Since we took charge in 2016, we made mental health, and specifically supporting better children and young people’s mental health an early priority for health and care devolution.

Context:

For too long, mental health services have been the poor cousin in the National Health Service. The consequences of poor mental health can have a life-long impact.

We’ve worked together across Greater Manchester to make some big improvements and have started to make good progress to ensure mental health is treated as seriously as physical health. We are doing this by improving mental health treatment services but also by investing in prevention.

In July 2017, the Partnership announced a £134m investment to transform mental health in Greater Manchester – the biggest and most ambitious of its kind in the country. A total of 60 per cent of this cash (around £80m) was focused on supporting the mental health needs of children, young people and new mums as part of a wider commitment to increase the proportion of the budget focused towards early intervention.

This year, we have put in place more flexible specialist children and adolescent eating disorder services delivered through community-based teams, and ADHD (attention deficit hyperactive disorder) core care standards for children and young people across Greater Manchester. We are also beginning to roll out 24/7 community-based crisis care for children and young people.

In March 2018, with the support of a number of partners including across the voluntary sector, community and social enterprise sector, we rolled out a pilot with over 30 of our schools here in Greater Manchester to help children and young people look after their emotional health and wellbeing and provide specialist support where needed. We are working on plans to extend this to 10% of Greater Manchester schools over the coming two years and then meet an ambition for support in all Greater Manchester schools.

In October this year, the Mayor of Greater Manchester, Andy Burnham announced that, by the end of the year, Greater Manchester will be the first place in the country to start collating and publishing publicly waiting times data for children and young people’s mental health services. This data from 1st April 2018 to 30th September 2018 is shown below.

The data is an initial attempt at ensuring transparency – with recognition that some of these reported results are now being refined and will become more accurate over the coming year as recording systems improve. The Partnership will publish data on a quarterly basis

There is no national mental health equivalent to the 18 week referral to treatment pledge enshrined in the NHS constitution for physical health – and in fact best practice guidance suggests that where appropriate, initial assessments should begin within 4-6 weeks and then be followed up by access to specialist treatment where warranted within a further 6-8 weeks.

As such, in the longer-term, in Greater Manchester, we want people seen within 4 weeks for their first appointment and within a school-term for their second appointment (referral to treatment).

This will require significantly more services and professionals, and the Partnership is planning to launch a new workforce plan for children and young people’s mental health. The aim will be to get at least 150 more clinicians in place across Greater Manchester by 2021.

Mayor of Greater Manchester, Andy Burnham said:

“This is one of the clearest signs yet that devolution is bringing a much needed change of focus and priorities.  The mental health of our young people is one of the most urgent health challenges we face and by becoming the first area to publishing this information we are showing that we’re not running away from it.

“I’m very proud that Greater Manchester is the first area of the country to publish its waiting times for children and young people’s mental health. Some of these figures may make for difficult reading, but Greater Manchester, under its devolved health and care partnership, is leading the way on being both open and honest about the scale of the challenge and also its plans to make sure that more children and young people are provided with the right support.

“For too long, mental health has been the poor relation in the NHS, and as we know, the effects of poor mental health can have a life-long impact. We’re keen to make sure that every child here in Greater Manchester gets the best start in life. We’re spending more than the national average on mental health care and investing in prevention to help stop problems developing later on in life.”

 

Access:

The current NHS England access standard is that 32% of children and young people with a diagnosable mental health condition (based on a national 2004 prevalence study) receive treatment from an NHS-funded community mental health service. Nationally, performance is at 30.5%. In Greater Manchester, we are performing at 38.5% – so above the national target at this time – and 8% above performance nationally – and within the top 3 ‘sustainability and transformation’ areas.

Information on the data:

GPs remain the single biggest single referrer to services at 33%. Other referrals come from amongst others individuals, education, community paediatrics, social workers and A&E.

A total number of 29,074 children and young people referrals were made last year to mental health services (with 5% of total referrals rejected – these being totally inappropriate referrals, not referrals that are likely signposted to other emotional wellbeing and mental health services).

More were male (56.64%) than female (43.26%) and most referrals are for children ages 5 – 16, with a small number on either side.

Referral to first appointment by CCG (clinical commissioning group):
This is the total number of weeks waited between the referral being received and the first direct (usually face-to-face) appointment divided by the number of children and young people who waited.

The average wait across Greater Manchester for a first appointment is already now down to 6.2 weeks.

Referral to second appointment (or referral to treatment) by CCG:
This is the total number of weeks waited between the referral being received and second direct (usually face-to-face) appointment divided by the total number of children and young people who waited.

Average wait across Greater Manchester for a second appointment is now down to 12.14 weeks.

Second appointment to third appointment (or referral to further treatment) by CCG:
The total number of weeks waited between the second direct appointment and the third direct appointment (usually face-to-face) divided by the total number of children and young people who waited.

Average wait across Greater Manchester for a second appointment once fully accepted into treatment is 5.59 weeks.

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