Appendix 10
Appendix 10
Strategies and Plans
Health and Wellbeing Strategy 2016 - 19:

Within each of the outcomes, key areas of activity for the next three years of the Strategy have been identified. In order to meet
the priority on tackling health inequalities it is the intention that the delivery plan will ensure that the activity is focused on those
areas which will have the greatest impact on health and wellbeing inequalities. For each of the outcomes, the key areas of
activity are:
Outcome 1: Every child has the best start in life
Key areas of Activity: Promoting breastfeeding;
Tackling childhood obesity; and
Improve mental wellbeing of children and young people.
Cumbria Children’s Improvement Plan 2015 (Ofsted):
The purpose of this plan is improve outcomes for vulnerable children in Cumbria by supporting the improvements necessary for
Cumbria Children’s Services to provide them with services judged as “Good” and ultimately “Outstanding”. This means that
children and young people, their families and carers, will receive the right support at the right time, when needs arise, at the earliest
possible time, through good quality practice and services, whose outcomes are improving. The voice of children and young people,
their families and carers and the voice of staff and continuing to develop Cumbria’s Early Help Offer through a shared leadership
approach to early help arrangements across partner agencies supported by the development of the JSNA and commissioning
intentions based on the service gaps identified by Early Help assessments are both priorities.
Children and Young People’s Plan 2015:

Outcome 1 - Children and young people are healthy
Priorities:
1. Emotional wellbeing: children and young people are experiencing a number of pressures which are leading to a rise in
demand for mental health services; Through the Transformation Plan we are taking a whole system approach to
maximise the opportunities to provide quicker earlier support to significantly improve children’s lives;
Cumbria Adult Mental Health Strategy:
The aim of Cumbria’s new adult mental health commissioning strategy Better Mental Health for All is to make a real difference to
people’s mental health and wellbeing through a person centred and holistic approach. It recognises the importance of work at a
Appendix 10
population level to reduce stigma and to prevent suicides. These work streams are led by consultant, public health and HeadStart
joint strategic lead, Jane Mathieson. Work to reduce stigma, Meaningful conversations about Mental Health, is being piloted from
April 2016 using a test and learn approach based on the TIDieR framework, and the Time to Change evidence base. Multi-agency
suicide prevention work to is well established, and consists of audit, training, work with the media, post bereavement support and
pathway development, including work on the self-harm pathway for CYP. Cumbria was the UK partners for Euregenas, the
European suicide prevention project that ended in December 2014, and has contributed to national guidance on prevention of
suicide clusters.
Cumbria Transformation Plan:


Identified Need and Service Challenges: Sufficient capacity in the system for the provision of evidence-based direct
interventions/work provided to children and young people experiencing difficulties but not to the extent of meeting the threshold
for a specialist Tier 3 service.
Our Action Plan to Address: As part of our HeadStart phase 2 evaluation we are looking closely at the impact of an online
emotional support and counselling service. The outcome of that evaluation and partnership decision to include in phase 3 could
go part way to ensuring a consistency of support for children and young peoples’ mental health and wellbeing. In 2015/2016 we
will evaluate phase 2 of HeadStart and produce a strategy and implementation plan for phase 3.
Suicide Prevention Strategy:
Children and Young People will be a key focus for work on suicide and self-harm prevention in the coming year. We will continue to
support work to improve the wellbeing and mental health of children and young people, through service development and re-design
(e.g. CAMHS), and training (e.g. Young Minds). We will also continue to support implementation of recommendations of Serious
Case Reviews, and will assist in developing a post-suicide intervention protocol for Cumbria.
Cumbria LSCB Business Plan:
The LSCB provides the strategic and operational direction of safeguarding and continuous monitoring of performance in Cumbria.
The Board produces a Three-Year Business Plan and an Annual Report. The LSCB has 9 themes for 2015-18. The actions to
deliver on these in the first 12-18 months are included in the Actions in the Business Plan (please follow above hyperlink for further
details). Included in these themes are: Early Help, Developing the workforce and Emotional Health and Wellbeing of Children.
