discrimination under the SEND Strategy, Joint Commissioning Strategy and
the Statutory Assessment Process.
What is being done to address this? What is being done to address the high figures for SEMH and below average figures for ASD?
It appears that many SEMH cases may be cases of undiagnosed Autism.
The previous autism strategy showed that most young people in Somerset
were diagnosed with autism between the ages of 14-19 yrs.
By this time the opportunity for early help interventions has well and truly
passed. Failing to identify autism in a timely way means that autistic young people
may have experienced many years without reasonable adjustments
appropriate to their needs and therefore suffered discrimination and even
trauma in education.
Receiving appropriate autism specific support, early on in a timely manner
means that educational needs can be met early on.
Reducing the risk of MH issues and the need for higher level interventions,
so is more cost effective.
How does the Joint Commissioning Strategy specifically address these
How does the Joint Commissioning Strategy plan to address the issues of
discrimination of young people with complex neurodevelopmental disability?
Currently these young people are not having their educational needs
identified as part of the statutory assessment process?
Current assessment services are limited, and no pathways are made
available to NHS England commissioned complex neurodisability services which provide multidisciplinary team assessment.
Paediatric services in Somerset refuse to make referrals to these services
on parent request. Access to these pathways does not incur local cost but appears to be an attempt to hide the needs of those with complex neuro developmental
Failing to identify the provision and reasonable adjustments needed around
support and ineffectively using SEND investment on inappropriate
provisions. Early access to more specialist services supports young people
to meet their potential, reduces the risk of MH issues and helps to prevent
the need for more involved and costly provision in the longer term.
The local area needs assessment refers to all CYP with SEND and partners are committed to effective joint working between Health, Education and Social Care. This includes the groups you refer to, those with ASC and learning disabilities.
There are currently six groups leading the work on improving our local area in relation to Special Educational Needs and Inclusion. One of these groups is the joint commissioning group and has a number of participants working towards more effective commissioning practices and improving outcomes for children and young people with complex needs.
There are a number of other workstream relevant to your question, including ‘Identifying and Managing Challenging Behaviour’. This group is jointly led by the Designated Medical Officer and a Strategic Manager from the Inclusion Service and will include engagement from parents. Planning for this will come from feedback from the planned parent roadshows. The initial focus is on accurately identifying the underlying cause of behaviour presentations, to facilitate early intervention and accurate support for children and young people.
However currently Paediatrics and CAMHS have weekly triage meetings to discuss children .Autistic children with Mental Health needs will be seen by CAMHS; at the same time many ASD children with behavioural/emotional needs should have intervention from ASD and behavioural services and from paediatrics perspective, the majority of ASD diagnoses are made between ages 4-7. Some children with High functioning -ASD are diagnosed later and there is clear guidance in place for referrers considering ASD. Specifically MDT assessment forms a core part of managing all children with complex ND and paediatrics will work with families to ensure appropriate teams are involved.
Marianne Evans asks:
I would like to ask a question to be asked at the meeting, I'm unable to attend. I ask on behalf of families with children with epilepsy, which is a neurological medical condition. Why is it that EHA"s are not being carried out so that services can be implemented to help the vulnerable.
Also, when a child with epilepsy has an EHCP awarded why are they not using a neuropsychologist to help implement a person centred approach to their educational healthcare plan. Children with epilepsy are known to struggle with memory problems and also have additional needs too which are not being recognised. What is being done to bring young people’s diagnostic services in line with NICE Guidance, in order to support the Joint Commissioning Strategy? (E.g. Occupational therapist)
The Local Area is aware that the implementation of the EHA as the primary method for accessing support for children and young people with additional needs has presented some difficulties for GPs. The refinement of this process is ongoing with multi-agency support.
Parents of children with draft EHCPs should ensure they are happy with the content of the plan and feel that it has had sufficient input from the appropriate professionals, including health professionals. If there is some uncertainty about this it is recommended that you continue to work with your Case Work Officer to finalise the plan.
Many children with epilepsy will have SEND so will have High needs funding or an Education health and care assessment. Others should have support through a Medical Plan.
Family Voice Somerset ask:
Are the SEND consultations Jointly commissioned?
