Agenda and minutes

The Chair welcomed everyone to the meeting.  Health and safety information was provided.

Also, in attendance were;

• Christina Gray, Director of Communities & Public Health (DoPH)
• Councillor Asher Craig, Deputy Mayor and Cabinet Member for Children’s Services, Education and Equalities

• Cllr Brenda Massey, Committee Member
• Cllr Amal Ali, Committee Member
• Reena Bhogal-Welsh, Director: Education & Skills
• Helen Holland, Cabinet Member for Adult Social Care and Integrated Care System
• Councillor Ellie King, Cabinet Member with responsibility for Public Health and Communities
• Becky Balloch, Head of Communications & Engagement NHS & Integrated Care Board (ICB)

• Jennifer Bond - Associate Director of Communications & Engagement, NHS & Integrated Care Board (ICB)

No declarations were received.

The minutes of the previous meeting were approved as an accurate record.

Chair highlighted the recent announcement by North Bristol NHS Trust and University Hospitals Bristol and Weston NHS Foundation Trust that they are to “have a Joint Chair and Joint Chief Executive who will lead both NBT and UHBW as the first and important step on a journey for our organisations to form a Hospital Group within the next two years”.  It was suggested this topic could be included as and when a joint BNSSG Health Overview and Scrutiny Committee (JHOSC) or ‘meeting in common’ took place.

Up to 30 minutes is allowed for this item.

Any member of the public or Councillor may participate in Public Forum.  The detailed arrangements for so doing are set out in the Public Information Sheet at the back of this agenda.  Public Forum items should be emailed to scrutiny@bristol.gov.uk and please note that the following deadlines will apply in relation to this meeting:-

Questions - Written questions must be received 3 clear working days prior to the meeting.  For this meeting, this means that your question(s) must be received in this office at the latest by 5pm on Friday 1^st December.

Petitions and Statements - Petitions and statements must be received on the working day prior to the meeting.  For this meeting this means that your submission must be received in this office at the latest by 12 noon on 6^th December.

The Public Forum received was published prior to the meeting and can be viewed here Public Forum Doc

• One statement was received from Jen Smith regarding agenda item 8. Children and Adolescent Mental Health Services (CAMHS).

RESOLVED; That the Public Forum be noted.

Vicky Marriott briefly introduced the item that focussed on information and data based on the feedback received on the most frequent themes during Quarter 2 of 2023.

This was said to be the largest feedback received and in Bristol comprised of 472 respondents. The report can be found here: Healthwatch Slides.

It was reported that Healthwatch were currently producing booklets such as ‘changes in your surgery’ to help people better understand what was happening.  These would be circulated to Members as soon as they were available.

A Member asked about the longitudinal nature of the data and commented that even where it showed a quarter of the comments were negative about the care they had received this was still a very negative rating.  Had the figures changed much over time? It was said it was difficult to gauge this due to the changes in how the feedback had been gathered.

The Committee thanked Vicky for the useful and insightful information.  The Chair commented that the data was very helpful but wondered if perhaps the data was slightly skewed as the respondents had gone to Healthwatch? A Committee Member responded that any patient feedback provided, especially in this context, was relevant.

Heather Kapeluch, Head of Operations – CAMHS, AWP and Anna Clark, Senior Performance Improvement Manager, BNSSG ICB attended to introduce the paper and respond to questions from the Committee. 

Some of the highlighted included the following;

• The number of referrals had increased and so had the complexity of cases.
• Recruited to half of the posts now. Can recruit in Bristol but other areas are much more difficult.  So, they were trying to make these roles more accessible and linking with other areas.
• Getting advice is hard and this can seem like a hidden service. The aim was to make this more accessible so they were setting up an advice line now.
• Some people were rejected, so the phone line advice could help signpost to other support services.

• The number of eating disorder cases had risen locally and nationally.  The main focus was on prevention work to avoid people needing to go into hospital.
  • A pilot project was underway to support people early and had significantly reduced the numbers going into hospital.
• There was a clear need to help improve access for young black and minority ethnic (BAME) people.  -  In response, a second outreach worker had been recruited to help make services more accessible. 
• 16+transition; They said to be looking at best practice in other areas and undertaking discovery work. Successes are on the published slides. 
• Riverside Tier 4 Service; has opened all 12 beds now (these are day beds).  This is a positive development.
• The southwest region does not have any 24-hour beds for young people with eating disorders. They are looking to provide this in the BNSSG area but there are no timescales as of yet and this could take another couple of years.
• CAMHS Crisis Team; currently refining model. This was a 24/7 service but is now only until midnight.

The following points were discussed and questions asked:

A Member asked about the ‘Referrals Bristol CAMHS’ slide and the shape of the graph which appeared to show there was very little consistency. Why was this?  It was replied that school holidays and terms affected when referrals came in. With regards to trends, it was said there was a 70% increase in referrals relating to eating disorders but there was also a general increase, especially in Bristol.  Work was being undertaken with a referrers group and schools to try and understand more about the increases.

