The Health and Wellbeing Board met on Tuesday 13 November 2018 to discuss the Richmond Transformation Plan refresh for Child and Adolescent Mental Health Services (CAMHS) and the Healthwatch Richmond Annual Report. The Board also reviewed the governance of the Richmond Health & Care Plan.

Richmond Transformation Plan Refresh for CAMHS

The Board received an update on the Richmond Transformation Plan refresh for CAMHS, a key project aiming to improve mental health services for children and young people. The plan focuses on system-wide transformation, incorporating national policy developments and a significant focus on schools through the emotional wellbeing project. Digital technology will be utilised, and support will be available in both inpatient and community settings. A notable achievement has been the reduction in waiting times for Neurodevelopmental assessments and the introduction of a local pathway. The plan aspires to have 35% of children and young people with a diagnosed mental health condition accessing evidence-based treatment by 2020/21.

Discussions highlighted that while the number of children wellbeing practitioners would remain at three, there would be an overall increase in staff across the service. Work is planned to integrate risky behaviour into the transformation plan, with the South West London emotional wellbeing project identifying school staff to support interventions and providing access to online counselling. Data on treatment referrals for various service tiers is available and can be shared. Funding for the transformation plan is additional to existing business-as-usual funding. The plan aims to address unmet needs through positive behaviour programmes and skills training, with a complex needs model considering all risk factors. Concerns were raised about the reduction in staff working with children and young people with emotional difficulties by Achieving for Children, and the unknown numbers of self-harm incidents in Richmond due to out-of-date Public Health data. The Local Safeguarding Children Board is developing an action plan. Increasing demand on services was identified as a challenge, and service models will be reviewed to ensure timely access to treatment. Funding was acknowledged as a key risk, with resource challenges noted. The system will be mapped to target priorities effectively, and collaboration between services is crucial. The Board suggested that financial constraints could impede achieving parity of esteem for mental health services compared to physical health. Funding has been allocated to the Richmond cluster project. Early intervention and prevention during the transition between children's and adult services are considered vital. Tier one services are performing well, with young people able to access confidential counselling. The voluntary sector's contribution to the service offer in Richmond was recognised as valuable. An extensive engagement programme is planned, including work with Kingston and Richmond Youth Council and Healthwatch, with a particular emphasis on engaging harder-to-reach children and families.

The Health and Wellbeing Board resolved that it had provided comments on the 2018/19 CAMHS transformation Plan refresh priorities.

Healthwatch Richmond Annual Report 2017/18

The Board received the Healthwatch Richmond Annual Report for 2017/18. Healthwatch, established under the Health and Social Care Act 2012¹, acts as a critical friend to service providers. Richmond Healthwatch is a commissioned service with three full-time employees and numerous volunteers, also generating income through external service reviews and consultations.

In the previous year, Healthwatch completed reviews of care and nursery services, expressing satisfaction with the outcomes. A joint event with the Clinical Commissioning Group (CCG)² was held to develop a response to the Mental Health Green Paper. Other reviews covered urgent and emergency care, and inpatient care at West Middlesex Hospital. Healthwatch also collaborated with crisis support teams at Kingston and West Middlesex, the Youth Council for youth engagement, and Mencap for learning disabilities.

Looking ahead to 2019/20, Healthwatch plans to analyse patient feedback to identify emerging trends and inform its work plan, which will be shared with the Board and partners. The Board noted Healthwatch's findings on mixed outpatient experiences, suggesting that the rollout of the electronic referral service could help address this. An increase in complaints to Healthwatch was attributed partly to greater public awareness, following a borough-wide leaflet drop. The Board acknowledged the essential nature of Healthwatch's powers of entry and recognised them as a trusted partner, commending areas where concerns had been highlighted. Gratitude was expressed for Healthwatch's role in the recent Green Paper consultation event.

A discussion on unplanned hospital discharges took place, with Healthwatch noting that such instances could lead to complaints. Adult Services are working on a clear protocol and process for hospital discharges, and a sustainable funding source is deemed necessary. The Board felt that Richmond Health and Wellbeing Board could use its influence to lobby for increased funding for this purpose.

The Health and Wellbeing Board resolved to:

• Receive and formally acknowledge the Healthwatch Richmond Annual Report 2017/2018.
• Ensure all members understand the role Healthwatch plays.
• Note the work Healthwatch Richmond planned for 2018/19 and consider its relation to the Board's work.

Richmond Health & Care Plan Governance

The Board reviewed the proposed governance for the Richmond Health & Care Plan. Deliverables will be mapped against priorities, and the Board noted the proposed timescales, acknowledging they may be subject to change. A Government Social Care paper was anticipated in December 2018, which would influence the Health and Care Plan's development. Regular updates will be provided to the Board. Sponsors and allocations will be agreed following a consultation event on Monday 19 November 2018. The Health and Care Plan is a component of the wider Health and Wellbeing Strategy.

The Board considered that the outcomes within the Health and Care Plan would be beneficial for updating the Health and Wellbeing Strategy and placing it in a broader context. The Board's wider role should involve increasing accountability to residents and facilitating collective working among health and social care partners. The council's communications team will support the engagement aspect of the Strategy.

The Board noted the complexity of the health and social care system, exacerbated by multiple strategies driven by national health bodies and silos between central government departments. The Board's critical role in bringing partners together for collective action and ensuring service accountability to residents was emphasised.

The Health and Wellbeing Board resolved to:

• Note and agree the proposed governance process for the Health & Care Plan.
• Note the potential change in timeline for the published plan.
• Develop proposals to confirm Health and Wellbeing Board sponsors for the Themes of the Health & Care Plan.