Education Committee and
Health and Social Care Committee
Oral evidence: Children and Young People’s Mental Health, HC 239
Tuesday 27 October 2026
Ordered by the House of Commons to be published on 27 October 2026.
Education Committee Members present: Helen Hayes (Chair); Jess Asato; Dr Caroline Johnson; Darren Paffey; Manuela Perteghella; Mark Sewards; Peter Swallow; and Caroline Voaden.
Health and Social Care Committee Members present: Jen Craft and Josh Fenton-Glynn.
Questions 295 to 341
Witnesses
I: Arjan Bains, Senior Operations Manager, Compass UK; Michelle Hill, Group Chief Executive, Talk Listen Change; Jordan Letts, Chief Executive, Northampton Saints Foundation; and John Poyton OBE, Co-founder and CEO, the Well Centre Charity.
Witnesses: Arjan Bains, Michelle Hill, Jordan Letts and John Poyton OBE.
I need to put on the record at the start of this meeting that one of our witnesses, John Poyton, runs an organisation based in my constituency and is well known to me. I invite our witnesses to introduce yourselves to us, please, starting with Michelle Hill.
Michelle Hill: Hi, thank you for having me. I am Michelle Hill, Group Chief Executive of TLC, Talk, Listen, Change. We are a relationships charity based in Manchester but delivering services all over England.
Arjan Bains: Hi, thank you for having me. My name is Arjan Bains. I am the Senior Operations Manager with Compass. We are a charity that delivers mental health and emotional wellbeing services. I deliver 18 mental health support teams in Birmingham. Compass nationwide has about 45 in total, so that is the perspective I hope to bring to you today.
John Poyton: Thank you, Helen. Good morning, everyone. It is lovely to be here. I am John Poyton, founder and Chief Executive of a charity called the Well Centre. It is a model that is looking at embedding youth workers into the health system, particularly in primary care and general practice. I have been working in this area with one foot in youth work and one foot in the NHS for the last 25 years, previously also developing and founding the first hospital-based violence intervention programme, embedding youth workers into emergency departments as well. Today I am here looking at the joint integrated workforce of youth workers working with primary care at the heart of the community, where young people pass day to day.
Jordan Letts: Good morning, everyone. I am Jordan Letts, Chief Executive of Northampton Saints Foundation, the charity arm of the professional rugby club Northampton Saints. We have 17 individual programmes that range across Northamptonshire, more particularly, in the inquiry that you have already heard, in partnership with the integrated care board and CAMHS. Our support programmes range from four to 104, and we have people in the community who we support in any way that we can.
Michelle Hill: Thank you. I will tell you a little bit more about TLC. We are a relationships charity and principally that means that we believe that every child and adult needs to be surrounded by a circle of safe, healthy, happy relationships. We talk about the relationship that somebody has with themselves, with a partner or ex-partner, family or friends, school or work or the local community. All our services across the country follow that kind of belief in safe, healthy, happy relationships but particularly around children and young people’s mental health, we deliver a range of services. We deliver lots of counselling therapy services predominantly for children and young people affected by domestic abuse, either in their own right as victims, living in homes where there is domestic abuse, or where they are starting to use harm in their own relationships, either against parents and carers or against intimate partners and relationships. That will be by providing counselling therapy, sometimes in schools, sometimes in community settings.
We also deliver a range of interventions around healthy schools, which is working with children and young people in school who are suffering with mental health. That is providing support for the children and young people themselves in school, but also for the wider parents and families around their young people’s engagement in school and providing support as part of a whole-school approach, so working with the teachers themselves. That might be providing training for teachers, psychoeducation programmes, or providing clinical supervision for teachers.
The final set of services that we deliver is via a crisis mental health service called Safe Zones, which we deliver in Stockport. That is for young people who have been assessed as not being bad enough to need support through the CAMHS service—there is a five-year waiting list in the local area for CAMHS services—and that is a step-across intervention so that people can be supported by Safe Zones rather than waiting to get to the end of that CAMHS waiting list.
That is the range of services that we deliver. The trends we are seeing are in increased demand and increased complexity coming through to us. We are also seeing a change in that lots of parents and carers are really keen to get a diagnosis for children and young people. We are seeing the need for services prior to diagnosis, and that diagnosis should not be the end goal for the child or young person. It is about putting support around individuals for what they need now rather than waiting for a diagnosis. That is a very specific change in the last couple of years.
