Mole Valley Council - Adults and Health Select Committee

Adults and Health Select Committee - Friday, 10 May 2024 10.00 am

May 10, 2024 View on council website

Transcript

Health Select Committee and I'd particularly like to welcome you members of the committee which is District Counselor Paula Keay. So, glad to see you here. In the event of the fire alarm sounding, please proceed out of the council chamber using the door through which you entered and take the exit immediately to your left. Please note that today's meeting has been broadcast live via the council's website as part of our webcasting facility in line with our guidance on the use of social media. I'm happy for anyone attending today's meeting including members of the select committee to use social media, provided that this does not disturb the business of the meeting. Please can you ensure that your mobile phones are either switched off or put on silent and for select committee members and the officers presenting, please speak clearly and directly into your microphones. When called upon the speak, press the right hand button on your microphone and start speaking when the red light appears and then please remember to turn off your microphone when you have finished. If you are sharing a desk and microphone then you need to press the right or left hand button depending on which side of the microphone you are sitting. For those officers who have joined the meeting remotely, please use the raised hand function to indicate that you would like to speak and please mute your microphone and turn off your camera when not speaking. I'd also now like to introduce those witnesses with standing invitations to each select committee meeting. We have a apologies today from Maria Millwood but Sumerfi, Patrick Walter, Oliver Hearn and Nikki Roberts and moving on to item one, apologies for absence and substitutions. We have an apology from Mikayla for today. Are there any others? Sorry, definitely practic services, have we got any others? Just Mikayla Martin? Yeah, Mikayla Martin, Centre of Apologies and Centre of Glory and Millwood. Yeah, okay, I've done Maria as well. Dennis Booth has as well. Dennis Booth, thank you. Thank you, Robert. Councillor, I be king from running me council. I think there's another meeting in running me. Okay, thank you very much, Robert. Okay, the minutes of the previous meeting, 7th of March 2024, have been published, so the item two is for the select committee to agree the minutes of the previous meeting on the 7th of March 2024 as a true and accurate record of the proceedings. Are we agreed? Thank you. Okay, moving on to item three declarations of interest, I have a declaration to make in the, as I usually do, to state that I am a community representative to NHS friendly. Any others? Thank you, Chair. I would like to declare that I have a close family member work in Brimley Park Hospital. Thank you. Right, so moving on to item four questions and petitions. We have five written questions on the subject of mind works. Are any of the questions present? Okay, then we'll pass on from those, since there are no questions, and we have one question on adult safeguarding. Is the question of present or on the call? Thank you. Then we can move on that there are no supplementary's. Which then takes us to item five, mind works, which is a joint scrutiny item in conjunction with members of the children, families, life belonging and culture select committee. So, can I please welcome the members of the committee today? I think we've got Fiona Davidson, Jonathan Essex, Fiona White, Rachel Lake, Liz Townsend and Jeremy Webster. And as witnesses we have Mark Newty, she made Mooney, Kerry Clark, Susan Smith, Harriet Derritt Smith, Professor Helen Rostell, Lawler Pine, Trudy Pirate, Justine Leonard, and Kenny Ellie M. Ellis and Carol Hing, and I think you're there as well, I'll grab. Okay. So, moving in to... So, if we can hear from mind works first, please. Could I make a declaration? I'll follow these, Chair, slightly late. Of course you may. Council nominated Government for the Surrey and Borders Partnership. Okay. Graham, let's see if you'd like to... Sorry, Chair, are you asking us to be in declaration of interest or just to move on to the agenda item? Yeah, okay. How would you like to stand up? You've obviously asked some questions. Do you want us to... Well, do you want us to present the paper first? Okay, all right. Harriet's going to provide that. Thank you. Hi. Good morning everyone. Harriet Derritt Smith, Associate Director for Children's Commissioning in Surrey-Hartland's ICB and also into the County Council. I think fundamentally we know that children and families and schools and people at working schools tell us that children need more support managing what may be ADHD and what may be ASD or autism. Any respective of diagnosis, they need that support in the school, in a community and at home. And I think hopefully what we've set out in the report is a balanced view in terms of the support and the diagnostic events. That view was clear, I guess, in the sending inspection that came last September, which quite rightly highlighted the impact of the longer waits on children and their families for an autism diagnosis and asked us as a system, so from the county council through education and health, to work together to improve the pathway of support and diagnosis for children and young people. The support needs... In respect of diagnosis, we could diagnose every child, should that be an injured, and have no support in place for them and that in itself would not be helpful when they're in the school environment at home or working and living within their communities. And so the paper balances the work of the all-aged autism strategy to really look at how communities and the environment functions for children and young people to make them more friendly and possible to really be their best and really get the most out of their lives. The actions in the report and in the action plan hopefully will be monitored through the additional needs partnership board due to its links to the send improvement plan, but hopefully also describe a range of activities that are already underway and that will be taken to look at both the environment, the support and the diagnostic pathways for children and young people with a potential ND supporting needs. And that continues work across the partnership due to the kind of... Did the priority we feel needs to be placed on their outcomes. So welcome questions. We've got a head teacher joining us also online just to make sure members are aware of that, who works with us quite closely in this area. And we've got a good range of partners, very from SAP, but also from the vulture and community sector, who are part of the model with MindsWorks and who have a really key role in supporting children and families earlier as part of that diagnostic and supporting pathway. I don't know if any other colleagues want to add to that introduction. We're happy to move into the paper. I just wanted to welcome, I think, the cross partnership working that I think we're trying to do here and I completely endorse what Harriet was saying about. We're really focused on how we can provide practical support to schools in the classroom to support children and then think about how that relates to the families because we recognise we've got to take a whole child and family approach in taking this forward. So I think this report really demonstrates the fact that it's that practical support that is going to be the most helpful for allowing children to live the lives they want to lead. We've just got two more witnesses that were remote to come in, so we want to try to make sure that we bring them in first, so if we can just pause for a moment. In the interim, we have a request for a supplementary on one of the questions. So Amanda, if you'd like to introduce yourself and ask your supplementary question. Thank you very much. Yes, my supplementary question is actually to ask again the original question which hasn't been answered and that is, why is the specific advice from NHS England regarding autism diagnosis being ignored at this stage. The report was made in total contrast to every recommendation on the NHS framework which has been put together by the leading experts in autism and I'm just curious as to why none of that advice has been taken on board. Thank you. I'll pass that back to my work. I think hi Amanda, we've spoken before and it's nice to see you again. I think the report from NHS E is absolutely correct in kind of what it sets out and it's ambition and it's a challenge of every area nationally in terms of being able to implement that. I'm hoping that as we move forward with the work we've set out in this paper, we can dovetail much more clearly with the ambitions within the NHS England report and actually most importantly being able to meet the needs of our population, sorry. As we've said, food that support but also improve kind of access to diagnosis and support that that may bring with it. I'm happy to pick up further Amanda afterwards as well as we've always had those conversations. Yes please. Thank you for that. We're now going to move on to one of the school witnesses with Kerry Oakley who is secondary school head from Carrington School. You're invited to speak for up to 10 minutes. Thank you very much and good morning everybody. This is a very new process to me so forgive me if I get a bit nervous speaking to the front of so many people. I've been asked just to talk a little bit about the issues that our young people face. I'm at school in Red Hill, we are a thousand children strong from year seven to eleven. Like everybody we have our fair share of young people who are presenting with the need to have mind works referrals and are facing neurodevelopmental conditions and they are really struggling in our school to access the aspects of the curriculum, social aspects of their school day. They're not able to necessarily self-regulate as easily and those are traits that are coming through I know from the primary schools and then and as they hit puberty can be exacerbated by all of those sort of complexities that they have to face. We have an increasing sensory need for requiring ear defenders, exit cards, uniform adjustments, amended timetables and we are having to find spaces for young people who need a quieter space at social times. I'm in a new build and as a new build school it wasn't considered part of the DFE program to put in quiet spaces and as you can imagine schools are very large and very noisy particularly at breaks and lunch times and all of that can become very overwhelming. Now we do put on quiet rooms and we have something called the everyone room in at some of our year groups that are run by year managers through lunch times to support that and I suppose the biggest challenge that we've had is about getting those referrals through quickly to the people that can support these young people because we don't necessarily have the skill set community to manage these young people and we we never attempt to do so and the changes there and the processes that have changed with mind works are particularly have been challenging because the lead times have been so long and then actually getting a consultation is even longer recognising that there are more and more children that need these because the referrals were then stopped and it was very difficult in the last few months to get anything accepted that's meant we've got a backlog of young people an increase in number of non-attenders as a result that are not being managed with their complexities and I'm aware that that is now changing and that some of those referrals are beginning to come through but note that the working hours of the telephones are between nine and twelve which as a teacher is probably the time that they are teaching and if you miss that slot then it's really difficult to actually get hold of somebody and and being able to then discuss and follow up and get somebody into the system. The impact is huge actually we're finding that we get outbursts with young people we get very frustrated parents and we become the middle people to those parents who have an expectation that we can get their child the help that they need and that can then really break down the relationships that we have with them and we did find that very difficult when we weren't able to make referrals at all and then I think we were promised that it would start again and it wasn't and some children were sitting for three months without any feedback and we were trying to manage that and the parents feel very let down by us. Staff then also feel a bit challenged because they don't necessarily have all of that training we do try to do we work with nurture UK and trauma-based approaches with our young people we have counselors from MCR placed to be and relate within our own school community but even they can't manage the depth of what MindWorks provides as a professional community there so that that's really challenging and it's also very time consuming so we find that you know we'll spend a long time on phones trying to access follow-up referrals to see where they are in the system and again that means it's time away from the young people so you know we we would really like to see a greater ability to cope with the young people that are coming through I think one of the suggestions would be to have some open of hours of MindWorks outside of the school day so that people who then can make those phone calls would be able to get hold of somebody and we do a lot of work with the mental health support team who are a really excellent service and have provided us with some really great opportunities for our young people and particularly Victoria Graham and Fiona Wilson who we've had team around the school meetings with and they've come in and offer some help for us as well but the trouble is when we get then to that point where they need greater consultation we find the momentum stops where our families and that then helps that doesn't help the breakdown of relationships what would we like to see changed if i've just got some a few moments left of time we I think it's just about the speed of acknowledgement and that triage in so that we can go back to parents and say yes it's it's there it's in the system it's seen to be a need and then okay we might have to tell them there's a wait but at least they know that something is going to be happening and we can give them that information and then maybe some more work with us as a school because sometimes we find that what MindWorks thinks is the right option for young people in schools is not practical in the school and getting more of an understanding between the professional at MindWorks and the professionals in the school will really help then when a parent comes back and says but we've been told we should be doing this and I think that's something that would be really helpful and then I think just having a streamlined way to receive those updates and to be able to make those referrals so that we can reduce anxiety on our families and on our staff and and be able to share that with them would be really helpful I'm happy to take questions I hate that's kind of covered what people wanted to hear but if there's anything else I can take that thank that Kerry if we could come to you with questions in a few moments I think it would be helpful if we heard from Alison Symester as well first Cinco for Audley School hopefully Alison's on the line yeah Alison are you able to join us okay given the audio issues then I'll suggest that we actually move into questions and maybe come back later okay um before we do um I'm there is an obvious thing to say here which is you know historically neuro diversity has been seen as being maybe something just over 1% of the population we are now coming to a new understanding that actually it's probably more like 4% that have got significant issues of one sort or another and that many people have some of the features of neuro diversity and you know we actually need to adopt as a society a totally new model of approaching it a different way of working so it's really vital that we actually do that and one of the key things you know that we will be looking for today is evidence of a real transformation plan that actually delivers that and has that in the situation so it's vital that we all change it's vital that society is a whole views neuro diversity in a different way to the way it's been but our provision in relation to it needs to be much stronger and this is true frankly of very mental health provision across the board historically it's always been inadequate we need to change so I'm going to move to Fiona Davidson chair of the Families and Lifelong Learning Committee to kick things off Chair would you like me to start the questioning or to speak specifically to Kerry's statement I think if you go to Kerry's statement first and then move into questioning I think you could do that seamlessly okay one of one of the things I'd like to ask Kerry is Kerry of the thousand children in your school how many do you believe are probably I'm going to go down some sort of neurodevelopmental treatment what sort of percentage are we talking about? Oh well we're about a thousand strong say it will be less than five percent but I would say we're showing signs between five and ten students in a year group on a year group is between 180 and 210 students from there but that does increase it seemingly is increasing year on year so and as exams kick in that again changes in somebody who hasn't maybe displayed any symptoms as the anxiety of age and of think increases so they too are suffering with problems we have for exams starting now and we have over 30 children who are not able to sit in the main area where exams are set due to ASD traits and mental health issues and things like that and obviously and just general anxiety and you can imagine how difficult that is to manage in an exam season when everything has to be regulated very closely it puts extra pressure on us and if we can get some help for these youngsters a bit earlier we might be able to help them manage some of that to be able to sit exams thanks Kerry my last question to you really is if there was one thing that you could change tomorrow what would it be? Being able to get hold of somebody to have a conversation with around a young person and then being able to go back with to their families and talk even if timelines are long but just being able to say we've spoken this is what it might look like this is what might be able to help you with and I think it's just that early dialogue and communication increasing so that we can get young people through a system and seen with a known timeline appreciating the challenges that brings Thanks very much Kerry I think that's really helpful Chair I was going to suggest that I could go into the questioning if we're still unable to yeah I think that's exactly what we'll do Fiona okay I mean it my first question really is a follow-on from what Kerry has just been speaking about parents and schools tell counselors that they feel completely abandoned because mind works which is the lead agency in this arena has given up providing frontline neurodevelopmental screening and assessment now we know we know that you haven't given it up completely but that's what parents and schools tell us they feel abandoned that you know that that front line screening and assessment just doesn't there it's impossible to access it is so rationed as to be partly worth having and it appears that the responsibility has been and this is from the perspective of schools and parents being wholly handed over to schools without a proper transition or without proper preparation why has mind works done this thank you Fiona and just to acknowledge that from a mind works perspective there is absolutely an appreciation of how challenging this is for families and for schools in response to the what why have we done this we we are a team so so the neurodevelopmental pathway is isn't a partnership and it's really important to remember that we work together with our sorry well-being colleagues with Bernardo's the National Autistic Society learning space there's a there's a pathway in a range of offers so in borders provides a predominant the the assessment and diagnosis element of the pathway and that includes in in deploying the expertise that we have from some of our staff to ensure that neurodevelopmental expertise is coming alongside the early help support and strategies that families and schools and others are trying to implement to support a child in a school situation prior to implementing the consultation approach and in response to having implemented an assessment of needs for the team were absolutely inundated with with referrals understandably so we've talked about the statistics and they had about four thousand referrals in less than six months and for a team of about 26 all that they were doing was processing referrals and responding to concerns there simply was not the capacity to be present in schools alongside parents alongside their colleagues and providing the immediate help and support that we know children and young people and families need so the the strategy for how we responded to the demand that we collectively face was to bring all of our expertise from across our partnership together and to position that front facing alongside schools alongside families we know we're trying to in parallel empower schools and others to have really good access to what the nice guidance says works for children young people with neurodevelopmental need and that is access to information advice support and strategies and we've done that through a number of different methods including enhancing our website but but also consultations and training and working together with others so we're trying to really maximize the universal offer for children young people who present as having neurodevelopmental need our binados and and naz colleagues in learning space all do really brilliant pre-diagnostic support the consultations was a space in which we could together with schools help to identify children who are more vulnerable we know that children with neurodevelopmental need and where their needs are complex and profound they are more at risk in terms of exploitation in terms of safeguarding type concerns terms of being excluded from school being socially isolated so we wanted to make sure that our neurodevelopmental experts in our spoke service that's four staff were able to engage with schools to work together with them with the children around in relation to the children that they are most concerned about so we're trying to we're trying with the resource and the capacity that we have to do our best to understand needs we are we are concerned that families are having the experience that they do and our our clinicians are wrestling with what to do for the best so we're really trying to expand our universal offer to work together with the support network around children to increase their their ability and confidence in supporting young people and then making sure that we're deploying our expertise to try and identify the children who are more vulnerable and where we know the the added advice and support and experience that we can bring to schools will make a difference to those children we then can make decisions also about moving into the assessment and diagnostic pathway so that that's why we did it it's really helpful hearing carries and we talked with schools all the time and but to hear carries reflections in particular and I can I can hear that there are you know already there are some things that I can immediately think about the telephone line and its availability so really happy to think further about that and I hope that's a helpful explanation I mean I I think I think I'm quite surprised that you're not aware that the telephone line only being open three hours a day in a school would be problematic so it bothers me that that basic piece of information is news to you today but can I say one other thing actually which is that we are told that the London boroughs surrounding Surrey have much much shorter referral lead times they have much better processes I'm talking about Richmond I'm talking about Kingston I'm talking about a number of others so they they haven't given up the front end they have a really good referral process doesn't mean that there isn't a significant way it but they also get through and the treatment pathways waiting lists much faster as well so what I want to know is have you benchmarked your performance both in terms of referrals and also the treatment to diagnosis treatment pathway with you know other organizations in the south east who appear to be performing much more effectively so I was going to say so we have done some benchmark we actually employed what's called a CSU which commissioning support unit to benchmark our services and certainly there were changes that could be done across the thing which we're looking at implementing and I can't speak directly to those boroughs I haven't looked at that data but the benchmarking that we looked at suggest in terms of the sort of effectiveness as a clinical model it was it was in the range of what you'd expect nationally but there are still a challenge I think just to go back we have to remember that when we set this up we were working towards a 1% prevalence rate obviously as Trevor introduced at the beginning the prevalence rate has gone up to maybe four obviously Kerry's data suggests more at the four and then the two end probably and that has effectively it's it's not like a positive decision was made to do this but that that movement on the prevalence rate has meant demand has gone up it exceeded capacity and we've had to do different things now my view on this is there's a danger that we put lots of effort into diagnosis and not enough effort into into support and treatment and I think treatment itself as a word is a bit of a difficult word obviously because we're all aware that you cannot cure autism and you cannot cure ADHD so the treatment for autism is actually about practical support to the school and the family and helping the child have insight for themselves and so I think the question that we're now wrestling with is really have we got have we got the right model in terms of its emphasis on diagnosis versus an emphasis on support so so that's the work we're doing we are looking around at best benchmarks I think London is a very different proposition I can't recall this specific data but I'm aware on other times I've looked at London the underlying prevalence in London is far higher across a range of health conditions and therefore the historic level of investment and services they have in London is very different from any of the Shire counties and what I have done is looked at Shire counties and in that case as I understand it they are all wrestling with a similar set of problems but I'm more than happy after today to have another look at the London boroughs I haven't looked at those ones in specific so happy to look into that. Thank you. Shall I ask my next question or? If we can hold for a moment because Alison Simmons has cured her audio problems so it's a little bit muddled I'm afraid that's technology for you so I'm going to ask Alison to come in first and then I've got a whole crew of people with their hands up so we need to deal with those before we can move on so Alison if you'd like to come in now and talk for up to 10 minutes on the issues schools are facing. Good morning I'm hoping you can now hear me. That's perfect thank you. Brilliant thank you. Apologies I am at home today deliberately because the internet at the school has been poor but here we go. So I'm Alison Simmons. I am Senko at two small primaries in Caterham. I'm perhaps what you might call a career Senko. I always wanted to work with SEM children and I had done for the past 27 years in a range of roles including as perhaps pertinent here a job before last as a head of unit as we call them then but especially centre for ASC children within Surrey. So I can come with a lot of the concerns that were raised earlier. I think my my headline would be that we understand in schools the prevalence as I think we're calling it today and yes we also do feel very much on the front line we feel that the information that's coming out of mind works is limited it's only hitting a certain audience and that once the information does come out there's then a time lag in us seeing the strategies the ideas the support actually coming through. What I would like to do what I thought would be most useful was for me to tell you just one case study. So across both schools I probably have six or seven children who I feel need to go through the diagnosis process but this young man kind of emphasises strengths that schools have schools like mine and where perhaps we and families feel that the system as it's now presenting is going to I'm going to say letters down but certainly it's causing frustration for a family. I do have this young man's mum's permission to talk about him I will try and keep it anonymous but if I slip she does know. This little boy is now in our year one we have had his older sister with us for three years so I know this family quite well because mum was started coming to me as a DSL because her little girl had scratches and marks that I needed to investigate largely because of the needs of the sibling that I'm going to go on and talk about so I know I've known this family for quite some time. So little boy came into us in year R so he came in in September 22. He had very very limited nursery access obviously he would have been a young man that was impacted by the Covid closures. We put some transition support in for him he hadn't been involved with any of the earlier services in Surrey. Although parents had already saw quite a lot of support from elsewhere he was awaiting earlier speech and language therapy it hadn't been it hadn't started. Again we know that those children weren't seen during the Covid period because people couldn't get into nurseries. So he came into reception he struggled. We did part-time timetables he couldn't part from mum. He was hurting other children mum was getting very very upset she didn't want him to get a reputation. We worked with mum and we put a lot of support of her parenting support in for her working with our local children's centre. I put in an early help assessment and we were declined. The family were declined on the basis that school were doing a good job. We were in early days the family weren't at any risk and things moved on. He did manage to settle a little bit into school. We managed to get him in full time by Christmas with adaptions to his lunch time and with a lot of visuals a lot of small group work, social skills a lot of playing alongside and modelling for him. We continued to have concerns for the sibling safeguarding concerns and she was supported by a thrive and we referred her into young carers. We also then had a further DSL issue around disclosures but both children met about mum needing to restrain the child and mum and dad then came in and spoke to us much more widely and explained that dad did actually they had converted their shed and I do mean a shed not a pod in the garden because this young man was not sleeping through the night was wanting to co-sleep with them. Dad wasn't getting any sleep mum and dad were falling out because they were having different views of whether he should be put back to bed or not. Again we referred to early help and they did at that point get two months of early help and were supported through. I had made a referral in the November to the one-stop system for a pediatric consult. At that point the triage informed us that there wasn't yet enough evidence he was new at school and they wanted us to waste a little bit longer. By spring term of his reception year we had had him seen by the speech and language therapist and they noticed some articulation difficulties but decided that the majority of his problems were social communication. Those of you that know and will know that our mainstream speech and language team generally don't work with those children unless it happens to be on their ECHP so he was discharged from that team. We then spoke again to one-stop and I did manage to get him referred into the pediatric service. We continued to work with the children's centre and parents completed the parenting puzzle. By summer term we were a lot more settled but obviously we have to move towards transition. We were still waiting for the pediatric referral. Parents at this point paid for three sessions for this child with a sensory processing team who work out of a centre in Walton so they're paid privately and that was really helpful particularly for the family to understand how they could help to regulate this young man but also in helping staff. The staff, some of our staff went over to Walton for the final session and that helped them as well. We then started a transition process for him in year one and we included a 20 weeks, so 10 weeks in the year are 10 weeks into year one of our Thrive provision funded by school and I might add with no additional funding. During the summer holidays he was seen by Pete. They identified some sensory needs. They referred him to OT. They identified that he had some neurodiversity tendencies. They were looking all towards ADHD but they noted he was now too old for pediatrics and suggested that we might refer him into the ND spoke team. So this is a year after I first tried to contact pediatrics. In September I referred this young man in and of course that was just as the ND spoke team closed for that first period. I was then in the front line. I then had to explain to our family that it wasn't actually something to do with the school's mistake. We're on the front line to this. The grandmother in this case wanted to come into school to school and make a formal complaint. Not helped by the fact that the family had been to the GP who hadn't caught up with the mindwork's temporary closure, whatever we're calling that period when they weren't taking referrals. We were able to placate the family, reassure them that actually we'd been told by mindworks that we would be able to re-refer children from November, which we did. I prepared the paperwork, made sure that we had lots of evidence and I sent it to two minutes past midnight. I think it was on the first of November. I scheduled it. I hastened to add I wasn't sitting there. That bounced back of course to us because although that date had been shared, actually we weren't able to take that assessment wasn't accepted. We now have a young man who continues to present with overload. He continues to have some very, very vulnerable days and he is now showing the signs of Ebstner. He has had a reduced time table. He's now back in full time. We have referred this with some more agencies. The NES have offered some group work. In Godalming, which is a long way away from Caterham, at two o'clock on Wednesday afternoon, these are both working parents. He may or may not be able to be seen because he is showing all signs of ADHD by their home one-to-one service, the NES. They're considering him. You may know that they're taking on some new home family support workers. He's on their list and he's also on their radar. It happens to be that I know two members of the team I worked with them previously, so we do have a professional dialogue. I have referred him to learning space and as yet we haven't had an offer. School continues to support. We've referenced we have the mental health support team in our school. We're one of their learning schools. I work with the primary mental health team. I work with the mind works. I'm on the steering group. I think these parents have probably been as well-supported as a primary school can manage. However, this family are now considering a private assessment. They are not hearing my explanations because there isn't on for parents to receive yet from the seminar I attended from mind works, which I completely understand the medical versus the social model. I have spoken to the health line. It did take me a long time to get through. It is a lot very awkward. St Co's tend to be child facing in the morning and perhaps not in the afternoon. It would be helpful if those times are going to be three hours a day. They didn't always happen at the same time of the day. As it stands, this child attends school. We put Edison as support him. He doesn't meet any of the criteria. He's not urgent. He's not seen as a priority child. We wait. Whilst that happens, this family can't access any support. I suspect he would be a child. They would all benefit from melatonin. He does present very strongly as ADHD. He may be a child when medication would be helpful. I'll stop there on him. Just a second child to mention to you because you were talking about waiting list elsewhere. I'm really sorry but I'm going to have to ask you to sort of wind up because we are very long. This was just a coincidence. This young man has just come to me from a Croydon school where he's been waiting in 2021 for assessment. They've been told the wait is currently 36. These parents will not come off the Croydon list. They haven't changed their GP and therefore I can't refer him into any mind work services because they know the situation in Surrey. At the moment, I cannot access any of the support for him. Two weeks ago, this child took another child, had an outburst, took another child around the neck and had to be physically removed. We had to exclude him for a day. At the moment, I can't see where this child's going to get any support. It's purely and simply because those parents do not come off the Croydon list. I'll finish. Thank you, Alison. It's incredibly moving to listen to the problems actually being faced by families. The issues that delays and non-availability of services are causing. Thank you. Have any other members of the committee got questions for Alison while we're here? Liz. Thank you. Thank you, Alison. I'm also mindful that we've got a little cure people that want to join the conversation. I'll bring them in immediately. Liz, if you can just keep it very sure. I will keep it brief, Chair. I just wanted to ask, Alison, listening to you that it seemed to be that you were saying that, you know, where one agency seems to stop and you seem to have to search for the next level of support and to find that next level. So it seems to me, and from what you're saying, that things just drop off and you are left as a Senko to find that support. Could you just clarify if I'm understanding that correctly? Thank you. Yes. I'm particularly the gap between when a children can be referred into and may be discharged by the pediatric service. The official referral age is 5.5 as I currently understand it into the pediatric team. If when those children then get to the point of being seen, they then are more than 5.5 when they may need ND assessment. There seems to be a complete peppercorn response. Sometimes they are discharged and we're told to go through to MindWorks. Other times, assessment seems to be done by Pete's. There's nothing. There doesn't seem to be any consistency. The only theme I can see that runs through those are perhaps children who are more complex. One of those that I is now 6 and is being assessed by Pete's also has mitochondrial disease. I can only consider it because he's more complex in that way and would stay underpeeds. Does that help? Thank you. That's very helpful. Thank you. Thank you. I'm just going to bring in some of the people from the Teams call because I know that they've been waiting a very long time now. So if we start with Emma Ellis, followed by Chris Townsend and Trudy Pirate. Thank you, Chair. Could you hear me? Yeah, you're fine, Emma. Good. My name is Emma Ellis. I'm a service manager for the National Autistic Society. Thank you to Karen Allison for giving us your experiences and I acknowledge that because I'm in touch with families and schools and young people every day. And thank you, Graham and Allison for mentioning the social model concept versus the medical model concept. So our work very much sits within that social model and in that the support that we are providing, which I'm actually very proud of because I think that Surrey actually stands out amongst the counties in the UK for this level of support that we're providing. We are providing support in a quite a holistic way because we support the families, the young people and the schools. Sometimes it's difficult to get the breadth of the service out to people. So we use methods like school bulletin, we talk at Senko network meetings at Foster Care Network meetings. As much as possible, we are promoting our service because most importantly, because of our contract as one of the partners in mind works, we don't need a diagnosis of autism for families to be to self-refer into us. A lot of our service, our group work is provided actually predominantly online. So it is accessible either in the morning, in the afternoon and we work in the evening right across Surrey. So I think this year we have, we're on target to produce about 450 workshop events and in the main program that we offer, which is a really deep dive into autism but a very practical deep dive, we are looking specifically at areas such as social communication and social interaction, sensory processing and how to manage distress behaviours. So we're looking in those areas in great depth and we give parents a lot of skills and techniques and tools that they can implement at home but also most importantly the knowledge that they can then take to the schools to explain why their child might need these various adaptations that they're asking for and I think the knowledge behind why those adaptations are needed is really really helpful for the schools as well because then they're acting in a proactive way rather than a reactive way to behaviours. We also do school training but if we were thinking about this in a Venn diagram, we would be predominantly in the family space, slightly smaller in the young person space because we do work one to one with young people and then smaller still in the school space and that's really because of the size of our contracts but we go into schools and we're doing, we do a three two and a half hour training session and it's a whole school approach so everybody from the dining room staff to the front office to the LSA's to the teachers to the heads can access our training and so in a similar way to the parent program it covers all of those key areas the social interaction differences, social communication, sensory behaviour and we're again doing a deep dive and it's a hundred percent of teachers and staff who attended that have said that they would recommend that service to to other schools and I know that they get a lot from it and they go away with with school-based strategies or confirmation that what they're doing is right and it might just be extending that a little bit further and so and the other support we do is one-to-one support for parents in complex situations but of course because of the big demand and we've seen about 6,000 parents under this contract so far because of the big demand we do ask that parents do that group work first because otherwise we just wouldn't be able to support everybody for the more complex cases we then offer that one-to-one support when they've got that foundation of knowledge so I just wanted to fly the flag a bit actually because although I acknowledge the difficulties on the medical side, on the social side there is a lot of support out there and partly it's about getting the message out to families, to schools that there is no waiting list. Parents can self-refer and they can get that support pretty much immediately. We also have the out-of-hours support line which is out-of-school hours and in fact teachers can also phone that out-of-hours support line for some specialist advice directly with with our team and that is manned by ADHD specialists on the Bernardo side and autism specialists on the NAS side and it's open from 5 to 11. Thank you Chair. Thank you and if you move on to Chris Townsend please. Thank you very, thank you Chair. I'm very interested in what the last speaker said because that's not the experience the schools in my division have and I'm very interested that they've got no waiting list for the service they're providing. My concern is the one that Fiona brought up which is the the pressure being put on schools but I really want to touch on something that's in the meeting chat and let me just read what's in the meeting chat. The pausing of the school's ND referral pathway is now at six months in without any timescale of the next stage. The loose solution of stopping the referrals it's sourced by pausing the pathway does not make the issues go away. It is only when a child or young person is in crisis that they may be accepted for assessment. That's in the chat and I would suggest that somebody from MindWorks actually responds to that because that must be a very, very serious issue. Thank you. Thank you for the question and I'm just reflecting on the most helpful way to respond to the concerns that are raised. I think it's really important that we hold in mind that when we are talking about the assessment and diagnostic pathway it is for assessment and diagnosis of neurodevelopmental need. There are medical treatments conscious we're using the language medical pathway. There are medical treatments for a small percentage of children who may have a diagnosis of ADHD. It is the case that nationally there is a problem with the supply of ADHD medication and that has been a problem this year and we're being told that nationally we could expect an update in July. I think we have to hold in mind that it is a diagnostic pathway and when we think about medical treatment there is a small element of the pathway that relates to medication for children who may go on to receive a diagnosis of ADHD. It is not the same pathway for children who have mental health difficulties so we are really confident that where children have mentally or health concerns whether or not they're waiting for a diagnosis there are accessible pathways there is help and support for those children without delay and we've seen improvements in access to assessment and treatment for children who have routine needs. So mental health crisis children in mental health crisis there's no delay they should they should not be waiting on that pathway. Our communications are really very clear that access or escalation in concerns there are there's help and support available and there are ways in which schools and parents and others can access that help and support. With regard to the question of when will there be a revision to the current consultation approach that is in place. We're working together with our commissioning colleagues, our social care colleagues, schools and others and our focus is really on growing the offer of early help and support because we know that that's what makes a difference. So at this time all our efforts and I know that county council colleagues and commission colleagues can talk to the growth of help and support that is happening across our schools. So that is where our focus and our energies are right now in making sure that we deploy our capacity to meet the needs of children to support schools to support families. But can I just say that the timescale there's no timescale for going forward it's now six months in and there's still no timescale I think you mentioned July perhaps you could be a bit clearer about answering that please. So sorry thank you the reference to July related to what we understand with regard to the supplies of ADHD medication. So the latest information is that we should at a national level we're hopeful that supplies will resume in July. With regard to the consultation approach our strategy so asking for an end date our strategy is to ensure that we're putting all of our efforts all of our energies into providing help and support and then being really clear about those children that will benefit from consultation and go on to assessment and therefore diagnosis of neurodevelopmental need. And the rationale behind that is because