A Member requested more data on the demographics of referrals from deprived areas and wards in Bristol.  ACTION: It was agreed that more in-depth information would be provided on the demographics of referrals from deprived areas and wards in Bristol.

It was discussed how the Integrated Care Partnership’s (ICB) positive investment in new outreach workers in 2024 would also help to provide more data on this and that the locations they would work in were based on deprivation data provided by Public Health. 

A Member highlighted that under new plans, some police forces in England will no longer respond to concerns primarily  ...  view the full minutes text for item 8.

The item and information were introduced by;

• Joanna Herbelot, Primary Lead, and Jacqueline Ward-Warren, Secondary Lead, Bristol Royal

Hospital for Children.

• Bethany Shirt, Deputy Director of Nursing Bristol Royal Hospital for Children
• Mark Goninon, Deputy Chief Nurse UHBW

The Hospital school was said to be part of the wider Bristol Hospital Education Service provision.  It had been judged by Ofsted as outstanding in the last three inspections.

Staff numbers were now equivalent to 10 full-time positions. 

The Service provides a personalised curriculum for each child, based on their needs, both educational and emotional. The Serviced worked closely with schools.  However, they were sick children and so it was not always straight forward. 

Some teachers included some subject specialist teachers and also two SEND specialist teachers.  The provision was there for all children and young people from day one where possible.  The service offered all subjects and provided a rich learning experience. 

It was highlighted that the service was very lucky to be supported by charities. It was also partnered with Deloitte over a 3-year period.  This meant that they could offer what was over and above the core local offer. 

The learning experience was said to be informal and not uniformed.  There were usually about 40- 60 pupils at any one time and they were usually teaching 30 – 40 children daily as some as some are in theatre etc.  But they did get around to all children in a daily basis. 

Provision could be for both short stay and long stay patients.  One child had currently been receiving hospital education for 18 months.

The service was provided from diagnosis to treatment and when patients leave they can be home tutored. It could also be provided to siblings if they came from other areas outside of Bristol.

The service was said to be working very well and the Ofsted rating had they had had for some time now reflected that.  The feedback received and evaluation was also said to be very good.

The following points were discussed and questions asked

The Cabinet Member - Councillor Asher Craig offered her congratulations on the ‘outstanding’ Ofsted rating and said she had no questions. 

A brief discussion was had about children who were too sick to go to school but are not in hospital and what could be provided for them.  It was said it was possible to provide schooling at a base or at their home and the service communicated with schools in order to continue the curriculum as much as possible so progress is as uninterrupted as can be.

A Member asked about continuity and how they knew what was needed for example where children where in their curriculum? The practitioners said they mostly looked at the relevant websites for secondary schools as the majority of the information was there.  If children look to be long-term patients, are in secondary education or have and ECHP they will communicate with the school directly.  They plan individual programmes of learning with  ...  view the full minutes text for item 9.

The item was introduced by;

• Jan Potts, Interim Deputy Chief Operating officer, Sirona care & health
• Penny Agent, Chief Therapy and Allied Health Professional Officer, Sirona care & health
• Kate Lavington, Head of Design, BNSSG ICB
• Laura Westaway, Head of Children – Performance and Delivery, BNSSG ICB

The report provided an overview of the work being undertaken to transform the services and support for

neurodiverse children, young people and their families. Some of the key points highlighted to Members included the following:

The services were overrun with approximately 387 referrals per month. There were said to be variations within data but it was said that 86% of referrals were accepted after triage.  Demand was said to be twice as high as capacity and was a significant problem. This was why work was taking place with the ICB on a transformation programme. It was understood and appreciated how frustrated families were whilst they waited for services.

The transformation programme was a key piece of work and the problems it faced were detailed in the published paper.  Local practitioners were learning from others nationally and internationally.  It had been agreed that the best way to look the issues were by user-co-design and so it was being led locally by the Parent Carer Forum. 

An event had recently taken place that brought around 90 people together to hear and understand the work that’s been done to-date and find solutions that fit people’s needs. Some of the conversations were said to be difficult but it had been important to be honest with people.  Another event would be organised early in 2024 to continue this developmental work.

It was said that practitioners were now starting to see children with specific needs at primary and early years now.  Some situations were complex and often parents did not know the right routes to take, feeling they were being blamed. Many said they wanted a medical diagnosis in order to get the right support, which can help from an educational perspective. 

Structural inequalities needed to be understood in this context.   There were high levels of referrals across the region and especially in Bristol.  The experience was not good for anyone but was said to be worse for some people, particularly those who do not speak English. The changes to service provision we not said to be about cutting services but rather about early intervention to help people to get the right support.

A relatively new Member of the team said they were not happy with how things currently were but they were also working with other teams such as the Intensive Support Team to find ways to make improvements.  

There were backlogs of assessments, but it was questioned whether assessments were always what was needed and if they did actually help all children.  Some professionals suggested they did but apparently not all.  The developmental work would look at this.  The Intensive Support Team were also working with other similar teams around the UK with similar issues and who were feeling  ...  view the full minutes text for item 10.

The Committee noted the Work Programme.