As for what young people and children are coming to us with, predominantly it is anxiety and that is showing up in lots of different ways. It is different if they are living in a home where there is domestic abuse, and obviously you can understand that that anxiety would be around trauma. However, it is also young people at point of transition from primary into secondary, young people struggling with the impact of social media and what that means in their friendship groups, but an increase in anxiety in how young people are presenting as well.
Arjan Bains: We deliver mental health support teams and some other emotional wellbeing services. MHST, I think you may have heard before, delivers on three core functions. Primary is direct intervention, so that is our low-intensity cognitive behaviour; therapy, whole-school approach; and advice and liaison. Primarily the MHST functions within schools, clear partnership work that happens within schools to embed mental health expertise that comes from MHST into the school context.
There also a link with specialist CAMHS, community providers. We have been really keen to develop that further with the integration community provision. MHST works in providing some of that expertise, and the whole-school approach is the prevention arm, enabling schools and mental health practitioners to deliver some of that preventative work before a child or a young person becomes a referral.
Direct interventions—one of our primary presenting needs is managing emotions and anxiety—are fairly prevalent and consistent across all our Compass services, but children and young people do not often neatly fit within that. In need we see quite a lot of intersect with high and increasing demand, but often SEND neurodevelopmental needs. Often there is safeguarding trauma and family circumstances, and some of those needs vary between schools.
We often see that schools have really quite good provision in areas of mental health and wellbeing. We try to allocate resource through our whole-school approach, our audit process, to make sure that we are following the need rather than having the children and young people trying to fit within the system. That encapsulates what we do.
John Poyton: The Well Centre is looking at embedding a new workforce of youth workers with a health specialism, youth workers trained up to be health specialists, to work in a multidisciplinary team. The service model has been tried and tested and has been building an evidence base over the last 15 years in Lambeth and Wandsworth. That shows that it is able to engage with young people who recent reports such as the Fonagy review and so on are calling the missing middle, those young people who often fall between the gaps of waiting lists for CAMHS and are not getting access to other services while they are on those waiting lists.
The Well Centre model is simple in that it is about joining up and integrating the ecosystem of support for young people much more clearly at a neighbourhood level. Youth workers who are trained up to be health specialists and are part of this multidisciplinary team can work with a much sort of greater risk with the young people because they are working closely with GPs but also with the CAMHS teams.
Although GPs are not necessarily incentivised to focus on adolescents in their general typical day-to-day work, they have a real passion for young people in their community. The team recognises that at that community level if you engage with young people and young people’s health now, it creates a triple-dividend return in the community, and also in a financial sense at the big picture policy level, because we can support the young people right here and right now.
General practice is where we particularly embed the teams because they can focus on what the young people’s concerns are rather than just being a specialist mental health only focus. The young people might also be concerned about their physical health, their sexual health and so on. That triple dividend return is a real focus for the team and the community in healthier young people, healthier adults and healthier children in turn.
We are seeing in Lambeth alone around 1,000 young people coming through and referred each year and that is due to the capacity. If there was a wider focus on this integrated workforce, there would be more young people to be seen but it is about integrating with all of the other best practice in a community.
Arjan has referenced the mental health in schools teams. Everyone is doing amazing work and there are case studies of great practice that undoubtedly you have seen in your evidence but often it is working in silos and the health and wellbeing practitioner. The youth worker and health specialist can meet the young people where they are at but also walk alongside them in school or where a young person is avoiding school, they can be seen in the home or in the community, in a café or a youth centre.
That is the Well Centre model. It is meeting needs locally around mental health currently. When we started, teenage pregnancy and sexual health concerns were some of the trends in the adolescent cohort. In other trends, we have seen violence affecting young people in our communities. The Well Centre model can pivot to meet the needs of those young people and do it in a way that meets the needs of the missing middle cohort who otherwise are often on the radar but not getting the support.
Jordan Letts: Our work runs on really well from what John is talking about there because the missing middle is exactly where our services are based. We are not a clinical-offering outward service but sports-based charities have the brand attachment with the club, which automatically adds a bit of an engagement tool for young people. It acts as a motivator.