treatments are limited as I said it's just medication for a minority of children with ADHD but what we know is effective is making sure that there is a consistent and collaborative approach to how the strategies supports and interventions are put in place for a child at home in school for their lives. Yes I just wanted to add if it's okay a bit of this. So on this waiting issue I think for me that there's sort of two parts to it. So one I think sometimes neurodiversity is used as an umbrella term it is it's useful sometimes just to go into ADHD and autism separately because they are different presentations. So for autism a post diagnostic treatment for autism would be exactly the type of service that we heard from our colleague at NAS. So I think what we need to work through the schools I've heard very clearly today from schools about how they're not feeling supported. So I think we need to think about given that we think that the treatments the post diagnostic treatment you would get there is already being offered and there isn't a significant waiting list. Why is it that for schools it feels like they're not getting that support because that's the model and we need to we need to a bit time to dig into why the world as we imagine it and the world as it's experienced by schools while there's that dissonance. So that's what I want to say about autism. For ADHD as Justine has said there's two components again to ADHD. So the treatment for ADHD is not always to medicate the child and obviously there is guidance out there to say we should use medication we should try and restrict the use of medication we shouldn't always move to medication as our first treatment solution. So there are non-medication treatments for ADHD as well and they also are like not like what the NAS person they are using the social model to treat. So there are three treatment pathways if you like medication for ADHD, social for ADHD, and social for autism. We absolutely need to get on top of the delays for prescribing on ADHD medication but and there are two problems within that. So one is that nationally there is a shortage of the of the medicine. So even if we had no problem with assessment and diagnosis today we wouldn't be able to initiate prescribing for ADHD because there is a national shortage of the medicine. However, when the national shortage goes away there will still be a problem about how we diagnose and prescribe for ADHD and we absolutely need to come up with a solution and we're working as a system to do that and I think I absolutely own that is an issue. But the other two cohorts as I said we need to work out why for schools despite mental health in schools teams, despite prevention mental health, despite NAS schools are feeling like they have no frontline support. We have to get underneath that because clearly we're putting a lot of energy in and it's not having the impact we want. So that would mean effectively that that's not doing what we all want it to do. So we need to understand why it's not doing what we want to do because I think we've got some really good practitioners across the charity sector and the health sector who can work with those schools. So we just need to dig into that bit. So that's what I wanted to say in terms of waiting times. I think you just need to look at the chat. I think you need to look at the chat because it's saying here the support isn't there. If schools say it's not happening and families say it's not happening then I'd be worried it's not happening. I'll leave it there Trevor but they need to look at what's being said in the chat because it's obviously not happening. Yeah thank you Chris I think we have to acknowledge it's very obvious from the two scoreances. There are significant problems. I'll just mention one other thing just for clarity for anyone listening from the public. Of course ASD and ADHD can also occur together just for clarity. They're not two things that are mutually exclusive and yeah we've on the team's call also got Trudy Pike who's also had her hand up for a very long time and then after that I'm actually going to ask Councillors Rebecca Jennings Evans and Jonathan Essex who happen to be sitting very conveniently next to each other to pick up the questions on the amount of the problem, the effectiveness of the support service and if you could actually team up to actually pick those up next that would be very helpful. So Trudy if you'd like to just go ahead. Thank you Chair. Thank you for inviting me to contribute. My name is Trudy Pyatt. I am the interim assistant director for inclusion and additional needs southwest quadrant with Surrey County Council. I'm also delighted to say that I've been asked recently to step forward and to champion this work amongst our colleagues and to work with schools, health and all associated partners that you've heard from today and I also want to say a big thank you to Kerry and to Alison for sharing their experiences and to shame Kerry's gone because some of the things that she was saying about the adaptations and the reasonable adjustments that made in our school I think are terrific and I don't want to underestimate the work that was going on in our schools to really support and make those reasonable adjustments to include everybody in every child no matter what their prevalence of need is in a really spirit of thriving in an environment and as Kerry said you know she's got modern school that you know it wasn't necessarily set up for what the Chair really able to describe as our cohorts of children who are presenting very differently over the last five years to what they have done previously and I recognize Alison you've been a Senko for a very very long time and you will have seen the prevalence of need changing ASD social emotional mental health issues are more prevalent these days and we're getting more children young people particularly youngsters and you know younger age groups coming through with really complex needs so it's a national problem how we address this you will read no doubt every time in the papers and on the news about send crisis in terms of funding in terms of placements and in terms of kind of you know getting the right support the right time for all of our children young people which is obviously our ambition we want our children to thrive we want them to be served by their communities we want our parents and carers to get the support that they need and we also want our schools and our practitioners really well trained and equipped to work with the children young people within their care because they care about them passionately but they are feeling overwhelmed I'm listening to you I hear you and we had a webinar a couple of weeks ago I don't know if Alison and Kerry were there but we had about 250 delegates and we talked about the social model and the medical model and it's recognized that the EHCP is a piece of paper it's what it happens around that EHCP the support the technical specialist advice that really makes that challenging difference for our children and young people this isn't a Surrey problem this is a national problem I think with Surrey you know we have a high use of enemy placements that might be a little bit unsustainable for us moving forward and we're looking to work to with all of our stakeholders and with all of our schools and settings to make sure that they're not feeling overwhelmed in such difficult times so I want to recognize that I also on that webinar asked colleagues if they could share examples of helping their children young people thrive in that space I'll tell you now we were inundated it was fabulous the things that the schools are doing and I'm not underestimating that we need to be creative in this space as you know my works have said that the ND path is about a medical diagnosis that diagnosis doesn't change what happens about the support the wraparound care the education and the sort of kind of enriched curriculum and lifestyle that we want for all of our youngsters I'm very proud of the work that we're doing with partners I know there are issues along the way this further work for us to do and I think you know we need to get under the skin of why I think Graham Hughes said it why our schools are not feeling as supported as they possibly can we have specialist teachers in practice that work closely with our schools and I know they do excellent work there is obviously more for us to do and in some challenging financial times for everybody but that should not take away from what we want for our children and young people and I just thought I would offer that education side view so that you know you do realize that colleagues in you know educational life long work learning are there for the the head teachers but more importantly we are champion of children and we will occupy that space and work with all of our partners to make sure we're getting better and we're providing what we need to do thank you chair thank you true um I'm now as I said I'm gonna ask a counselor back to Jenny Zevens and Councillor Jonathan Essex um to weigh in on the questions in terms of the size of the problem the length of the delays that are now in the system and you know asking about you know what are the plans to actually get out of this situation so I'm over to Rebecca and and Jonathan thank you very much mr chair um I'd like to understand I've got three questions I'd like to pose but I'd like to understand how many children who would have been referred to the ND pathway since it closed on the 1st of September are still awaiting referral and of those outstanding referrals how will they be managed going forward because the major concern is whether those young children and young or young people get lost so that's the the first part and then I'd like to also ask of of those children that are now on a diagnosis or treatment pathway how many are there and who retains the information sorry do I I can answer now yes yes please sorry you're not familiar with proceedings so give me um thank you for your questions um I um in terms of demand it's it we we know that um we we are not so we do not have weights for consultation for the consultations but I know that that doesn't answer the question around how do we know um the number of children that would have otherwise been referred I think that's and I'm not sure how we would answer that what we do know is that there there there's not a weight for consultation our current caseload is circa 7300 cases on the neurodevelopmental pathway and we we know that there are again circa I think it's about 3,600 children on the diagnostic element of the pathway so that's waiting for ASD ADHD and then a dual diagnosis of ASD and ADHD so appreciating that the conversation and quite rightly so is focusing on what's happening about the approach that we're taking now to children that require assessment and support and I think it's also important to remember that the the team are incredibly incredibly busy working through a significant number of children young people who are currently on the pathway and going through the process of diagnosis so we we we've um we we've got support uh commissioning support to work with an independent provider CCON so we've significantly increased our capacity to be able to diagnose um and and we've been doing that for the last two years so so we know there are lots of children who are on the pathway and will go on to receive a diagnosis um and we also know there's a cohort of children approximately 900 who are waiting for ADHD medication and as Graham explained that there's a challenge for us in that the national supply um hasn't there hasn't been a supply of ADHD medication so sorry just to be clear there how are we ensuring that those children who are still awaiting referral are not being lost yes so um we have um so when referrals are received um we open a record an electronic patient record and and we're able to pull that data through so we've got a business intelligence system that enables us to um know who those 7,300 children are and where they are on the pathway and where they're waiting um in terms of their journey um across that pathway and is there regular communication with them so they know where they are on the pathway so we um we we have um at the point of referral we make sure that um families have good information about how to access um help and support when when families contact us and ask us how long have I got to wait we're able to talk with families about um the children that we see so we know that children that are um on the diagnostic element of the pathway now um have waited for approximately two years so that's the longest um wait at the moment so we we we we can we don't have the digital infrastructure to be able to say your weight will be X amount of time but we can say um that we're seeing children who have waited for this amount of time and we we are currently seeing children on a chronological basis so the point of which they we're referred so we're looking chronologically um at weights on the diagnostic pathway okay but but kroydon does okay yeah i think we need to take that on board so like coming now are you gonna add something yeah uh councilor six if you'd like to come in now so in my head's a bit of a mash because i keep hearing things then hearing what i feel is the complete opposite afterwards so i've heard there's a growing gap from Trevor at the start between um the level of provision level of need and then i heard Harriet in her instruction say well we could diagnose all people and have no support and that made me think well okay if we did that would we be reaching our statue moral duties as a councilor as a provider are we actually allowed to do what we said we were doing the introduction that i heard we that it's a national problem and it's everywhere um but it's best in London and it's worse here but we've only benchmarked against other other councils that suffer as we do we don't seem to be benchmarking against those who have vision of what good enough actually means and then i'm really struck with this idea that somehow we've we've told schools we're stopping the the front door um which they thought was a temporary pause and now we're hearing it's a new approach and and i think you Graham has said that you've got a social ADHD pathway a social autism pathway and a medication delay or three separate things but then Trevor has said well ADHD and a HD overlap and how on earth do you know which pathway someone should be on until you've done a diagnosis and how can you do a diagnosis if you close the front door or or apparently do so so it seems to be that you know if you don't diagnose for everyone if you close that front door then you are choosing to ration and delay who gets support and when they get support so in in you know thinking about that i mean so if mine works is basically a rationing organization you're severely rationing access to nd screening and assessment so you're rationing and you're restricting the number and who gets support and when and by massively delaying it you're also affecting the the overall pathway for someone getting ehcp and getting that additional payment as a school so schools are being starved of money for the support they need to help those children so you know how do you monitor how do you monitor the outcome of this change of approach which you've introduced from september how will you monitor what the demand for screening and assessment is now if you're not taking any through your front door and and given the scale of demand that there is for these mine work services the size of your current waiting list as well as the invisible waiting list you don't know about because you've shut your front door what strategy does mine works have to address the need otherwise other than what i've heard so far is sort of little bit better little bit more little bit less variations on the status quo if the difference between one percent and four percent is fourfold or at least twofold and a really big change is needed how do you bring that big change in whilst not leaving behind all the people that are stuck on the waiting list already and are desperate to get on it and can't get through your front door hi thank you for your question and i'd like to answer from a conditioning perspective and then let my mind work to colleagues come back in as well sorry could you speak up or move the mic please thank you sorry can you hear me now hi and yeah so i'd like to come in i'm carried like i'm head of motion i have to be with me hi Jonathan i'd like to come in from a commissioning perspective so Councillor Rebecca i think what you're trying to ask fine for us to do is exactly the numbers of children that are in in the medical model that we're trying to seriously move away from so i think what we've done and we have spent a lot of time talking to schools to families you've heard it today that what schools and families and children young people are telling us is they want swift access to direct support from people that they can trust and they can learn from themselves and learn together as families and children and young people and when we've explored that that a lot of that is from the social model that we've talked about and we're implementing we absolutely believe to support these children we need to move away from the the medical model and have everybody on a single pathway and to have a holistic approach that is multifaceted and joined up so we've heard from families we've heard from schools we heard today that they want more direct access and more support schools are asking for support for children in their schools and some of the specific issues you were seeing the action plan that we've invested in nd advisors so we're expanding the teams that worked directly alongside schools and they will look at the support and bring schools that can learn together so that we can change the system in schools and support families that will give you a response to a child so a child that i was speaking to the other day that was in a group program sorry i wasn't talking to him i was talking to people that working with him he was he'd been on a group work program and he loved it he got to know other people and he really enjoyed it and he was learning techniques and part of the evaluation we said well what difference is that going to make and he said well i knew some of this before he said what i needed is learn how to use those techniques and not be any different from other people in the classroom and in school when the third sector partner scaffold that learning into the school and the school looked and worked together to introduce regulation zones that's what made the difference for the child it wasn't the diagnosis it was that example of work so we're expanding the support that's for schools from nd advisors we're expanding the support that will help them look at learning environments that is being recruited so they haven't stepped in yet so we're in that change process you also heard today from our school colleagues that they want access to parent support and our third sector partner and talked about some of the parent support that they've provided and the experience of that we've also looked at the opportunities to expand that so they're in the recruitment process to expand that one of the things that we're looking at process of changing again is and again again i think it was Keri said she's got NAS and she's got learning space and she's got a third sector another partner what we're in the process of looking at is named leads district and borough levels so you can start to form relationships with partners as opposed to trying to find three or four partners organizations so that's in the process of being changed to get direct support to families and get direct support to children what we're then finding is we were having to look at how can we make sure that the right children are getting the diagnostic support and the pathway how can we make that pathway streamlines the schools and families are really telling us it takes too long there's too much paperwork we want the answer straight away the consultation process that is in place gives the answer straight away it enables all the correct paperwork to be completed and submitted and a dialogue and that to be in place and a direct decision what we know is that we need to evaluate that now so SABP and Tavistock appointment are evaluating that who are the children that we're missing how is that working the timeline the telephone time that we talked about today that's all been looked at to do how we can respond differently there as an ICB we had to listen to the information that SABP was giving us some mind works in terms of the children young people waiting too long on the pathway when we started to look at that they were they have wait i think it was three years three years in the pathway and a year at the beginning sorry it's not it's come down it is come actually the data on page 54 shows that it's still between two and three years the diagnostic can i finish what i'm sorry sorry because i suppose what i'm trying to do is get you because we are trying to learn the best way to meet the needs of children young people hearing what people are telling us and implementing change that change will take a bit of time because we've got to recruit some of those posts and i suppose the reason i wanted to highlight about the pressure on the access point is as a system it wasn't mind works in themselves that made that decision about the criteria we had to look across the system and look at it from a quality and safeguard in perspective and the numbers that were coming through at that time we weren't prepared to extend waiting lines to significant levels if we stay in that model medical model of approach so it wasn't SABP on their own that made that decision it was a collective decision around the process that was put in place the criteria was a collective decision about what that criteria was and again we're now in the process of relooking are we missing children in that criteria do we need to relook at that again so there's an evaluation process in place in terms of the timelines i'll give that to Justin to talk about but i wanted to set the scene that we need to move and shift the culture and give families and children young people what they're asking for which is the early support as well and that's coming it's increasing i hope that was helpful yeah thank you so that i think if i might come back briefly chair i'll i'll just hold a moment Jonathan i'll come to you back to you again in a second don't worry um yeah i think you know the key thing that we are looking here for here it are you know concrete numbers concrete plans things that are measurable and you know that's really you know at the crux of the whole thing so i would just say you know we've had massive delays we know that it's massive discontent you know we need to you know really get down to how big is the problem what are we actually doing about it and i'll come back to you now Jonathan thank you and thank you so it's just briefly so if i'm understand correctly Kerry the the decision to send the note in september to all schools saying there's no more referrals wasn't a mind works decision it was an icb decision it was a collective decision so it's but it was approved and scrutinized and agreed by the icb but it just didn't seem it's i think it's what you said but it didn't seem that any counselors were involved in that process or we we heard because schools sent us that letter and and then in terms of this paper this paper is looking at mind works and scrutinizing mind works one year on from where we were a year ago but we've heard sort of various snippets as chef has referred to about this new approach and this transition process but i can't see much in the report that says well how much how much more money do you need to actually implement this new reproach so you talk about supporting schools are you supporting all schools or just some schools and is there sufficient support to all of those schools and if not when will that be in place and you know do you need extra money to make that happen or do you have that money already and if you haven't got that money where is it coming from and when will you get it it that sort of detail about yeah there's lots of really nice words in this report if i'm to say i'm i'm not an expert in nice words i'm an engineer so i'm trying to get from the start to the end from the problems to the solution i know it's not a simple problem solution thing but reading this i don't have any real clarity or confidence as to how quickly we're going to get to where we need to get to or whether the plan to get there has been agreed by everyone except for us we haven't seen it yet um or or and whether it's properly resourced with people and and money that that's really why i'm going to share so in terms of the initial communications um about the changes to the pathway that was agreed across with um cfll colleagues um the icb and sabp and and the link to obviously cfll and the council was because of the links to the send inspection um and the improvement work um through that through as well and that's why the introduction today was was purposely also setting it within that within that context and the introduction today was also sort of purpose all about the continued bit of the conversation we had over the last hour or so the need to bring in that support to children irrespective of a diagnosis because if that child was waiting three years with no diagnosis and no support that would be even worse situation so we're trying to do both bits at the same time um and at the moment because of as you've absolutely hit on some of the resourcing issue which is not just financial it's also about workforce availability in some instances about medication availability and some of that is improving um but where we can and have banished to to bring in additional funding um so from the icb last year there was 1.5 um a half a million sorry put in against the number of programs that are within your report um some of the which is which Kerry's described we've been able to draw down additional money through the mental health investment fund which is obviously a joint funding pot and within the system across the icb in the county council again to prioritise work around um this area and so it's coming back to Trevor's introduction of with the increasing prevalence and the need to do something different that social aspect that support aspect is kind of paramount that's not negating the need that many children families will want to still access a diagnostic route and trying to balance those two within the resources we've got is I guess the challenge we have um and and I absolutely take your point in terms of the how do we know when some of these things are going to take impact and I think that's two things I think that's so the work that mind works are done in terms of articulating the numbers in the pathway which again you've got in the table in your report um does that for one aspect I think the join up now with the county council in particular um and with education colleagues about that more of that social bit I think we need to be able to do exactly as you've asked which is say what are the three three things for example we're going to do with schools around that social model and when like they take impact and have effect because we've been asked for that here we've been asked for that by schools and families and linked to the improvement work in the send inspection from a statutory perspective as well. Professor Helen Rostell. Thank you chairman um so I just um I just wanted to come in really to to talk about the need for I guess more assurance uh for the committee around the transformation plan so we're hearing there are lots of different pieces of work underway we also have a plan um beginning in May actually in next next two weeks to step back look at the mind works model and look strategically at what we're doing but then in June we're going to have a wider workshop with with partners um to uh review key areas of transformation of which this will be won and I think we really then need to be able to articulate what that transformation program looks like what its milestones are and when to expect delivery of those milestones and what the impact of those changes is likely to be so I think we we do have those steps in train I think it's about how we capture that how we present that back so I think that's a that's a must do I do want to emphasize that this is a national problem we know that NHS England are leading a whole piece of work across the country about how to tackle some of these issues I recognize that there are areas of good practice and it's really important that we are learning from areas of good practice we've heard about some of the practice that we have in Surrey as well from the National Autistic Society which you know is also important to to recognize so we need to be able to collect all of that and put it into our plans around transformation so what is the evidence based behind what what we're proposing so um so I think it's about just how we capture that together and present it back to the committee uh Graham thanks yeah thanks Jonathan so um I just wanted to pick up on a few of the points you made um so one I just in terms of the sort of confusing message just to reiterate that as I understand it so one we have seen a growth in presentation of need and it you know whether it's doubled or quadrupled it has certainly grown substantially um what that meant was that the NHS model was very much embedded in what's called the medical model i.e. this idea that you would diagnose and there would be specific medical treatments that you could deploy that would make someone better as we've seen that prevalence grow we recognize that that isn't the right solution that we have to introduce the social model the mind works contract and thrive was the beginning of introducing the idea of the social model as a way of dealing with this change in prevalence we need to go further we've heard today absolutely that that school support that we thought we put in isn't working for schools we need to go away and do our homework and understand why for some schools that's not working and and change ourselves and that's the transformation work that Helen's just described you also talked about the fact that because we were rationing the availability of diagnosis we were effectively rationing the delivery of treatment now as I kind of tried to say earlier um that's not necessarily the case because if the treatment is the social model of treatment then waiting for a diagnosis does not delay practical support for that child and their family and we need to make sure that they are getting that practical support there is a component of diagnosis which is round ADHD where medication is indicated where it is delayed today that is not about how this system organizes itself that is about a national shortage of that medicine so that needs to be dealt with at a national level to bring that medicine back online um the door as I understand it is not closed the door has changed its shape so the door used to be a medical door and we have changed the shape of the door to emphasize the importance of the social model so therefore we're using the consultation model and we're saying we should seek to do the social model first and then where there is a continuing need we can bring in the medical model we don't need a diagnosis to provide the social model solution you can use what's called traits of neurodiversity which healthcare practitioners are well versed in using to formulate a care plan that addresses those needs so that for me is the reason why rationing of the diagnosis of itself does not prevent all children from accessing treatment however it is depriving some children who need an ADHD medication so that's related to a national issue but we do need to go away we've heard from schools really clearly and we had heard it before today because that's why we've kicked off lots of work with schools so we recognize there's a dissonance between what we're planning and what schools are experiencing we've got a lot of work kicking off right now about mapping school need about working with schools to address this dissonance between the in-reach offer we're offering to schools and their practical experience of that in-reach offer Hi Chair so my name is Anne Kenny I'm the independent Chair of So Wellbeing Partnership and we represent 13 voluntary organizations that are part of the MindWorks Alliance and very much in the early intervention and prevention space which is around about a quarter of the contract so absolutely take on board the concerns around the diagnostic pathway and the changes and I think to be fair we do recognize that there should have been more communication around that and more of a plan around how we would implement that so that that's some of the learning and I think we we accepted that the time when we got feedback from schools I think this is a journey of transformation and actually getting the balance of making sure we meet need now whilst transforming is difficult it is challenging particularly in the light of the fact that we are also have a fixed financial envelope we have been able to add some funds from COVID funds previously which we've now had to take out and so we were constantly there's no mechanism as well in the contract to increase that financial envelope only on demand even though we know that demand has outstripped capacity since the beginning of the contract so that's part of the context that's not so we're on the journey of transformation and I wanted to just mention a few things about what the voluntary sector has been doing as part of that recognizing the increased prevalence in ND traits for instance so and linking in with Kerry's comments and Graham and Justin's comments on the social model so one of the things we've recognized across the work that we've been doing is that the prevalence of ND traits so whether or not you've had a diagnosis doesn't matter but that those sort of behavioral reports and concerns are coming from schools and from families recognizing that that's going up and that the referrals that we are receiving both through our access and advice team but also through self-referral direct to the volunteer organizations I think try through one particular pathway for instance where there was 80% where we thought there was ND traits and actually the teams that we had put in place for emotional well-being and mental health at the beginning weren't specialists in ND in that sense because we have specialist partners have been mentioned National Statistics Society and Bananas providing bespoke specialist services across the 14 voluntary organizations some of which have been mentioned today as part of the school support so relate was mentioned for instance learning space etc and as in fact also provide that early intervention at a well-being sport what we've done as a partnership across our voluntary organizations is ensure that all of our practitioners have been trained and will continue to be trained in how to support children with ND traits at that point so pre-diagnosis so that that is to help us with this transformation so that we have competent staff at all levels to deal with whichever children's needs are at the point of need now that that's happening now that will also help things as we move forward on top of our specialist providers that you've heard about and the overarching transformation that commissioners are working on to bring that together I want to just before I finish also just answer the question about GBOs as you'll see from goal-based outcomes when children young people do land in our services and I appreciate there are there are delays they're actually their experience is good and I think that's important and we were not able to report that to the committee last time we saw you because we were just in the process of building that up so we've done a lot of work getting that that's not perfect yet either but I think you can see that starting to come through and I hope that is giving you some comfort there and finally checks I know you want me to wrap up I want to talk about waiting well the experience of people whilst waiting is very important to us and there's a number of deep dives going on at the moment to look at what people's experiences are and what we can do more of to help make sure that their experience is is okay and they feel supported when they're waiting waiting for service that they've got good sign posting information that we have regular check-ins and that piece of work was going on through audits within our partnership but also across mine works so if that's okay chair I just wanted to see if I can answer some of those points. Thank you very much yeah I it's obvious overall yeah there is a massive problem in terms of weights, cues, children who are not receiving the things that they need to do for one reason or another that's then causing delays in their education, treatment and everything else so you know we're really looking for a plan that starts to really bite into address that and it's needed now frankly it's it's not needed you know in a year's time so I'm just gonna you know very briefly pick up we've got Chris Townsend on Teams Chris if you could be very brief please because very brief yes I'm very brief Trevor thank you very thank you very much Trevor I just want to I always worries me when I think it was Graham came back and he said the door isn't closed it's changed shape that that's a I think that's an absolute classic statement of of on both on both station I think it's called but I don't understand what he means by it's changed shape and my last point would be that if the child isn't diagnosed how can you treat them you give them treat them before you diagnose that sounds crazy to me and I'm just a layman so maybe somebody could just make me make me understand that particularly this changed shape of this that the door is the door now round rather than square I guess I'm gonna I'm gonna have a go because you know it it is tricky trying to to reassure that there continues to be access to help and support and to diagnosis what we're trying to do is deploy our resources in the ways that we've described to ensure that that the the expertise we have is in the right place in the system so when we when we're thinking the door is not closed it's changed shape it's because we know that there is still the opportunity for children to come on to the assessment and diagnostic pathway the difference is that we are offering a consultation in relation to children young people who we know schools are we know there there's lots of concern and lots of and lots of help and support needed there are some especially vulnerable children and for those children having access to a consultation is really important for other children the the door is not closed because we know that the the treatment as Graham has has articulated is is is is limited to children who might benefit from ADHD diagnosis but using the language of treatment then all of the help and support and so it's things like we heard a colleague talk earlier about children with neurodevelopmental need or traits of neurodevelopmental need that will struggle in an exam hall situation and so having an alternative arrangement for that child is really important it might be that help in an advice and support to parents can make a difference to the way in which they think about how to support their child when they're in distress we we know we we can know through consultation and connection with the people that are with the child what their strengths are and where they are challenged so being in big classrooms for example or preferring once one interactions so there there's a there's a whole range of of ways in which a child might present with need that may be indicative of neurodevelopmental need it is need that also may be indicative of difficulties with sleep with trauma behavioral type concerns a response to what might be going on elsewhere in their lives so what we are trying to do is instead of as per the previous model cue all of those children are on a waiting list until they can see our neurodevelopmental team we're trying to engage quickly educate others do our best to identify what might be contributing to that child's difficulties and therefore what support can be made available to them immediately and that is in preference so just you know for us we read pre consultation I cannot emphasize enough we had a hundred and eighty three percent more referrals than we have contracted in 23 24 and 26 staff if we do not have this pathway in place if we cannot engage at the earliest opportunity in multiple ways to support children and young people our clinical team will spend their time processing referrals and not getting around to diagnosis or or or or being able to share their experience across the system to help children young people so that's what we mean by the door is not closed thank you for that I'm just going to ask Fiona to come in briefly to give her rap on this from a CFLL point of view I know it's a mouthful isn't it it's a terrible I say not I try not to say it's a terrible tongue twist to actually try to save the initials but if you could immediately after that we're going to have a short 10 minute break so you're in between everyone else the the break excellent thank you um it worries me hugely that the information that you've had from us today and from the head teachers is news in terms of how parents are feeling and how schools are feeling that worries me hugely um because we hear it every day so I don't really understand why the mind works consortium isn't absolutely aware of what's happening on the ground and I I do understand the limited resources but actually it seems to me that the response is still failing and you know I think if if perhaps there was more listening to schools if there was more listening to parents maybe the response would be would be more appropriate so I come away as chair of the select committee and I can't speak for my colleagues but I don't feel assured that there is a plan which you know has timelines has activities has accountabilities has funding which is really designed to try to address what schools and what parents are feeling so I don't feel that assurance I'm willing to believe that you can put a plan together but today we just don't have it can I say one other thing actually in relation to this plethora of of um tools and techniques that seem to be around parents have not a clue how to find them and there was one other interesting point that was absolutely the language is just doesn't work for parents it's the language is inaccessible you're absolutely right Liz can just say one other thing the report of um a survey undertaken by primary teachers reported about the effectiveness of services and support other the mind works so it said that 48 percent of respondents thought external services such as the national autistic society were effective but 42 percent find no other services were effective and then remember this is that this is a survey of primary heads talking about the services that were available for them to actually deal with the issues they have on a daily basis of all the partner support services offered via mind works only the national autistic society and to a lesser extent learning space is overwhelmed by demand so what I'm wondering is do we actually know the effectiveness of that plethora of support services that we're saying are available to deal with the social issue because it seems to me I'm not sure our mind works monitoring the effectiveness of these services because I really thought that survey which is in the report from the primary heads was actually very illuminating when you see the demand statistics you know there seems to be a pattern there for some services being deemed to be effective and a whole plethora of other services which seem not to be very effective but the people who can really judge that are mind works and I would I would hope that that is being very actively monitored thank you chair thank you we are going to break at this point for 10 minutes so if we could be back here by 12 minutes past 12 so 12 12 and we'll resume with the remainder of the questions on the subject you know so but clearly the plan and needing one very soon is very highly agenda but the next question we have on the list of questions is really about asking about the support for parents and families of children in this situation because there are obvious stresses and strains I regularly sit on homeschool transport appeals and hear very directly from parents about the challenges that they are facing so I'd really like to know what's being done to actually help focus on families parents the mental health issues the pressures of dealing with children with neuro diversity creates chair do you want me to I think it could be helpful to hear from Emma Alice if she's still online because okay perfect because she's very well placed to talk about that part of rnd workstream within the mind works working together to look at it but also in terms of direct services from the National Autistic Society shall we do Emma first Emma if you'd like to join in this conversation thank you chair yeah so not only is my professional life dedicated to the NAS but so is my private life too and I am also a parent of neuro diverse young adults so I can speak from my own personal experience as well as professional experience the national the NAS professional organization offers parents support through our group workshops so when people join those workshops they stay with the same group of parents throughout their journey with us and they often set up their own WhatsApp groups or they meet outside of our our workshop environment but we also run family fundays in the school holidays and that's an opportunity for people to meet in person and for the children to meet in person and we consistently have amazing feedback from those groups I did have a quick look and I have a lovely quote here which says so happy to meet new people having the feeling that other families are on a similar journey we normally avoid family days out as it could be quite challenging and normally ends in tears however you get the feeling that you're not alone and others are on bumpy journeys too we find school holidays very tricky and knowing that the family fundays are offered during school holidays is a bit of a lifeline and that sort of feedback is that there's lots and lots of that you did touch on what type of feedback how these things being measured and I just want to say that we all of our work is goal-based so we have quantitative and qualitative data for all of the work we do we are actually putting back some incredible results I think 93% of our clients are reporting an improvement in all of their goals and that's against the national average of 20 and a contractual target of 70 and across the alliance that figure is 90 so I can speak off of all of the partners in that sense so going on to the parent support and parent mental health in our voluntary organization we run parent support groups as well and those are either in person or online and what we find is that having a network of other parents who understand exactly what they're experiencing can be incredibly validating and we are incredibly supportive group of parents and often the challenges are the same and that learned experience that lived experience can help those other people who are perhaps earlier on in their journey and that's very active so in Surrey we have 4 000 members of the NAS Surrey branch and in fact that's increased by 2000 over the last two years so that kind of reflects the increase in demand for this sort of support service I think and we also do days out for the children swimming events all sorts of different events where it gives the opportunity for the families and the children to get together and be amongst their peer group so yeah I think there's there's very good support and sorry there's a very good network we also have an online forum which is a moderated forum and that's got about a thousand members and that's where parents can reach out for support to other parents and get advice or information on simple things like where they might be able to get their children's haircut and they're