Appendix 10
System Change Infrastructure
Cumbria Learning Improvement Collaborative (CLIC): Our learning and improvement collaborative is a shared
"umbrella" initiative which exists to drive a positive transformation in health and social care across Cumbria and the Morecambe
Bay area by leading and embedding a culture of collaboration for continuous learning, continuous quality improvement, and living
within our means. CLIC's first three key priorities relate to:
1. Learning together in teams to improve services and save money
2. Agreeing and adopting a common improvement methodology, called the Cumbria Production System
3. Developing leaders at every level
CLIC brings together everyone working in health and social care in Cumbria and the Morecambe Bay area, including people who
use services, but founding partners include:
1. Cumbria Clinical Commissioning Group (CCG)
2. Cumbria Partnership NHS Foundation Trust
3. Cumbria County Council, in particular Health and Care Services and Children's Services
4. North Cumbria University Hospitals NHS Trust
5. University Hospitals of Morecambe Bay NHS Foundation Trust
Cumbria Alliance of System Leaders (CASL) and Local Alliance of System Leaders (LASL):
Children and young people live in communities. Each community has the responsibility for the education within it. At a
fundamental (and local) level, this is provided by individual schools / settings. Young people’s academic skills, enthusiasm for
learning and many personal/social skills are nurtured in individual schools. However, schools do not operate as islands. Ours are
part of a Cumbria-wide community, which can both enrich and protect the learning experience.
CASL and LASLs recognise this wider responsibility and potential. CASL and LASLs is a structure which supports (and, if
necessary, drives) the improvement work throughout education settings in Cumbria. It is a collaborative system drawing on the
strengths of all partners. We aim for much of its work to be proactive and preventative. It will also respond to leadership &
management crises, sudden data-driven concerns, and Ofsted category requirements.
The aim is to create a robust system with the capacity
•To identify improvement needs
•To create action plans for improvement, to be supported by relevant partners
•To review success
Appendix 10
It is Cumbria’s response to the challenge of creating a self-improving, school led system and close the gaps for disadvantaged
pupils. To this end, partners in school improvement work have joined to create this new system. Bringing a variety of expertise
and responsibilities to the group partners include: schools, academies, colleges, nurseries, the Diocesan Boards of Education, the
University of Cumbria, Teaching School alliances, the Local Authority and The National College for Teaching and Leadership. The
partnerships will no doubt continue to evolve, as the educational landscape shifts.
Early Help Assessment: Early Help is the support that can be provided for a child, young person or family who may have
additional needs that cannot be met by universal provision and there is perceived to be no risk of significant harm. Early Help is
everyone’s responsibility and any professional working with a child can initiate an assessment. (please see section????? for further
details)
Children and Young People’s Improving Access to Psychological Therapies Programme:
The programme works to transform existing services provided by the NHS and partners from Local Authority and Third Sector that
together form local area CAMHS Partnerships. The programme aims to create, across staff and services, a culture of full
collaboration between child, young person and/or their parent or carer by:
•using regular feedback and IAPT’s trademark session-by-session outcome monitoring to guide therapy in the room, but using a
mixture of goals and symptom measures suitable for all those presenting to community CAMHS, not just anxiety and depression.
See CORC’s website for more details.
•improving user participation in treatment, service design and delivery
•improving access to evidence-based therapies by training existing CAMHS staff in targeted and specialist services in an agreed,
standardised curriculum of NICE approved and best evidence-based therapies
•training managers and service leads in change, demand and capacity management
•improving access through self-referral.
This programme does not create standalone services, but works to embed the above principles into existing services providing
mental health care to children and young people.
Decision support data systems including data linkage:
Through HeadStart and the Transformation plan, we are developing the local infrastructure to collect and use intelligence to support
continuous improvement and change in an integrated way, including through data linkage systems. Our HeadStart senior analyst, a
joint CCC and Cumbria CCG post, will lead on this.
Appendix 10
Evolving Delivery Mechanisms
Healthy Child Programme – School Age Nursing: The HCP sets out the good practice framework for prevention and early
intervention services for children and young people aged 5–19 and recommends how health, education and other partners working
together across a range of settings can significantly enhance a child’s or young person’s life chances. The HCP is designed to help
local children’s services planners use their resources as effectively as possible, informed by the best available evidence. The HCP
is a progressive universal programme – i.e. it outlines the recommended good practice framework of a universal service
appropriate for all children and young people and additional services for those with specific needs and risk factors. Improving
emotional health and wellbeing and delivering a comprehensive range of CAMHS is central to the HCP. Early intervention is crucial
when young people first experience mental distress, by building their resilience and providing them and their families with
appropriate support. a new contact for school nursing is under development, aligned to HeadStart.