We have numerous programmes ranging across education, employability, health and wellbeing. The whole model of what we try to achieve in them is a trend around looking at the complexity of the level that they are at when they first join us, so not always supporting young people towards the end of that journey or the middle of it.
We work very closely with CAMHS locally through our Engage programme. Engage supports children on the brink of exclusion or children who are struggling with their school attendance. A lot of children who access our provision are EBSA students—emotion based school avoiders—and we look to put a wraparound care around them and their families to make sure they are supported with the next steps into the community.
In some of the trends that we see—it is difficult because it is very much place-based—the direct issues are anxiety, schoolchildren struggling to even set foot in a school and making sure that we are providing an opportunity to the young people to break down that step so it does not seem so overwhelming when education is staring you in the face.
Chair: Thank you. Arjan, I apologise that I got your name wrong. There is TV screen just obscuring the bottom of the J. I read it wrong. Apologies for that. We will go now to Manuela Perteghella.
Michelle Hill: Thank you. We believe that prevention is key and intervening early, trying to get to the stage of working with and supporting children and young people before they get to crisis. We all talk about that all the time and I think we have won the battle on the fact that that is what we should be doing but actually, unfortunately, it is still not what is happening and the majority of resources are still going to crisis interventions.
The things that have been most successful for us are where we have done work with schools and community groups around a whole-school partnership. That is not just around offering intervention in school but it is doing assemblies and education programmes, working with the teachers and the headteachers and then offering interventions for young people. It is, as a charity, being completely integrated and embedded in the school environment.
I can think of a couple of schools that we have been in partnership with for five or six years, or maybe longer now, and we are seen as an embedded part of that school community. All of that destigmatises a child or young person getting support and the support is in school when they need it. It is about meeting young people where they are.
Another key thing for us is not forgetting the support that needs to happen at home. For young people going back into homes, the relationship with parents, carers and siblings is key. We have to hold a balance in that we understand the confidentiality that young people need if they are accessing a counselling professional or in therapy but we also have to put support in for parents and carers.
I can think of an example that we have delivered in Salford over a number of years called the Healthy Schools Partnership. It was doing exactly that. It was that kind of whole-school approach to the school itself, support for individual children and young people, and also support for parents and carers, and particularly thinking about the transition from primary to secondary. All of that was focused on helping children, young people and carers support developing mental health challenges before they needed crisis intervention. It was all about intervening early but also giving children, young people, parents and carers coping mechanisms that they can go back to.
Another example that I will pick up is a crisis intervention, Safe Zones. It might feel strange to talk about crisis when the question is about prevention but the key thing for Safe Zone is the ability for children and young people to refer back in. We currently have 30 children, young people who have accessed the intervention and have gone away and are living their lives. Maybe suicidal ideation and self-harm aspects are better, they are engaging back in education and then something happens in their lives that triggers them to see they need some more support. Rather than having to start the process again, they can just re-refer back in and get support again for what they need. It is not just the initial intervention, it is about how you stay the journey with the young person, parent and carer for as long as you need to. That is another element.
I think that sometimes we de-simplify it or over-simplify it by thinking it is just about moving things from crisis to early intervention. It is actually about sticking with young people for the journey for as long as they need and also recognising that young people, like all of us, do not fit in a box. Just six sessions will not be enough for some young people—that might be what some need—but the opportunity to come back when they need it is really important. Those are the key things I will highlight.
Arjan Bains: From a Compass perspective, effective early intervention means starting with a really simple sort of front door and I think sophistication really needs to come behind that with effective screening and triage. It needs to be easy for children, young people and families to access the service. The rollout of 100% coverage of MHSTs is certainly a good start but having an MHST attached to the school does not necessarily equate to equity of access.
A primary pillar of MHST is certainly the one-to-one therapy, but we are seeing more and more positive outcomes particularly in groups, parent work, consultation, that whole-school approach to building capability around mental health in schools. Often some of the best MHST work can happen before a child becomes a referral and building that capability is really important because it prevents some of the dependency on services.
We see gaps between services but children and young people are experiencing need and some of the delivery of capability can be around the child. Sometimes that earliest intervention may be with the child but it could also be with parents and school rather than directly with them. Making the front door really simple with sophistication behind it is important.