living in the red hill area for example does anybody know of an ND friendly hairdresser or tooth brushing which is always a major issue what toothpaste of people tried what toothbrushes of people tried right the way through to EHTP questions send support questions and there's a lot of activity around that and it has to be said that a lot of parents who have those EHTP questions do think that they need that diagnosis in order to get an EHTP so we are very very frequently and regularly supporting those parents to understand that they don't actually need that diagnosis to get sent support we are supporting them to understand that process and understand what adjustments they can request at that early stage without the need to go through that process thank you thank you and Jeremy I believe you've got some questions on learning space yeah I have we note that learning space is not going to be commissioned further what's being done to replace their capacity because we just had a look here at some of the waiting time and there's 28 people waiting in East Surrey and 23 in in West Surrey so what's going to be done to replace that capacity do you want me to take that um so we are we're working together with learning space to look at whether they can continue service um I think that um yeah that that's the situation at the moment so at the moment learning space there's a period of time before they would exit so we're looking now so service is there at the moment once if if we're working now to see if we can smooth that process and maybe have a way of learning space staying with us but we're doing that work with them now so we're working with them to do that if if they do indeed exit they'll there'll be a procurement exercise and we'll make sure that that continuity of services is key and so we're doing all the work around mitigating that risk at the moment so they may stay with you we're in conversations in conversation okay can I add that second question Trevor because that'll date them then take a hold right so in relation to the autism activity evenings and day events offered for children young people with autism or waiting at our social care assessment which also involves appearance what data is being recorded on how networks are supported benefiting those children and parents as a result of this initiative and what is the learning so what's being recorded in terms of what's happened these activities evening and what analysis is being done this is the effective is that question was that question for me well I'm whoever whoever's suitable to answer it yeah we don't have qualitative data we have qualities of data sorry we don't have quantitative data that looks ahead I'm afraid so what we use is the feedback questionnaires to design further services going forward and we take that feedback we take that learning and we create new events which are meeting the parents needs but we can't sort of unless we would be very difficult to ask people to form us about the sort of personal connections they've made going forward if we were asked sort of three years down the line or five years down the line we haven't found a way of doing that at this point okay thank you very much and uh council clack cruises to come in just for a minute I was just very in thank you very much chair and I'll be very brief just listening to Emma there earlier in her description of support for for young people and their families before they were diagnosed I thought that was incredibly supportive and I'd just like to ask her how easy is it and how accessible is it and you know do GPs and schools advise parents to contact her organization for that sort of support how how can they you know get that pre-diagnosis help during the you know facing up to the problems of with children with with um learning difficulties is a big thing in life and you know that that early help is really important before diagnosis and I was impressed with what Emma was saying so I just want to know how easy is it to access that sort of advice yeah um I have to say if if we were able to afford marketing and communications um person it would it would be easy but but we can't so it's not so it relies on um practitioners and individuals taking every opportunity that we see to get out there so it's um and of course our resources are limited so we try and attend community events where we can um we try and get information and communication in things like the school bulletin which we have which we have done and does generate quite a big response we have a small team um in fact that it's just the equipment of one full full-time person actually um but a portion of that person's time is spent going into schools and talking to parents about neurodiversity explaining what services are on offer including the um voluntary and parents support groups and also are answering questions on the spot to try and give some understanding into some of the behaviors and things that they might see um and in terms of the parent support groups we have a website and again we attend local events so in autism awareness week the other week it was a Saturday and I was there in hazelmeer with a with a table and a stand in a church hall talking to people as they come in but this is on a voluntary basis so that sort of work is is limited to the to the amount of time that people have to give because we don't have that as a specific role marketing and communications within our sorry hub um and a word of mouth of course so on the voluntary side we have a newsletter that goes out every two months but people need to join up in order to receive that newsletter so they need to be able to find out about us either through word of mouth or through some of these community events that we do um but we are very uh committed to trying to raise our profile and a lot of that is through schools but again we have limited resources to to be able to do that if we could go into every single school and hold apparent information session that would be absolutely amazing if we could go into every school and deliver the school training that would that would also be amazing because I very much believe that it's that the real earliest point of support is what makes the most difference and it's also helping parents to understand what they're in control of and what they can um push for within their environment with their family and friends with their school um and in their own home what what difference they can make that doesn't need that diagnosis because ultimately as um my colleagues have been saying earlier for autism there is when you have a diagnosis um that is just really a confirmation a validation of that difference because there is no treatment as such it's a way of living it's a way of being and it's the environment around you that needs to adapt and change to support you where it does make a difference to young people is where it's about their identity and a validation of why they feel different um sometimes that sense of needing that validation comes early sometimes it comes a lot later on and for some children the mental health difficulties that arise out of not knowing can cause a different set of problems but that's when they will go into mindworks in a different through a different pathway for those for those mental health needs does that answer the question? Thank you um I think we've now got some questions on the care lever service because sorry could I just add to that answer because I think um Emma's done a wonderful response from one of our partners so you'll see in the paper um there are lots of ways on where we're listening and hearing from our families and family voice is very influential and giving us some feedback and the examples of the practice that Emma talked about is where we have saw and secured some investment to increase the capacity of that type of activity so you'll see that mental health support teams have invested was it 460 that extra funding into the capacity to have more of those types of sessions you'll see that there's um 1.2 million from mental health investment fund that's gone into sorry well being partnership to support primary school children and their families so you can see that we're building that support the bit that we've also got to do that we're working on is a single process so there's work across the partnerships around a single referral process irrelevant of what organizational partner you are information governance arrangements has been signed off around that and we're working on how we can provide that digital solution because it shouldn't be up to a school or a family to get to the support of the different selection of partners so just want to add to what Emma's name we're increasing the capacity of that and we're looking at a process that's more streamlined and digital okay thank you and Fiona is like to start on the care levers questions sure i'd like to ask a question about care levers so the care lever service for young people age 1625 we're struggling with emotional and mental health difficulties aims to support them to reduce the risk of long-term mental health needs how are you working with others to do this and what are the key issues in reducing risks of long-term mental health needs what more needs to be done as well to improve outcomes because we've had a very sad example of what happens when this doesn't work in the not very distant past thank you for the question Fiona i'm happy to talk about so two elements of service so our new leave services are services that support children who are looked after and children who have left care and includes specialist support for for example on a company to sign them seeking children and this the service from a clinical perspective includes it's a multi-disciplinary team multi-agency team that are really expert in working with children who've experienced trauma in particular and they network and engage with all of the agencies that are supporting the child and work with the family to be able to support that child's needs and that that's one element of service the the other element of service to think about is our reaching out service so reaching out services again are aimed at children who are hard to reach and we know that children who are hard to reach are very often challenged with mental health and neurodevelopmental needs and they may be struggling with addiction with homelessness and they may not be in education and so our reaching out services works with children up until the age of 25 but at the point at which a young person may need to transition and that might include transitioning into adult services there's a sort of a really comprehensive offer to ensure that that transition happens together with that young person and their family and takes account of their vulnerabilities and we've got different approaches including making sure that there's a really comprehensive transition checklist we've got courses and support available to families and young people through our transition recovery college and we make we align a support worker with a young person there's sort of more vulnerable points in their care journey so transition and being one of them and there's direct sort of one-to-one support for those young people so there's a range of supports and offers through reaching out a new leaf for this especially vulnerable group of children can i just follow up justine because i'm a young person who is on my own i'm a carelaver i don't have much contact with my birth family and i grew up outside celery so i don't have any contact much with the foster family so i arrive back in celery and you know i've got quite a few problems how do i access support how do i even know that there is support there because you know there's a there's a real i mean you know these young people you know are not often part of a family back in celery so you know they are particularly vulnerable in that respect how do they access the services absolutely so so it it the access might be via sorry county council and our relationships with sorry county council if a young person presents and and they have emotional well-being or mental health need in our screening criteria we would look at particular vulnerabilities including identifying if that child is a carelaver or or or is a child who is looked after so as part of our triaging and screening processes we would we would look out for vulnerabilities like the vulnerabilities that you've described and children who might have been in care and we give prioritization to their needs so there would be a direct referral to new leaf services who would engage and offer support and network with agencies to support that young person so can i just check there's an assumption that somebody's going to help the young person to be referred so there is going to be a PA or there is somebody who can refer that young person that carelaver is that is that the working assumption the young person can't immediately access services themselves they have to be referred by an agency of some description is that how it works press the button the wrong way and there isn't a self-referral to our new leaf services but for children like the children that you describe it is it is usually known that they that they are in the county and in need of support and our agencies will work together in that respect it is also the case that there are a range of supports that young people can access by a self-referral so i think that's important to hold in mind so they may be may may access through one of our so well-being partners they may come to their attention it may be that they come to the attention of their GP so there are different opportunities including opportunities to work together with sorry county councils and other agencies for children who are more vulnerable okay thank you thank you Fiona um okay um councilor Robert Evans i believe you've got some questions around sign-posting Robert could you turn your mic on i have just done that i'm sorry yeah um yeah it's really whether how how people can access the the sign posted to know the services that for which they're eligible and um whether you are happy that you've got a joined-up approach that you know we're talking about vulnerable people um and to ensure that there's the continuity of service and the all options open to them are actually um made aware the the emphasis in our mind works alliance partnership is to really increase the presence of help and support um in places and spaces where children and young people are um in order that they can immediately um access or talk about their needs and and throughout network of partners um build confidence in understanding the needs of a young person and making sure that they can be directed and supported in the right way as early as possible so we we've talked about mental health support teams for example we've got 15 mental health support teams our partners as and has described our third section voluntary sector partners are present in schools and in communities um our recovery college offer is um self-referral um there's really good information on related websites and we are working hard through webinars with gps and schools and with parents we work really closely with family voices so we we really do try to adopt um what we call our thrive approach which is really trying to grow the confidence competence and understanding of what is available for children and young people across across our communities across Surrey forgive me do you feel confident in telling this committee that it's working uh and you know is there really a sort of sophisticated jigsaw that fits together that provides those services rather than just explain what you hope will be happening can you actually convince us that it really is effective yeah um hi so um I think the sign posting and information that we have available to us we we put out in all the channels we are able to do um the work that we do in the community in across multiple organizations um with uh children young people in in targeted groups but also our universal work we go to a sem we do assembly so much like Emma was saying earlier multiple organizations are doing that across um sorry so I think we there is definitely a concerted effort to do that I've no doubt there's an effort what I'm trying to argue is ask you is what what I'm trying to argue I understand you're making the effort but what I'm trying to discover is what procedures or mechanisms you've got in faith in place to see if it's effective to make sure people don't slip through because if you're doing school assemblies but the people you want to get to aren't at the school assemblies what do you what you know we're here constantly here are cases of people who fall through the system and I'm just anxious to know what your mechanisms are to ensure that that's not happening how you're getting through to the most vulnerable people those that are most in need most desire your support yeah so I think that is that is to do with our our focus on vulnerable groups and that is through the reaching out team so Justin was referring to the fact that we do have more demand than capacity does tell us that people know where we are and they're requesting our support so we do we do have that we some of the work that we do for instance you've have early intervention coordinators in schools that work with the mental health support teams the primary mental health practitioners and work in school clusters so it was our school based needs team as an example is multidisciplinary in its approach it works with local clusters of schools where all practitioners can come meet the relevant people and hear what we've got to offer but specifically our early intervention coordinators would work with schools to make sure they support in school any vulnerable pupils but also to refer them to the right partners if necessary so I don't know if Justin you want to add about the vulnerable groups part yeah I've talked about reaching out and new leave I was just thinking about and thinking how to frame the question so forgive me but thinking about when children really are at their most vulnerable so in crisis and so we have a 24/7 crisis and mental health support line and we have put posters in schools and created cards that children can carry around in their pockets emerge out one of our partners they are present in emergency departments we we have CYP havens as part of our mind works officer children can can walking can present and we work with amplify who are young people themselves and they're a network of young people that do a lot through sort of peer support and connections to promote the range of help and supports that are available with regard to measuring effectiveness and so as Anne says we we can see that demand for all of our partners is significantly increased particularly post COVID so it is it is evident that more children are accessing emotional well-being and mental health support and when I think about effectiveness there are there aren't measures your views matters and talked earlier about goal-based outcomes which help us to think about what a child's needs were at the commencement their assessment and then at the conclusion of interventional treatment was that effective in meeting their needs and and we've got much richer evidence around the effectiveness of the interventions that we're providing and when I think about complaints we do we tend to get more compliments than complaints the compliments are usually about the experience that families and children have had with our frontline teams our complaints are about waiting times that's the strongest theme waiting times for new developmental need so we're trying to be present we're trying to be responsive we're trying to give a range of offers via self-referral and via referral to ensure that we are present and engaged with our most vulnerable children we do yes yeah yeah we've got a mind works and and actually our amplifier our young people support that so for example we have campaigns through exam season we know that certain times of the year are more difficult for young people so we'll heavily promote access to our crisis services and havens and there have been amplified events and which have you sort of bought together all of our partners so that we're we're continually sharing what what is available in the full range of support and offers that are available i don't know if i could just add the social media communication strategy is an important one and we have recently been reviewing it to add things like tick tock and things into that so that we are putting our communication in the right spaces so we're looking how we might do that but we're certainly on instagram at the moment um facebook and twitter all the usual places putting out those key messages particularly the crisis numbers but but also um signposting the website where where we do have resources on lots of lots of information for families as well as have access services could i also thank you thank you i just wanted to add just in terms of the reaching out service which is supporting young people vulnerable young people from some of those underserved groups so we have been doing a piece of research with the McPinn Foundation under an NIR National Institute of Health Research Grant to look at the experience of young people in those transition services and to learn from their experiences so i think that's that's another helpful piece of work in terms of shaping that offer and making sure that it is it is user led design and it is meeting the needs of that particular group of vulnerable young people and moving on um Fiona Davidson has uh I think a question on recovery college in this space I do and it's it's um it's appropriate actually because Justin has just talked about the recovery college so I think what we're interested in is what services are currently being offered for young people with neurodevelopmental issues by the um sorry and borders um recovery college so what proportion of young people with neurodevelopmental um issues have taken up the recovery college offering how could you encourage more take up and if you had more take up what would that mean for you as an organization last point is could the recovery service recovery college service be widened to include more support for parents of children and young people with um lived experience of neurodevelopmental conditions thank you uh so thank you Fiona so um yeah so I mentioned specifically one of the courses which is the transition course so um young people particularly those who are more vulnerable open to our reaching out services will be encouraged to um attend that course um there are a range of offers um uh that um so these are our working age adult services um but they um have um looked at um ways in which they can engage um young people and particularly those young people who are transitioning to adulthood and there are three specific courses um which focus on um neurodevelopmental um need and a fourth in production um and uh the courses um so include um introduction to the um autistic spectrum um understanding adult ADHD and the post diagnostic ASD and understanding adult ADHD courses um and there's a of the opportunity to attend online and in person um and they're well attended um the there's um a degree of anonymity as we said earlier there is self-referral to um recovery colleges so in fact parents and teachers others you know the recovery college is open to all um can join um those um courses um and because of that because there are um it there is an emphasis on um uh sort of sharing who you are and what your conditions are um it's more difficult to be able to ascertain what proportion of attendees have neurodevelopmental need but we do know that those courses are well attended thank you can can i just add to that just to say this one of the strategies to increase take up of the recovery college has been to instill that anonymity um as a way of challenging stigma um from the recovery college the reports are that most people do not want to disclose a diagnosis so and they're treated as students rather than patients or clients so that's the self-solved the whole recovery program thank you and we've already touched on the transformation plan quite a few times so the um the need for it but i'm gonna ask Jeremy to sort of wrap that one up please well it's actually Jeremy and Jonathan um actually there's a lot in this meeting that i found actually very good and very optimistic i shall not forget Graham's metaphor i just looked up the meaning of metaphor Graham but at the shape of the door it is a metaphor and that's going to stay with me for a very long time i did what's been nagging me for the last hour hour and quarter of those what's the plan i used to work with a manager in family book said what's the plan so in my sort of simple mind i i think of a you know you have a partnership you know within that there's somewhere there's an office there's a group of people who sit together and say right how are we going to achieve this could you see i've been very impressed also with the work of the same clothes you know and and the lady that came on the screen today is known to me i've been around other primary schools of mayor and seen children who can't go into class just in corridors with individuals so i suppose you know if my mother's here she said we can't go on like this so i suppose so what is the plan and who's doing it and Jonathan might like to add a few things to that so you can answer in the round Jonathan thank you um and thank you for your presentations i what i'm stuck with not so much is front doors but silos and whether we've been delving into one particular silo the ones that you're responsible to and and seeking to try to resolve the whole issues of which go far beyond what you're capable of and what you're funded to do and what your commission to do within that little bit and and i'm trying to think of a nice catchphrase the the close i've got is trying to put a court into a pint park and i thought i just googled to find what court is to make sure that that is a correct analogy um but you know if if you don't have enough resources to do the social model as well as the the the part of the medical model you have to do presumably you are the NHS so i guess we should like rely on you to the medical bit and in in the past there was more social wraparound provided by Surrey County Council in the form of shore salt centers across Surrey so that less children were presenting a reception with the same developmental challenges and then were being referred on to a medical response to something which could have been maybe addressed in a universal provision well we're we're an adults here aren't we so adults and the NHS work together in terms of better care but this is the the child bit of adults if you like or for inflation the health part of our brief is all ages it's all like yeah so but there's the better isn't there the better care fund where health and adults work together well this part of health and children need to work together so how do we get the universal provision the social model whether it was funded by the NHS or whether Surrey County Council that does the care bit should fund the social model as well as its targeted stuff that needs to do to pass its office that exam or orders NHS need to give vastly more money to this service so it can actually deliver what's required because my worries we could create all the plans of the world when Esther's money to deliver the plan unless there's the wraparound things outside of the mindwork silo that you're looking for I mean presumably the reason you're reaching out to the social model is the Surrey bit isn't doing what it's supposed to be doing in that partnership so how much of the blame for the uprise and in mental health cases that you're having to deal with should form our doorstep Surrey County Council and the lack of universal young persons provision I don't know but I wonder you know what is the overall plan because otherwise we could have little plans within little silos which don't get very political because you're not allowed to be within your own little silo but it doesn't actually address the root cause of the problem which you I know are passionate about because that's your day job and that's why you're here and and we want to solve this together so can we have some money with this plan and be honest about how much money we need and whether it should sit within your contract or whether you think there are money needs elsewhere that are needed which which are what's really holding you back from delivering what everyone expects of you. I'll try and start Jonathan and just to thank you really for I think that that acknowledgement I think it hits the nail quite splendidly on the head for one of another analogy metaphor whatever we're doing at the moment I don't know but I think it does speak to kind of the working day for lots of people and also the day for lots of parents who have children who are experiencing difficulties accessing support whether that's where the diagnosis or otherwise and we hear a lot from children or families and we have ways of engaging with schools on a very regular basis so I think we need to listen more to that what we hear and what we talk about to make some small changes that could make a big difference. In terms of the overarching plan we've put some things in the paper which as you've said to feel a bit disparate and we've heard that really loudly from committee members today and thank you for being as obvious in your comments as you are it's actually helpful because I think it helps provide us clarity in terms of what helps you when we come back again and I think we'd all like to come back again and be able to show you something different and what feels different it might not yet that then feel different to families that can take time but in terms of that partnership bit I think the people we've got in the room today demonstrates that partnership the people we had on the screen the teacher had to go and so does our colleague from education in the counter-council. Kerry and I are very fortunate we straddle both camps so to speak we sit in the counter-council in the ICB and so are able to try and start to knit some of it together into a more coherent plan that really draws on what children families and parents and schools are telling us what we then need to do about those things and kind of what that might look like in terms of action and next steps and outcomes and so I hope if we can come back again we can articulate that much more clearly the mind works part as part of that puzzle which is absolutely clear and present but also what the other parts of puzzle are Jonathan that you just articulated around that social model and I think for me and we've been talking kind of in the break of it there's a lot of work going around the all-aged autism strategy which absolutely resonates in this space there's a lot of improvement work around the SENS work and the children's additional needs which again builds on the kind of the work particularly around children who have additional needs for due to neurodivergence. It's not all siloed it's a child in the middle and that's what we try and keep central to the way that we want to work and you're right we do need to break down some of those silos and bring some of that together. The money bit I'm not going to comment on I think we try. I'm not sure I'm able to I'll be honest I think we try and make sure funding from the ICB and likewise within the counter council is shaped and moved to where that need is certainly in the ICB when we've raised risks around this particular pathway for children's and adults it's been heard and some investment has been made we need to see what that looks like for the year ahead given where the ICB is currently as you would in terms of financial planning exception within the counter council. Thank you Chairman. So thank you for those questions and observation so from my perspective I would say that universal early years provision is absolutely critical in the sport of families and young people and there are certainly gaps in that provision across the country not just in sorry say recognising that. I talked earlier about our plan around the transformation work that we've got a number of workshops in train. I think there is a risk that that becomes a siloed piece of work and it's really important that we try to make sure it's well connected in. The plan is to ensure that that work feeds in through a broader transformation board that's chaired by Suzanne as part of the county council so that it can connect into all of the other aspects of work so the send work and the other bits of work that we've talked about today so that we can have a more holistic plan. So I think that's what we're going to try to deliver and there will be segments within that plan clearly there is a part that's going to be for the mind works partnership but there's going to be a part that sits around send and delivering the autism strategy so but we need to make sure there's a golden thread that goes through that plan that makes it feel more holistic and connected. Through that planning clearly we're going to be looking at the the finance or the financial plan that sits underneath that what we got what haven't we got where the gaps can we get any more resources to deliver that plan can't answer that at the moment without the plan so we need to do the work and we need to ensure the right partners are engaged in those conversations it's critical that we hear from more from families more from schools in terms of the best fit for that plan. Thank you Trudy you've been very patient on there on teams if you'd like to come in. Yeah just to add support to what Harriet and a colleague have just said about the work we're going to do around the plan. Jonathan I think you and I hit the nail on the head we focused on one sort of kind of element and you know the mind works colleagues have been under intense scrutiny today because of the wait times which they've acknowledged. I do think there's an awful lot of things for us to do in support of schools and families and actually as part of the you know educational lifelong learning director we will be focusing heavily on that we have a as people alluded to the offstead inspection to respond to and part of that is about having a cohesive plan that makes sure that we all work in close partnership. I will say it's lovely to hear from Emma and other colleagues around the table about all the support that's going into schools. I think for us it's about mapping it out making it very clear to schools what's available and also yeah there's much to talk about what's ordinary available in schools. I think we need to have a real look at that schools are dealing with different cohorts of children these days and actually the way that they've been working for years under you know difficult circumstances have fallen from the pandemic. We're not looking at what we used to look at we're not comparing the same sort of education system that was there previously and I know that our schools and partners are really keen to support all these children and learners plus their families in getting better outcomes for them. We want them to be an integral part of their community they are we don't want them to have to go and find specialist settings elsewhere unless their needs actually demand that and so we need to look at what our offer is what our training and development is for our practitioners and actually learning from other local authorities who are facing the same issues that we're facing taking what's the very best but making it tailored for the children and young people and families of Surrey as it's really important that we have that kind of unique offer but most importantly is that we have equity in the system for all of our children and young people this is really important that they thrive in an education setting that's appropriate for them. Thank you for everybody that's participated in the questions session and I'll come back to just saying that among part of this issue is society as a whole has to become much more inclusive and regard people with neurodiversity they're actually just part of the variation and we need to actually manage things like that in a much better way where we all take our part in supporting them Fiona. I guess my one last question is what's the time for him for the plan you know are we talking three months six months nine months because I think that's I think that's very important for us to feel that a very clearly I mean that the plan that that you suggested Helen signs appropriate you know the structure that you suggest is signs appropriate but you know the proof is in the pudding so when do you think it will be out there when will be see what in what time skill will we get a view of how it is actually going to deal with the the the fragmentation and missing you know we're missing so many needs today so when when do you think we'll see that plan? So I think we've got a fairly tight timeline so we have committed ourselves to be able to present at a national conference in November in terms of our improvement plan so so we will be expecting obviously to have that plan in place fairly quickly we need to make sure that we we've had the right conversations though and you know a plan is only as good as a plan it's about how you implement it isn't it so and so we you know I think we would be expecting to see that well before November because we're going to be presenting it so I don't know if Suzanne wants to comment on on time frame but I think our expectation is certainly within the next few months we look forward to seeing it thank you thank you we're going to move on to the recommendations section of the discussion now so so if you could put them up on the screen please you suggestion please on the on the recommendations I think it's going to need a little bit of surgery and tidying up because it doesn't really it's not coherent as it is at the moment and I would suggest that we if it's the only suggestion that we look at it over lunch time and come back after a break because I think we could spend a long time playing around with words on this on the screen now because I don't think at the moment quite in the format it serves its purpose I'm mindful that we've got safeguarding teams waiting patient here as well so I thought you were going to take it after this take the lunch break well we'll take a short break but just you know worrying about the timing yeah I think we'll take the break yeah we'll take the break and if we could be back here promptly at half past okay you can do a full screen excellent I think we're including one so do you like me to read them out or are you happy with them on now so yeah I think let's read them because I think most most members go struggle with that and most people online would struggle with it so you can have a chance to talk to them more. Okay. I am going to say good. Do you not think you think that we're not sure? We do not make the transformation plan because what we've been able to do is just make the transformation plan because what we've been able to do is just make the transformation plan. Remember as the CFLC is with requested that the confirmation plan comes back to the CFLC for a scrutiny by the end of this calendar year with all the basic things. Well they say the first is Christmas Eve. They said they said they didn't remember their book take it to a conference so you know it's got to be online. Yeah I would suggest that it's October. So before it went to the conference. I don't know if you've heard that Graham. What we're saying is we'd like to see the transformation plan. I think there is a consensus that the children's committee would like to see it in October but the question is is it going to be feasible to do that if it's going to be presented nationally in November. I'm not sure that one that they need to be in sort of in series like that. I think there can be a degree of which they can parallel run. So I think when we go to the national conference we'll be laying out our thoughts but this process should be about the actual transformation plan and its delivery time scale. So I think October is a reasonable time frame to go and then we would only, I mean it's a presentation at a conference isn't it? So it's going to be sort of you know ten slides not the sort of thing you'd have in committee. So I don't see but I think October is a good timeline. Let's go for October then. That would be great. Thank you. Thank you. So that covers the transformation plan section. Next one is recommended that the response to the joint area inspection report is extended to accommodate a joined up mind works, education, health and care plan process. That's because these are very, very different processes at the moment. So you know they're part of the same continuum but actually each is being done in isolation. And I think some level of integration to give certainty about what happens when and in what time scales would be an excellent addition. Okay, recommendation three there is the Surrey and Borders Partnership Trust Recovery College needs to be more accessible to people and encourage more local access with better publicity and provision of outreach services. Ensure that the recovery college is given more active publicity and has the capacity to take on the extra workload. Establish skills and works coaches to help coach and support people to enable the transition that's the transition into adulthood with helping people to maintain employment and getting to employment and critically to help people with regards to the recovery college. And then number four is mind works and I believe you want to say something on the information guide. Yeah, I'm just wondering whether that's something that the National Autistic Society and some of the parents who use their services may be able to work collaboratively on with mind works. I mean for my own personal experience that the NES have a plethora of information and contacts and things like that within the community. And obviously, you know, having been through the NES and the various workshops and things like that, you know, they have a program events from the suitable for young, you know, young children right through to adulthood and, you know, beyond 25 years when you start to get to all the adult services and things like that. And I was just wondering whether or not they could work together with mind works to try and put something initially together and without it will be built on a made alive document. I'm not saying we have to put that in the recommendations, but that's something that might be considered online. Thank you. I also had a conversation with Graham in the break suggesting that quite a lot of professionals would quite like a simple guide as well. So it's a problem because you may not have that many cases come to you as an individual, but having something that's simple that tells you where to go is enormously helpful. Yeah, I was just thinking about whether the use of the words information guide narrows the recommendation quite quickly into a particular document and whether guidance. If you like would provide more freedom within the transformation work for us actually to think about what's the right sport. We were having a conversation about how, even if you've got a great document and actually parents might need someone to actually talk to as part of a guidance process. So, yeah, I would actually go to it needs something clear, simple and coherent. Yeah. So, yeah, I'm going to point it to the complicated stuff, but you should actually have. A simple guide. A simple clear guide that actually shows a complete bit and doesn't go something wonderful happens here is exactly what's needed. I mean, I think the thing about a guide is that at the moment parents have no idea where to turn. I mean, we were talking about this in the break. So, they need information. They need it in a format that is digestible to them that has terminology that is appropriate to the terminology that they use, you know, that is not a specific set of terminology. So, I think all those things, you know, to find somehow, to find that access into a whole lot of information and different pathways through it that will help people make sense of a huge amount of complete fragmentation that doesn't seem to address many people's needs at the moment. It also needs to be simply worded. I don't know how you want to express that. I think, let's just say that I think it's accessible language, so it's not the language used by professionals, which is a very particular subset, which is heavily medicalised language actually. I love the page really. Oh, Jonathan, sorry, yep. Yeah, very briefly, talk there about ensuring the communication is clear, but I think the point from the National Autistic Society was the communication could be further reaching and better hitting the target audience so that there might be, you might want to beef up that little bit as well. Yeah. Okay, I think hopefully we're agreed with that after a very long and very full discussion and move on to adult safeguarding. Thank you very much. Yeah, thank you, Graham, and please thank your team. Okay, team adult safeguarding. Okay, thank you, Chair. Can you all hear me? Is the mic on? Okay, that's blended. Thank you. This report sets out our performance in relation to safeguarding adults. Broadly, there are two aspects to the report. We set out the responsibilities in the context of the Care Act 2014. Additionally, we have a test of assurance coming up, and the first part of the report also briefly touches on that. And the second part of the report indicates overall performance. It highlights our strengths and areas of challenge and our improvement plans in conclusion. So setting out the broad responsibilities of the Care Act, we have a clear legal framework for how local authorities are required to perform. We must have a multi-agency local adult safeguarding system that seeks to prevent abuse and also respond to it once it's identified. I have to say, Chair, our first responsibility is always to protect adults at risk. That is our number one priority within the Council and within Adult Social Care. We also carry out safeguarding adult reviews when it's suspected that there are lessons learned within the systems where there are potential. We can't use the word failures, but where there are multi-agency systemic lessons to be learned if we can do things differently to protect adults at risk. And we also arrange for independent advocates. We've also got an inspection coming up, which is defined as a test of assurance. This is new for Adult Social Care. Years ago, inspections of Adult Social Care ceased, but now they're brand new as defined by law. They're defined as test of assurance, but we know in any other name there are inspections. And our regulator, Care Quality Commission, is undertaking that test of assurance or inspection and worries on the cusp of having its inspection very soon. The assessment framework uses quality statements from an overall single assessment framework. I hope that's a test, Chair. That was a two o'clock rehearsal I didn't tell me about. Thank goodness, it's just a test. So, there are nine quality statements mapped across four overall themes, and within the themes, there are nine I statements. I'll carry on. Can everyone still hear me? Okay, thank you. Which reflect the individual experience of the people that use our services, and the I-State measure about what people expect and their experience. Theme three of those four targeted themes within that inspection relate to ensuring safety within the system, and that includes safeguarding. So, we move on to the second part of the report, which is the most important part. It reflects our current position, what we believe we do well, what our strengths are, and what our challenges are moving forward. And this is what we have submitted to the CQC in preparation for our inspection. So, we believe we have a good track record in making safe God impersonal with our frontline staff, consistently reflecting on people's wishes and supporting individuals to meet those wishes, focusing on the outcomes, what they would like their outcomes to be, particularly when considering adult safeguarding. And we can evidence that through benchmarking data across comparative local authorities. We're an active partner within the safeguarding