Foundations For Our Future Report of the Sussex-wide review of Emotional Health and Wellbeing Support for Children and Young People V5 May 2020 Independent Chair’s Foreword ............................................................................. 7 Foreword from the Review Panel Members ......................................................... 9 A response to the review from the Chair of the Oversight Group ....................... 11 Building the Foundations: A concordat for action ............................................... 13 Executive summary ............................................................................................ 16 Introduction ........................................................................................................ 20 The context ........................................................................................................ 21 Section One ....................................................................................................... 25 The Review Process, Approach and Governance .......................................... 25 Why this review has been undertaken ......................................................... 25 The scope of the review .............................................................................. 25 Governance of the review ............................................................................ 26 The Review Panel ....................................................................................... 26 The Oversight Group ................................................................................... 27 Terms of Reference ..................................................................................... 27 The Key Lines of Enquiry ............................................................................ 27 How the review has been conducted .............................................................. 28 Section Two ....................................................................................................... 30 Population and epidemiology .......................................................................... 30 West Sussex ............................................................................................... 30 East Sussex ................................................................................................ 31 Brighton & Hove .......................................................................................... 32 Health and Wellbeing .................................................................................. 35 Section Three ..................................................................................................... 38 Current service pattern ................................................................................... 38 Section Four ....................................................................................................... 43 Current performance and activity .................................................................... 43 Provision across Sussex ................................................................................. 43 Referral rates .................................................................................................. 44 Acceptance rates for SPFT specialist mental health services ........................ 45 Conversion rates ............................................................................................. 45 Waiting times for SPFT specialist services ..................................................... 45 Brighton & Hove .............................................................................................. 47 East Sussex .................................................................................................... 47 West Sussex ................................................................................................... 47 Waiting times for other services ...................................................................... 47 Activity (caseloads) ......................................................................................... 49 1 Activity (contacts) ............................................................................................ 49 Workforce (community) ................................................................................... 50 Self-harm in children and young people ......................................................... 50 Suicide in children and young people ............................................................. 54 School nursing ................................................................................................ 57 Use of Mental Health Act assessment (MHAA) .............................................. 57 Prevalence in schools ..................................................................................... 57 Special Educational Needs and Disabilities (SEND) ....................................... 58 Section Five ....................................................................................................... 59 Finance ........................................................................................................... 59 Brighton & Hove Local Authority financial data ............................................ 60 East Sussex Local Authority financial data .................................................. 61 West Sussex Local Authority financial data ................................................. 61 Clinical Commissioning Group investment .................................................. 62 Breakdown of key finance and performance data by CCG area ..................... 64 Brighton & Hove CCG ................................................................................. 64 East Sussex CCGs ...................................................................................... 64 West Sussex CCGs ..................................................................................... 64 Section Six ......................................................................................................... 65 What we heard ................................................................................................ 65 Access ......................................................................................................... 66 The obstacles to access .............................................................................. 66 Equity of access .......................................................................................... 67 What could be done to improve access? ..................................................... 68 What worked well? ...................................................................................... 68 Capacity ...................................................................................................... 68 Staffing/workforce ........................................................................................ 69 The nature of the ‘system’ ........................................................................... 69 Workforce .................................................................................................... 69 What could be done to improve capacity? ................................................... 70 The experience of children, young people, their families and carers ........... 70 The experience of poor emotional health and wellbeing .............................. 71 The experience of the pathway.................................................................... 71 Do children and young people experience their voice being heard? ........... 72 What works well and what could be improved? ........................................... 72 Commissioning of services and support ...................................................... 73 The commissioning structures ..................................................................... 73 2 Strategic development ................................................................................. 74 The approach to service transformation ...................................................... 74 What could be improved? ............................................................................ 74 Other issues of note .................................................................................... 75 Schools and colleges ................................................................................... 75 Children and young people who may be at ‘multiple disadvantage’ ............ 75 Organisational change, policy and their impact ........................................... 76 Section Seven .................................................................................................... 77 Emerging good practice from literature review................................................ 77 Models of specialist services provision ........................................................... 77 Single Point of Access .................................................................................... 78 Approaches to system change and collaboration ........................................... 79 Section Eight ...................................................................................................... 81 Our findings .................................................................................................... 81 Return on Investment (RoI)............................................................................. 81 Access to Services ........................................................................................