John Poyton: With the Well Centre model we are deliberately looking at embedding it into general practice because it is right there in the heart of the community. Mental health in schools teams are absolutely brilliant at what they do but there are about 3,000, 3,500 secondary schools in England and about 6,500, 7,000 GP practices. I am really interested in shifting the dial and making the general practice much more accessible to young people, in which case it needs a more youth-friendly front door.
The Well Centre has an evidence base proving that it can do early intervention and meet young people where they are at with their families, their parents, on their own or with their friends. Also, importantly, if young people have been in crisis, as Michelle says—whether they have ended up in the emergency department, in police custody or in the youth defending institutions, all of these different crisis places young people might end up with an underlying mental health condition—when they come home, they are back on the doorstep of general practice.
General practice currently is not a particularly youth-friendly shop window, if we are using that analogy, but by embedding this youth work health specialist workforce, there is an eminently scalable model to support every single constituency that has general practice within it to meet young people upstream preventatively but also downstream to reduce the likelihood of re-traumatisation and re-crisis. That is where we are looking at prevention upstream.
General practices are often seeing parents and children when they are worried and concerned and but those young people often don’t understand how to engage with and navigate a pretty complex system. What we are seeing are that some pretty small incremental shifts to improve that access and a greater youth-friendly workforce of youth work in general practice mean that in essence you are opening the door and allowing young people to come in.
John Poyton: You are quite right. The reason we set up the charity with the strategy to look at scaling best practice is from our evidence base in Lambeth where by embedding youth workers who are trained to work in a multidisciplinary team you do not have to then suddenly send those young people from pillar to post.
About general practice, you are right. Currently it is not about putting more weight or responsibility on the shoulders of GPs, who are obviously working to support the whole population, but about recognising that there is an opportunity to partner with the youth sector rather than just signposting or referring the young person or telling them to self-refer or referring them to CAMHS and them being on a two- or three-year waiting list. There are plenty of youth organisations in the community but often collaborations or partnerships are not created.
I set up the Well Centre charity to take a model that has an evidence base, which is quoted in the recent Fonagy review—page 421, if that is helpful—to show that you can have a model for when a young person sees their GP, they can scaffold the trust that they have built in getting to understand the young person’s needs to their colleague, their youth worker, their health and wellbeing practitioner.
In one sense, young people often feel a sense of rejection from a referral because they are told, “You are too big a deal. You need to go somewhere else to see an expert”, but that can be done in a community, in a neighbourhood, and the young people then will vote with their feet and come back the next time they feel that they have a question or a concern. That prevents an unhelpful referral pathway.
Jordan Letts: For our organisation, early means different to a lot of people. We have taken a focus of going into primary schools and working with young people before situations escalate. A lot of the time, we look at early intervention as a prevention of spend further down the line but the reality is actually young people can be supported in a different way. Engage is a prime example of that. It is for children who are on the CAMHS waiting list. They come to us for support. That support could be as small as youth work, mentorship, assisting young people on to the next step of what they want in life.
The majority of the children that we had in that provision last year no longer needed the support of CAMHS so they were taken off CAMHS waiting as a result of the work that we did with them. It was not rocket science. It was ultimately giving children an opportunity, not just putting in an hour’s intervention around a therapy or counselling session, but spending five hours with them in their school day, and asking them to come along and work with our youth workers to make sure they feel part of something.
To me, belonging and accountability is a huge thing for children. I think when children feel that in an organisation and want to see the support that is going to be given outwards, they naturally can see that. That is not the case for some and they do need additional support but I think our provision is a really easy way to shortlist the children who need additional support and the children who potentially can come off that waiting list.
I will start with you, John, because you mentioned at the beginning about how everyone is working in silos. Can you tell us what we need to do, what needs to be done, to have the different systems—local authorities, GPs, schools—focus on early intervention?
John Poyton: This is timely. There are reports and reviews coming out—the recent Fonagy review into ADHD and autism, for example—and I am sure we are all eagerly awaiting the Milburn review and focus on NEETs, after the Budget undoubtedly.
All evidence points to the fact that there needs to be less silo-working and much more collaboration. If we were to take a young person in any one of your constituencies across the country, undoubtedly there is an ecosystem of support. Young people are known to their GPs, or at least registered, whether or not they have been seen for a while. Obviously there are schools and the voluntary sector and there is the youth justice system, as you say.