adults board, and that's multi-agency partnership. We have invested strongly in leadership to improve our position with adult safeguarding. Although we know that there is increased demand nationally, and that's reflected too, in Surrey, and that's reflected in our statistics. Provided business continuity plans are scrutinised as part of our commissioning process. And we've also introduced a proportionate response for managing safe God in concerns where a full Section 42 inquiry, and what that means is a Section 42 means a full safe God investigation. So, where a full safe God investigation isn't required, we manage the immediate risk. And we ensure that no vulnerable individual is open to abuse is left at risk. Nevertheless, people still feel safe. In Surrey, we did have a high referral rate for safe God in, but we're reducing that by that proportionate approach. And the number of inquiries open for longer than 52 weeks has also dropped dramatically down 80%. And we've also reviewed targeted audits using a local government association approved tool. And part of our improvement program does include reviewing that audit process right the way across the county. And ensuring staff write safe God in plans in response to inquiries. We've improved our internal governance process, and introduced a practice assurance board, which assures that learning from case audits saw us, safe God in adult reviews, and other learning opportunities are disseminated across the county. And we will continue to review that audit process. And some of the challenges that we face is that, that is national picture and reflected in Surrey, as I've said, the complexity and national demand for safe God in adults has continued to increase year one year, with the most common types of risk being neglects and acts of omission. And there were an estimated 587,970 raised during 22 to 23, and that was an increase of 9%. And the number of inquiries under section 42 also increased by 7%. And in Surrey, the number of concerns received per 100,000 was towards the top end of our comparator group. And you'll see there that when the stats that's borne out. In July 23, an audit was undertaken to establish the workforce's level of understanding of risk assessments. And it recommended training and risk assessments, and relaunching the assessment form and guidance. And that is all underway as part of an overall approach. I'll keep going unless someone raises their hand and say they can't hear me. I can always move closer to the mic. No, it's fine. You're coming across well. Just be glad that the paper shredding Laurie hasn't shown up. Thank you. So we have a number of improvement plans to improve safeguarding. We've reviewed the Care Act training as part of our training offer. And we intend to increase understanding of proportionate risk management. And we're actively sorting and developing training modules for registered and unregistered staff, focusing on identifying risk and working with people to enact that and enable staff. And indeed, enable a vulnerable adult population to manage their own risk. We've established a new safeguard and improvement group, which is a strategic group to develop strategy and drive forward improvements. Principal social worker is also key to that. And working on risk management and improvement tools. The improvement work continues with processes and systems. And safeguarding audits have already mentioned, but we're also looking at disseminating lessons learned right the way across the county. And that includes lessons learned from SARS by applying different methodology. We've commissioned a commissioner and provide a concern improvement group. And again, this is a strategic group to own the development and delivery of specific improvement strategies, including market position statements and focus groups and so on. And that reviews how provision service are monitored and effectively assessing the impact of all of that work, working with providers and so on, including best value for money, high quality and meeting appropriate demand and to resolving any concerns and reviewing national guidelines. So, Chair, we know that in recent months, we have made good progress and we continue to monitor that progress because we want to embed it across the county. We're improving outcomes for adults at risk. And that is evidence in several performance measures, including the improvement in safeguarding data, especially making safeguarding personal, which is one of our key performance indicators. And whilst we recognize the challenges, we've got improvement plans in place to continue to improve the lives of those at risk. So, the recommendation is for the report to be noted by all members of this select committee. For our next steps, what we would like to do is to review the safeguarding adults board training offer to partners, to specifically ensure that carer concerns are appropriately dealt with and safeguarding alerts raised as appropriate, notwithstanding low-level provided concerns, and all other concerns are appropriately referred and dealt within a timely matter manner. Because what we're really keen to see is that people who have need of service get the best possible service at the right time and in the right place. And also, because we're on a continuous journey, we'll continue to focus on the performance trends, particularly in the referral data, to make sure that we're still on track, and timeliness of responses to ensure that the measures are being fully implemented and effective. And we will also offer adult safeguarding training to elected councillors as well, because we also recognise that elected councillors are the eyes and ears or our eyes in the community, and we really value and recognise the intelligence that elected members can bring to us. So, thank you, Chair, and now we're open to questions. Okay, I'll open the questions. We had some recent reports from Health Watch Surrey. Can you talk to what improvements have been implemented since those reports, particularly, how is more coordinated working, improve the experience of families and carers, and where do you think you still have issues with safeguarding that need to be addressed? In relation to the Health Watch report, so in reviewing that, there is a series of individual cases that are highlighted and they are noted. In terms of our improvements, we're driving our main improvements through the safeguarding improvement plan, which there's an existing one which will set up in relation to preparation for CQC assessment. That plan is in the process of being updated now that the self assessment has been completed for an inspection, so we're in the midst of completing over the next few weeks. There is a wide range of things that we're looking at, particularly in terms of how we are managing volume and the different trends and it's across a whole range of areas. Chair, would you mind if I? I did something to that as well. Thank you. I just want to just touch on the Health Watch point if I'm a chair, just to say that we very much welcome the Health Watch report. I know that Luke and George, I hope you've all met George, he's new here at Surrey County Council. We're very pleased he's here. But I know that we are all committed within adult social care to improving practice, which are report highlights around safeguarding. And it also highlights a focus on improving communication across the agencies. So on the back of that report, as you know, I was in children's recently come back to adults. On the back of the Health Watch report, I met with Kate Scriven, Chief Executive of Luminous, and we had a really good chat about the report and looking at how adult social care, health watch can improve those communications. And improve those outcomes really for vulnerable residents. So, you know, we know Luke has said the report's clear. We do have a way to go, but we've got clear plans in which to get to where we need to get to. But it was a really strong meeting with Kate, and I think if we stick to those commitments around improving communications and improving practice, we'll see some significant improvements at their next report, hopefully. Chair, if I could just add to that as well, Health Watch and our senior leadership team do have regular meetings, and we're using the data to make sure that we understand the experience as reflected in the Health Watch report. And we're using case tracking audits and so on. In the SAB, we work closely with system partners, including Health, and our Executive Director meets regularly with Claire Stone, who's the Chief Nurse of the ICB. And the other part of your question, I think, was where we think we still have issues with safeguarding that needs to be addressed. So, we have had a very risk-averse culture, and that has led to huge volumes of safeguarding referrals into the system. So, we're wanting to shift from risk-averse practice to positive risk management, and Georgia set up a risk enablement board. And that's established to promote that proactive and positive approach to risk management within our organization's adult safeguarding framework. And the primary goal is to facilitate a practice culture shift towards risk enablement, and that focuses on well-being, managing risk effectively, and of course, reducing unnecessary Section 42 inquiries. In other words, inquiries that would lead to a full-blown safeguarding investigation. And it links to the point I made earlier, really, Chair, in terms of ensuring that people who need a service, nevertheless, get it in a more timely and more appropriate manner. Thank you for that much better and more complete answer. Fiona. Thank you, Chair. How is poor communication measured amongst carers, the health service and other organizations, as well as social workers, and between different family members who are often contacted at different times? So, how is the communication measured? I think we've probably all had examples of having been given different information by different people at different points in time, and wondering who actually to believe. So, how is that communication process being managed? How is it being improved? And is there a complaints process if you kind of just get to the end of your tether and you think, I can't make any sense of this and something needs to be done about it? Yeah, thank you for that question. I think that's a really important question. We're trying to engage more and more with users of our service. First of all, there is a survey, a user survey, and the take-up of that traditionally has been quite low. So, it's not alone in that. There are other authorities where the take-up is quite low, and we're trying to encourage people, making people aware that there is a complaints process. As we have contact with people, as we do assessments with people, as we have contact with carers, because I know that from the health watch report, there's a lot of reference there to carers, so we're trying to enable carers and make carers aware that there is that process. And, of course, encouraging carers and users of service to participate in that annual survey. That's the first thing. The second thing is where there is feedback, our frontline workers receive feedback to feed that up to the chain. As part of our new Practice Assurance Board, all comments are taken forward as lessons learned as part of that process now, because we want to become known as a listening authority and a hearing authority. And that's part of our governance process now as well. In terms of communication, we do measure the complaints that we get through the council's complaint process. In adults, it's a single tier process, and that's a statutory process. We define and analyse complaints by the data recording, process the nature of the complaints, and communication is a category within this. We are able to understand how many complaints we receive about specific issues, and we try and make the best use of that communication to drive improvements to the service at a local level. And, of course, we remind staff of the importance of good communication at all times, and we explain eligibility and social care processes from the outset to fulfil improvements in training. We run training in complaints for our staff, and that's specifically run by our complaints department, which we think is important. And complaints also includes ombudsman investigations, and they're reported upwards to our corporate leadership team, as well as our direct leadership team. And under the new governance arrangements, we're taking lessons learned, not just from complaints, but from ombudsman complaints as well, to disseminate them across the county. So, thank you for that really important question. Thank you. Thank you, Chair. Thank you. Section 43 of the care act requires every local authority to establish a safeguarding adults board with the major task of coordinating and reviewing the multi-agency approach across all member organisations. Inevitably, in a multi-agency situation, gaps, problems do sometimes occur at the boundaries. What improvement efforts are you taking to make sure that those are as much as possible eliminated? Thank you, Chair. In some ways, that's a good old chestnut of a question, if I may say, and it's not unique to Surrey. You'll hear me saying that a lot. Every time you've got more than my organisation involved, you've got gaps and problems of communication. It goes without saying. I mean, I think the SAP here in Surrey has endorsed a number of principles, which underpin our approach. So, the first thing I would say is that no one agency can create an effective safeguarding system by itself. So, and we recognise that only a joined approach at a strategic level can deliver a better response. So, to test the effectiveness of strategic arrangements, we always ask, how is the partnership making a positive difference to the lives and experience of local people? And at the very best, local arrangements show that ambitious, joined up strategic partnerships have clear sight on lines of practice, and on the experiences of local individuals and the impact of that direct work, and will be informed by the lived experience of local people. And that's what we focused all of the partners involved in the SAP on, and that helps. Now, we've been progressing the ambitions to improve countywide links and working, and that's crucial to improving the ability to understand communities across Surrey and strengthening the voice of people with lived experience. And I think key to answering that specific question in the gaps is that earlier in the year, the SAP established a new communications network, which was led by our partnerships officer, and that had a broad membership from all sectors to inform and extend our methods for awareness of raising all adults safeguarding issues. The main sub-meetings encourage white and exclusive membership, and are used as a forum for sharing, learning and insights, local, regional, and national practice and research, as well as SARS, and serious incidents. It's steered by an executive group, and shared by the independent chair, and comprises of statutory partners, as defined in the care act. And the independent chair is now leading a review of our approach to quality assurance, and he's working with the SAP's quality and performance subgroup. And what we're trying to do in the SAP is to develop a new quality assurance framework. And the focus is strongly on multi-agency approach to assurance, and the questions that we are asking all our partners to try and fill those gaps is, where does abuse happen, why, by whom, what are the biggest risks. Do we have skilled, informed, and a confident workforce across the partnership? How can we address that together? Do we listen to the views of local people, and how do we, as a partnership, make that difference together, and if not, what can we do about that together? Thank you for that very full answer. People living in poverty find it much harder to live healthy lives, much harder to access NHS services. They live with greater illness, and die earlier than the rest of the population. How is the improvement plan, an integrated collaboration with ICB's and the community, helping to improve safeguarding amongst vulnerable adults in Surrey's priority neighbourhoods, and where are the biggest improvements really needed? I won't pretend this isn't an easy answer, Chair, because I think it is recognised that there is the link there between impoverished neighbourhoods and safeguarding. However, there are priority neighbourhoods set out health and wellbeing strategy, and they are being used to target specific resources in order to prevent issues of safeguarding occurring, because part of the focus of certainly the SAB, and our partnership work, is about prevention. So, resources include things like local area coordinators, and they are there to understand need experienced by those neighbourhoods, and to enable better access to services to respond to that need. And that, indeed, might include safeguarding issues, or prevention of safeguarding issues, to even the low-level risks, and enabling us to work together to manage those risks, to prevent them escalating. And, yes, it's about that working together, really, in that partnership way. And I'm going to pass over to Councillor Gooden. Hello there. I've been interested to hear what improvements are being made to address the difficulties in accessing professional help. Specifically, what improvements are being made to help people to access the right kind of support to reduce risk and promote wellbeing. And then my second question, because you might be wrapping it all up in one answer, what improvements of staff training and management have been implemented to help improve the effectiveness of adult safeguarding. And has there been any safeguarding protocols implemented for clients and volunteers? If so, it would be great if you could just share a bit of information there. Thank you. Thank you for that question. I won't prolong the answer to this, but I can list a few of those initiatives. So, improvements being made to address difficulties in accessing professional help. Certainly, internally, as far as adult social care or the Council is concerned, we have improved our triage process. I referred earlier to the referrals that are coming in. And, you know, we're adopting a single point of access approach to triage more effectively, so we're able to connect people to the most appropriate service. There's things like initiatives like, sorry, County Council, Fuel Poverty and Energy Efficiency Network, working with partners to increase access to specialist advisors and sources of support such as debt and energy efficiency, working with utility providers and understanding veals, housing first approach and actions to ensure duty to refer and acted upon. The Fuel Poverty Program links to work with, sorry, fire and rescue, so that when they go into people's houses, they're able to sign posts. Those haven't been put on the heating to get support, for example. Warm hubs, there's a web link, list of food banks in Surrey to enable access for the most impoverished. And it was found that many people, leaving with disabilities, for example, weren't able to access the appropriate food support. There's the work of community link officers to link people with services that they need, working with partners, for example, to make physical activities more accessible, connecting people to four prevention programs, and that is an example of possible prevention of safeguarding or escalating safeguarding issues and linking people with free health checks, particularly at a time when sometimes it can be difficult to access GP services, so linking people with those free health checks is a preventive measure. Staff training and management, we have an academy, and there's dedicated sites within Surrey County Council, which lists safeguarding training and competencies, and we've also linked with the safeguarding adult or competencies framework, which will enable staff to identify specific training for each role and develop awareness, and that's something that we are also auditing as part of our improvement plan to make sure that people at the right level get exactly the right training, and everyone will have a level of safeguarding awareness, and of course, some will need more than that in terms of safeguarding investigations. So, we're in the process of establishing no response guidance, and we've agreed to the new process for handling low-level provided concerns, and that links to our commissioning teams as well. So, there's an awful lot of activity to refresh our training offer for us to offer. Yes, thank you very much. I was listening as I came along today sitting on the M25 to Nikki Campbell and somebody else talking about their experiences of abuse in schools, and how the system of reporting it totally failed because the person responsible just brushed it under the carpet. I mean, I think things are better now, but I have no experience of saying that. How can you assure us that there are better systems for reporting and recording concerns, and that issues are not going to get brushed under the Carpian care homes and other places? Well, I think that for us, we take every safeguarding concern seriously, and we don't leave any stone unturned, and we have professional curiosity training in the council that was produced some time ago, and as part of our training refresh, we're also going to refresh that professional curiosity. And professional curiosity means, particularly in adult social care, because adults are not children, they're able, if they've got the ability, you know, and the capability to make decisions for themselves. Nevertheless, professional curiosity means that we won't leave any stone unturned, and we'll keep going until we're satisfied about the concern, and we're going to refresh that training as part of our overall review, because it is very important to us, and it is our number one priority in adult social care. Adults at risk and protecting adults at risk has to be a number one priority, and all I can do to assure you is that professional curiosity training will be refreshed as well. Do you pay or does somebody pay unannounced visits to care homes and sort of go around to ask people there if everything is all right, because you see these parents who do video cameras and see old people being poorly treated. I just wondered if you can, you know, whether you follow things up like that? Yes, absolutely. It's part of our quality assurance process within commissioning, and in our monitoring visits, we don't just look at the care homes, speak to the staff and look at the records, but we actively speak to residents as well. We look for evidence of how residents are treated, and each care home has its whistle-blowing policies as well, and also CQC has whistle-blowing policies, and we make carers of loved ones aware of that. Each care home should make them aware, and we look at that they are being made aware, but in any case, we ourselves will make people aware, and we do follow up some concerns. That's not to say that we don't have some providers who require provider support, or in the county the size of Surrey, we don't have provider failures. I was surprised when I came here, actually, with the number of provided concerns that there are. There are relatively few, which is to the credit of Surrey and the commissioning and Q18 here, but nevertheless, that can happen, and we respond robustly when it does. But yes, is the answer. Thank you, Chair. If I could just add as well, Councillor Evans, the safeguarding adults board has a really good website, and it's really easy to navigate round, and it tells you the golden threads throughout the whole, all the different pages of the website are you concerned, and if you are, this is how you can report, and there's been some real improvements around that soon, recently, sorry. We also meet with our providers on a very regular basis. We have a provider forum, and concerns and issues can be raised there, and safeguarding is regularly on the agenda to be discussed. And there are, as well, we had a complaint come to this committee chair, I think probably about 12 months ago, and the quality assurance team, the relevant director, and social work team got very involved in that particular case, and that came to a very satisfactory conclusion, particularly for those vulnerable residents. And as Councillors, we always get case-working queries about this, and the team are very responsive to those issues as well. And there's lots of co-production and discussion that goes on with our stakeholders, our providers, our residents as well, those vulnerable people we support. So I think the safeguarding routes to raise concerns are clear. I think we can do more, I'm raising awareness, and we should always do more, and never say we've done enough ever. And you could say the volume of cases that we have is testament to that, but it's a continual piece of work for us for raising awareness. Thank you, Councillor Mooney. Thank you. And Councillor Fiona Davidson on whistle-blowing, I believe. Yeah, I think you've just been speaking about this. I was interested, when I read the document, I didn't see the word whistle-blowing anywhere, and I wondered why that was, so neither in the report, and neither of the reports alluded to how the word whistle-blowing in. And I wondered about that, because, you know, in this kind of environment in terms of safeguarding, you know, nobody can forget Winterborne View. You know, it's formed part of the lexicon of our society and I. And it continues, I believe, to be very difficult for employees, quite often employees in the health service actually, even more so than in care homes, and to raise whistle-blowing issues. So I'm just wondering how confident you are that there are good whistle-blowing policies in place, that they do not, as far as this humanly possible, lead to victimisation, and to what extent they are actually followed through, because, you know, there have been a number of Winterborne Views since the original in 2011 or whenever it was, and I think it's something that many people are concerned about. Thank you. I entirely agree, there has been a lot of concern, and it still crops up in the media about the quality of care, and indeed safeguarding concerns within care homes. In terms of the wide provider market, all providers are required to have whistle-blowing policies in place, and are required to publicise those whistle-blowing policies, and CQC in their inspections, have tightened that up since Winterborne View, and that is something that they look for, and it is something that our commissioners and QA team look for as well. What I can say is that we know that they work here in Surrey, and we did have a whistle-blowing incident recently, someone felt confident enough, and this was actually the carer of a service user within a home who contacted CQC, who subsequently contacted us. I responded to it, our QA team went out with health to, you know, did a spot check on the home, and it was anonymous, but we identified the service user about whom it was. There were actually no safeguarding concerns, as was initially suggested, but there were some minor quality concerns that were addressed, but that was a strong example to me that whistle-blowing policies are effective, and they are in existence here in Surrey. On one level, I was concerned that someone felt the need to use it, but I was actually very happy that someone did have confidence to use it, and also it was evidence that they exist, and that our system in Surrey is working in terms of having whistle-blowing policies embedded within our homes, as is required. So I can provide some assurance to you that not only is it an obligation, but also that we check and that they are followed up here in Surrey. I'm sorry that it wasn't included in the report, but I note that, and we can make reference to it to provide assurance to members in future reports, so thank you for raising that. Thank you. I think that would be reassuring. I still worry about the safeguarding of the whistle-blowers, but I hear what you say, but it's still a concern. I have to admit. Thank you. Thank you, Councillor. I just want to thank Councillor Davison, because I think that's a really valid point and question that you raised, and I know of some adult social care services outside of Surrey, children services, where whistle-blowing is mentioned on a frequent basis, particularly when you look at their procedural kind of part of the work that they do. And I think we should take away, actually, as an action or a recommendation from the committee, that we do reflect on the importance of whistle-blowing, particularly when the safety aspect of it, confidentiality. I think, in particular, on the adult safeguarding website, I think we should make particular reference to that. If the committee agrees, Luke's nodding his head, I think we should take that as an action, because it is quite a gap, I feel, and should be there. Yes, I quite agree, actually. Thank you, Councillor Mooney. Thank you for that. I think it's a great suggestion to actually do so. Next question is for me. Councillor Mooney knows that I've come across a couple of cases of modern slavery in the care sector, so it is, I'm afraid, an unfortunate concern. Very difficult to actually get the confidence of the individuals concerned as well, because of the climate of fear that they live within. It's obviously places both them and the people they are caring for at risk, particularly with the criminality that's collected with it. So the question is really around vetting of organisations and actively fostering awareness that it does exist. Yes, thank you, Chair. I think that's absolutely right. And I think that's something that I need to take away, not only just to consider, but also have a discussion with my commissioning colleagues in terms of the way we contract with providers, just to make sure that that aspect is considered very carefully. I don't have an answer for this committee right here and right now, but that is something I'll take away and discuss with commissioners. I think it's something that's very much a risk when commissioning, because trying to get the best price may lead people to taking actions that they absolutely should never take, and obviously we need to be very aware of it. I absolutely agree. Thank you, Chair. Thank you very much, Chair. This has been quite an interesting discussion this afternoon going over a range of issues around safeguarding, adult safeguarding. At least that comment I think about modern slavery, considering the pressures on resources and getting people into work in this sector, very, very difficult. And also, I'm quite concerned about some of the carers that do look after adults. We know a lot of the vulnerable adults can also be very demanding in their needs and quite difficult to manage. And I have letters in my inbox from people looking for support from anything from a monetary sector to adult social care, because the person that they look after is so demanding and so difficult, and it makes them almost have to be saints sometimes to manage some of the problems that they can occur when things get chaotic or chaotic. Making safeguarding personal, this is a sector-led initiative, and enables to develop outcomes on focusing on safeguarding work. How will that help making people be more safer in the sector? And particularly, as I say, I'm focusing on making sure that staff and carers are able to feel confident and share those feelings when they feel they may have. I think your report particularly focuses on acts of omission and neglect, and I can understand it. Any human can understand it when someone has enough of looking after someone who is very difficult and demanding, and then subsequently feels enormously guilty about it. How do you manage to make sure that they can be helped? Maybe that's the sort of purpose of personal safeguarding. Thank you, Councillor. In relation to carers, we do have carers assessments that we do offer for unpaid carers, for example, family relatives, so we do look to understand what the position is for individual carers who are looking after a relative or someone linked to them. It is a real considerable sort of task for somebody to take on, particularly as people now are living much longer, and can go on for many years, and that does unfortunately at times create situations where their potential safeguarding issues. The add-on social care role within that is to ensure that we have got the right tools and skills and experience to pick these issues up at an early point. That's the key part is to prevent escalation. So we would be looking through our carers assessment process to support those carers and intervene at the right time. The work of the risk-enabled board, the first session is next week is to look at how we risk assess situations in a more positive way as well, and at the right time, and that's real crucial for add-on social care to make a difference in terms of preventing escalation. So we're looking at it through a number of different routes, and the whole sphere of carers is really big, particularly for, sorry, there's a high number of carers, even when you unscale up to the size of, sorry, there is a lot of people who do care for family members and friends and others. I hope you answered your question. Yeah, please. Yeah, I think, you know, we can't underestimate the importance of informal carers, unpaid carers to our kind of adult social care system here in Surrey. There's a significant number of people who are looking after family friends every day, and, you know, in some challenging situations like you talk about. So we do look after this cohort of our population because they are so important to our service. They do a tremendous job, and they replace the role really of statutory services. So that's why, you know, carers and paid carers are so important to us. We have a couple of providers that we commission who do give carers respite, and that is hugely valued by those carers because that gives them an opportunity to have a short break once a week, potentially. Sometimes that's the only break people do get. To spend time with friends or families or go out and do things that they need to do or things that they enjoy doing, it's often the only opportunity that they can have in these particularly very challenging circumstances. We also do carry out carers assessments. That's a requirement under the Care Act to make sure that we are doing the best for our carers, particularly in the more challenging situations. So it's an area that is very important to us, and we're looking at it actually, to see if we can do more. And I think it will become part of our adult social care transformation plans over the next four to five years given the importance of carers to us. Yeah, please help. If you don't mind, just because in relation to adult safeguarding, you know, in particular, because I know there's a lot of work doing and we absolutely don't. We value our unpaid carers in this county. But what are we doing to make sure that they are specifically not getting into problems regarding their, safeguarding their patients or their abusers if you like? What's happening? What are we doing specifically to support unpaid carers in this field that we're talking about this afternoon? So in relation to, I'm actually supporting carers. The main sort of platform for that is through the carer assessment process. So there's an established way of, you know, identifying what is the circumstance of the carer and in relation to their role for caring for someone. And it's about the timeliness, which is the key part generally from our experience and situations that sort of deteriorate are as a result where carer comes perhaps too late to us and things have gone quite far and they're very stressed. So it's about us sort of picking these things up and in between as soon as we receive them. But also at times people don't recognize themselves as a carer and it's about ensuring our staff recognize that and pick that up and to offer those carers' assessments when they are coming across other people being referred to us, for example, their husband or wife. So it's about us having, you know, those skills to pick that up and to be receptive to it and many a situation people not want to be recognized as an unpaid carer. So we have to try and work around that because those can be very complex situations to resolve. So it's a range of things that we would have to consider when we are a receiving referrals but also when we get out into the community to see people because that's where we often don't find them hidden carers if I can put it that way. Thank you. Thank you. And Councillor Fiona Davison has a question on safety and managing those at higher risk. Yeah, older people and people with disabilities are statistically more likely to be abused and neglected. But often they won't recognize it themselves. Now, sometimes families will recognize it, sometimes carers will recognize it. But what I'm wondering is, if an adult has communication difficulties or doesn't recognize that actually they are subject to abuse, they're not going to be able to alert others. So what I'm wondering is, and it may be an impossible question to answer, but I'm wondering how does the improvement plan deliver improvements for safe guarding in those very difficult circumstances? We're probably, are we relying on a third party where the elderly person or the disabled person has communication difficulties or perhaps has difficulty making sense of the world around them? I just wonder how we do that and how we're looking to improve that going forward because it gives agency and we always want to give agency where that's possible. Thank you. Sorry. Okay, I'll answer this initially. So in relation to people who have, say, communication challenges or they have issues with their mental capacity, then we would treat each of those situations individually. But with people with sensory challenges, that does become more risky for some of the reasons that you've just highlighted. And it's about ensuring, again, our workforce is appropriately skilled to pick up on those and to involve other forms of communicating with an individual, presumably they have capacity. So there will always be alternatives so that we ensure we get their viewpoint and that's the key part with safe guarding is keeping that person at the centre of it rather than focusing on other things. If there is a person with mental capacity issues, then we will be certainly looking to involve an independent advocate for that person through a section for you to enquire it if that's what applies to that situation. So we're looking to give everybody an even playing field in these sort of situations. So we have to make those necessary adjustments and the key part for us as a department is to make sure the workforce pick up on those issues and they identify them at the right time. Okay, thank you. Thank you. Okay, I have some questions on training and risk assessments. Last year in July, there was an audit recommendation workforce undergo training in risk assessments. The risk assessment form would be relaunched with new guidance and management oversight would be improved. When do you expect those recommendations to be completed? And how do you expect that to improve processes? And when do you think you will be able to say that it is completely embedded into practice? Thank you, Chair. This has become a broader issue than just that specific training. We have included it as part of our overall audit of training offer, which is being undertaken by the academy and also at a local level by safeguarding advisors. If I explain that each of our localities, each district has its own safeguarding advisor and each of those safeguarding advisor regularly delivers safeguarding training. George, as the new head of safeguarding, right now is currently reviewing the training undertaken by those safeguarding advisors. And together, we're standardizing that to ensure consistency across the county and ensuring that it includes appropriate risk management and risk assessment. And that piece of work will be concluded within the next month. So, the first level will be included very soon. And it's broader level, as part of the overall audit of safeguarding training, that will be completed the audit within the next few months. But nevertheless, the localised training for each district will be completed within the next month, which will satisfy part of the safeguarding audit training that you referred to from July last year. Thank you. And moving on, we have a question, I think, on the safeguarding improvement group with Councilor Hill. Thank you, pardon? Thank you. Thank you, Chair. My question is, how will the newly developed safeguarding improvement group oversee and drive continuous improvement in safeguarding practice to ensure staff have the key skills and resources required to fulfil the statutory safeguarding duties and keep residents safe? And how will you work collaboratively to achieve those improvements? Thank you. Good question. With the safeguarding improvement group, there's the first session was held a few weeks ago, so we're right at the start of a programme of developing a new safeguarding improvement plan, and that will run for a whole year, and then we will review it on an annual basis. That plan is informed by the views of a whole cross-section of them, operational people and leaders as to what are our current areas of them and focus that we need to work on moving forward. The plan is built on what was done in relation to preparation for CQC assessment. Now that we have the self-assessment completed, we're looking to expand the plan further, so there will be a revised plan going forward. It's also informed by what our data is saying in terms of our overall performance around safeguarding, and as mentioned earlier, we do have a very high volume of our firm safeguarding within, sorry, and there's something in there about ensuring that there is good application of the safeguarding and criteria as to what is a section 42 inquiry. We would also be looking to implement an embed learning from safeguarding adult reviews through that group as well, that's key thing. It's about what are the lessons learned and alongside that will develop a process around embedding learning, that's a real key part, and that process will also detail a more bespoke approach to learning, so depending on the individual case that's been reviewed, we will have a range of options in terms of how we share the learning, how do we embed it into practice, and a system of measuring that at a later point once the learning has, and the changes have been made so that we can reassure ourselves that the issue that's been raised in those safeguarding adults' reviews should not happen again. We will also be working very closely with the academy in terms of the whole area of learning development, to make sure that staff groups do have the right skills and knowledge and tools to work with the wider range of people that we do work with. I hope that answers the query. Okay, and finally, over to Dr. Andrew Goodwood. Thank you. My question is about the section on monitoring performance of data and ensuring timeless with communication. You mentioned that improvement work will remain under review, and there will be a focus on performance trends. But how will you be working collaboratively to ensure that communication is responded to and referrals are timely, and who will be monitoring this process improvement? Thank you. So, thank you. I have oversight for the multi-agency safeguarding hub, which is where all of the safeguarding referrals come into, and I have regular meetings with our performance people to have oversight of how we're doing against our key performance indicators. So, my role is to work closely with the performance team, but also with the MASH team around identifying where our blockages are, where we might have bottlenecks and to really focus down on those areas for creating a flow through the system. That's absolutely crucial so that we can ensure we have timely responses to concerns. We're looking to enhance the data further so we have a much more robust and reporting framework, and that work is currently underway at the moment and should be concluded quite soon. So, yes, there's a range of monitoring and oversight. I hope that answers your question. Can I just add to that one final thought, if I may, Chair? I think given the volume that we have had in Surrey, I'd like to hold my hands up really and to say that the responsiveness to Section 42's inquiries and concerns hasn't always been as robust as we would like it to have been, because anyone who sends a Section 42 in or a concern is entitled to an acknowledgement at least and a response that says we've received this. We can't always, because of data protection, share the outcome of where it's gone, but people need to know, and that's an area of improvement for us, and we've already taken steps to improve that, and I think that has been something that we have improved, and we will continue to monitor that, and that falls within George's remit and the remit of the new team manager. So I think that, I don't know whether that was part of the motivation for this question, but I'd like to acknowledge that to Committee as another area of improvement, and we've taken steps to address that as well. Thank you, and Councillor David Hammer. I just wanted to ask why, if you get the same question from two different people, one's been done before the other, why you wouldn't just make sure the second, make sure the first one was not clearly specific, and just repeat the same answer. Why not give both people the answers they've asked for? I'm sorry, Councillor. Chair. I don't quite understand that question. Councillor Harper, qualify, what he's asking there. I don't understand your question. What you've just said is that you may not be able to answer some of the questions because you had already answered that question to somebody else, and you wouldn't want to identify that person, because in the interests of security or whatever it might be. But why wouldn't you just send the same answers as a second questioner? Perhaps if I can clarify that, Chair. What I was actually saying is that in sending a response to the referral, we may not always be able to disclose information about the person that they're referring because of data protection. That's actually what I was saying. So I hope that clarifies my response. What you're saying is that it's person-specific at the referral end. Okay, that's fine. Thank you. I think we're now done with questions. So it's over to the recommendations, please, Sally. Yes, please. So we've got the following proposed recommendations. Provide an update from the new safeguarding panel on progress on the questions raised, particularly around communication and working in partnership, ensuring that people don't fall through the gaps. Provide a measurement of feedback from staff, patients, and from other services so that we can see what improvements have been made, and as a result, we can show how we deliver a safer environment. Provide an analysis of how effective your measurement services so that we can be reassured on how effective the service is running and that activity is arresting in more resolve. To examine best practice on whistleblowing and to make every effort to provide a process that protects the individuals who are using the process and that it is effective. Continue improving the measurement of safety and demonstrate that the service as a whole is actively eliminating problems. I agree. Thank you, everybody. Next up is the recommendations tracker and forward -- oh, sorry, yes, apologies. I've been diagnosed by so many people that they want to finish earlier. Let's get out of the room, folks. Thank you so much for attending. I'm also aware that the M25 closes later on this evening, and it's going to get very busy before it closes. Anyway, recommendations, tracker and forward plan. I'm not going to go through it in any detail whatsoever. People can read it. I just will note that the forward work plan at the moment has a lot of things in October, and some of that is going to have to change. The date of the next meeting is the 10th of October 2024. Summer break is coming. [BLANK_AUDIO]