Primary Mental Health Early Intervention Service: The aim of the Primary Mental Health Early Intervention Service, (PMHEIS)
is that it forms an effective and key part of a wider Whole System Approach to supporting the emotional wellbeing and Mental
Health of all children and young people living in Cumbria. The service will embrace a shared vision of an integrated, responsive,
equitable and accessible service for children and young people from the age of 0-18 years (normally, 18th birthday with flexibility as
required up to their 19th birthday).
The service is commissioned for children and young people who present with issues/symptoms of a mild to moderate degree of
difficulty and require a multi-disciplinary approach that offers a mix of professional skills, inclusive of training for families and
universal practitioners and the identification of more severe or complex needs requiring more specialist involvement.
Whilst PMHEIS will function as the Tier 2 element of the Cumbria CAMHS, via a single point of access and act as the interface
between universal first contact services for children and families (with particular emphasis on Primary Care, Early Help Services,
and Education) & Specialist CAMHS in Cumbria, the function of this service is not to act as a screening service for Specialist
CAMHS referrals and should be conceptualised in terms of function as ‘bottom up’ as opposed to ‘top down.’ The primary
objective of this service is to provide effective early targeted intervention by:
•
indirect support
•
direct support
Appendix 10
Early Help 11-19 Service: Developments in this service model currently underway as part of the whole system model and with
clear links to HeadStart. The service will aim to work on several levels from universal to case holding and will provide external
support as part of the HeadStart pathways for CYP.
Vanguard Success Regime Integrated Care Communities:
Heathcare communities in North Cumbria and South Cumbria and North Lancashire have joined up respectively under the
‘Success Regime’ and the Better Care Together ‘Vanguard’ to provide high quality joined-up healthcare. The Success regime is
part of the NHS’s Five Year Forward View and provides national support for the most challenged health areas. This additional
support will be used to deliver short-term improvements against quality, performance and financial targets, support longer-term
transformation and the development of appropriate new care models, and to develop leadership capacity and capability across the
health system. ‘Vanguard’ communities have been selected by the NHS New Care Models Programme, to help deliver the NHS
Five Year Forward View. Better Care Together made a successful application to be a Vanguard community.
Joint Commissioning:
Significant developments include consideration of new models of commissioning. For example, CCC (children’s services and public
health) and Cumbria CCG, with our statutory provider, Cumbria Partnership NHS Foundation Trust, have jointly commissioned the
new Primary Mental Health Early Intervention Service. Plans for providers to share responsibilities for population healthcare as
Accountable Care Organisations; and new geographies of care, with a number of natural communities identified across the county
around which care is provided in an integrated way, by GPs, NHS Trusts, social care and other partners working together, across
these Integrated Care Communities. Resources are available to ICCs to work together on identified priorities. Two of the seven
ICCs in the South Cumbria ‘Vanguard’ have chosen to focus on child (mental) health, and one is considering developing the offer in
primary care of mindfulness training for adults.
Troubled Families/Focus Family:
In Cumbria we are strengthening how we work with families who need extra help by working closely in partnership with others and
jointly tackling all the different needs that are faced by the family as a whole. We’re calling this way of working the “Focus Family”
approach. A “family” is defined as a household and must meet at least 2 of the 6 criteria below:
 Domestic Violence
 Benefits/Financial Problems
 Education – Attendance
 Crime
Appendix 10


Children who need help
Parents and children with a range of health problems (including mental health)
.
The ethos of Focus Family is to pull together existing support and address the needs of individuals through family centred work.
Family members are all influenced by, and have an influence on their environment. If they are to be supported into making
significant and sustainable improvements all agencies need to recognise and respect the role of each other in this process.
Through using a strength based approach families will be challenged to address their barriers and supported to develop appropriate
strategies to deal with them. It is an expectation that LSCB guidelines will be followed and that any families not in receipt of a
statutory assessment will have an Early Help Assessment.
Time to Change:
Time to Change is a national campaign that aims to end the stigma and discrimination often attached to mental health issues. From
2016 onwards, the programme is seeking to further embed and grow through the creation of a number of local Time to Change
hubs. To achieve this, T2C is looking to help create local co-ordination hubs nationwide. Cumbria has expressed an interest to link
with this agenda, alongside our County Mental Health Partnership, our third sector and service user and carer organisations. We
will be well placed to do so, having just commissioned an exciting new ‘Meaningful Conversations about Mental Health’
programme across Cumbria, to test and learn from innovative ways of reducing stigma in workplaces and communities. This
programme explicitly builds on the T2C approach, and references HeadStart’s anti-stigma work with CYP (e.g. through Mates in
Mind).