The youth work model that intersects the experts that you have on the panel today offers an interesting opportunity. We often see best practice as looking at the team around the child, which obviously is about looking at us all collaborating, but often young people, when they are known to lots of services—and they feed this back to us—can feel that they are going from appointment to appointment and being asked the same sets of questions.
It is interesting to pivot and look at who is the trusted adult or key worker that the young person recognises and then look at the ecosystem of support pivoting to support the key worker. That may be the teacher, the youth worker, the GP, the social worker the youth offender team officer, but it is about us collaborating as a team.
I think that there is all the will in the world but that often there is a perverse incentive for organisations to count the numbers of young people that they are working with and not to collaborate. There is an opportunity to encourage collaboration. Within general practice, for example, there aren’t any incentives to ask GPs to think about the young people because they are so busy focusing on other crisis points in their population.
Youth work is an ideal example of where we can look at that role being not only the relational rapport-building, trusted-adult role with the young person and with the family, but also becoming a conduit or an integrator in the community to join up between schools and the other parts of the system.
Michelle Hill: I agree with everything that John said. It is about partnership being different, being generous and collaborative, but the commissioning system is not set up like that on lots of occasions. At the moment voluntary sector organisations, which often have good relationships with children and young people, are often pitted against each other to bid for competitive pieces of work.
A lot of the voluntary sector and commissioning system is set to incentivise young people being put in boxes and counted as bums on seats. The way forward is exactly as John says. It is that kind of partnership where we meet young people where they are at their best, in familiar settings for them, often non-clinical settings.
Then it comes to the relationship, exactly as John said, with a trusted adult. That trusted adult could be a parent, a carer, a teacher, a youth worker, but it is then about wrapping the support that they need around that trusted adult. That does not need to be from somebody who is clinically trained; they do not need to be a counsellor or a therapist, but they might need to know what interventions are appropriate for the young person. They might need safeguarding support, access to clinical supervision or they might just need somebody to talk to, to offload at the end of a difficult, challenging session with a young person. I think it is about doing something really quite fundamentally different in seeing the system changing around the young person, rather than us expecting young people to navigate different referral mechanisms and go from place to place.
Another thing is that often the system retraumatises young people at the moment. We ask them to retell their story over and over again and to put themselves in different assessment criteria. This should be about us working collectively as a partnership, so that young people do not have to keep retelling their stories, do not have to keep sharing that trauma, and we can just wrap things around the young person. That is just to build on what John said.
Chair: We will go in a second to Mark Sewards. We have talked quite a lot by way of introductory comments, and it has been really helpful to get an understanding of what each of your organisations does. Can I encourage you to be a bit more succinct in your answers now? We have a lot of different topics to get through, things that we want to ask you about, and we will not be able to do that if we continue in the way that we have for the last half hour. With that in mind, I will go to Mark.
Jordan Letts: Yes. When we set up the programme, it was to work with young people in the criminal justice system. The idea of the programme was to support that transition for children and meet them where they were at that point. We spoke locally to the integrated care board, which saw a local issue with children who were on waiting lists and not being seen for a number of years, so we developed the programme offer to be quite different. The student-to-staff ratio was massively reduced. There are now three students to one member of staff.
The idea of the provision is to support children with wherever they are at in that day. They will come to us instead of going to school. They will spend the full five hours of a school day with us, and will do activity-based things such as trampolining but that is supported by youth workers, qualified counsellors who assist with the provision, trying to build a relationship with the children. It is not going into a dark room to have counselling or therapy. We can do it on a trampoline, on a walk, at the stadium.
We can break down the barriers where the anxiety point of it is not about accessing what that looks like day to day. We have had children referred into the programme who have not left their bedrooms. For the first bit of the induction, we have taken the induction to them, to where they are comfortable and where they are safe, and then steadily built on that over time. Some of the incredible success stories are looking further and seeing children who were not leaving their bedrooms now accessing full-time mainstream education.
Sometimes we look at the system and think that there are all these issues. Our biggest issue right now—we do not have waiting lists across any part of our service at all but then we look at our CAMHS waiting lists and see that there are 26 children waiting for that support. This becomes a money challenge—how much money can be allocated to it.
To the last question, we speak about early intervention. Early intervention is exactly that. Hopefully, we are preventing people coming up the stream but ultimately, if there was more investment into our early intervention programme, we would be able to support more of the children on that list.