Transcript

Health Select Committee, and I'd particularly like to welcome and remember to the Committee which is District Councillor Paula Keay. So, glad to see you here. In the event of the fire alarm sounding, please proceed out of the Council Chamber using the door through which you entered and take the exit immediately to your left. Please note that today's meeting has been broadcast live via the Council's website as part of our webcasting facility. In line with our guidance on the use of social media, I'm happy for anyone attending today's meeting, including members of the Select Committee, to use social media, provided that this does not disturb the business of the meeting. Please can you ensure that your mobile phones are either switched off or put on silent? For Select Committee members and any officers presenting, please speak clearly and directly into your microphones. When called upon the speak, press the right hand button on your microphone and start speaking when the red light appears. Then please remember to turn off your microphone when you're finished. If you are sharing a desk and microphone, then you need to press the right or left hand button depending on which side of the microphone you are sitting. For those officers who have joined the meeting remotely, please use the raise hand function to indicate that you would like to speak and please mute your microphone and turn off your camera when not speaking. I'd also now like to introduce those witnesses with standing invitations to each Select Committee meeting. We have apologies today from Maria Millwood, but Sue Murphy, Patrick Walter, Oliver Hearn and Nikki Roberts. Moving on to item one, apologies for absence and substitutions. We have an apology from Michaela for today. Are there any others? Sorry, the democratic services, have we got any others? Just Michaela Martin? Michaela Martin sent her apologies on the side of Maria Millwood. Yeah, OK, I've done Maria as well. Dennis Booth has as well. Dennis Booth, thank you. Thank you, Robert. Councillor Abbie King from Runnimide Council, I think there's another meeting in Runnimide. Thank you very much, Robert. The minutes of the previous meeting, 7th of March 2024, have been published. So the item two is for the Select Committee to agree the minutes of the previous meeting. On 7th of March 2024, there's a true and accurate record of the proceedings, are we agreed? Okay, moving on to item three, declarations of interest. I have a declaration to make in that, as I usually do, to state that I am a community representative to NHS friendly. Any answers? Thank you, Chair. I would like to declare that I have a close family member work in Frimmy Park Hospital. So, moving on to item four, questions and petitions, we have five written questions on the subject of mind works, are any of the questions present? Okay, then we'll pass on from those, since there are no questions, and we have one question on adult safeguarding, is the question of present or on the call? Thank you. Then we can move on that there are no supplementary. Which then takes us to item five, mind works, which is a joint scrutiny item in conjunction with members of the children, families, lifelong learning and culture select committee. So, I cannot please welcome the members of the committee today, I think we've got Fiona Davidson, Jonathan F6, Fiona White, Rachel Lake, Liz Townsend and Jeremy Webster. And as witnesses, we have Mark Newty, she made Mooney, Kerry Clark, Susan Smith, Harriet Derritt Smith, Professor Helen Rostell, Lorna Pine, Trudy Pyatt, Justine Leonard and Kelly Emma Ellis and Carolyn Hing, and I think you're there as well, I'll let you grab. Okay. So, moving into... Can we hear from mind works? So if we can hear from mind works first, please. Could I make a declaration, apologies, Chair, slightly late. Of course you may. All nominated Government for the Surrey and Borders Partnership. Okay. Greg, I want to see if you'd like to... Sorry, Chef, are you asking us to be in declaration of interest or just to move on to the agenda item? Yeah. Okay. How would you like us to handle? You've obviously asked some questions. Do you want us to work? Sure, do you want us to present the paper first or...? Okay. All right. Sorry. So Harriet's going to provide that. Thank you. Hi. Good morning everyone. Harriet Derritt Smith, Associate Director for Children's Commissioning in Surrey-Hartland's ICB and also into the County Council. I think fundamentally we know that children and families and schools and people at working in schools tell us that children need more support managing what may be ADHD and what may be ASD or autism. And irrespective of diagnosis, they need that support in the school, in a community and at home. And I think hopefully what we've set out in the report is a balanced view in terms of the support and the diagnostic requirements. That view was clear, I guess, in the sending inspection that came last September, which quite rightly highlighted the impact of the longer waits on children and their families for an autism diagnosis and asked us as a system, so from the county council to education and health, to work together to improve the pathway of support and diagnosis for children and young people. The support needs its irrespective of diagnosis. We could diagnose every child should that be that needed and have no support in place for them. And that in itself would not be helpful when they're in a school environment at home or working and living within their communities. And so the paper balances the work of the all-aged autism strategy to really look at how communities and the environment functions for children and young people to make them more friendly and possible to really be their best and really get the most out of their lives. The actions in the report and in the action plan hopefully will be monitored through the additional needs partnership board due to its links to the send improvement plan. But hopefully also describe a range of activities that are already underway and that will be taken to look at both the environment, the support and the diagnostic pathways for children and young people with the potential ND supporting needs. And that continues work across the partnership due to the kind of the priority we feel needs to be placed on their outcomes. So welcome questions. We've got a head teacher joining us also online just to make sure members are aware of that who works with us quite closely in this area. And we've got a good range of partners from SABP but also from the Bonton community sector who are part of the model with MindsWorks and who have a really key role in supporting children and families earlier as part of that diagnostic and supporting pathway. I don't know if any other colleagues want to add to that introduction. We're happy to move into the paper. I just wanted to welcome I think the cross partnership working that I think we're trying to do here and I completely endorse what Harriet was saying about we're really focused on how we can provide practical support to schools in the classroom to support children and then think about how that relates to the families because we recognise we've got to take a whole child and family approach in taking this forward. So I think this report really demonstrates the fact that it's that practical support that is going to be the most helpful for allowing children to live the lives they want to lead. We've just got two more witnesses that are remote to come in so we want to try and make sure that we bring them in first so we can just pause for a moment. In the interim we have a request for a supplementary on one of the questions. So Amanda, if you'd like to introduce yourself and ask your supplementary question. Thank you very much. Yes, my supplementary question is actually to ask again the original question which hasn't been answered and that is why is the specific advice from NHS England regarding autism diagnosis being ignored at this stage. The report was made in total contrast to every recommendation on the NHS framework which has been put together by the leading experts in autism and I'm just curious as to why none of that advice has been taken on board. Thank you. I'll pass that back to my work. I think hi Amanda, we've spoken before and it's nice to see you again. I think the report from NHSE is absolutely correct in kind of when it sets out and it's the challenge of every area nationally in terms of being able to implement that. I'm hoping that as we move forward with the work we set out in this paper we can dovetail much more clearly with the ambitions within the NHS England report and actually most importantly being able to meet the needs of our population, sorry, as we said food that support but also improve kind of access to diagnosis and the support that that may bring with it. I'm happy to pick up further Amanda afterwards as well as we've always had those conversations. Yes please. Thank you for that. We're now going to move on to one of the school witnesses with Kerry Oakley who is secondary school head from Carrington School. You're invited to speak for up to ten minutes. Well thank you very much and good morning everybody. This is a very new process to me so forgive me if I get a bit nervous speaking in front of so many people. I've been asked just to talk a little bit about the issues that our young people face. I'm at school in Red Hill, we are a thousand children strong from year 7 to 11 and like everybody we have our fair share of young people who are presenting with the need to have mind works referrals and are facing neuro developmental conditions and they are really struggling in our school to access the aspects of the curriculum, social aspects of their school day, they're not able to necessarily self-regulate as easily and those are traits that are coming through I know from the primary scores and as they hit puberty can be exacerbated by all of those sort of complexities that they have to face. We have an increasing sensory need for requiring ear defenders, exit cards, uniform adjustments, amended time tables and we are having to find spaces for young people who need a quieter space at social times. I'm in a new build and as a new build school it wasn't considered a part of the DFE program to put in quiet spaces and as you can imagine schools are very large and very noisy particularly at breaks and lunch times and all of that can become very overwhelming. We do put on quiet rooms and we have something called the everyone room in some of our year groups that are run by year managers through lunch times to support that and I suppose the biggest challenge that we've had is about getting those referrals through quickly to the people that can support these young people because we don't necessarily have the skill set community to manage these young people and we never attempt to do so. And the changes there and the processes that have changed with mind works are particularly have been challenging because the lead times have been so long and then actually getting a consultation is even longer, recognising that there are more and more children that need these because the referrals were then stopped and it was very difficult in the last few months to get anything accepted. That's meant we've got a backlog of young people an increase in number of non-attenders as a result that who are not being managed with their complexities and I'm aware that that is now changing and that some of those referrals are beginning to come through but note that the working hours of the telephones are between 9 and 12 which as a teacher is probably the time that they are teaching and if you miss that slot then it's really difficult to actually get hold of somebody and being able to then discuss and follow up and get somebody into the system. The impact is huge actually we're finding that we get outbursts with young people, we get very frustrated parents and we become the middle people to those parents who have an expectation that we can get their child the help that they need and that can then really break down the relationships that we have with them and we did find that very difficult when we weren't able to make referrals at all and then I think we were promised that it would start again and it wasn't and some children were sitting for three months without any feedback and we were trying to manage that and the parents feel very let down by us. Staff then also feel a bit challenged because they don't necessarily have all of that training, we do try to do, we work with nurture UK and trauma-based approaches with our young people, we have Councillors from MCR placed to be and relate within our own school community but even they can't manage the depth of what mind works provides as a professional community there so that's really challenging and it's also very time consuming so we find that we'll spend a long time on phones trying to access follow up referrals to see where they are in the system and again that means it's time away from the young people so we would really like to see a greater ability to cope with the young people that are coming through. I think one of the suggestions would be to have some open of hours of mind works outside of the school day so that people who then can make those phone calls would be able to get hold of somebody and we do a lot of work with the mental health support team who are a really excellent service and have provided us with some really great opportunities for our young people particularly Victoria Graham and Fiona Wilson who we've had team around the school meetings with and they've come in and offer some help for us as well but the trouble is when we get then to that point where they need greater consultation we find the momentum stops for our families and that then helps that doesn't help the breakdown of relationships. What would we like to see changed if I've just got some a few moments left of time we I think it's just about the speed of acknowledgement and that triage in so that we can go back to parents and say yes it's there it's in the system it seemed to be a need and then okay we might have to tell them there's a wait but at least they know that something is going to be happening and we can give them that information and there may be some more work with us as a school because sometimes we find that what mind works thinks is the right option for young people in schools is not practical in the school and getting more of an understanding between the professional at mind works and the professionals in the school would really help then when a parent comes back and says but we've been told we should be doing this and I think that's something that would be really helpful and then I think just having a streamlined way to receive those updates and to be able to make those referrals so that we can reduce anxiety on our families and on our staff and and be able to share that with them would be really helpful I'm happy to take questions I hope that's kind of covered what people wanted to hear but if there's anything else I can take that thank for that Kerry if we could come to you with questions in a few moments I think it would be helpful if we heard from Alison Simister as well first Cinco for Audley School hopefully Alison's on the line [inaudible] Alison are you able to join us okay given the audio issues then I'll suggest that we actually move into questions and maybe come back later before we do there is an obvious thing to say here which is historically neuro diversity has been seen as being maybe something just over one percent of the population we are now coming to a new understanding that actually it's probably more like four percent that have got significant issues of one sort or another and that many people have some of the features of neuro diversity and you know we actually need to adopt as a society a totally new model of approaching it a different way of working so it's really vital that we actually do that and one of the key things that we will be looking for today is evidence of a real transformation plan that actually delivers that and has that in the situation so it's vital that we all change it's vital that society is a whole views neuro diversity in a different way to the world is being but our provision in relation to it needs to be much stronger and this is true frankly of very mental health provision across the board historically it's always been inadequate we need to change so I'm going to move to Fiona Davidson chair of the family's own lifelong learning committee to kick things off chair would you like me to start the questioning or to speak specifically to Kerry's statement I think if it was if you go to Kerry's statement first and then move into questioning I think you could do that seamlessly okay one of one of the things I'd like to ask Kerry is Kerry of the thousand children in your school how many do you believe are probably I'm going to go down some sort of neurodevelopmental treatment what sort of percentage are we talking about well we're about a thousand strong say it will be less than five percent but I would say we are we're showing signs between five and ten students in a year group on a year group is between 180 and 210 students from there but that does increase it seemingly is increasing year on year so and as exams kick in that that again changes in somebody who hasn't maybe displayed any symptoms as the anxiety of age and of think increases so they to our suffering with problems we have for exams starting now and we have over 30 children who are not able to sit in the main area where exams are sat due to ASD traits and mental health issues and things like that and obviously and just general anxiety and you can imagine how difficult that is to manage in an exam season when everything has to be regulated very closely and it puts extra pressure on us and if we can get some help for these youngsters a bit earlier we might be able to help them manage some of that to be able to sit exams thanks Kerry my last question to you really is if there was one thing that you could change tomorrow what would it be being able to get hold of somebody to have a conversation with around a young person and then being able to go back with to their families and talk even if timelines along but just being able to say we've spoken this is what it might look like this is what might be able to help you with and I think it's just that early dialogue and communication increasing so that we can get young people through a system and seeing with a known timeline appreciating the challenges that brings thanks very much Kerry I think I think that's really helpful Chair I was going to suggest that I could go into the questioning if we're still unable to find the other witness yeah I think that's okay okay I mean it my first question really is a follow on from what Kerry has just been speaking about parents and schools tell counselors that they feel completely abandoned because mind works which is the lead agency in this arena has given up providing frontline neurodevelopmental screening and assessment now we know we know that you haven't given it up completely but that's what parents and schools tell us they feel abandoned that you know that that frontline screening and assessment just doesn't there it's impossible to access it is so rationed as to be hardly worth having and it appears that the responsibility has been and this is from the perspective of schools and parents being wholly handed over to schools without a proper transition or without proper preparation why has mind works done this thank you Fiona and just to acknowledge that that from a mind works perspective and there is absolutely an appreciation of how challenges this is for families and for schools in response to the what why have we done this we we are a team so so the neurodevelopmental pathway is isn't a partnership and it's really important to remember that we work together with our Surrey well-being colleagues with Bernardo's the National Autistic Society learning space there's a there's a pathway in a range of offers so in borders provides a predominant the the assessment and diagnosis and element of the pathway and that includes in deploying the expertise that we have from some of our staff to ensure that neurodevelopmental expertise is coming alongside the early help support and strategies that families and schools and others are trying to implement to support a child in a school situation prior to implementing the consultation approach and in response to having implemented an assessment of needs for the team were absolutely inundated with with referrals understandably so we've talked about the statistics and they had about 4000 referrals in less than six months and for a team of about 26 all that they were doing was processing referrals and responding to concerns there simply was not the capacity to be present in schools alongside parents alongside their colleagues and providing the immediate help and support that we know children and young people and families need so the the strategy for how we responded to the demand that we collectively face was to bring all of our expertise from across our partnership together and to position that front facing alongside schools alongside families we know we're trying to in parallel empower schools and others to have really good access to what the nice guidance says works for children young people with neurodevelopmental need and that is access to information advice support and strategies and we've done that through a number of different methods including enhancing our website but but also consultations and training and working together with others so we're trying to really maximise the universal offer for children young people who present as having neurodevelopmental need our binados and and now as colleagues in learning space all do really brilliant pre-diagnostic support the consultations was a space in which we could together with schools help to identify children who are more vulnerable we know that children with neurodevelopmental need and where their needs are complex and profound they are more at risk in terms of exploitation in terms of safeguarding type concerns terms of being excluded from school being socially isolated so we wanted to make sure that our neurodevelopmental experts in our spoke service that's four staff were able to engage with schools to work together with them for the with the children around in relation to the children that they are most concerned about so we're trying to we're trying with the resource and the capacity that we have to do our best to understand needs we are we are concerned that families are having the experience that they do and our our clinicians are wrestling with what to do for the best so we're really trying to expand our universal offer to work together with the support network around children to increase their their ability and confidence in supporting young people and then making sure that we're deploying our expertise to try and identify the children who are more vulnerable and where we know the the added advice and support and experience that we can bring to schools will make a difference to those children we then can make decisions also about moving into the assessment and diagnostic pathway that that's why we did it it's really helpful hearing carries and we talk with schools all the time and but to to hear carries and reflections in particular and I can I can hear that there are you know already there are some things that I can immediately think about that the telephone line and its availability so really happy to think further about that I hope that's a helpful explanation I mean I think I'm quite surprised that you're not aware that the telephone line only being open three hours a day in a school would be problematic so it bothers me that that basic piece of information is news to today but can I say one other thing actually which is that we are told that the London boroughs surrounding Surrey have much much shorter referral lead times they have much better processes I'm talking about Richmond I'm talking about Kingston I'm talking about a number of others so they they haven't given up the front end they have a really good referral process doesn't mean that there isn't a significant way it and but they also get through and the treatment pathways waiting lists much faster as well so what I want to know is have you benchmarked your performance both in terms of referrals and also the treatment diagnosis treatment pathway with you know other organisations in the south east who appear to be performing much more effectively so I was going to say so we have done some benchmark we actually employed what's called a CSU is Commissioning Support Unit to benchmark our services and certainly there were changes that could be done across thing which we're looking at implementing I can't speak directly to those boroughs I haven't looked at that data but the benchmarking that we looked at suggest in terms of the sort of effectiveness as a clinical model it was it was in the range of what you'd expect nationally but there are still a challenge I think just to go back we have to remember that when we set this up we were working towards a 1% prevalence rate obviously as travel introduced at the beginning the prevalence rate has gone up to maybe four obviously Kerry's data suggests more at the four and then the two end probably and that has effectively it's it's not like a positive decision was made to do this but that movement on the prevalence rate has meant demand has gone up to exceeded capacity and we've had to do different things now my view on this is there's a danger that we put lots of effort into diagnosis and not enough effort into into support and treatment and I think treatment itself as a word is a bit of a difficult word obviously because we're all aware that you cannot cure autism and you cannot cure ADHD so the treatment for autism is actually about practical support to the school and the family in helping the child have insight for themselves and so I think the question that we're now wrestling with is really have we got have we got the right model in terms of its emphasis on diagnosis versus an emphasis on support so so that's the work we're doing we are looking around at best benchmarks I think London is a very different proposition I can't recall this specific data but I'm aware on other times I've looked at London the underlying prevalence in London is far higher across a range of health conditions and therefore the historic level of investment and services they have in London is very different from any of the Shire counties and what I have done is looked at Shire counties and in that case as I understand it they are all wrestling with a similar set of problems but I'm more than happy after today to have another look at the London boroughs I haven't looked at those ones in specific so happy to look into that thank you shall I ask my next question or if we can hold for a moment because Alison Simmons has cured her audio problems so it's a little bit muddled I'm afraid that's technology for you so I'm gonna ask Alison to come in first and then I've got a whole crew of people with their hands up so we need to deal with those before we can move on so Alison if you'd like to come in now and talk for up to ten minutes on the issues schools are facing good morning I'm hoping you can now hear me that's perfect thank you brilliant thank you apologies I am at home today deliberately because the internet at the school has been poor but here we go so I'm Alison Simmons I am Senko at two small primaries in Katerum I'm perhaps what you might call a career Senko I always wanted to work with SEM children and I had done for the past 27 years in a range of roles including as perhaps pertinent here the job before last as a head of unit as we call them then but especially centre for ASC children within Surrey so I can come with a lot of the concerns that were raised earlier I think my my headline would be that we understand in schools the prevalence as I think we're calling it today and yes we also do feel very much on the front line we feel that the information that's coming out of mind works is limited is only hitting a certain audience and that once the information does come out there's then a time lag in us seeing the strategies the ideas the support actually coming through what I would like to do what I thought would be most useful was for me to tell you just one case study so across both schools I probably have six or seven children who I feel need to go through the diagnosis process but this young man kind of emphasizes strengths that schools have schools like mine and where perhaps we and families feel that the system as it's now presenting is going to I'm going to say letters down but certainly it's causing frustration for a family I do have this young man's mum's permission to talk about him I will try and keep it anonymous but if I slip she does know this little boy is now in our year one we have had his older sister with us for three years so I know this family quite well because mama started coming to me as a DSL because her little girl had scratches and marks that I needed to investigate largely because of the needs of the sibling that I'm going to go on and talk about so I know I've known this family for quite some time so little boy came into us in year R so he came in his September 22 he had very very limited nursery access obviously he would have been a young man that was impacted by the COVID closures we put some transition support in before him he hadn't been in involved with any of the earlier services in Surrey although parents had already saw quite a lot of support from elsewhere he was awaiting earlier speech and language therapy it hadn't been it hadn't started again we know that those children weren't seen during the COVID period because people couldn't get into nurseries so he came into reception he struggled we did part-time timetables he couldn't part from mum he was hurting other children mum was getting very very upset she didn't want him to get a reputation we worked with mum and we put a lot of support and a parenting support in for her working with our local children's centre I put in an early help assessment and we were declined the family were declined on the basis that school were doing a good job we were in early days the family weren't at any risk and things things moved on he did manage to settle a little bit into school we managed to get him in full time by Christmas with adaptions to his lunch time and with a lot of visuals a lot of small group work on social skills a lot of playing alongside and modelling for him we continued to have concerns for the sibling safeguarding concerns and she was supported by a thrive and we referred her into young carers we also then had a further DSL issue around disclosures but both children read about mum needing to restrain the child and mum and dad then came in and spoke to us much more widely and explained that dad actually they had converted their shed and I do mean a shed not a pod in the garden because this young man was not sleeping through the night was wanting to go sleep with them dad wasn't getting any sleep mum and dad were falling out because they were having different views of whether he should be put back to bed or not again we referred to early help and they did at that point get two months of early help and were supported through I had made a referral in the november to the one stop system for a pediatric consult at that point the triage informed us that there wasn't yet enough evidence he was new school and they wanted us to waste a little bit longer by spring term of his reception year we had had him seen by the speech and language therapist and they noticed some articulation difficulties but decided that the majority of his problems were social communication those of you that know and will know that our mainstream speech and language team generally don't work with those children unless it happens to be on their ECHP so he was discharged from that team we then spoke again to one stop and I did manage to get him referred into the pediatric service we continued to work with the children's center and parents completed the parenting puzzle by summer term we were a lot more settled but obviously we had to move towards transition we were still waiting for the pediatric referral parents at this point paid for some for three sessions for this child with the sensory pro sensory processing team who work out of a century in wollstone so they're paid privately and that was really helpful particularly for the family to understand how they could help to regulate this young man but also in the helping staff the staff some of our staff went over to wollstone for the final session and that helped them as well we then started a transition process for him into year one and we included a 20 weeks or 10 weeks in the year and 10 weeks into year one of our Thrive provision funded by school and I might add with no additional funding during the summer holidays he was seen by Pete's they identified some sensory needs they referred him to OT they identified that he had some neuro diversity tendencies and they were looking all towards ADHD but they noted he was now too old for pediatrics and suggested that we might prefer him into the ND spoke team so this is a year after I first tried to contact pediatrics in September I referred this young man in and of course that was just as the ND spoke team closed for that first period I was then in the front line I then had to explain to the family that it wasn't actually something to do with the schools in the state we're on the front line to this the grandmother in this case wanted to come into school to school and make a formal complaint not helped by the fact that the family had been to the GP who hadn't caught up with the mind works temporary closure whatever we're calling that period when they weren't taking referrals we were able to placate the family reassure them that actually we'd been told by mind works that we would be able to re-refer children from November which we did I prepared the paperwork make sure that we had lots of evidence and I sent it that two minutes past midnight I think it was on the 1st of November I scheduled it I hastened to add I wasn't sitting there and that bounced back of course to us because although that date had been shared actually we weren't able to to take that the assessment wasn't accepted so we now have a young man who continues to present with overload he continues to have some very very vulnerable days and he is now showing the signs of Ebstner he has had a reduced time table he's now back in full time we have referred this with some more agencies the NES have offered some group work in God only which is a long way away from catering at two o'clock on Wednesday afternoon these are both working parents he may or may not be able to be seen because he is showing all signs of ADHD by their home one-to-one service the NES they're considering him you may know that they're taking on some new home family support workers he's on their list and he's also on their radar it happens to be that I know two members of the team I worked with them previously so we do have a professional dialogue I have referred him to learning space and yet we haven't had an offer so school continues to support we've referenced we have the mental health support team in our school we're one of their learning schools I work with the primary mental health team I work with the mind works I'm on the steering group I think these parents have probably been as well supported as a primary school can manage however this family are now considered considering a private assessment they are not hearing my explanations because there isn't on for parents to receive yet from the seminar I attended from mind works which I completely understand the medical over versus the social model I have spoken to the helpline it did take me a long time to get through it is a lot very awkward Senko's tend to be child facing in the morning and perhaps not in the afternoon would be helpful if those times are going to be three hours a day they didn't always happen at the same time of the day um as it stands this child attends school we put heads in a support and he doesn't meet any of the criteria he's not urgent he's not seen as a priority child and so we wait um whilst that happens this family can't access any support I suspect he would be a child they would all benefit from melatonin um he does because I'm very strongly as ADHD he may be a child on medication would have would be helpful I'll stop there on him just a second child to mention to you because you were talking about waiting list elsewhere Alison I'm really sorry but I'm gonna have to ask you to sort of wind up because we are a little fine this was just permanent this young man's just come to me from a Croydon school where he's been waiting twenty one week a month for refer for assessment um they've been told the weight is currently 36 these parents will not come off um the Croydon list they haven't changed their GP and therefore I can't refer him into any mind work services because they know the situation in Surrey so at the moment I cannot access any of the support for him two weeks ago this child took another child had an outburst took another child round the neck and had to be physically removed we had to exclude him for a day at the moment I can't see where this child's going to get any support and it's purely and simply because those parents do not come off the Croydon list I'll finish thank you Alison I know it's incredibly moving to listen to the problems actually being faced by families you know the issues that delays and non-availability of services are causing um so you know thank you um and um have any of the members of the committee got questions for Alison while we're here Liz thank you and thank you Alison I'm also mindful that we've got a little cure people that want to join the conversation so I'll bring them in immediately so Liz if you could just keep it very sure I will keep it brief Chair I just wanted to ask Alison listening to you that um that you it seemed to be that you were saying that you know when where one agency seems to stop and you see you seem to have to search for the next level of support and and to find that next level so it seems to me in it from what you're saying that things just drop off and you are left as a same code to find that support could you just clarify if if I'm understanding that correctly thank you yes um I'm particularly um the gap between when a children can be referred into and may be discharged by the pediatric service um the official referral age is 5.5 as I currently understand it into the pediatric team if when those children then get to the point of being seen they then are more than 5.5 when they may need ND assessment there seems to be a complete peppercorn response sometimes they are discharged and we're told to go through to mind works other times um assessment seems to be done by Peds there's nothing there doesn't seem to be any consistency the only theme I can see that runs through those that perhaps are seen other perhaps children who are more complex and one of those that I is now six and is being assessed by Peds also has has mitochondrial disease um so I can only consider it's because he's more complex in that way I would stay under Peds does that help thank you that's very helpful thank you thank you um I'm just going to bring in some of the people from the teams call because um I know that they've been waiting a very long time now um so if we start with Emma Ellis followed by Chris Townsend and Trudy Pirate thank you chair could you hear me yeah you're fine Emma good um my name's Emma Ellis I'm a service manager for the National Autistic Society um thank you to Karen Allison um for giving us um your experiences and and I acknowledge that because I'm in touch with families and schools and young people every day um and thank you Graham and Allison for mentioning the social model concept versus the medical model concept so our work very much sits within that social model and in that the the support that we are providing which I'm actually very proud of because I think that Surrey actually stands out amongst the counties in the UK for this level of support that we're providing um we are providing support in a quite a holistic way because we support the families the young people and the schools um sometimes it's difficult to get the breadth of the service out to people so we use uh methods like school bulletin we talk at Senko network meetings at foster care network meetings um as much as possible we we are promoting our service because most importantly um because of our contract as one of the um partners in mind works we don't need a diagnosis of autism for families to be to to self-refer into us um a lot of our service our group work is provided actually predominantly online so it is accessible um either in the morning in the afternoon and we work in the evening right across Surrey so I think this year we have we're on target to produce about 450 workshop events and in the main program that we offer which is a really deep dive into autism but a very practical deep dive we are looking specifically at areas such as social communication and social interaction sensory processing and how to manage distress behaviors so we looking in those areas in great depth and we give parents a lot of skills and techniques and tools that they can implement at home but also most importantly the knowledge that they can then take to the schools to explain why their child might need these various um adaptations that that they're asking for and I think the knowledge behind why those adaptations are needed is really really helpful for for the schools as well because then they're acting in a in a proactive way rather than a reactive way to to behaviors we also do school training um but if we were thinking about this in a Venn diagram we would be predominantly in the family space um slightly smaller in the young person space because we do work one to one with young people and then smaller still in the school space and that's really because of the size of our contracts but we go into schools and we're doing um we do a three two and a half hour training session and it's a whole school approach so everybody from the dining room staff to the to the front office to the LSA's to the teachers to the heads can access our training and it's in a similar way to the parent program it covers all of those key areas the social interaction differences um social communication sensory behavior and we're again doing a deep dive and it's a hundred percent of teachers and staff who attended that have said that they would recommend that service to to other schools and I know that they get a lot from it and they go away with with school based strategies um or confirmation that what they're doing is right and it might just be extending that a little bit further um and uh so and the other support we do is one to one support for parents in complex situations but of course because of the big demand and we've seen about 6,000 parents under this uh contract so far because of the big demand um we do ask that parents do that group work first because otherwise we just wouldn't be able to support everybody um for the more complex cases we then offer that one-to-one support when they've got that foundation of knowledge um so I just wanted to fly the flag a bit actually because although I acknowledge the difficulties on the medical side on the social side um there is a lot of support out there and partly it's about getting the message out to families to schools that there is no waiting list parents can self-refer and they can get that support pretty much immediately um we also have the out of hours support line which is out of school hours and in fact teachers can also phone that out of hours support line for some specialist advice directly with with our team and that is manned by ADHD specialists on the Bernardo side and autism specialists on the NAS side and it's open from 5 to 11 thank you chair thank you and if we move on to Chris Townsend please thank you very thank you chair I'm very interested in what the last speaker said because that's not the experience the schools in my division have um and I'm very interested that they've got no waiting list for the service they're providing my concern is the one that Fiona brought up which is the the pressure being put on schools but I really want to touch on something that's in the meeting chat and let me just read what's in the meeting chat the pausing of the school's ND referral pathway is now it's six months in without any timescale of the next stage the loose solution of stopping the referrals it's sourced by pausing the pathway does not make the issues go away it is only when a child or young person is in crisis that they may be accepted for assessment that's in the chat and I would suggest that somebody from MindWorks actually responds to that because that must be a very very serious issue thank you so thank thank you for the question and and I'm just reflecting on the most helpful way to respond to the concerns that are raised so I think it's really important that we hold in mind that when we are talking about the assessment and diagnostic pathway it is for assessment and diagnosis of neurodevelopmental need treatments are there are medical treatments conscious we're using the language medical pathway there are medical treatments for a small percentage of children who may have a diagnosis of ADHD it is the case that nationally there is a problem with the supply of ADHD medication and that that has been a problem this year and we're being told that nationally we could expect an update in July so I think we have to hold in mind that it is a diagnostic pathway and when we think about medical treatment there is a small element of the pathway that relates to medication for children who may go on to receive a diagnosis of ADHD it is not the same pathway for children who have mental health difficulties so we are really confident that where children have mentally or health concerns whether or not they're waiting for a diagnosis there are accessible pathways there is help and support for those children without delay and and we've seen improvements in access to assessment and treatment for children who have routine needs so mental health crisis children in mental health crisis there there's no delay they should they should not be waiting on that pathway our communications are really very clear that access or or escalation in concerns there are there's help and support available and there are ways in which schools and parents and others can access that help and support and with regard to the the the question of when will there be a revision to the current consultation approach that is in place we're working together with our commissioning colleagues our social care colleagues at schools and others and our focus is really on growing the the offer of early help and support because we know that that's that's what makes a difference so at this time all our efforts and I know that sorry county council colleagues and commission colleagues can talk to the growth of help and support that is is happening across our schools so that that is where our focus and our energies are right now in in making we did making sure that we deploy our capacity to meet the needs of children to support schools to support families but but we're trying to say that the the timescale there's no timescale for going forward it's now six months in and there's still no timescale I think you mentioned july perhaps you could be a bit clearer about answering that please yes so sorry thank you the reference to july related to what we understand with regard to the supplies of ADHD medication so the latest information is that we we should we should we're not at a national level we're hopeful that supplies will reduce will resume in july and with regard to the consultation approach and our strategy so asking for an end date our strategy is to ensure that we're putting all of our efforts all of our energies into providing help and support and then being really clear about those children that that will benefit from consultation and go on to assessment and therefore diagnosis of neurodevelopmental need and the rationale behind that is because treatments are limited as I said it's just medication for minority of children with ADHD but what we know is effective is making sure that helps there is a consistent and collaborative approach to how the strategies supports and interventions are put in place for a child at home in school for their lives yes i just wanted to add if it's okay a bit of this so on this waiting issue i think for me that there's sort of two parts to it so one i think sometimes neurodiversity is used as an umbrella term it is it's useful sometimes just to go into ADHD and autism separately because they are different presentations so for autism a post diagnostic treatment for autism would be exactly the type of service that we heard from our colleague at NAS so i think what we need to work through the schools i've heard very clearly today from schools but how they're not feeling supported so i think we need to think about given that we think that the treatments the post diagnostic treatment you would get there is already being offered and there isn't a significant waiting list why is it that for schools it feels like they're not getting that support because that's the model and we need to we need to a bit time to dig into why the world as we imagine it and the world as it's experienced by schools why there's that dissonance so that's what i want to say about autism for ADHD as justine has said there's two components again to ADHD so the treatment for ADHD is not always to medicate the child and obviously there is guidance out there to say we should use medication we should try and restrict the use of medication we shouldn't always move to medication as our first treatment solution so there are non medication treatments for ADHD as well and they also are like not like what the NAS person they are other using the social model to treat so there are three treatment pathways if you like medication for ADHD social for ADHD and social for autism we absolutely need to get on top of the delays for prescribing on ADHD medication but and there are two problems within that so one is that nationally there is a shortage of the of the medicine so even if we had no problem with assessment and diagnosis today we wouldn't be able to initiate prescribing for ADHD because there is a national shortage of the medicine however when the national shortage goes away there will still be a problem about how we diagnose and prescribe for ADHD and we absolutely need to come up with a solution and we're working as a system to do that and i think i absolutely own that is an issue but the other two cohorts as i said we need to work out why for schools despite mental health in school teams despite printer and mental health to start NAS schools are feeling like they have no frontline support we have to get underneath that because clearly we're putting a lot of energy in and it's not having the impact we want so that would mean effectively that that's not doing what we all want it to do so we need to understand why it's not doing what we want to do because i think we've got some really good practitioners across the charity sector and the health sector who can work with those schools so we just need to dig into that bit so that's what i wanted to say in terms of waiting times i think you just need to look at the chat i think you need to look at the chat because that it's saying here the support isn't there if schools say it's not happening and families say it's not happening they're not being worried it's not happening i'll leave it there Trevor but they need to look at what's being said in the chat because it's obviously not happening yeah thank you Chris i think we have to acknowledge it's it's very obvious and from the two scorenesses there are significant problems i'll just mention one other thing just for clarity for anyone listening from the public of course ASD and ADHD can also occur together just you know for clarity that they're not two things that are mutually exclusive and yeah we've on the team's call also got Trudy Pike who's also had her hand up for a very long time and then after that i'm actually going to ask council's Rebecca Jennings Evans and Jonathan Essex who happened to be sitting very conveniently next to each other to pick up the questions on the amount of the problem the effectiveness of the support service and if you could actually team up to actually pick those up next that would be very helpful so Trudy if you'd like to just go ahead thank you chair thank you for inviting me to contribute my name is Trudy Pyatt i am the interim assistant director for inclusion and additional needs southwest quadrant with Surrey County Council i'm also delighted to say that i've been asked recently to step forward and to champion this work amongst our colleagues and to work with schools health and all our associated partners that you've heard from today and i also want to say a big thank you to Kerry and to Alison for sharing their experiences and so shame Kerry's gone because some of the things that she was saying about the adaptations and the reasonable adjustments that made in their school i think are terrific and i don't want to underestimate the work that was going on in our schools to really support and make those reasonable adjustments to include everybody in every child no matter what their prevalence of need is in a really spirit of thriving in an environment and as Kerry said you know she's got modern school that you know it wasn't necessarily set up for what the chair really able to describe as our cohorts of children who are presenting very differently over the last five years to what they have done previously and i recognize Alison you've been a Senko for a very very long time and you will have seen the the prevalence of need changing ASD social emotional mental health issues are more prevalent these days and we're getting more children young people particularly youngsters you know younger age groups coming through with really complex needs so it's a national problem how we address this you will read no doubt every time in the papers and on the news about to send crisis in terms of funding in terms of placements and in terms of kind of you know getting the right support at the right time for all of our children young people which is obviously our ambition we want our children to thrive we want them to be served by their communities we want our parents and carers to get the support that they need and we also want our schools and our practitioners really well trained and equipped to work with the children young people within their care because they care about them passionately but they are feeling overwhelmed i'm listening to you i hear you and we had a webinar a couple of weeks ago i don't know if Alison and Kerry were there but we had about 250 delegates and we talked about the social model and the medical model and it's recognized at the EHCP as a piece of paper it's what it happens around that EHCP the support the technical specialist advice that really makes that challenging difference for our children and young people this isn't a Surrey problem this is a national problem i think with Surrey you know we have a high use of NMI placements that might be a little bit unsustainable for us moving forward and we're looking to work to with all of our stakeholders and with all of our schools and settings to make sure that they're not feeling overwhelmed in such difficult times so i want to recognize that i also on that webinar asked colleagues if they could share examples of helping their children and people thrive in that space i'll tell you now we were inundated it was fabulous the things that the schools are doing and i'm not underestimating that we need to be creative in this space as you know my works have said that the ND path work is about a medical diagnosis that diagnosis doesn't change what happens about the support the wraparound care the education and the sort of kind of enriched curriculum and lifestyle that we want for all of our youngsters i'm very proud of the work that we're doing with partners i know there are issues along the way this further work for us to do and i think you know we need to get under the skin of why i think Graham you said it why our schools are not feeling as supported as they possibly can we have specialist teachers in practice that work closely with our schools and i know they do excellent work there is obviously more for us to do and in some challenging financial times for everybody but that should not take away for what we want for our children and young people and i just thought i would offer that education side view so that you know you do realize that colleagues in you know educational life long work learning are there for the the head teachers but more importantly we are champion of children and we will occupy that space and work with all of our partners to make sure we're getting better and that we're providing what we need to do thank you chair thank you true um i'm now as i said i'm going to ask a counselor back to jenny zevons and counselor jonathan sx um to weigh in on the questions in terms of the size of the problem the length of the delays that are now in the system and you know asking about what are the plans to actually get out of this situation so um over to Rebecca and jonathan thank you very much mr chair um i'd like to understand i've got three questions i'd like to pose but i'd like to understand how many children who would have been referred to the nd pathway since it closed on the first of september are still awaiting referral and of those outstanding referrals how will they be managed going forward because the major concern is whether those young children and young or young people get lost so that's the first part and then i'd like to also ask of of those children that are now on a diagnosis or treatment pathway how many are there and who retains the information sorry do i i can answer now yes please sorry you're not familiar with proceedings so give me um thank you for your questions um i um in terms of demand it's it we we know that um we we are not so we we do not have weights for consultation for the consultations but i know that that doesn't answer the question around how do we know um the number of children that would have otherwise been referred i think that's and i'm not sure how we would answer that what we do know is that there it there there's not a weight for consultation our current caseload is circa 7,300 cases on the neurodevelopmental pathway and we we know that there are again circa i think it's about 3,600 children on the diagnostic element of the pathway so that's waiting for ASD ADHD and then a dual diagnosis of ASD and ADHD and so it appreciating that the conversation quite rightly so is focusing on what what's happening about the um approach that we're taking now to children that require assessment and support and i think it's also important to remember that the team are incredibly incredibly busy working through a significant number of children young people who are currently on the pathway and going through the process of diagnosis so we we we've we've got support uh commissioning support to a work with an independent provider secon so we've significantly increased our capacity to be able to diagnose um and and we've been doing that for the last two years so so we know there are lots of children who are on the pathway and will go on to receive a diagnosis um and we also know there's a cohort of children approximately 900 who are waiting for ADHD medication and as Graham explained that there's a challenge for us in that the national supply um hasn't there hasn't been a supply of ADHD medication so sorry just to be clear there how are we ensuring that those children who are still awaiting referral are not being lost yes so um we have um so when referrals are received um we open a record an electronic patient record and and we're able to pull that data through so we've got a business intelligence system that enables us to um know who those 7,300 children are and where they are on the pathway and where they're waiting um in terms of their journey um across that pathway and is there regular communication with them so they know where they are on the pathway so we um we we have um at the point of referral we make sure that um families have good information about how to access um help and support when when families contact us and ask us how long have I got to wait we're able to talk with families about um the children that we see so we know that children that are um on the diagnostic element of the pathway now um have waited for approximately two years so that's the longest um wait at the moment so we we we can we don't have the digital infrastructure to be able to say your weight will be X amount of time but we can say um that we're seeing children who have waited for this amount of time and we we are currently seeing children on a chronological basis so the point of which they we're referred so we're looking chronologically um at weights on the diagnostic pathway okay but but Croydon does okay yeah i think we need to take that on board so i can come in now are you going to add something yeah uh councilor six if you'd like to come in now so in my head's a bit of a mash because i keep hearing things then hearing what i feel is the complete opposite afterwards so i've heard there's a growing gap from Trevor at the start between um the level of provision level of need and then i heard Harriet in her instruction say well we could diagnose all people and have no support and that made me think well okay if we did that would we be reaching our statue moral duties as a councilor as a provider are we actually allowed to do what we said we were doing the introduction that i heard we that it's a national problem and it's everywhere um but it's best in London and it's worse here but we've only benchmarked against other other councils that suffer as we do we don't seem to be benchmarking against those who have vision of what good enough actually means and then i'm really struck with this idea that somehow we've we've told schools we're stopping the the front door um which they thought was a temporary pause and now we're hearing it's a new approach and and i think you Graham has said that you've got a social ADHD pathway a social autism pathway and a medication delay or three separate things but then Trevor has said well ADHD and a HD overlap and how on earth do you know which pathway someone should be on until you've done a diagnosis and how can you do a diagnosis if you close the front door or or apparently do so so it seems to be that you know if you don't diagnose for everyone if you close that front door then you are choosing to ration and delay who gets support and when they get support so in in you know thinking about that i mean so if mine works is basically a rationing organization you're severely rationing access to nd screening and assessment so you're rationing and you're restricting the number and who gets support and when and by massively delaying it you're also affecting the the overall pathway for someone getting ehcp and getting that additional payment as a school so schools are being starved of money for the support they need to help those children so you know how do you monitor how do you monitor the outcome of this change of approach which you've introduced from september how will you monitor what the demand for screening and assessment is now if you're not taking any through your front door and and given the scale of demand that there is for these mine work services the size of your current waiting list as well as the invisible waiting list you don't know about because you've shut your front door what strategy does mine works have to address the need otherwise other than what i've heard so far is sort of little bit better little bit more little bit less variations on the status quo if the difference between one percent and four percent is fourfold or at least twofold and a really big change is needed how do you bring that big change in whilst not leaving behind all the people that are stuck on the waiting list