What funding, training and provision of resources are being allocated to provide effective talking therapies to neurodivergent children who have developed mental health disorders due to unmet Special Educational Needs e.g. therapy to treat Depressive mood disorders, PTSD, Phobias, Generalised and Separation Anxiety etc. ?

Local arrangements do vary between different areas.

Each child is assessed, needs identified and a care plan is developed with CYP/families. All our offers are open to neuro diverse children however the therapies are adapted to meet individual need. We offer a comprehensive range of therapies across our services and support staff to access training (e.g., DBT – Dialectical Behaviour Therapy) and skill development to enhance the clinical offer. This includes access to internally delivered courses, those provided by organisations such as Anna Freud and we engage with the respective regional CYPIAPT networks to ensure that we take up every opportunity. These are defined within our locality workforce development plans.

It is also the case that there are variations between different areas at present:

Kent offers specific neurodiversity anxiety groups as well as Positive behaviour support (PBS) which is evidence based for parents with children with ASC as well as NVR, which is another parenting approach, working with co morbidity.  We are also focussing on skilling up our work force and recruited to training posts specialising in ASC and LD.  Staff also undertake facilitation training to enhance knowledge of working with children with ASC to the wider staff cohort.

In North East London we are working to make adaptations to programmes to enable neurodiverse young people to be able to access all treatment offers. We have appointed a Psychologist Clinical lead for Neurodiversity who oversees this work to ensure the quality of interventions offered. She provides specialist consultation and training across the service. Each team, including Crisis and Eating Disorder, has a champion for Neurodivergent children/young people who promotes and supports work within the team.   Training is being accessed from a range of training providers including the Anna Freud centre and some champions have already completed the CYIAPT-ASC training.

In the London areas of NELFT there is also a limited offer of Positive Behaviour Support (PBS) and NVR (non-violent resistance) parenting groups, and we have a range of staff in our respective locality CAMHS teams who have specific learning disability skills and knowledge. However, we recognise that this capacity varies from area to area. We have recently been successful with the award of a Recruit to Train (RtT) post specialising in ASC and LD and will join the newly formed BHR ASD Service and we have submitted a joint bid for an increased offer for PBS across all 4 localities in partnership with our ELFT colleagues; for which we expect to hear the outcome by the end of September

Psychodynamic Psychotherapy is not accessible for neurodivergent children and is therefore discriminating against this group of patients, leaving children without the appropriate talking therapy to treat the above disorders.

It is not the case that long term psychodynamic psychotherapy is the most appropriate treatment for neurodivergent children. There is a broad range of appropriate treatments available for this population group. Short term psychotherapeutic interventions are all available to those children with neurodiversity needs.

Speech and Language and OT assessments are not currently being commissioned to children of secondary school age in mainstream schools.

These assessments are available. Referrals are received and triaged alongside all our other referrals to our CYP Therapy teams.

Executive functioning and sensory processing differences have a severe impact on neurodivergent children’s mental health. Would NELFT consider putting together a business case to Commissioners for this provision to be available to these children?

We view the child’s needs holistically at triage and work in partnership with schools and other settings to deliver appropriate support and interventions. We have a growing parent/carer/young person engagement programme and are utilising patient leadership and voice in channelling our service developments. Where gaps in services are identified, we are committed to working in partnership with our respective local place forums and/or collaboratives to prioritise and support service growth and improvements to meet needs.  

I should like to ask a question about if and how NELFT plans to continue to provide clinical support to the new Whipps Cross Hospital, particularly to the U&EC / A&E Department, after the new hospital has been commissioned (and the land on which NELFT's services at WXH presently stand has been sold by the NHS).  Does such a question fall within item 3 of the AGM agenda?  Or should I wait for a business meeting?

NELFT are an active member of the Whipps Cross Redevelopment programme and are part of the key workstreams that enable ongoing and enhanced care provision to our residents.