Jordan Letts: We have grown. We were established in 2018, and we have grown a workforce of about 50 people now. Our two big issues were around people and premises, where to deliver the programmes and also people to deliver them. A big focus has been on learning to recruit the right person, who we can train. If a person has the right kind of warm nature with a young person, they can actually help and you can see that, so part of recruiting is based on that need. We currently have a number of apprentices who were previous students. We are trying to get a workforce of people with lived experience working with the children who are struggling now.
Jordan Letts: It is always going to be hard. It depends on how much you grow within a year. To go from two people to around 50 now has been challenging. It is hard to find those people because they are not always there. Sometimes you have to look at the sector differently and look at the personality of the person that you are recruiting and then train them to become what you need them to be.
Michelle Hill: I think it is for children and people who are in school. The key then is it being embedded in the culture of the school. That is being at the assemblies, the PSHE lessons, support for teachers, counsellors and therapists being co-located and part of the school community and not seen as an add-on. That is key where support is in school.
You see a different experience for young people. They go into a counselling or therapy session and when they come back, teachers understand what has happened. They don’t know the detail of it, but they will understand the emotional processes that young people are going through and they put the support in around that at lunch and break times. The whole-school approach is key for young people in education.
Then it is about is taking the things that work in that approach and applying them for young people who are in alternative provision as well. They have the double whammy, not just missing out on a formal education but also missing out on emotional support from schools. Making sure we take that learning into alternative provision is equally important.
Michelle Hill: Yes, it is challenging. We have a very similar approach. We talk about recruiting for values and training for skill. Values and engagement with young people are key.
Pay is an issue in the charity sector, trying to make sure that the terms and conditions that we offer are competitive. We cannot match things such as pension contributions or long-term continuity of contracts. That is the biggest challenge for us and within that it is about funding continuity. We have lots of projects that are extended for six months at a time or 12 months at a time. How we can recruit and retain the best people when we cannot give them that permanence of contract is a challenge for us and I think it is getting harder rather than easier.
Arjan Bains: I think there have been conversations about community provision organisations, both voluntary and otherwise, doing active navigation and screening assessment. These are information gathering processes, but I think we have learned that active navigation is very relational. We have a really good collaboration with CAMHS in our Barnsley service, Branching Minds, a physical front door where professionals can do some of their thinking together, really understand the child, prevent some of those rejected referrals, prevent them having to retell their stories. That is key to making sure that children, young people and families are finding the right support and professionals are coming together. Can I add on the workforce part?
Mark Sewards: Yes, please.
Arjan Bains: It is a challenge across the piece and is one of our more practical considerations, particularly with further expansion. Within mental health support teams, it needs to be a little bit more than just having more educational mental health practitioners. There is significant infrastructure around them with leadership, clinical supervision and professional development of practitioners.
If we want people to stay in an MHST or mental health team, they need to be able to see a career, certainly pay for professional development. When we get to 100% coverage, I think there are potentially concerns about whether there will be further investment for people to progress. We have developed volunteers who can progress into trade and paid roles. We have a trainee band 6 role so as people get to one-year post qualified, they get developed. Then once they have hit two years, they can go on to do the supervision course.
If there was a national workforce strategy that went along with expansion, that would make that sustainable workforce effective. That needs to happen. If we continue expanding without having that consideration, I think we will hit a quality bottleneck, particularly with staffing. As we are seeing higher need and demand and more complexity, that capability needs to be built into the workforce.
John Poyton: As Arjan has said, the children’s wellbeing practitioner and the mental health in schools teams are brilliant examples of creating and training up a workforce.
In the Well Centre and in our pilot sites across the country, down in Cornwall or up in Stockton-on-Tees, we are looking very much at the need to ensure that there is a training programme to create a new workforce. The health and wellbeing practitioner and the youth work health model can work very well in general practice and across the community but it does need a training programme to be able to recruit and then know that you can train up a team to work as part of this multidisciplinary offer.