already and are desperate to get on it and can't get through your front door hi thank you for your question and i'd like to answer from a conditioning perspective and then let my mind work colleagues come back in as well sorry could you speak up or move the mic please thank you sorry can you hear me now hi thank you yeah so i'd like to come in i'm carri-clark i'm head of motion i have to be with me hi Jonathan i'd like to come in from a commissioning perspective so councillor Rebecca i think what you're trying to ask fine for us to do is exactly the numbers of children that are in in the medical model that we're trying to seriously move away from so i think what we've done and we have spent a lot of time talking to schools to families you've heard it today that what schools and families and children young people are telling us is they want swift access to direct support from people that they can trust and they can learn from themselves and learn together as families and children and young people and when we've explored that that a lot of that is from the social model that we've talked about and we're implementing we absolutely believe to support these children we need to move away from the the medical model and have everybody on a single pathway and to have a holistic approach that is multifaceted and joined up so we've heard from families we've heard from schools we heard today that they want more direct access and more support schools are asking for support for children in their schools and some of the specific issues you were seeing the action plan that we've invested in ND advisors so we're expanding the teams that work directly alongside schools and they will look at the support and bring schools that can learn together so that we can change a system in schools and support families that will give you a response to a child so a child that i was speaking to the other day that was in a group program sorry i wasn't talking to him i was talking to people that working with him he was he'd been on a group work program and he loved it he got to know other people and he really enjoyed it and he was learning techniques and part of the evaluation was they were what difference is that going to make and he said well i knew some of this before he said what i needed is learn how to use those techniques and not be any different from other people in the classroom and in school when the third sector partner scaffold that learning into the school and the school looked and worked together to introduce regulation zones that's what made the difference for the child it wasn't the diagnosis it was that example of work so we're expanding the support that's for schools from ND advisors we're expanding the support that will help them look at learning environments that is being recruited so they haven't stepped in yet so we're in that change process you also heard today from our school colleagues that they want access to parent support and our third sector partner and talked about some of the parent support that they've provided and the experience of that we've also looked at the opportunities to expand that so they're in the recruitment process to expand that one of the things that we're looking at process of changing again is and again again i think it was Kerry said she's got NAS and she's got learning space and she's got a third sector another partner what we're in the process of looking at is named leads at district and borough levels so you can start to form relationships with partners as opposed to trying to find three or four partners organizations so that's in the process of being changed to get direct support to families and get direct support to children what we're then finding is we were having to look at how can we make sure that the right children are getting the diagnostic support and the pathway how can we make that pathway streamlines the schools and families are really telling us it takes too long there's too much paperwork we want the answer straight away the consultation process that is in place gives the answer straight away it enables all the correct paperwork to be completed and submit in and a dialogue and and that to be in place and a direct decision what we know is that we need to evaluate that now so SABP and Tavistocka Portman are evaluating that who are the children that we're missing how is that working the timeline the telephone time that we talked about today that's all been looked at to do how we can respond differently there as an ICB we had to listen to the information that SABP was giving us some mind works in terms of the children and young people waiting too long on the pathway when we started to look at that they were they have wait i think it was three years three years in the pathway and a year at the beginning sorry it's not it's come down it is come actually the data on page 54 shows that it's still between two and three years the diagnostic can i finish what i'm sorry sorry because i suppose what i'm trying to do is get you because we are trying to learn the best way to meet the needs of children young people hearing what people are telling us and implementing change that change will take a bit of time because we've got to recruit some of those posts and i suppose the reason i wanted to highlight about the pressure on the access point is as a system it wasn't mind works in themselves that made that decision about the criteria we had to look across the system and look at it from a quality and a safeguarding perspective and the numbers that were coming through at that time we weren't prepared to extend waiting lines to significant levels if we stay in that model medical model of approach so it wasn't SABP on their own that made that decision it was a collective decision around the process that was put in place the criteria was a collective decision about what that criteria was and again we're now in the process of re-looking are we missing children in that criteria do we need to re-look at that again so there's an evaluation process in place in terms of the timelines i'll give that to adjusting to talk about but i wanted to set the scene that we need to move and shift the culture and give families and children young people what they're asking for which is the early support as well and that's coming it's increasing i hope that was helpful yeah thank you for that i think if i might come back briefly chair i'll just hold a note Jonathan i'll come to you back to you again in a second don't worry yeah i think you know the key thing that we are looking here for here are you know concrete numbers concrete plans things that are measurable and you know that's really you know at the crux of the whole thing so i will just say you know we've had massive delays we know that there's massive discontent yeah we need to you know really get down to how big is the problem what are we actually doing about it i'll come back to you now Jonathan thank you thank you so it's just briefly so if i'm understanding correctly Kerry the the decision to send the note in september to all schools saying there's no more referrals wasn't a mindwork decision it was an icb decision it was a collective decision so it's but it was approved and scrutinized and agreed by the icb but it just didn't seem it's i think it's what you said but it didn't seem that any counselors were involved in that process or we we heard because schools sent us that letter and and then in terms of this paper this paper is looking at mind works and scrutinizing mind works one year on from where we were a year ago but we've heard sort of various snippets as chep has referred to about this new approach and this transition process but i can't see much in the report that says well how much how much more money do you need to actually implement this new reproach so you talk about supporting schools are you supporting all schools or just some schools and is there sufficient support to all of those schools and if not when will that be in place and you know do you need extra money to make that happen or do you have that money already and if you haven't got that money where is it coming from and when will you get it it that sort of detail about yeah there's lots of really nice words in this report if i'm to say i'm i'm not an expert in nice words i'm an engineer so i'm trying to get from the start to the end from the problems to the solution i know it is not a simple problem solution thing but reading this i don't have any real clarity or confidence as to how quickly we're going to get to where we need to get to or whether the plan to get there has been agreed by everyone except for us we haven't seen it yet um or or and whether it's properly resourced with people and and and money that that's really why i'm going to share come back on a bit so in terms of the initial communications um about the changes to the pathway that was agreed across um with um CFLL colleagues um the ICB and SABP and and the link to obviously CFLL and the council was because of the link to the send inspection um and the improvement work through that through as well and that's why the introduction today was was purposely also setting it within that within that context and the introduction today was also sort of purpose all about the continued bit of conversation we had over the last hour or so the need to bring in that support to children irrespective of a diagnosis because if that child was waiting three years with no diagnosis and no support that would be even worse situation so we're trying to do both bits at the same time um and at the moment because of as you've absolutely hit on some of the resourcing issue which is not just financial it's also about workforce availability in some instances about medication availability and some of that is improving um but where we can and have managed to bring in additional funding um so from the ICB last year there was 1.5 um a half a million sorry put in against a number of programs that are within your report um some of the which is which Kerry's described we've been able to draw down additional money through the mental health investment fund which is obviously a joint funding pot and within the system across the ICB and the county council again to prioritize work around this area and so it's coming back to Trevor's introduction of with the increasing prevalence and the need to do something different that social aspect that support aspect is kind of paramount that's not negating the need that many children and families will want to still access a diagnostic route and try and to balance those two within the resources we've got is I guess the challenge we have um and and I can absolutely take your point in terms of the how do we know when some of these things are going to take impact and I think that's two things I think that's so the work that mine works are done in terms of articulating the numbers in the pathway which again you've got in the table in your report um does that for one aspect I think the join up now with the county council in particular um and with education colleagues about that more of that social bit I think we need to be able to do exactly as you've asked which is say what are the three three things for example we're going to do with schools around that social model and when like they take impact and have effect because we've been asked for that here we've been asked by schools and families and linked to the improvement work in the sending inspection from a statutory perspective as well. Professor Helen Rostell. Thank you chairman um so I just um I just wanted to come in really to to talk about the need for I guess more assurance uh for the committee around the transformation plan so we're hearing there are lots of different pieces of work under why we also have a plan um beginning uh in May actually actually in next next two weeks to step back look at the mine works model and look strategically at what we're doing but then in June we're going to have a wider workshop with with partners um to uh review key areas of transformation of which this will be won and I think we really then need to be able to articulate what that transformation program looks like what its milestones are and when to expect delivery of those milestones and what the impact of those changes is likely to be. So I think we we do have those steps in train I think it's about how we capture that how we present that back so I think that's that's a must do I do want to emphasize that this is a national problem we know that NHS England are leading a whole piece of work across the country about how to tackle some of these issues I recognize that there are areas of good practice and it's really important that we are learning from areas of good practice we've heard about some of the practice that we have in Surrey as well from the National Autistic Society which you know is also important to to recognize so we need to be able to collect all of that and put it into our plans around transformation so what is the evidence based behind what what we're proposing so um so I think it's about just how we capture that together and present it back to the committee. So I just wanted to pick up on a few of the points you made so one I just in terms of the sort of confusing message just to reiterate that as I understand it so one we have seen a growth in presentation of need and it you know whether it's doubled or quadrupled it has certainly grown substantially and what that meant was that the NHS model was very much embedded in what's called the medical model i.e. this idea that you would diagnose and there would be specific medical treatments that you could deploy that would make someone better. As we've seen that prevalence grow we recognize that that isn't the right solution that we have to introduce the social model. The Mindworks contract and thrive was the beginning of introducing the idea of the social model as a way of dealing with this change in prevalence. We need to go further we've heard today absolutely that that school support that we thought we put in isn't working for schools we need to go away and do our homework and understand why for some schools that's not working and and change ourselves and that's the transformation work that Helen's just described. You also talked about the fact that because we were rationing the availability of diagnosis we were effectively rationing the delivery of treatment. Now as I kind of tried to say earlier um that's not necessarily the case because if the treatment is the social model of treatment then waiting for a diagnosis does not delay practical support for that child and their family and we need to make sure that they are getting that practical support. There is a component of diagnosis which is round ADHD where medication is indicated where it is delayed. Today that is not about how the system organizes itself that is about a national shortage of that medicine so that needs to be dealt with at a national level to bring that medicine back online. The door as I understand it is not closed the door has changed its shape so the door used to be a medical door and we have changed the shape of the door to emphasize the importance of the social model so therefore we're using the consultation model and we're saying we should seek to do the social model first and then where there is a continuing need we can bring in the medical model. We don't need a diagnosis to provide the social model solution you can use what's called traits of neurodiversity which healthcare practitioners are well versed in using to formulate a care plan that addresses those needs so that for me is the reason why rationing of the diagnosis of itself does not prevent all children from accessing treatment however it is depriving some children who need an ADHD medication so that's related to a national issue but we do need to go away we've heard from schools really clearly and we had heard it before today because that's why we've kicked off lots of work with schools so we recognize there's a dissonance between what we're planning and what schools are experiencing we've got a lot of work kicking off right now about mapping school need about working with schools to address this dissonance between the in-reach offer we're offering to schools and their practical experience of that in-reach offer. Hi Chair so my name is Anne Kenny I'm the independent chair of So Wellbeing Partnership and we represent 13 voluntary organizations that are part of the Mind Works Alliance and very much in the early intervention and prevention space which is around about a quarter of the contract so absolutely take on board the concerns around the diagnostic pathway and the changes and I think to be fair we do recognize that there should have been more communication around that and more of a plan around how we would implement that so that's some of the learning and I think we accepted that the time when we got feedback from schools. I think this is a journey of transformation and actually getting the balance of making sure we meet need now whilst transforming is difficult it is challenging particularly in the light of the fact that we are also have a fixed financial envelope we have been able to add some funds from COVID funds previously which we've now had to take out and so we were constantly there's no mechanism as well in the contract to increase that financial envelope only on demand even though we know that demand has outstripped capacity since the beginning of the contract so that's part of the context that's not so we're on the journey of transformation and I wanted to just mention a few things about what the voluntary sector has been doing as part of that recognizing the increased prevalence in ND traits for instance so and linking in with Kerry's comments and Graham and Justin's comments on the social model so one of the things we've recognized across the work that we've been doing is that the prevalence of ND traits so whether or not you've had a diagnosis doesn't matter but that those sort of behavioral reports and concerns are coming from schools and from families recognizing that that's going up and that the referrals that we are receiving both through our access and advice team but also through self-referral direct to the volunteer organizations I think through one particular pathway for instance where there was 80% where we thought there was ND traits and actually the teams that we had put in place for emotional well-being and mental health at the beginning weren't specialists in ND in that sense because we have specialist partners have been mentioned national autistic society and bananas providing bespoke specialist services across the 14 voluntary organizations some of which have been mentioned today as part of the school support so relate was mentioned for instance learning space etc and as in fact also provide that early intervention at a well-being sport what we've done as a partnership across our voluntary organizations is ensure that all of our practitioners have been trained and will continue to be trained in how to support children with ND traits at that point so pre-diagnosis so that that is to help us with this transformation so that we have competent staff at all levels to deal with whichever children's needs are at the point of need now that that's happening now that will also help things as we move forward on top of our specialist providers that you've heard about and the overarching transformation that commissioners are working on to bring that together I want to just before I finish also just answer the question about GBOs as you'll see from goal-based outcomes when children young people do land in our services and I appreciate there are there are delays they're actually their experience is good and I think that's important and we were not able to report that to the committee last time we saw you because we were just in the process of building that up so we've done a lot of work getting that that's not perfect yet either but I think you can see that starting to come through and I hope that is giving you some comfort there and finally check I know you want me to wrap up I want to talk about waiting well the experience of people whilst waiting is very important to us and there's a number of deep dives going on at the moment to look at what people's experiences are and what we can do more of to help make sure that their experience is is okay and they feel supported when they're waiting we're waiting for a service that they've got good sign posting information that we have regular check-ins and that piece of work was going on through audits within our partnership but also across mine works so if that's okay chair I just wanted to see if I can answer some of those points thank you very much yeah I it's obvious overall yeah there is a massive problem in terms of ways cues children who are not receiving the things that they need to do for one reason or another that's then causing delays in their education treatment and everything else so you know we're really looking for a plan that starts to really bite into address that and it's needed now frankly it's it's not needed you know in a year's time so I'm just gonna very briefly pick up we've got Chris Townsend on teams Chris if you could be very brief please because very brief yeah I'm very brief Trevor thank you very thank you very much Trevor I just wanted I always worries me when I think it was Graham came back and he said the door isn't closed it's changed shape that that's a I think that's an absolute classic statement of of on both on both equation I think it's called but I don't understand what he means by it's changed shape and my last point would be that if the child isn't diagnosed how can you treat them you give them treat them before you diagnose that sounds crazy to me and I'm just a layman so maybe somebody could under make me make me understand that particularly this change shape of this that the door is the door now round rather than square i guess i'm gonna i'm gonna have a go because you know it it is tricky trying to to reassure that there continues to be access to help and support and to diagnosis what we're trying to do is deploy our resources in the ways that we've described to ensure that that the the expertise we have is in the right place in the system so when we when we're thinking the door is not closed it's changed shape it's because we know that there is still the opportunity for children to come on to the assessment and diagnostic pathway the difference is that we are offering a consultation in relation to children young people who we know schools are we know there there's lots of concern and lots of and lots of help and support needed there are some especially vulnerable children and for those children having access to a consultation is really important for other children the the door is not closed because we know that the the treatment as Graham has has articulated is is is limited to children who might benefit from ADHD diagnosis but using the language of treatment then all of the help and support and so it's things like we heard a colleague talk earlier about children with neurodevelopmental need or traits of neurodevelopmental need that will struggle in an exam hall situation and so having an alternative arrangement for that child is really important it might be that help in an advice and support to parents can make a difference to the way in which they think about how to support their child when they're in distress we know we we can know through consultation and connection with the people that are with the child what their strengths are and where they are challenged so being in big classrooms for example or preferring one's one interactions so there there's a whole range of ways in which a child might present with needs that may be indicative of neurodevelopmental need it is need that also may be indicative of difficulties with sleep with trauma behavioral type concerns a response to what might be going on elsewhere in their lives so what we are trying to do is instead of as per the previous model cue all of those children are on a waiting list until they can see our neurodevelopmental team we're trying to engage quickly educate others do our best to identify what might be contributing to that child's difficulties and therefore what support can be made available to them immediately and that is in preference so just you know for us we pre consultation I cannot emphasize enough we had 183 more referrals than we have contracted in 23 24 and 26 staff if we do not have this pathway in place if we cannot engage at the earliest opportunity in multiple ways to support children and young people our clinical team will spend their time processing referrals and not getting around to diagnosis or or or or being able to share their experience across the system to help children young people so that's what we mean by the door is not closed thank you for that I'm just going to ask Fiona to come in briefly to give her wrap on this from a CFLL point of view I know it's a my fault isn't it it's a terrible I say not I try not to say it's a terrible tongue twist to actually say the initials but if you could immediately after that we're going to have a short 10 minute break so you're in between everyone else the the break excellent thank you it worries me hugely that the information that you've had from us today and from the head teachers is news in terms of how parents are feeling and how schools are feeling that worries me hugely and because we hear it every day so I don't really understand why the mind works consortium isn't absolutely aware of what's happening on the ground and I I do understand the limited resources but actually it seems to me that the response is still failing and you know I think if if perhaps there was more listening to schools if there was more listening to parents maybe the response would be would be more appropriate so I come away as chair of the select committee and I can't speak for my colleagues but I don't feel assured that there is a plan which you know has timelines has activities has accountabilities has funding which is really designed to try to address what schools and what parents are feeling so I don't feel that assurance I'm willing to believe that you can put a plan together but today we just don't have it can I say one other thing actually in relation to this plethora of of tools and techniques that seem to be around parents have not a clue how to find them and there was one other interesting point that was absolutely the language is just doesn't work for parents it's the language is inaccessible you're absolutely right Liz can just say one other thing the report of a survey undertaken by primary teachers reported about the effectiveness of services and support other the mind works so it said that 48% of respondents thought external services such as the national autistic society were effective but 42% find no other services were effective and that remember this is that this is a survey of primary heads talking about the services that were available for them to actually deal with the issues they have on a daily basis of all the partner support services offered via mind works only the national autistic society and to a lesser extent learning space is overwhelmed by demand so what I'm wondering is do we actually know the effectiveness of that plethora of support services that we're saying are available to deal with the social issue because it seems to me I'm not sure our mind works monitoring the effectiveness of these services because I really thought that survey which is in the report from the primary heads was actually very illuminating when you see the demand statistics you know there seems to be a pattern there for some services being deemed to be effective and a whole plethora of other services which seem not to be very effective but the people who can really judge that are mind works and I would I would hope that that is being very actively monitored thank you chair thank you we are going to break at this point for 10 minutes so if we could be back here by 12 minutes past 12 so 12 12 and we'll resume with the remainder of the questions on the subject you know so but you know clearly the plan and needing one very soon is very high up the agenda but you know the next question we have on the list of questions is really about asking about the support for parents and families of children in this situation because there are obvious stresses and strains I regularly sit on homeschool transport appeals and hear very directly from parents about the challenges that they are facing so I'd really like to know what's being done to actually help focus on families parents the mental health issues the pressures of dealing with children with neurodiversity creates chair do you want me to I think it could be helpful to hear from Emma Ellis if she's still online because okay perfect because she's very well placed to talk about that part of R&D workstream within the mind works working together to look at it but also in terms of direct services from the National Autistic Society shall we do Emma first Emma if you'd like to join in this conversation thank you chair yeah so not only is my professional life dedicated to the NAS but so is my private life too and I am also a parent of neurodiverse young adults so I can speak from my own personal experience as well as professional experience the national the NAS professional organization offers parents support through our group workshops so when people join those workshops they stay with the same group of parents throughout their journey with us and they often set up their own WhatsApp groups or they meet outside of our our workshop environment but we also run family fundays in the school holidays and that's an opportunity for people to meet in person and for the children to meet in person and we consistently have amazing feedback from those groups I did have a quick look and I have a lovely quote here which says so happy to meet new people having the feeling that other families are on a similar journey we normally avoid family days out as it could be quite challenging and normally ends in tears however you get the feeling that you're not alone and others are on bubpy journeys too we find school holidays very tricky and knowing that the family fundays are offered during school holidays is a bit of a lifeline and that sort of feedback is that there's lots and lots of that you did touch on what type of feedback how are these things being measured and I just want to say that we all of our work is goal-based so we have quantitative and qualitative data for all of the work we do we are actually putting back some incredible results I think 93 percent of our clients are reporting and in improvement in all of their goals and that's against the national average of 20 and a contractual target of 70 and across the alliance that figure is 90 percent so I can speak off of all of the the partners in that sense so going on to the parent support and parent mental health in our voluntary organization we run parent support groups as well and those are either in person or online and what we find is that having a network of other parents who understand exactly what they're experiencing can be incredibly validating and we are incredibly supportive group of parents and often the challenges are the same and that learned experience that lived experience can help those other people who are perhaps earlier on in their journey and that's very active so in Surrey we have 4000 members of the NAS Surrey branch and in fact that's increased by 2000 over the last two years so that kind of reflects the increase in demand for this sort of support service I think and we also do days out for the children swimming events all sorts of different events where it gives the opportunity for the families and the children to get together and be amongst their peer group so yeah I think there's there's very good support in Surrey there's a very good network we also have an online forum which is a moderated forum and that's got about a thousand members and that's where parents can reach out for support to other parents and get advice or information on simple things like where they might be able to get their children's haircut and they're living in the red hill area for example does anybody know of an ND friendly hairdresser or tooth brushing which is always a major issue what toothpaste of people tried what toothbrushes of people tried right the way through to EHDP questions send support questions and there's a lot of activity around that and it has to be said that a lot of parents who have those EHDP questions do think that they need that diagnosis in order to get an EHDP so we are very very frequently and regularly supporting those parents to understand that they don't actually need that diagnosis to get sent support and we are supporting them to understand that process and understand what adjustments they can request at that early stage without the need to go through that process thank you thank you and Jeremy I'll leave you got some questions on learning space yeah I have we note that learning space is not going to be commissioned further what's being done to replace their capacity because we just had a look here at some of the waiting time and there's 28 people waiting in East Surrey and 23 in West Surrey so what's going to be done to replace that capacity do you want me to take that um so we are we're working together with learning space to look at whether they can continue service um I think that um yeah that that's the situation at the moment so at the moment learning space there's a period of time before they would exit so we're looking now so service is there at the moment once if if we're working now to see if we can smooth that process and maybe have a way of learning space staying with us but we're doing that work with them now so we're working with them to do that if if they do indeed exit they'll there'll be a procurement exercise and we'll make sure that that continuity of services is key and so we're doing all the work around mitigating that risk at the moment so they may stay with you we're in conversations in conversation okay can I add that second question Trevor because that'll date the whole right so in relation to the autism activity evenings and day events offered for children young people with autism or waiting at our social care assessment which also involves the parents what data is being recorded on how networks are supported benefiting those children and parents as a result of this initiative and what is the learning so what's being recorded in terms of what's happened these activities evening and what analysis is being done this is the effect was that question was that question for me well i'm whoever whoever's suitable to answer it yeah we we don't have qualitative data um we have qualities of data sorry we don't have quantitative data that looks ahead i'm afraid so what we use is the feedback questionnaires to design further services going forward and we take that feedback we take that learning and we create new events which are meeting the parents needs but we can't sort of um unless we would be very difficult to um ask people to inform us about the sort of personal connections they've made going forward if we were asked sort of three years down the line or five years down the line we haven't found a way of doing that at this point okay thank you very much and uh council clack cruises to come in just for a minute i was just very in thank you very much chair and i'll be very brief just listening to Emma there earlier in her description of support for for young people and their families before they were diagnosed i thought that was incredibly um supportive and i'd just like to ask her how easy is it um and how accessible is it and you know do gps um and schools advise parents to contact her organization for that sort of support how how can they you know get that pre diagnosis um help during the you know facing up to the problems of with children with with um learning difficulties is a big thing in life and you know that that early help is really important before diagnosis and i was impressed with what Emma was saying so i just want to know how easy is it to access that sort of advice yeah um i have to say if if we were able to afford marketing and communications um person it would it would be easy but but we can't so it's not so it relies on practitioners and individuals taking every opportunity that we see to get out there so it's um and of course our resources are limited so we try and attend community events where we can we try and get information and communication in things like the school bulletin which we have which we have done and does generate quite a big response we have a small team in fact that it's just the equipment of one full full-time person actually but a portion of that person's time is spent going into schools and talking to parents about neurodiversity explaining what services are on offer including the um voluntary and parent support groups and also our answering questions on the spot to try and give some understanding into some of the behaviors and things that they might see um and in terms of the parent support groups we have a website and again we attend local events so in um autism awareness week the other week it was a Saturday and i was there in hazelmere with a with a table and a stand um in a church hall talking to people as they come in but this is on a voluntary basis so that sort of work is is limited to the to the amount of time that people have to give because we don't have that as a specific role marketing and communications within our sorry hub um and and a word of mouth of course so on the voluntary side we have a newsletter that goes out every two months but people need to join up in order to receive that newsletter so they need to be able to find out about us either through word of mouth or through some of these community events that we do um but we are very committed to trying to raise our profile and a lot of that is through schools but again we have limited resources to to be able to do that if we could go into every single school and hold a parent information session that would be absolutely amazing if we could go into every school and deliver the school training that would that would also be amazing because i very much believe that it's that the real earliest point of support is what makes the most difference and it's also helping parents to understand what they're in control of and what they can um push for within their environment with their family and friends with their school um and in their own home what what difference they can make that doesn't need that diagnosis because ultimately as um my colleagues have been saying earlier for autism there is when you have a diagnosis um that is just really a confirmation of validation of that difference because there is no treatment as such it's a way of living it's a way of being and it's the environment around you that needs to adapt and change to to support you where it does make a difference to young people is where it's about their identity and a validation of of why they feel different um sometimes that sense of needing that validation comes early sometimes it comes a lot later on um and for some children the mental health difficulties that arise out of not knowing can cause a different set of problems but that's when they will go into mindworks in a different through a different pathway for those for those mental health needs does that answer the question thank you um i think we've now got some questions on the care leaveer service because could that sorry could i just add to that answer because i think um Emma's uh done a wonderful response from one of our partners so you'll see in the paper um there are lots of ways on where we're listening and hearing from our families and family voice is very influential and giving us some feedback and the examples of the practice that Emma talked about is where we have um saw and uh secured some investment to increase the capacity of that type of activity so you'll see that mental health support teams have invested was it 460 the uh extra funding into the capacity to have more of those types of sessions you'll see that there's um 1.2 million from mental health investment fund that's gone into sorry well being partnership to support primary school children and their families so you can see that we're building that support the bits that we've also got to do that we're working on is a single process so there's work across the partnerships around a single referral process irrelevant of what organizational partner you are uh information governance arrangements has been signed off around that and we're working on how we can provide that digital solution because it shouldn't be up to a school or a family to get to the support of the different selection of partners so just want to add to what Emma's saying we're increasing the capacity of that and we're looking at a process that's more streamlined and digital okay thank you and Fiona it's like to start on the care levers questions sure i'd like to ask a question about care levers so the care lever service for young people is 1625 we're struggling with emotional and mental health difficulties aims to support them to reduce the risk of long-term mental health needs how are you working with others to do this and what are the key issues in reducing risks of long-term mental health needs what more needs to be done as well to improve outcomes because we've had a very sad example of what happens when this doesn't work in the not very distant past thank you for the question Fiona i'm happy to talk about so two elements of service so our new leaf services are services that support children who are looked after and children who have left care and includes specialist support for for example on a company to sign them seeking children and this the service from a clinical perspective includes a multi-disciplinary team multi-agency team that are really expert in working with children who've experienced trauma in particular and they network and engage with all of the agencies that are supporting the child and work with the family to be able to support that child's needs and that that's one element of service the the other element of service to think about is our reaching out service so we're reaching out services again are aimed at children who are hard to reach and we know that children who are hard to reach are very often challenged with mental health and neurodevelopmental needs and they may be struggling with addiction with homelessness and they may not be in education and so our reaching out services works with children up until the age of 25 but at the point at which a young person may need to transition and that might include transitioning into adult services there's a sort of a really comprehensive offer to ensure that that transition happens together with that young person and their family and takes account of their vulnerabilities and we've got different approaches including making sure that there's a really comprehensive transition checklist we've got courses and support available to families and young people through our transition recovery college and we make we align a support worker with a young person at the sort of more vulnerable points in their care journey so transition being one of them and there's direct sort of one-to-one support for those young people so there's a range of supports and offers through reaching out a new leaf for this especially vulnerable group of children. Can I just follow up Justine because I'm a young person who is on my own, I'm a care believer, I don't have much contact with my birth family and I grew up outside CERI so I don't have any contact much with the foster family so I arrive back in CERI and you know I've got quite a few problems how do I access support how do I even know that there is support there because you know there's a real I mean you know these young people you know are not often part of a family back in CERI so you know they are particularly vulnerable in that respect how do they access the services absolutely so so the access might be via CERI County Council and our relationships with CERI County Council if a young person presents and they have emotional well-being or mental health need in our screening criteria we would look at particular vulnerabilities including identifying if that child is a care leaver or is a child who is looked after so as part of our triaging and screening processes we would look out for vulnerabilities like the vulnerabilities that you've described and children who might have been in care and we give prioritization to their needs so there would be a direct referral to new leaf services who would engage and offer support and network with agencies to support that young person so can I just check there's an assumption that somebody's going to help the young person to be referred so there is going to be a PA or there is somebody who can refer that young person that care leaver is that is that the working assumption the young person can't immediately access services themselves they have to be referred by an agency of some description is that how it works press the button the wrong way and there isn't a self referral to our new leaf services but for children like the children that you described it is it is usually known that they are in the county and in need of support and our agencies will work together in that respect it is also the case that there are a range of supports that young people can access by a self referral so I think that's important to hold in mind so they may be may may access through one of our so well-being partners they may come to their attention it may be that they come to the attention of their GP so there are different opportunities including opportunities to work together with sorry county council and other agencies for children who are more vulnerable thank you thank you Fiona um okay um councilor rob Evans I believe you've got some questions around sign posting Robert could you turn me mic on I have just done that I'm sorry yeah um yeah it's really whether how how people can access the the sign posted to know the services that for which they're eligible and whether you are happy that you've got a joined up approach that you know we're talking about vulnerable people and to ensure that there's the continuity of service and the all options open to them are actually made aware the the emphasis in our mind works alliance partnership is to really increase the presence of help and support in places and spaces where children and young people are in order that they can immediately access or talk about their needs and and throughout network of partners build confidence in understanding the needs of a young person and making sure that they can be directed and supported in the right way as early as possible so we we've talked about mental health support teams for example we've got 15 mental health support teams our partners as Anne has described our third section voluntary sector partners are present in schools and in communities and our recovery college offer is self-referral and there's really good information on related websites and we are working hard through webinars with GPs and schools and with parents we work really closely with family voices so we we really do try to adopt what we call our thrive approach which is really trying to grow the confidence competence and understanding of what is available for children and young people across across our communities across Surrey forgive me do you feel confident in telling this committee that it's working and is there really a sort of sophisticated jigsaw that fits together that provides those services rather than just explain what you hope will be actually happening can you actually convince us that it really is effective yeah um hi so um I think the sign posting and information that we have available to us we put out in all the channels we are able to do um the work that we do in the community in across multiple organizations um with uh children young people in in targeted groups but also our universal work we go to a sem we do assembly so much like Emma was saying earlier multiple organizations are doing that across um Surrey so I think we there is definitely a concerted effort to do that I've no doubt there's an effort what I'm trying to argue is ask you is what what what I'm trying to argue I understand you're making the effort but what I'm trying to discover is what procedures or mechanisms you've got in faith in place to see if it's effective to make sure people don't slip through because if you're doing school assemblies but the people you want to get to aren't at the school assemblies what do you you know we're here constantly here are cases of people who fall through the system and I'm just anxious to know what your mechanisms are to ensure that that's not happening how you're getting through to the most vulnerable people those that are most in need uh most desire your support yeah so I think that is that is to do with our our focus on vulnerable groups um and that is through the reaching out um teams like Justin was referring to the fact that we do have uh more demand than capacity does tell us that people know where we are and they're requesting our support so we do we do have that we some of the work that that we do for instance you've have early intervention coordinators in schools that work with the mental health support teams the primary mental health practitioners and work in school clusters so it's our school based needs team as an example um is multidisciplinary in its approach it works with local clusters of schools where all practitioners can come meet the relevant people and hear what we've got to offer but specifically our early intervention coordinators would work with schools to make sure they support in school any vulnerable pupils but also to refer them to the right partners if necessary so I don't know if Justin you want to add about the vulnerable groups part yeah I I've talked about reaching out and um new leave um I was just thinking about um I think he had to frame the question so forgive me but thinking about when children really are at their most vulnerable so in crisis and so we have a 24/7 crisis mental health and support line and we have put posters in schools and created cards that children can carry around in their pockets and emerge out one of our partners they are present in emergency departments we have CYP havens as part of our mind works office so children can can walk in can present and we work with amplify who are young people themselves and they're a network of young people that do a lot through sort of peer support and connections to promote the range of help and supports that are available with regard to measuring effectiveness and so as Ann says we we can see that demand for all of our partners is significantly increased and particularly post COVID so it is it is evident that more children are accessing emotional well-being and mental health support and when I think about effectiveness there are there aren't measures your views matters and talked earlier about goal-based outcomes which help us to think about what a child's needs were at the commencement at their assessment and then at the conclusion of interventional treatment was that effective in meeting their needs and and we've got much richer evidence around the effectiveness of the interventions that we're providing and when I think about complaints we do we tend to get more compliments than complaints the compliments are usually about the experience that families and children have had with our frontline teams our complaints are about waiting times that's the strongest theme waiting times for neurodevelopmental need so we're trying to be present we're trying to be responsive we're trying to give a range of offers via self-referral and via referral to ensure that we are present and engaged with our most vulnerable children we do yes yeah yeah we've got a mind works and and actually our amplifier our young people support that so for example we have campaigns through exam season we know that certain times of the year are more difficult for young people so we'll heavily promote access to our crisis services and havens there have been amplified events and which have you sort of brought together all of our partners so that we we're continually sharing what what is available in the full range of support and offers that are available I don't know if I could just add the social media communication strategy is an important one and we have recently been reviewing it to add things like TikTok and things into that so that we are putting our communication in the right spaces so we're looking how we might do that but we're certainly on Instagram at the moment Facebook and Twitter all the usual places putting out those key messages particularly the crisis numbers but but also signposting the website where we do have resources on lots of lots of information for families as well as have access services could I also thank you thank you I just wanted to add just in terms of the reaching out service which is supporting young people vulnerable young people from some of those underserved groups so we have been doing a piece of research with the McPinn Foundation under an NHR National Institute of Health Research Grant to look at the experience of young people in those transition services and to learn from their experiences so I think that's that's another helpful piece of work in terms of shaping that offer and making sure that it is it is user-led design and it is meeting the needs of that particular group of vulnerable young people and moving on Fiona Davidson has a question on recovery college in this space I do and it's it's um it's appropriate actually because Justin has just talked about the recovery college so I think what we're interested in is what services are currently being offered for young people with neurodevelopmental issues by the sorry and borders recovery college so what proportion of young people with neurodevelopmental issues have taken up the recovery college offering how could you encourage more take-up and if you had more take-up what would that mean for you as an organization last point is could the recovery service recovery college service be widened to include more support for parents of children and young people with um lived experience of neurodevelopmental conditions thank you thank you Fiona so yeah so I mentioned specifically one of the courses which is the transition course so young people particularly those who are more vulnerable open to our reaching out services will be encouraged to attend that course and there are a range of offers um that so these are our working age adult services but they have have looked at ways in which they can engage young people and particularly those young people who are transitioning to adulthood and there are three specific courses which focus on neurodevelopmental need and a fourth in production and the courses so include introduction to the autistic spectrum understanding adult ADHD and the post diagnostic ASD and understanding adult ADHD courses and there's a of the opportunity to attend online and in person and they're well attended the there's a degree of anonymity as we said earlier there is self-referral to recovery colleges so in fact parents and teachers others you know the recovery college is open to all and can join those courses and because of that because there is an emphasis on sort of sharing who you are and what your conditions are it's more difficult to be able to ascertain what proportion of attendees have neurodevelopmental need but we do know that those courses are well attended thank you can i just add just to say this one of the strategies to increase take up of the recovery college has been to instill that anonymity as a way of challenging stigma and from the recovery college the reports are that most people do not want to disclose a diagnosis so and they're treated as students rather than patients or clients so that's the self-referral recovery program thank you and we've already touched on the transformation plan quite a few times and the need for it but i'm gonna ask Jeremy to sort of wrap up on up please well it's actually Jeremy and Jonathan um actually there's a lot in this meeting that i found actually very good and very optimistic i shall not forget Graham's metaphor i've just looked up the meaning of metaphor Graham like the shape of the door it is a metaphor and that's going to stay with me for a very long time i did what's been nagging me for the last hour hour and a quarter of those what's the plan i used to work with the manager in family work said what's the plan so in my sort of simple mind i i think of a you know you have a partnership you know within that there's somewhere there's an office there's a group of people who sit together and say right how are we going to achieve this could you see i've been very impressed also with the work of the same clothes you know and the lady that came on the screen today is known to me i've been around other primary schools of mayor and seen children who can't go into class just in corridors with individuals so i suppose you know if my mother's here she said we can't go on like this so i suppose so what is the plan and who's doing it and Jonathan might like to add a few things to that so you can answer in the round Jonathan thank you and and thank you for your presentations i what i'm stuck with not so much is front doors but silos and whether we've been delving into one particular silo the ones that you're responsible to and and seeking to try to resolve the whole issues of which go far beyond what you're capable of and what you're funded to do and what your commission to do within that little bit and i'm trying to think of a nice catchphrase the the closest i've got is trying to put a court into a pint pot and i thought i just googled to find what court is to make sure that that is a correct analogy but you know if if you don't have enough resources to do the social model as well as the the part of the medical model you have to do presumably you are the NHS so i guess we should line rely on you to the medical bit and in in the past there was more social wrap around provided by Surrey County Council in the form of shoreside centers across Surrey so that less children were presenting a reception with the same developmental challenges and then were being referred on to a medical response to something which could have been maybe addressed in a universal provision well we're an adults here aren't we so adults and the NHS work together in terms of better care but this is the the child bit of adults if you like all of it for inflation the health part of our brief is all ages it's all yeah so but there's the better isn't there the better care fund where health and adults work together well this part of health and children need to work together so how do we get the universal provision the social model whether it was funded by the NHS or whether Surrey County Council that does the care bit should fund the social model as well as its targeted stuff that needs to do to pass its office that exam or does NHS need to give vastly more money to this service so it can actually deliver what's required because my worry is we could create all the plans of the world when s there's money to deliver the plan unless there's the wrap around things outside of the mindwork silo that you're looking for I mean presumably the reason you're reaching out to the social model is the Surrey bit isn't doing what it's supposed to be doing in that partnership so how much of the blame for the uprise and in mental health cases that you're having to deal with should fall on our doorstep Surrey County Council and and the lack of universal young persons provision I don't know but I wonder you know what is the overall plan because otherwise we could have little plans within little silos which don't get very political because you're not allowed to be within your own little silo but it doesn't actually address the root cause of the problem which you I know are passionate about because that's your day job and and that's why you're here and and we want to solve this together so can we have some money with this plan and be honest about how much money we need and whether it should sit within your contract or whether you think there are money needs elsewhere that are needed which which are what's really holding you back from delivering what everyone expects of you um I'll try and start Jonathan and just um to thank you really for I think that that acknowledgement because I think it hits the nail quite splendidly on the head for one of another analogy metaphor whatever we're doing at the moment I don't know um but I think it does speak to kind of the working day for lots of people and also the the day for lots of parents who have children who are experiencing difficulties accessing support whether that's where the diagnosis or otherwise and we hear a lot from children or families and we have ways of engaging with schools on a very regular basis so um I think we need to listen more to that what we hear and what we talk about to make some small changes that could make a big difference in terms of the overarching plan we've put some things in the paper which as you've said to feel a bit disparate and we've heard that really loudly it loudly from committee members today and thank you for being um as as obviously in your comments as you are it's actually helpful because I think it helps provide us clarity in terms of what you what helps you when we come back again and I think we'd all like to come back again and be able to show you something different and what feels different it might not yet that then feel different to families that's can take time but in terms of that partnership bit I think the people we've got in the room today demonstrates that partnership the people we had on the screen the teacher had to go and so does our our colleague from education in the counter-counsel um Kerry and I are very fortunate we straddle both camps so to speak we sit in the counter-counsel in the ICB and so are able to try and start to knit some of it together into a more coherent plan that really draws on what children families and parents and schools are telling us what we then need to do about those things and kind of what that might look like in terms of action and next steps and outcomes and so I hope if we can come back again we can articulate that much more clearly the mind works part as part of that puzzle which is absolutely clear and present but also what the other parts of puzzle are Jonathan that you just articulated around that social model and I think for me and we've been talking um kind of in the break of it there's a lot of work going around the all age autism strategy which absolutely resonates in this space there's a lot of improvement work around the send work and the children with additional needs which again builds on the kind of the work particularly around children who have additional needs for due to neurodivergence it's not all siloed it's a child in the middle and that's what we try and keep central to the way that we want to work and you're right we do need to break down some of those silos and bring some of that together the money bit I'm not going to comment on I think we try not to I'm able to I'll be honest I think we try and make sure um funding in from the ICB and likewise within the counter council um is is shaped and moved to where that need is um certainly in the ICB when we've raised risks around this particular pathway for children and adults um it's been heard and some investment has been made we need to see what that looks like for the year ahead given where the ICB is currently um as you would in terms of financial planning exception within the counter council thank you chairman um so um thank you for those questions and observation so from my perspective I would say that um universal early years provision is absolutely critical in the sport of families and and young people and there are certainly gaps in that provision across the country not just in sorry say recognizing that I talked earlier about our plan around the transformation work that we've got a number of workshops in train I think there is a risk that that becomes a siloed piece of work and it's really important that we try to make sure it's well connected in the plan is to