Are the SEND consultations including the recent survey by Public Health?
The public health responses questions the delivery of your 5 key strategic outcomes, in emphasising inclusion, quality, timely and positive experiences.
The health and well-being survey asked children about their health and well-being and we did generate a report about children who self identified as SEND and their health and well-being, but the survey did not ask children for their view on the SEND strategic outcomes, so I do not understand the question and as I had a prior commitment was not present when the question was asked
Why is the local offer not included in the joint commissioning partnership.
When can we expect a time line for a local offer that reflects what is local, what is available and not just a website? There are still to many gaps missing from the Children and families act 2014 and SEND COP
Please can all the autism bases and other bases recently re commissioned that are missing or currently ask families to contact the LA for the SEN policy, please consider the 6.79 SEND COP where this information must be on a website.
Work to agree final Service level agreements are in progress and when complete will be available
When will families be informed or offered a consultation on the restructuring of the SSE services that also include more than the PIMS services?
Has all 700 PIMS consultation invitations been sent, please could this be followed up as many families on our social media group have questioned that they were not aware. The breadth of the consultation needs to be questioned in terms of it being more accessible to parents who may have caring responsibilities.
Webinars and online questionnaires give more flexibility.
The PIMS service is also referenced in the schools building protocols, Have the PIMS team been involved with the building development for all the new schools and extensions?
In 2014 a document was created to list many of the health conditions known to Somerset, and listing if they would need PIMS, health care plan or EHCP. Many of the staff who worked on this service have left the services they represented. This document shows:
•147 health conditions that the hospital and the LA recognised as needing PIMS support.
•130 health conditions that may or would need a school health care plan and PIMS
•98 health conditions that may or would need an EHCP and PIMS
•96 Health conditions that may or would need an EHCP, school health care plan and PIMS
How are these requirements being jointly commissioned in line with children and families act 2014 section 25 and 26.
What is the process for commissioning the equipment to support children with SEN who have a medical condition with the requirements (for CFA2014 section 25&26)?
The LA and CCG are currently developing our joint commissioning arrangements.
Please could we have more information on the actual protocols being suggested and the pathways between “Maintained schools must make arrangements to support children with medical conditions” and “Health professionals may be commissioned in a variety of ways”
Who will be overseeing that the health plans meet safeguarding requirements to safeguard children?
Where are the joint commissioning for the duties of School Nurses who ideally should be the Practioner from health working with schools to identify the children who need health referrals, to support early intervention and to support other health conditions that do not require support from PIMS (a further link above)?
The service is a Public Health Nursing Service and so does not provide medical care or advice to children with complex physical health needs, they provide signposting support for health care advice and support for the school and parents. But provide Public Health support and interventions for all children of school age in Somerset. The community paediatric nurses undertake a lot of the health care planning for children with complex needs and support training for schools. Some School Nurses do fulfil medical care, as they have paediatric community nurses within the service but this is not the case in Somerset. There is no standardised capacity within School Nursing and Somerset has one of the smallest School Nursing workforces in the South West, which SCC inherited from the NHS.
When will the joint commissioning pathway for visual needs be consulted on?
The learning difficulty clinics who assessed for visual difficulties were stopped without consultation. Visual difficulty pathways appear to be difficult to understand, including CVI. Visual Difficulty clinics are included in The British Association for Child Community Health page 10.
Are the Communication services also being jointly commissioned? It would be very good if the SCC communication services including Facebook and twitter could share the publications from the short breaks newsletters, calendars and other events that frequently are not able to be added to the local offer.
The recent pre action letter sent to SCC raises the persistent concerns of consultations, including families and listening to the voices that families raise of the concerns and safety of many families. Will this letter be responded to by 12pm today (Friday) unlike many of the families who write many times in desperation, past their crisis point.
In order to answer your questions regarding SEND consultations we would need to be clear about which consultation you are referring to, however we remain committed to consultation with parents and families. Somerset Parent Carer Forum have a strategic lead in representing parents and families and we are confident that they ensure all relevant consultations are widely shared through a number of channels.
The Somerset Parent Carer Forum will be hosting a series of roadshows in January through to March where the local offer will be a main focus. All families, carers and young people will be invited to attend and contribute their views.