The Well Centre is not looking to be a provider. It is looking to share a model and workforce development is key. I am sure that many have talked about this in previous sessions, but over the last 16 or so years, 1,200 youth centres and 4,500 youth workers have been lost. Those youth workers are scattered far and wide, I am sure, into lots of different roles. It is not about us using rose-tinted glasses and just trying to put that straight back in as it was. It is about recognising where that workforce is and how they can be trained up or a new workforce be trained up so that they have one foot in the community and one foot in the health system, creating a workforce that is absolutely about integrating the brilliant work happening in the youth sector, the education sector and the health sector.
Mark Sewards: That is helpful. Thank you.
Arjan, there is a particular area that I would like to ask you about. Before I became an MP, I was in charge of the rape crisis service for Devon and Torbay. We know that survivors of childhood sexual abuse, and particularly young women who are victims of rape and sexual abuse during their school years, struggle with mental health and the trauma can be very deep and very long lasting. We also know that it is a really difficult thing to expect teachers to cover because they do not have the skills. One of the things I really wanted to do in that role was prevention work. You have talked about prevention work. You have talked about a whole-school approach. We could never get the funding for it.
Focusing on that area for a minute—and anyone else can come in if they want to—I would like to hear your thoughts on whether you think that is particularly relevant, whether that work needs to be done, whether investing in that kind of work actually could save a lot of money later on if you want to be purely economic about it, let alone the impact of improving someone’s mental health and relieving their trauma so that they can go on and live a full and happy life.
Arjan Bains: Schools and school staff have a critical role. Staff wear lots of hats in school. They can often be a therapist; they are working on education; they are supporting wellbeing. I do not think the expectation is that school staff will become therapists. I think it is our responsibility to bring the expertise into school. Schools could certainly be upskilled in supporting children, maybe upskilled in their identification, bringing in the expertise when that is appropriate.
Particularly with prevention and maybe trauma, we think about social media use. Last year in Birmingham, we did a whole-school approach and had about 52,000 attendees at over 1,000 different activities that happened over the year. It is difficult to say what impact some of that prevention had. Maybe an assembly that a practitioner had done, or a workshop, put out a little nugget of information that developed some resilience in a child and may have prevented harm down the line. There is also the presence, talking about mental health and wellbeing, developing some of the tools children and young people need. I think it is an important element to protect. We talk about early intervention and the purpose of MHST.
Those three functions are interdependent and for schools and school staff, that advice, signposting that consultation, provides some of the safety net for school and for them to be able to support children but not feel that they need to be the therapist or practitioner.
Michelle Hill: Adding to that, our experience of delivering work for children and young people affected by domestic abuse has some kind of learning. Our view is that you have to be an expert in that work to be able to do it. You have to understand what domestic abuse is, how it shows up for children and young people as victims in their own right, what happens if young people are starting to use abuse or harmful behaviour in their own relationships, what happens if they are living at home and domestic abuse is still happening at home, what does that mean for safeguarding, what is the relationship with the protective parent. There are so many things there that we think we need a specialist going in to do that work. I think the role of the school is often to enable that to happen in a safe space rather than provide the support themselves.
Then it is about partnering with specialist services in the voluntary and community sector, but I completely echo what you said. The biggest headache of my life really is trying to get funding to sustain that in different parts of the country. We have some brilliant examples of best practice in different parts of the country but we end up pooling money, sometimes through Home Office funding, sometimes through integrated care boards, sometimes through places such as Children in Need and charitable trust funding. It really is a kind of hopscotch approach to funding, which it should not be because these are children and young people who are already living with trauma and we are trying to enable their mental health to be better so that they can engage and have fulfilling lives.
I have just pulled up some of the stats. Across Greater Manchester, we have worked with 2,300 children and young people in the last few years affected by domestic abuse providing counselling in schools and 100% of them gained increased self-esteem, 87% improvement in coping with anxiety and 91% improvement in low mood and depression.
That is not in a clinical environment; that is from working with children and young people in community and education settings, but it is being provided by specialists who understand domestic abuse in its entirety. That is absolutely key and there is a real danger that we miss that if we are not careful by seeing young people as a wider group when actually there are loads of differences between people that we need to think through.
Jordan Letts: Yes. It is different from child to child really. We have had experience of supporting young people who have been victims of sexual assault. I think the journey is also not normalising what has happened but taking an opportunity to be open ears for them as well. We do not act as the solution or the potential support mechanism for all of that but in some of the cases that we have had, we have reached out to other local providers to try to help us and assist with young people.
