Children’s services transformation

Mental Health

What are we doing to transform these services?
We are currently reviewing our Children and Young Person’s Mental Health Transformation Plan for Shropshire, Telford and Wrekin. As part of the review, we will be engaging with and taking into account the views and experiences of children and young people and their families and carers.

We are committed to developing mental health services based around the five sectors of the iTHRIVE model. There is an emphasis on identifying personalised support regardless of diagnosis, working across organisational boundaries and with children and parents directly.

What do we want to achieve with this work?
We want to establish early, rapid and easy access to the care that is needed and we want to minimise, as far as we can, deterioration in the mental health of our children and young people.

How will we do this?
We will do this by placing reliance and trust in the committed workforces of our NHS, schools, social services, voluntary organisations and others and through cross-partnership working groups, representing the NHS, Local Authorities and patient groups, focusing on specific mental health issues such as Autism, Eating Disorders and Crisis Care.

What has been done so far?
We have already made great progress, including:

• A programme of establishing Mental Health Support Teams in Schools which will see 50% of all children in school covered by 2025. There are two teams already with three more in the pipeline.
• Partnership working, led by Shropshire Local Authority relating to the Autism pathway, incorporating the assessment process together with pre and post assessment support.
• Improving data flows relating to patient activity and outcomes to give better evidence for strategic decision making.
• Shropshire, Telford and Wrekin Integrated Care System has published the 2023/2024 refresh of the county’s Children and Young People’s Mental Health Services Transformation Plan. This plan gives an update of the emotional health and wellbeing services for children and young people living in Shropshire, Telford and Wrekin. The update captures an overview of current services, recognising the challenges in the system and identifies the transformation and commissioning during 2024/25. Using the system vision, the plan set out several next steps to ensure the system and its partners, through coproduction, continue to strive to continue to improve services for children and young people living in Shropshire, Telford and Wrekin.

Physical health

What are we doing to transform these services?
We are looking at where we have gaps and duplication to improve our offer to children and their families.

What do we want to achieve with this work?
We want to keep children as healthy as they can be, and when they need help we want them to have quick access to effective treatment and enable them to get back home as soon as possible.

How will we do this?
We will review our offer and improve pathways, and talk to children, young people and their families about their health needs and how to best meet them.

What has been done so far?
We are about to commence a pilot looking at how we support children with asthma to ensure they are treated effectively and don’t need to go to hospital unless really necessary.

We are also reviewing how we can ensure effective referrals are seen by a consultant quickly and the offer of our special school nurses.

Children and young people asthma programme

The local NHS has many exciting projects underway that aim to help children and young people (CYP) with asthma.

Integration Pilot
We have been successful in obtaining funding from NHS England to offer targeted care to children and young people with asthma who are at high risk of admission to hospital.

Patients at high risk will be assessed and recommendations will be made to GP practices by the Clinical Asthma Team at Shrewsbury and Telford Hospitals Trust (SaTH) and Shropshire Community Health Trust. These recommendations will be around the management of the child by the Clinical Asthma Team via an emailed form to the GP. There will also be an opportunity for high-risk children to be supported directly.

Specialist Asthma Training
The National Bundle of Care recommends that all healthcare professionals are trained to provide a high quality of care in children and young people with asthma. The expert panels in the National Review of Asthma Deaths (NRAD) identified that lack of knowledge of specific asthma expertise and guidelines are contributing factors in relation to poor outcomes in children and young people with asthma.

Therefore, a 5-level tiered framework for anyone involved in the care of children and young people with asthma has been developed, which has been approved by professional bodies.

Completion of appropriate training for healthcare staff will be included in provider contracting for 2023/24. The ICS Asthma Leads are actively connecting with practice nurses and GPs who offer annual asthma reviews to encourage completion of training to the minimum of Level 2.

Asthma Champions
We are keen to develop Asthma Champions across services to promote the importance of asthma care for children and young people. These champions will work within their organisations and teams to encourage awareness of asthma-related issues and concerns.

Asthma Reviews Project
Two Children’s Community Nurses (CCNs) were recruited in September 2022 to support with the delivery of 48-hour asthma reviews and annual asthma reviews in GP practices.

Since implementation in November 2022, the 48-hour review service has supported over 230 children with asthma across Shropshire, Telford and Wrekin who were admitted to the children’s ward at SaTH following an asthma attack. (Figure accurate as of 28 February 2023)

Practices who had a high number of admissions were targeted by the CCN service for additional support such as offering asthma reviews and asthma training for practice nurses.

Friends and family feedback for both 48-hour and annual asthma reviews in the CCN service has been fantastic with 100% of respondents rating the service as ‘Good’ or ‘Very Good’.

“It was reassuring and interesting to speak to an expert in asthma. I have been managing my son’s condition for years but hadn’t realised we were using the inhaler wrong.”

“We had an annual asthma appointment in January with this team, it was the first annual review we have had in the 6 years for my daughter’s asthma. It was a great appointment and we learnt a lot. She was unwell last week, but thanks to the asthma management plan and advice provided at the appointment, we were able to act and get her better sooner than I would have previously.”

The CCN’s have now completed a pilot of annual asthma reviews in Donnington Medical Practice which has been successful, and they have shared information with other agencies such as social care, school nurses and health visitors.