The review of PIMS services has been lengthy and detailed to ensure we are able to meet the needs of those who access the service now, and who may do so in the future. Close links are in place with Health colleagues, and these are now being formalised and strengthened to ensure a robust offer to children and young people with physical, medical and sensory needs. A working party is scheduled for January, where parents, Health professionals, SENCOs, and advisory teams will come together to explore pathways for effective joint working. This is the next step on our journey towards a jointly commissioned service which meets the needs of children and young people in a holistic and person centred way.
Item 9 - Young Carers Service – (Budget proposal CAF 20)
Somerset Parent Carer Forum ask:
We note from the report that the redesign of the service is now being undertaken by adults commissioning. The needs of young carers is very different to that of adult carers, acknowledged by many councils having separate services. We would like to know how the adult commissioning team are using the expertise of the existing Young Carers service to help support this work?
Family Voice Somerset ask:
What are the young carers requirements that need to be met by the local authority?
With the proposed changes of service to loose all the current staff, how will the requirement for providing personal advisors; assistance that welfare, education and training needs to be met; services if a CIN; type of grants available?
Adults Services have not been asked to redesign the Young Carers service. Adults commissioners have experience working with the voluntary and community sector and have been asked to identify opportunities for greater involvement of the community and voluntary sector in Young Carers support to enable Young Carers to share experiences, support each other and get some respite from their caring roles. Adults commissioners have worked with the Children`s Participation and Engagement team to ensure that young carers needs are understood and young carers are involved in developing options for community based support:
•Engagement with Young Carers took place during the October half term – these sessions facilitated by Participation and Engagement team in Children`s Commissioning looked at:
1.What a day in the life of a Young Carer is like
2.What help Young Carers access now
3.What opportunities Young Carers want for a good future
•The engagement gave the following key insights:
Young Carers shared many emotional issues related to their role. Stress and worry were commonly used words to describe how they felt.
Young Carers value the Young Carers service.
They value having time together and developing relationships with other people that understand their situation (staff and other young carers).
They value the relationship they have with their key worker in the Young Carers team and the support they provide (particularly regarding emotional stress and worries about their caring role)
We also identified that the Young Carers get other forms of support and this differed depending on the needs and age of the child.
Young Carers were aspirational and hopeful for their futures but also knew the barriers they needed to overcome to reach their goals.
•Adults commissioners have also conducted research into what other authorities are doing to involve communities in young carer support and how this is funded. Feedback from the Somerset Parent Carer Forum, Carers Voice and the Young Carers Team is also being sought.
•On 14th December Adults commissioners are holding an engagement event with the voluntary and community sector facilitated by SPARK to:
Share feedback from the Young Carers engagement in Oct Half term holiday
Explore what community-based services already exist for young carers
Identify what support communities could provide together to enable as many young carers to benefit as possible.
Discuss funding opportunities to maximise collective resources.
Adults Commissioners will present the outputs of the engagement process and options for community involvement to Cabinet in February. Should the decision be taken to commission any voluntary and community sector activity to enable young carers to spend time together and, share experiences and gain some respite from their caring roles, the Adults Commissioners have committed to including young carers in the tender process to ensure that they are involved in the decision making process. They will work with the Young Carers team to ensure that this is appropriately planned to fit around the young carers education and caring roles.
Item 10 – 2019/2020 Capital Programme
Somerset Parent Carer Forum ask:
Appendix B of the report highlights the proposed changes to several education provisions to increase capacity. While we welcome this investment and acknowledge that the additional spaces are needed we note many are academies. Can you confirm that robust service level agreements are in place with these settings, which are being remodelled/extended so as to protect the investment of public money into these sites which are not owned by the local authority?
As part of the expansion process, Academies are required to submit a significant change application for an increase in places of more than 30 pupils. This application (which makes it clear that additional places are required for basic need and being funded by the Local Authority) is made to the Education and Schools Funding Agency and is approved by the Regional Schools Commissioner. An increase in additional places requires a variation to the Academy’s Funding Agreement. The Funding Agreement is the Secretary of States contract with the Academy Trust.