ensure that that work feeds in through a border transformation board that's chaired by Suzanne as part of the county council so that it can connect into all of the other aspects of work so the send work and the other bits of work that we've talked about today so that we can have a more holistic uh plan so I think that's what we're going to try to deliver and there will be segments within that plan clearly there is a um a part that's going to be for the mind works partnership but there's going to be a part that sits around send and and delivering the autism strategy so um but we need to make sure there's a golden thread that goes through that plan that makes it feel more holistic and connected through that planning clearly we're going to be looking at the um the finance the financial plan that sits underneath that what have we got what haven't we got where the gaps can we get any more uh resources to deliver that plan we can't answer that at the moment without the plan so we need to do the work and we need to ensure the right partners are engaged in those conversations it's critical that we hear from more from families more from schools in terms of the best fit for that plan thank you uh Trudy um you've been very patient on there on teams if you'd like to come in yeah just to add support to what Harriet and a colleague have just said about the work we're going to do around the plan Jonathan I think you and a hit the nail on the head we've focused on one sort of kind of element and you know the mind works colleagues have been under intense scrutiny today because of the wait times which they've acknowledged I do think there's an awful lot of things for us to do in support of schools and families and actually as part of the um you know educational lifelong learning directorate we will be focusing heavily on that we have a as people are alluded to the offstead inspection um to respond to and part of that is about having a cohesive plan that makes sure that we all work in close partnership I will say it's lovely to hear from Emma and other colleagues around the table about all the support that's going into schools I think for us it's about mapping it out making it very clear to schools what's available and also yeah there's much to talk about what's ordinary available in schools I think we need to have a relook at that schools are dealing with different cowhorts of children these days and actually um the way that they've been working for years under you know difficult circumstances are following from the pandemic we're not looking at what we used to look at we're not comparing the same sort of education system that was there previously and I know that um our schools and partners are really keen to support all these children and learners plus their families in getting better outcomes for them we want them to be an integral part of their community they are we don't want them to have to go and find specialist settings elsewhere unless their needs actually demand that and so we need to look at what our offer is what our training and development is for our practitioners and actually learning from other local authorities who are facing the same issues that we're facing taking what's the very best but making get tailored for the children and young people and families of Surrey as it's really important that we have that kind of unique offer but most importantly is that we have equity in the system for all of our children and young people this is really important that they thrive in an education setting that's appropriate for them thank you for everybody that's participated in the question session and I'll come back to just saying that among part of this issue is society as a whole has to become much more inclusive and regard people with neurodiversity they're actually just part of the variation and we need to actually you know manage things like that in a much better way where we all take our part in you know supporting them and Fiona I guess my one last question is what's the timeframe for the plan you know are we talking three months six months nine months because I think that's I think that's very important for us to feel that a very clearly I mean the plan that that you suggest to tell them signs appropriate you know the structure that you suggest the signs appropriate but you know the proof is in the pudding so when do you think it will be out there when will be see what in what time skill will we get a view of how it is actually going to deal with the the the fragmentation and missing you know we're missing so many needs today so when when do you think we'll see that plan and so I think we've got a fairly tight timeline so we have committed ourselves to be able to present at a national conference in November in terms of our improvement plan so so so we will be expecting obviously to have that plan in place fairly quickly we need to make sure that we we've had the right conversations though and you know a plan is only as good as a plan it's about how you implement it isn't it so and so we you know I think we would be expecting to see that well before November because we're going to be presenting it so I don't know if Suzanne wants to comment on on time frame but I think our expectation is certainly within the next few months isn't it we look forward to seeing it thank you thank you we're going to move on to the recommendations section of the discussion now so Sally if you could put them up on the screen please suggestion please on the on the recommendations I think it's going to need a little bit of surgery and tidying up because it doesn't really make it's not coherent as it is at the moment and I would suggest that we if it's the only suggestion that we look at it over lunch time and come back after a break because I think we could spend a long time playing around with words on this on the screen now so I don't think at the moment quite in the format it serves its purpose I'm mindful that we've got safeguarding teams waiting patiently as well so I thought you were going to take it after this take the last well we'll take a short break but I'm just you know worrying about the timing yeah I think we'll take the break yeah we'll take the break and if we could be back here probably at half past you can do a full screen excellent I think we're including one so do you like me to read them out or are you happy with them on now? so yeah I think let's read them because I think most most members go struggle with that and most people online which struggle with it there's some new them as it is we do we do not make the transformation found because what we've remembered as the CFLC is we've requested that the transformation plan come back to the CFLC for a scrutiny by the end of this calendar year all the way to the CFLC Christmas Eve yeah I would suggest that it's October we saw it before it went to the conference I don't know if you've heard that Graham what we're saying is we'd like to see the transformation plan I think there is a consensus that the children's committee would like to see it in October but the question is is it going to be feasible to do that if it's going to be presented nationally in November yeah I'm not sure that one that they need to be in sort of in series like that if you think that I think there can be a degree of which they can parallel run so I think when we go to the national conference we'll be laying out our thoughts but this process should be about the actual transformation plan and its delivery time scale so I think October is a easy reasonable time frame to go and then we would only I mean it's a presentation at a conference isn't it so it's going to be sort of you know ten slides not the sort of thing you'd have in committee so I don't see but I think October is a good timeline let's go for October then that would be great thank you thank you so that covers the the transformation plan section the next one is recommend that the response to the joint area inspection report is extended to accommodate a joined-up mind works education health and care plan process that's because these are these are very very different processes at the moment so you know they're part of the same continuum but actually each is being done in isolation and I think some level of integration to give certainty about what happens when and in what time scales would be an excellent addition okay recommendation three there is the Surrey and Borders Partnership Trust Recovery College needs to be more accessible to people and encourage more local access with better publicity and provision of outreach services ensure that the recovery college is given more active publicity and has the capacity to take on the extra workload establish skills and works coaches to help coach and support people to enable the transition that's the transition into adulthood with helping people to maintain employment and get into employment and critically to help people with regards to the recovery college and then number four is mind works and Angela believe you want to say something on the information guide yeah I'm I'm just wondering whether that's something that the National Autistic Society and some of the parents who use their services may be able to work collaboratively on with mind works and enough of my own personal experience that the NES have a plethora of information and contacts and things like that within the community and obviously you know having been through the NES and the various workshops and things like that you know they have a program events from from that are suitable for young you know young children right through to adulthood and you know and beyond 25 years when you start to get all the adult services and things like that and I was just wondering whether or not they could work together with mind works to try and put something initially together and with that it'll be built on a made alive document I'm not saying we have to put that in the recommendations but that's something that might be considered online thank you yeah I also had a conversation with Graham in the break suggesting that you know quite a lot of professionals would quite like a simple guide as well so it's a well it's a problem because you know you may not have that many cases come to you as an individual but no having something that's simple that tells you where to go is enormously helpful Graham yeah I was just thinking about whether the use of the words information guide narrows the recommendation quite quickly into a particular document and whether guidance if you like would provide more freedom within the transformation work for us actually to think about what's the right sport we were having a conversation about how even if you've got a great document and actually parents might need a sort of someone to actually talk to as part of a guidance process so yeah I would actually go to at least something clear simple and coherent yeah um so yeah I can then point it to the complicated stuff but you should actually have you know a simple a simple clear guide that that actually you know shows a complete bit and doesn't go something wonderful happens here is exactly what's needed I mean I think the thing about a guide is that at the moment parents have no idea where to turn I mean we were talking about this in the break um so they need information they need it in a format that is digestible to them that has terminology that is appropriate to the terminology that they use you know that is not a specific set of terminology so I think I think all those things you know to to find some high to find that access into a whole lot of information and different pathways through it that will help people make sense of a huge amount of complete fragmentation that doesn't seem to address many people's needs at the moment sorry David yeah so it also needs to be simply worded I don't know how you want to express that but uh I think I think let's just said I think it's accessible language so it's not it's not the language used by professionals which is a you know which is a very particular subset which is heavily medicalised language actually okay and I love the page really oh Jonathan sorry yeah very briefly talk there about ensuring the communication is clear but I think the point from the National Autistic Society was the communication could be further reaching and better hitting the target audience so that there might be you might want to beef up that a little bit a little bit as well okay I think hopefully we're agreed with that after a very long and very full discussion and move on to adult safeguarding so thank you Graham and thank you please thank you team okay team adult safeguarding okay thank you check can you all hear me is the mic on okay that's blended thank you this report sets out our performance in relation to safeguarding adults broadly there are two aspects to the report we set out the responsibilities in the context of the care act 2014 additionally we have a test of assurance coming up and the first part of the report also briefly touches on that and the second part of the report indicates overall performance it highlights our strengths and areas of challenge and our improvement plans in conclusion so setting out the broad responsibilities of the care act we have a clear legal framework for how local authorities are required to perform we must have a multi-agency local adult safeguarding system that seeks to prevent abuse and also respond to it once it's identified I have to say chair our first responsibility is always to protect adults at risk that is our number one priority within the council and within adult social care and we have a robust safeguarding adult board as required by the responsibilities in the care act we we also carry out safeguarding adult reviews when it's suspected that there are lessons learned within the systems where there are potential I won't use the word failures but where there are multi-agency systemic lessons to be learned if we can do things differently to protect adults at risk and we also arrange for independent advocates we've also got an inspection coming up which is defined as a test of assurance this is new for adult social care years ago inspections of adult social care cease but now they're brand new as defined by law they're defined as test of assurance but we know in any other name there are inspections and a regulator care quality commission is undertaking that test of assurance or inspection and sorry is on the cusp of having its inspection very soon the assessment framework uses quality statements from an overall singing single assessment framework I hope that's a test chair that way the two o'clock rehearsal they didn't tell me about thank goodness it's just a test so there are nine quality statements mapped across four overall themes and within the themes there are nine I statements I'll carry on can everyone still hear me okay thank you which reflect the individual experience of the people that use our services and the I statement is about what people expect and their experience theme three of those four targeted themes within that inspection relate to ensuring safety within the system and that includes safeguarding so we move on to the second part of the report which is the most important part it reflects our current position what we believe we do well what our strengths are and what our challenges are moving forward and this is what we have submitted to the CQC in preparation for our inspection so we believe we have a good track record in making safeguard in personal with our frontline staff consistently reflecting on people's wishes and supporting individuals to meet those wishes focusing on the outcomes what they would like their outcomes to be particularly when considering adult safeguarding and we can evidence that through benchmarking data across comparative local authorities we're an active partner within safeguarding adults board and that's multi-agency partnership we have invested strongly in leadership to improve our position with adult safeguarding although we know that there is increased demand nationally and that's reflected too in Surrey and that's reflected in our statistics provided business continuity plans are scrutinized as part of our commissioning process and we've also introduced a proportionate response for managing safeguarding concerns where a full section 42 inquiry and what that means is a section 42 means a full safeguarding investigation so where a full safeguarding investigation isn't required we manage we manage the immediate risk and we ensure that no individual a vulnerable individual is open to abuse is left at risk nevertheless people still feel safe in Surrey we did have a high referral rate the safeguarding but we're reducing that by that proportionate approach and the number of inquiries open for longer than 52 weeks has also dropped dramatically down 80 percent and we've also reviewed targeted audits using a local government association approved tool and part of our improvement program does include reviewing that audit process right the way across the county and ensuring staff right safeguarding plans in response to inquiries and we've improved our internal governance process and introduced a practice assurance board which assures that learning from case audits saw us safeguarding adult reviews and other learning opportunities already disseminated across the county and we will continue to review that audit process and some of the challenges that we face is that that is national picture and reflected in Surrey as I've said the complexity and national demand for safeguarding adults has continued to increase year-on-year with the most common types of risk being neglects and acts of omission and there were an estimated 587,970 raised during 22 to 23 and that was an increase of 9 percent and the number of inquiries under section 42 also increased by 7 percent and in Surrey the number of concerns received per 100,000 was towards the top end of our comparator group and you'll see there that and the stats that that's borne out. In July 23 an audit was undertaken to establish the workforce's level of understanding of risk assessments and it recommended training and risk assessments and relaunching the assessment form and guidance and that is all underway as part of an overall approach. I'll keep going unless someone raises their hand and say they can't hear me I can always move that's it move closer to the mic. No it's fine coming across well just be glad that the paper shredding Laurie hasn't shown up. Thank you. So we have a number of improvement plans to improve safeguarding with review of the care act training as part of our training offer and we intend to increase understanding of proportionate risk management and we're actively sorting and developing training modules for registered and unregistered staff focusing on identifying risk and working with people to enact that and enable staff and indeed enable a vulnerable adult population to manage their own risk. We've established a new safeguarding improvement group which is a strategic group to develop strategy and drive forward improvements. Principal social worker is also key to that and working on risk management and improvement tools. The improvement work continues with processes and systems and safeguarding audits have already mentioned but we're also looking at disseminating lessons learned right the way across the county and that includes lessons learned from SARS by applying different methodology. We've commissioned a commissioner and provide a concern improvement group and again this is a strategic group to own the development and delivery of specific improvement strategies including market position statements and focus groups and so on and that reviews how provision service are monitored and effectively assessing the impact of all of that that work working with providers and so on including best value for money, high quality and meeting appropriate demand and to resolving any concerns and reviewing national guidelines. So Chair we know that in recent months we have made good progress and we continue to monitor that progress because we want to embed it across the county. We're improving outcomes for adults at risk and that is evidence in several performance measures including the improvement in safeguarding data especially making safeguarding personal which is one of our key performance indicators and whilst we recognize the challenges we've got improvement plans in place to continue to improve the lives of those at risk. So the recommendation is for the report to be noted by all members of this select committee. For our next steps what we would like to do is to review the safeguarding adults board training offer to partners to specifically ensure that carer concerns are appropriately dealt with and safeguarding alerts raised as appropriate not withstanding low level provided concerns and all other concerns are appropriately referred and dealt within a timely manner because what we're really keen to see is that people who have need of service get the best possible service at the right time and in the right place and also because we're on a continuous journey we'll continue to focus on the performance trends particularly in the referral data to make sure that we're still on track and timeliness of responses to ensure that the measures are being fully implemented and effective and we will also offer adult safeguarding training to elected councillors as well because we also recognize that elected councillors are the eyes and ears or our eyes and ears in the community and we really value and recognize the intelligence that elected members can bring to us. So thank you chair and now we're open to questions. Okay I'll open the questions. We had some recent reports from HealthWatch Surrey. Can you talk to what improvements have been implemented since those reports particularly how is more coordinated working improved the experience of families and carers and where do you think you still have issues with safeguarding that need to be addressed? In relation to the HealthWatch reports so in reviewing that there is a series of individual cases that are highlighted and they are noted in terms of our sort of improvements with driving our main improvements through the safeguarding improvement plan which there is an existing one which will set up in relation to preparation for CQC assessment. That plan is in the process of being updated now that the self assessment has been completed for an inspection so we're in the midst of completing over the next few weeks and there is a wide range of things that we're looking at particularly in terms of how we are sort of managing volume and the different trends and it's across a whole range of areas. Chair would you mind if I added something to that as well yeah thank you. I just want to just touch on the HealthWatch point if I may chair just to say that we very much welcome the HealthWatch report and you know I know that Luke and George I hope you've all met George he's new here at Sorry County Council we're very pleased he's here but I know that we are all committed within adult social care and to improving practice which the report highlights yeah around safeguarding and it also highlights a focus on improving communication across the agencies so on the back of that report as you know I was in children's recently come back to adults on the back of the HealthWatch report I met with Kate Scriven Chief Executive of Luminous and we had a really good chat about the report and looking at how adult social care HealthWatch can improve those communications and improve those outcomes really for vulnerable residents so you know we know Luke Lucas said the report's clear we do have a way to go but we've got clear plans in which to get to where we need to get to but it was a really strong meeting with Kate and I think if we stick to those commitments around improving communications and improving practice we'll see some significant improvements at their next report hopefully. Chair if I could just add to that as well HealthWatch and our senior leadership team do have regular meetings and we're using the data to make sure that we understand the experience as reflected in the HealthWatch report and we're using case tracking audits and so on. In the SAB we work closely with system partners including Health and our executive director meets regularly with Claire Stone who's the chief nurse of the ICB and the other part of your question I think was where we think we still have issues with safe guarding that needs to be addressed so we have had a very risk-averse culture and that has led to huge volumes of safeguarding referrals into the system so we're wanting to shift from risk-averse practice to positive risk management and George has set up a risk enablement board and that's established to promote that proactive and positive approach to risk management within our organisations adult safeguarding framework and the primary goal is to facilitate practice culture shift towards risk enablement and that focuses on well-being, managing risk effectively and of course reducing unnecessary section 42 inquiries in other words inquiries that would lead to a full-blown safeguarding investigation and it links to the point I made earlier really chair in terms of ensuring that people who need a service nevertheless get it in a more timely and more appropriate manner. Thank you for much better and more complete answer Fiona. Thank you chair. How is poor communication measured amongst carers, the health service and other organisations as well as social workers and between different family members who are often contacted at different times so how is the communication measured? You know I think we've probably all had examples of you know having been given different information by different people at different points in time and wondering who actually to believe so how is that communication process being managed, how is it being improved and is there a complaints process if you kind of just get to the end of your tether and you think I can't make any sense of this and something needs to be done about it? Thank you for that question. I think that's a really important question. We're trying to engage more and more with users of our service. First of all there is a survey, a user survey and the take up of that traditionally has been quite low. Surrey is not alone in that. There are other authorities where the take up is quite low and we're trying to encourage people, making people aware that there is a complaints process as we have contact with people, as we do assessments with people, as we have contact with carers because I know that from the health watch report there's a lot of reference there to carers so we're trying to enable carers and make carers aware that there is that process and of course encouraging carers and users of service to participate in that annual survey. That's the first thing. The second thing is where there is feedback to you know our front line workers receive feedback to feed that up to the chain. As part of our new practice assurance board all comments are taken forward as lessons learned as part of that process now because we want to become known as a listening authority and a hearing authority and that's part of our governance process now as well. In terms of communication we do measure the complaints that we get through the council's complaint process. In adults it's a single tier process and that's a statutory process. We define and analyse complaints by the data recording, process the nature of the complaints and communication is a category within this. We are able to understand how many complaints we receive about specific issues and we try and make the best use of that communication to drive improvements to the service at a local level and of course we remind staff of the importance of good communication at all times and we explain eligibility and social care processes from the outset to fulfil improvements in training. We run training and complaints for our staff and that's specifically run by our complaints department which we think is important and complaints also includes ombudsman investigations and they're reported upwards to a corporate leadership team as well as our directorate leadership team and under the new governance arrangements we're taking lessons learned not just from complaints but from ombudsman complaints as well to disseminate them across the county. So thank you for that really important question. Thank you, thank you chair. Thank you. Section 43 of the care act requires every local authority to establish a safeguarding at adults board with the major task of coordinating and reviewing the multi-agency approach across all member organisations. Inevitably in a multi- agency situation gaps problems do sometimes occur at the boundaries. What improvement efforts are you taking to make sure that those are as much as possible eliminated? Thank you chair. In some ways that's a good old chestnut of a question if I may say and it's not unique to Surrey you will hear me saying that a lot. Every time you've got more than my organisation involved you've got gaps and problems of communication. It goes without saying. I mean I think the SAP here in Surrey has endorsed a number of principles which underpin our approach. So the first thing I would say is that no one agency can create an effective safeguarding system by itself. So and we recognise that only a joined approach at a strategic level can deliver a better response. So to test the effectiveness of strategic arrangements we always ask how is the partnership making a positive difference to the lives and experience of local people and at the very best local arrangement show that ambitious joined up strategic partnerships have clear sight on lines of practice and on the experiences of local individuals and the impact of that direct work and will be informed by the lived experience of local people and that's what we focused all of the partners involved in the SAB on and that helps. Now we've been progressing the ambitions to improve countywide links and working and that's crucial to improving the ability to understand communities across Surrey and strengthening the voice of people with lived experience and and I think key to answering that specific question in the gaps is that earlier in the year the SAB established a new communications network which was led by our partnerships officer and and that had a broad membership from all sectors to inform and extend our methods for awareness of raising all adults they've got issues. The main sub meetings encourage white next inclusive membership and I use as a forum for sharing learning and insights local regional and national practice and research as well as SARS and serious incidents it's steered by an executive group and shared by the independent chair and comprises a statutory partners as defined in the care act and the independent chair is now leading a review of our approach to quality assurance and he's working with the SAB's quality and performance subgroup and what we're trying to do in the SAB is to develop a new quality assurance framework and the focus is strongly an multi-agency approach to assurance and the questions that we are asking all our partners to try and fill those gaps is where does abuse happen why by whom what are the biggest risks do we have skilled informed in a confident workforce across the partnership how can we address that together do we listen to the views of local people and how do we as a partnership make that difference together and if not what what can we do about that together thank you for that very full answer people living in poverty find it much harder to live healthy lives much harder to access NHS services they live with greater illness and die earlier than the rest of the population how is the improvement plan an integrated collaboration with ICB and the community helping to improve safeguarding amongst vulnerable adults and Surrey's priority neighborhoods and where are the biggest improvements really needed I mean this is a I won't pretend this isn't an easy answer chair because I think it is recognized that you know there is the link there between impoverished neighborhoods and safeguarding however there are priority neighborhoods set out you know health and well-being strategy and they are being used to target specific resources in order to prevent issues of safeguarding occurring because part of the focus of certainly the SAB and our partnership work is about prevention so resources include things like local area coordinators and they're there to understand need experienced by those neighborhoods and to enable better access to services to respond to that need and that indeed might include safeguarding issues or prevention of safeguarding issues to even the low-level risks and enabling us to work together to manage those risks to prevent them escalating and yes it's about that working together really in that partnership way Hello there I've been interested to hear what improvements are being made to address the difficulties in accessing professional help specifically what improvements are being made to help people to access the right kind of support to reduce risk and promote well-being and then my second question because you might be wrapping it all up in one answer what improvements of staff training and management have been implemented to help improve the effectiveness of adult safeguarding and has there been any safeguarding protocols implemented for clients and volunteers and if so it would be great if you could just share a bit of information there thank you thank you for that question I won't prolong the answer to this but there are you know I can list a few of those initiatives so improvements being made to address difficulties in accessing professional help certainly internally as far as adult social care or the council is concerned we have improved our triage process I referred earlier to the referrals that are coming in and you know we're adopting a SPAR a single point of access approach to triage more effectively so we're able to connect people to the most appropriate service there's things like initiatives like sorry counter council fuel poverty and energy efficiency network working with partners to increase access to specialist advisors and sources of support such as debt and energy efficiency working with utility providers and understanding bills housing first approach and actions to ensure duty to refer and acted upon and the fuel poverty program links to work with sorry fire and rescue so that when they go into people's houses they are able to sign post those haven't been put on the heating to get support for example warm hubs there's a web link list of food banks in in sorry to enable access for the most impoverished it was found that many people leaving with disabilities for example weren't able to access the appropriate food support there's the work of community link officers to link people with services that they need working with partners for example to make physical activities more accessible connecting people to four prevention programs and that is an example of possible prevention of safeguarding or escalating safeguarding issues and linking people with free health checks particularly at a time when sometimes it can be difficult to access GP services so linking people with those free health checks as a preventive measure staff training and management we have an academy and there's dedicated sites within sorry county council which lists safeguarding training and competencies and we've also linked with the safeguarding adult or competencies framework which will enable staff to identify specific training for each role and develop awareness and that's something that we are also auditing as part of our improvement plan to make sure that people at the right level get exactly the right training and everyone will have a level of safeguarding awareness and of course some will need more than that in terms of safeguarding investigations so we're in the process of establishing no response guidance so and we've agreed to the new process for handling low-level provided concerns and that links to our commissioning teams as well so there's an awful lot of activity to refresh our training offer for us to offer council robert yes thank you very much i do i was listening as i came along today sitting on the m25 to Nikki Campbell and somebody else talking about their experiences of abuse in schools and how the system of reporting it totally failed because the person responsible just brushed it under the carpet i mean i think things are better now but i have no experience of saying that how how can you you know assure us that there are better systems for reporting and recording concerns and the issues and not going to get brushed under the carpet and care homes and other places well i think that for us we take every safe guiding concern seriously and we don't leave any stone unturned and we we have professional curiosity training in the council that was produced some time ago and as part of our training refresh we're also going to refresh that professional curiosity and professional curiosity means particularly in adult social care because adults are not children they're able if they've got the ability you know and the capability to make decisions for themselves nevertheless professional curiosity means that we won't leave any stone unturned and we'll keep going until we're satisfied about the concern and we're going to refresh that training as part of our overall review because it is very important to us and it is our number one priority in adult social care adults at risk and protecting adults at risk has to be a number one priority and all i can do to assure you is that that professional curiosity training will be refreshed as well do do you pay or does somebody pay unannounced visits to care homes and sort of go around to ask people there if everything is all right because you see these parents who do video cameras and see old people being poorly treated i just wondered if you can you know whether you follow things up like that yes absolutely um it's part of our quality assurance process within commissioning and in our monitoring visits we don't just look at the care home speech the staff and look at the records but we actively speak to residents as well we look for evidence of how residents are treated and each care home has its whistle-blowing policies as well and and also cqc has whistle-blowing policies and we make careless of loved ones aware of that each care home should make them aware and we look out that they are being made aware but in any case we ourselves will make people aware and we do follow up some concerns that's not to say that we don't have some providers who require provider support or in the county the size of Surrey we don't have provider failures they don't happen i was surprised i came here actually with the number of you know provided concerns that there are there relatively few which is to the credit of Surrey and the commissioning and q18 here but nevertheless that can happen and we respond robustly when it does but yes is the answer thank you chair if i if i could just add as well um cancer evidence we we uh the safeguarding adults board has a really good website and it's really easy to navigate around and it tells you you know the the golden thread throughout the whole you know all the different pages of the website is is are you concerned and if you are this is how you can report and there's been some real improvements around that soon uh recently sorry we also meet with our providers on a very regular basis we have a provider forum um and concerns and issues can be raised there and safeguarding um is is regularly on the agenda to be discussed um and there are as well you know we had a complaint come to this committee chair um i think probably about 12 months ago and uh you know the quality assurance team the relevant director and uh social work team got very involved in in in that particular case and that came to a very satisfactory conclusion particularly for those vulnerable residents and as as counselors you know we always get casework inquiries um about this and and the team are very responsive to those issues as well and there's lots of co-production and discussion that goes on with our stakeholders our providers our residents as well those vulnerable people we support um so i think the safeguarding roots to to raise concerns are clear i think we can do more i'm raising awareness and we should always do more and never say we've done enough ever um and you could say the volume of cases that we have is testament to that but it's a continual uh piece of work for us raising awareness thank you councilor moonie thank you shney and uh council fiona davisson um on whistle blowing i believe yeah i think i think you've um we've just been speaking about this um i was interested when i read the document i didn't see the word whistle blowing anywhere and i wondered why that was so neither in the report and neither of the reports alluded to how the word whistle blowing in and i wondered about that because you know in this kind of environment in terms of safeguarding you know nobody can forget winter born view you know it's formed part of the lexicon of our society and i and it continues i believe to be very difficult for employees quite often employees in the health service actually even more so than in in um in care homes and to raise whistle blowing issues so i'm just wondering how confident you are that there are good whistle blowing policies in place that they do not as far as this humanly possible lead to victimization and to what extent they are actually followed through because you know there have been a number of winter born views since the original in 2011 or whenever it was and i think it's something that that many people are concerned about thank you i entirely agree there has been a lot of concern and it still crops up in the media about the quality of care and indeed safeguarding concerns within care homes in terms of the wide provider market all providers are required to have whistle blowing policies in place and are required to publicize those whistle blowing policies and cqc in their inspections have tightened that up since winter born view and that is something that they look for and it is something that our commissioners and and qa team look for as well um what i can say is that we know that they work here in serie um we did have a whistle blowing incident recently someone felt confident enough and this was actually the carer of a service user within a home who contacted cqc who subsequently contacted us i responded to it our qa team went out with health to you know did a spot check on the home and it was anonymous but we identified the service user about whom it was um there were actually no safeguarding concern as was initially suggested but there were some minor quality concerns that were addressed but that was a strong example to me that whistle blowing policies are effective and they are in existence here in serie and on one level i was concerned that someone felt the need to use it but i was actually very happy that someone did have confidence to use it and also it was evidence that they exist and that our system in serie is working in terms of having whistle blowing policies embedded within our homes as is required um so i can provide some assurance to you that not only is it an obligation but also that we check and that they are followed up here in serie and i i'm sorry that it wasn't included in the report but i note that um and we can make reference to it to provide assurance to members in future reports so thank you for raising that thank you i think i think that would be that would be reassuring i still worry about a bit about the safeguarding of the whistle blowers um but i you know i hear what you say um but it's still a concern i have to admit thank you thank you councillor thank uh i just want to um thank Councillor doose because i think that's a really valid point and question that you raised and um i know of some adult social care services outside of serie children's services where whistle blowing is mentioned on a frequent basis particularly when you look at their procedural kind of part of the work that they do um and i think we should take away actually as a an action or a recommendation from the committee that we do reflect on on the importance of whistle blowing particularly the safety aspect of it confidentiality i think in particular on the adults safeguarding website um i think we should make particular reference to that if the committee agrees and bloops nodding his head i think we should take that as an action because it is quite a gap i feel um and and should be there yes i quite agree actually thank you councillor moonie yep thank you for that i think it's a great suggestion to actually do so next um question is for me i um council moonie knows that i've come across a couple of cases of modern slavery um in the care sector um so it is i'm afraid an unfortunate concern uh very difficult to actually you know get the confidence of the individuals concerned as well because of the climate of fear that they live within uh it's obviously places both them and the people they are caring for at risk um particularly with the criminality that's collected with it um so um the question is really around um vetting of organizations and actively you know fostering awareness that it does exist yes thank you chair i think that's absolutely right um and i think that's something that i need to take away not only just to consider but also have a discussion with my commissioning colleagues in terms of the way we contract with providers just to make sure that that aspect is considered very carefully i don't have an answer for this committee right here and right now but that is something i'll take away and discuss with commissioners i think it's something it's you know very much a risk when commissioning because trying to get the best price may lead people to taking actions that they absolutely should never take um and obviously yeah we need to be very aware of it i absolutely agree thank you chair thank you very much chair this has been quite an interesting discussion this afternoon going over a range of issues around safeguarding adult safeguarding i'm not least that comment i think about uh modern slavery considering uh you know this sort of um the pressures on um on resources and getting people into work in this sector very very difficult and and also i'm quite concerned about um some of the carers that do look after adults we know a lot of the vulnerable adults can also be very demanding in their you know in their needs and and quite difficult to manage and i have you know letters in my inbox from people looking for support from anything from a monetary sector to adult social care because they're the person that they look after is so demanding and so difficult and it makes them almost have to be safe sometimes to manage some of the problems that they can occur when things get chaotic or chaotic chaotic making safeguarding personal this is a sector led initiative and enables to develop outcomes on focusing on safeguarding work how will that help making people be more safer in the sector and particularly as i say i'm focusing on um making sure that staff and carers are able to feel confident and um share those feelings where they feel they may have i mean your report particularly focuses on acts of omission and neglect and i can you know i could understand it any human can understand it when someone has enough of looking after someone who is is very difficult and demanding and then subsequently feels enormously guilty about it how do you manage to make sure that they can be helped maybe that's the sort of purpose of personal safeguarding thank you councillor okay in in relation to sort of um carers we we do have um carers assessments that we do offer for and unpaid carers for example family relatives so we do look to um understand what the position is for individual carers who are looking after a relative or or someone led to them it is a real considerable sort of task for somebody to take on particularly as people now are living much longer so that can go on for for many years and that does unfortunately at times create situations where their potential safeguarding issues um the add of social care role within that is is to ensure that we have got the right tools and skills and experience to pick these issues up at an early point that's the key part is to prevent escalation so we would be looking through our carers assessment process to support those carers and intervene at the right time the work of the risk enablement board the first session is next week is to look at how we um risk assess situations in a more positive way as well and at the right time and that's real crucial you know for add of social care to make a difference or in terms of preventing escalation so we're looking at it through a number of different routes and the whole sphere of carers is is really big particularly for sorry there's a high number of carers even when you unscale up to the size of sorry there is a lot of people who do care for family members and friends and others i hope you answered your question yeah please yeah i think um you know we can't underestimate the importance of informal carers unpaid carers um to our kind of adult social care system here in sorry there's a significant number of people who are looking after family friends every day and you know in some challenging situations like you talk about so we do look after this cohort of our population because they are so important to our service they do a tremendous job and they replace the role really of statutory services so that's why you know carers unpaid carers are so important to us we have a couple of providers that we commission who do give carers respite and that is hugely valued by those carers because that gives them an opportunity to have a short break once a week potentially sometimes that's the only break people do get to spend time with friends or families or go out and do things that they need to do or things that they enjoy doing it's often the only opportunity that they can have in this particularly very challenging circumstances we also do carry out carers assessments that's a requirement under the care act to make sure that we are doing the best for our carers particularly in the more challenging situations so it's it's an area that is very important to us and we're looking at it actually to see if we can do more and I think it will become part of our adult social care transformation plans over the next four to five years given the importance of of carers to us yeah please help if you don't mind it's just because in relation to adult social safeguarding you know in particular because I know there's a lot of work doing and we absolutely don't we value our unpaid carers in this county but what are we doing to make sure that they are specifically not getting into problems regarding their safeguarding their the the patients that they're all the abusers if you like what's happening what are we doing specifically to support unpaid carers in this field that we're talking about this afternoon so in relation to them actually supporting carers that the main sort of platform for that is through the carer assessment process so there's an established way of you know identifying what is the circumstance of the carer and in relation to their role for caring for someone and it's about the timeliness which is the key part um generally from our experience and situations that sort of deteriorate are as as a result where carer comes perhaps too late to us and things have gone quite far and they're very stressed so it's about us sort of picking these things up and intervene as soon as we receive them but also um at times people don't recognize themselves as a carer and it's about ensuring our staff recognize that and pick that up and to offer those carers assessments when they are coming across other people being referred to us for example their husband or wife so it's about us having you know those skills to pick that up and to be receptive to it and it and and many a situation people not want to be recognized as an unpaid carer so we have to try and work around that because those can be very complex situations to resolve so it's a range of things that we would have to consider when we are a receiving referrals but also when we get out into the community to see people because that's where we often have to not find them hidden carers if i can put it that way thank you thank you and uh counsel fierna davidson has a question of safety and managing those at higher risk yeah um older people and people with disabilities are statistically more likely to be abused and neglected but often they won't recognize it themselves now sometimes families will recognize it um sometimes carers will recognize it but what i'm wondering is if an adult has communication difficulties or doesn't recognize that actually they are subject to abuse they're not going to be able to alert others so what i'm wondering is and it may be an impossible question to answer but you know i'm wondering how does the improvement plan deliver improvements for safe guarding in those very difficult circumstances um you know we we're probably are we relying on a third party where the elderly person or the disabled person has communication difficulties or you know perhaps has difficulty making sense of the world around them i just wonder how we do that and and how we're looking to improve that going forward because it gives agency and we always want to give agency whether that's possible thank you sorry okay i'll answer this initially so in relation to people who have um say communication challenges or they have issues with their mental capacity then we would um treat each of those situations individually but with people with sensory say challenges that does become more risky for for some of the reasons that you've just highlighted and it's it's about ensuring again that our workforce is appropriately skilled to pick up on those and to involve other forms of communicating with an individual presumably they have capacity so they'll always be alternatives that so that we ensure we get their viewpoint that's the key part with safe guarding is is keeping that person at the center of it rather than focusing on other things if there is a person with mental capacity issues then we will be certainly looking to involve an independent advocate for that person through a section for you to inquire if that's what applies to that situation so we're looking to give everybody an even playing field in these sort of situations so we have to make those necessary adjustments and the key part for us as a department is to make sure the workforce pick up on those issues and they identify them at the right time okay thank you thank you okay i have some questions on training and risk assessments um last year in july um there was an audit recommendation workforce undergo training in risk assessments uh the risk assessment form would be relaunched with new guidance and management oversight would be improved when do you expect those recommendations to be completed and how do you expect that to improve processes and you know when do you think you will be able to say that it is completely embedded into practice thank you chair this has become a broader issue than just that specific training we have included it as part of our overall audit of training offer which is being undertaken by the academy and also at a local level by our safeguarding advisors if i explain that each of our localities each district has its own safeguarding advisor and each of those safeguarding advisor regularly delivers safeguarding training uh george as the new head of safeguarding right now is currently reviewing the training undertaken by those safeguarding advisors and together we're standardizing that to ensure consistency across the county and ensuring that it includes appropriate risk management and risk assessment um and that piece of work will be concluded within the next month so the first level will be concluded very soon and its broader level as part of the overall audit of safeguarding training that will be completed the audit within the next few months but nevertheless that the localized training for each district will be completed within the next month at which will satisfy part of the the safeguarding audit training that you referred to from july last year okay and um moving on uh we have a question i think on the safeguarding improvement group with council i hope that thank you pardon um thank you thank you chair so my question is how will the newly developed safeguarding improvement group oversee and drive continuous improvement in safeguarding practice to ensure staff have the key skills and resources required to fulfill the statutory safeguarding duties and keep residents safe and how will you work collaboratively to achieve those improvements thank you that's a good question um with the safeguarding improvement group there's the first session was held a few weeks ago so we're right at the start hall firm a program of developing a new safeguarding improvement plan and that will run for a whole year and then we will review it on an annual basis that plan is um informed by the views of a whole cross-section of them operational people and leaders as to what are our current areas of and focus that we need to um work on moving forward um the plan is built on what was done in relation to preparation for CQC assessment um now that we have the self-assessment completed we're looking to expand the plan further so there will be a revised plan going forward um it's also informed by what our data is saying in terms of our overall performance around safeguarding and as mentioned earlier we do have a very high volume our firm safeguarding within sorry um and there's something in there about ensuring that there is good application of the safeguarding and criteria as to what is a section 42 inquiry we'd also be looking to um implement and embed learning from safeguarding adult reviews through that group as well that's key thing it's about what are the lessons learned and alongside that we'll develop a process around embedding learning that's a real key part and that process will also detail a more bespoke approach to learning so depending on the individual case that's been reviewed we'll have a range of options in terms of how we um share the learning how do we embed it into practice and a system of measuring that at a later point once the learning has and the changes have been made so that we can um reassure ourselves that the the issue that's been raised in those safeguarding our adults reviews should not happen again um we'll also be working very closely with the academy in terms of the whole area of learning development to make sure that staff groups do have the right skills and knowledge and tools to work with with the wide range of people that we do work with I hope that answers the query okay and finally um over to the council and for good thank you um my question is about the um section on monitoring performance of data and ensuring timeliness with communication um you mentioned that improvement work will remain under review and there'll be a focus on performance trends okay but how will you be working collaboratively to to ensure that communication is responded to and referrals are timely and who will be monitoring this process improvement thank you so thank you um I have over time for the multi-agency safeguarding hub which is where all of the um safeguarding referrals come into and I am have regular meetings with our performance people to have oversight of how we're doing against our key performance indicators so my role is to work closely with the performance team but also with the mash team around identifying where our um our blockages are where we might have bottlenecks and to really focus down on those areas for um creating a flow through the system that's absolutely um crucial so that we can ensure we have timely responses to concerns um we're looking to enhance the data further so we have a much more robust and reporting framework and that work is currently underway at the moment it should be concluded quite soon um so yes there's um a range of monitoring and oversight I hope that answers your question can I just add to that one final thought if I may um chair I think given the volume that we have had him sorry I'd like to hold my hands up really and to say that um the responsiveness to section 42's inquiries and concerns hasn't always been as robust as we would like it to have been because anyone who sends a section 42 in or a concern um is in my view is entitled to an acknowledgement at least um and a response that says we've received this we can't always because of data protection share the outcome or where it's gone but people need to know and that's an area of improvement for us and we've we've already taken steps to improve that um and I think that has been something that we have improved and we will continue to monitor that and that falls within Georgie's remit and the remit of the new team manager so I think um that I don't know whether that was part of the motivation for for this question but I'd like to acknowledge that to committee as another area of improvement and we've taken steps to address that as well. Thank you and Council David Hummer yeah I just wanted to ask why if you get the same question from two different people you know one's been done before the other why you wouldn't just make sure it was the second make sure the first one was not clearly specific and just repeat the same answer why not give both people the answers they've asked for. I'm sorry Councillor I don't quite understand that question. In Councillor Hummer qualify what he's asking there. Yeah I don't understand your question. Okay well what you've just said is that you may not be able to answer some of the questions because it would because you had already answered that question to somebody else and you wouldn't want to to identify that person because in the interests of you know security or whatever it might be but why wouldn't you just send the same answers as a second questioner. Perhaps if I can clarify that Chair what I was actually saying is that in sending a response to the referrer we may not always be able to disclose information about the person that they're referring because of data protection that's actually what I was saying so I hope that clarifies my response. What you're saying is that it's it's person specific at the referral end okay that's fine thank you. Right fine I think we're now done with questions and so it's over to the recommendations please Sally. Yes please. So we've got the following proposed recommendations provide an update from the new safeguarding panel on progress on the questions raised particularly around communication and working in partnership ensuring that people don't fall through the gaps provide a measurement of feedback from staff patients and from other services so that we can see what improvements have been made and as a result we can show how we deliver a safer environment provide an analysis of how effective your measurement services so that we can be reassured on how effective the service is running and that activity is arresting in more resolve to examine best practice on whistle blowing and to make every effort to provide a process that protects the individuals who are using the process and that it is effective and continue improving the measurement of safety and demonstrate that the safe service as a whole is actively eliminating problems. Are we agreed? Thank you everybody. Next up is the recommendations tracker and forward sorry yes apologies. I've been tagged by so many people that they want to finish early on. I'm kind of on let's get out of the room folks but thank you so much for attending and for the yeah yeah but yeah I'm all to aware that the M25 closes later on this evening and it's going to get very busy before it closes. Yeah anyway recommendations tracker and forward plan. I'm not going to go through it in any detail whatsoever. People can read it. I just will note that the forward work plan at the moment has a lot of things in October and some of that is going to have to change and the date of the next meeting is the 10th of October 2024. Summer break is coming. [BLANK_AUDIO]