We are working with Whipps Cross and our other local Acute trusts to review our mental health pathway, key areas of action include enhancing the mental health expertise in Urgent Care/A&E Departments.  We are also working closely with the London Ambulance Service and the Police to enable more user of service to be diverted to local teams or our crisis hub and avoid A&E attendance as appropriate.

What steps are NELFT taking to mitigate the effects of the recent decision by the Metropolitan Police to attend fewer mental health crisis emergency calls?  How will NELFT support carers in the community, the LAS, social services departments and hospital-based Urgent & Emergency Care / Accident & Emergency services in intervening / caring appropriately for patients who present extreme risk of harming themselves and/or others?

A London Mental Health Crisis Care Concordat has been established and signed up to by all the statutory organisations involved in supporting people in crisis. These senior level discussions have resulted in an agreement to adopt the Right Care, Right Person (RCRP) approach developed in Humberside which changes the way emergency services respond to calls involving concerns about mental health.  4 key areas being discussed are Absence without official leave (AWOL) from Mental Health (MH) inpatient premises, Welfare Checks from Health & Social Care, transportation of MH patients and times at Health Based Places of Safety (HBPOS) for members of the public conveyed under S136. Four subgroups have been set up to oversee the preparations necessary for successful/ safe implementation: Policy and Legal Framework, Workforce, Data and Communications.  The London MH Chief Operational Officer group have already initiated a piece of work to have one aligned protocol for all MH providers in London covering AWOL, Welfare Checks and Missing Persons with a draft by 31 October.

The introduction of the 136/111 hubs in London from 31 October 2023 will enable more immediate advice to partners such as Police and LAS on current plans of care, alternative support, access to MH HBPOS if needed.  We anticipate a positive impact on the numbers of people conveyed under s136 thus reducing the need for ED to be used as a HBPOS in the absence of a physical health need.

Why are there no online appointments for blood tests?  Phoning for appointments is not an alternative because the service is so busy no one is available to answer calls. Can more money be spent on the service to employ additional staff?

Online appointments for blood tests are available and can be booked on the link below.

Blood test booking site

I'm hearing in some ICSs there are pressures to use mental health money to pay for A&E and elective backlog, in breach of the MH investment standard. Have you been able to hold on to MH funding?

ICS’s are audited on MHIS and therefore this standard has to be met. It is fair to say that all of the areas we deliver services in are some of the most financially challenged areas nationally and we work as part of the system to deliver efficient services for our residents in each system.

Planning jointly across North East London has meant that financial plans are developed once in partnerships with all providers which is an important step forward.

We are now seeing the government renege on the reforms for the MH Act amendments this will impact on specifically Black Men detained under the Act. What is NELFT doing with regard to this?

We have specific work in this area (PCREF) that Selina highlighted in her presentation, and we are working with local communities and partners but importantly we are working with organisations such NHS Confederation to tackle this national problem.

Just a comment again great to hear about the progress of health inequalities with Selina but you mentioned Co-production so why we not hearing from them here at the meeting? Direct that would be even more impactful.

This is a helpful observation, and we will look to incorporate more from our involvement representatives at next year’s bigger event.

One observation for noting, The Mental Health Learning Disability and Autism Collaborative makes no mention of Neurodiversity.

Neurodiversity is a key part of the overall Mental Health, Learning Disabilities and Autism Collaborative and there is a cross over with North East London Community Collaborative as well in terms of paediatric services. Work is underway to develop an improvement network to focus on this pathway and to respond to the priorities outlined by children, carers, and families.

Can I ask, do the Governors think NELFT is prepared for the challenges going forward? are they assured it can meet the chairs vision "to improve lives for the population you serve?"

As a Trust we are working to meet the various challenges facing us and the people we serve.  We have some good foundations in place through our work on a Just and Compassionate culture, and the strength of our financial position.  Moving forward, we will be working to embed clinical leadership, co-production, and a real focus on how we use data to help us try and improve the health in the areas we serve.  Our work on recruitment and retention is also an important part of our response to meeting this challenge.  To achieve this will require continued effort and improvement across the Trust and from us all in our different roles.