AI Generated

Summary

The Mole Valley Health Select Committee meeting focused on several key issues, with the most significant discussions revolving around the MindWorks program and adult safeguarding. The committee examined the effectiveness of MindWorks, a mental health service for children and young people, and explored the challenges and improvements in adult safeguarding.

MindWorks Discussion: The committee scrutinized the MindWorks program, which aims to support children and young people with neurodevelopmental disorders such as ADHD and autism. Concerns were raised about long waiting times for diagnosis and treatment, and the adequacy of support provided to schools and families. It was noted that while there are services like those offered by the National Autistic Society, many schools and parents feel unsupported. The discussion highlighted the need for a transformation plan to enhance service delivery and coordination among various stakeholders.

Adult Safeguarding: Adult safeguarding was another critical topic. The committee reviewed current practices and challenges in protecting vulnerable adults from abuse and neglect. Discussions covered the effectiveness of multi-agency collaborations, the role of the Safeguarding Adults Board, and the need for improved training for staff to handle safeguarding concerns more effectively. The upcoming inspection by the Care Quality Commission (CQC) was also discussed, with the committee expressing the need for robust preparations to ensure compliance with safeguarding standards.

Both topics are of high public interest due to their impact on vulnerable populations, including children with special educational needs and vulnerable adults. The committee's discussions are part of ongoing efforts to improve health and social care services in Mole Valley. The council meeting focused on reviewing and improving services related to health and safeguarding, with particular emphasis on the MindWorks program and adult safeguarding. The committee discussed the effectiveness of current practices, proposed improvements, and planned for upcoming inspections.

Transformation Plan for MindWorks: The committee discussed the need for a comprehensive transformation plan to address service gaps and inefficiencies in the MindWorks program. The decision aimed to enhance coordination and effectiveness in handling neurodiversity cases. Concerns were raised about the current system's responsiveness and integration with educational and social services. The implications include potentially better outcomes for individuals with neurodiversity through more streamlined and effective services.
Adult Safeguarding Improvements: The meeting addressed the need for strengthening adult safeguarding measures. The discussion highlighted ongoing challenges such as communication gaps and the need for better training and resources for staff. The decision to enhance training and implement a more robust monitoring system aims to improve the safety and well-being of vulnerable adults. This could lead to more timely and effective interventions, reducing instances of neglect and abuse.
Whistleblowing Policies: Surprisingly, the term whistleblowing was not initially included in the safeguarding report, leading to a decision to review and emphasize whistleblowing policies in future documents. This decision underscores the importance of protecting individuals who report misconduct or abuse, aiming to foster a safer and more transparent care environment.

The meeting also featured a fire alarm test, adding an unexpected interruption, but it did not significantly impact the proceedings. The discussions were marked by a strong consensus on the need for improvements and more effective service delivery models.

Adults and Health Select Committee - Friday, 10 May 2024 10.00 am

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