Jordan Letts: Yes. In our sessions, we deliver Pol-Ed, the police education programmes. In Pol-Ed there are modules that include healthy relationships. A lot of our staff also deliver sessions on what it is to live and grow up in today’s society. A lot of the time when we look at children and young people, there is this focus on, “I want to be something that I have seen on social media” but the reality is what we have as a professional sports club is male role models that children can look up to. They can drop into programmes. They can come and support the children and they can see what a role model should look like. I think rugby gives you a positive platform for that to happen.
John Poyton: Very briefly. My previous work as founder of Redthread was also very much focused on building a workforce of youth workers to work in the 150-plus A&E departments across the country—we did not work in 150 but there are more than150—where young people come when they are victims of sexual assault and rape, as you mentioned. Again, I think there is an opportunity to ensure that there is a workforce developed and funded across the country that can work with young people in crisis in the 150 A&E departments but also preventatively upstream and downstream in the 6,500 GP practices or the 3,000 schools.
However, it must be about not just putting more responsibility on the shoulders of isolated, individual, brilliant youth work charities. It has to be about looking at how accountability across those with that statutory responsibility and the rest of that ecosystem of support pulls everyone together so you do not end up with amazing, awesome charities suddenly taking on specialist roles that are not funded particularly well, as Michelle referenced, and are then holding traumatised young people and trying to do that work in isolation. I think there is an opportunity here to ensure that we pull together the system and improve it for young people.
Caroline Voaden: Thank you very much.
Michelle Hill: I have a couple of different examples. There are some about what we have just done ourselves as an organisation, which are around waiting well and for some young people who are waiting, what support we can put on while they are on a waiting list to make sure the young person still gets a relational approach. It can be for the young person themselves or for parents and carers.
There is some uncomfortableness about it. Some of our services are around parents and carers who can afford to pay for access to support and who then choose to pay for private therapy while they are on a waiting list, the danger being that by the time they get to the top of that waiting list they will have fallen out of being a child and will need adult support anyway. It feels positive for me that we can offer the support for people who can afford to pay for it but incredibly uncomfortable that that means there are huge parts of the population that we are not serving in that approach. That is part of it, as an organisation, recognising that for people who are waiting you still want to offer high-quality interventions.
Then as an alternative, there is the Safe Zones service in Stockport, which I have mentioned and which I think has done this really well. Five voluntary sector organisations are working together, recognising that the waiting time for CAMHS in that area is five years. It is about young people who are presenting at a statutory service—that might be A&E or CAMHS—are assessed as needing support but they are not going to get to the top of the CAMHS waiting list. They are then stepped across to one of the five voluntary sector organisations. It is a step-across approach rather than a step-down service. They get a different intervention when they are stepped across but it means that they get something, and that is the service where they can re-refer back in as well.
That is two different examples. Safe Zones have worked incredibly well for those young people who are risk-assessed as having need but are not going to get to the top of the CAMHS waiting list. Then we have innovated and put something else in for people who can afford to pay so that they are not just waiting on their own but have some support while they are waiting.
Arjan Bains: I would certainly advocate improving capability within MHST in the workforce, where that is appropriate and safe to do. It could be through skill-mix, supervision, professional development, bringing in specialised roles. We have a practitioner senior outreach, a wellbeing practitioner who works with emotion based school avoidance but that is a small part of it.
If we continue to expand that threshold, we end up prioritising those with more complexity or on the more moderate side with an early intervention and you shift that gap towards the bottom. That kind of undermines that early intervention element. There needs to be shared responsibility for the integration. That is professional consultation, step-up, step-down procedures, maybe horizontal moves between organisations. I think that can happen before referrals and that needs to be active navigation.
We need to try to reduce some of the referral/rejection because children experience need. It is the organisations that have the gap between the systems, and it is not the responsibility of families to try to navigate that system. I would look to build capability. That is a good direction to go in, but I would not necessarily expect services to try to fill those gaps across the board.
John Poyton: I have already mentioned that the Fonagy review, which was out only this month, referenced the Well Centre, one of the many case studies of good practice, but it is it is about recognising the missing middle. There is the between-the-services but also a gap in responsibility. They are known about but they are not hitting thresholds and they are not anyone’s responsibility. I think that is where we can absolutely start to look at better collaboration, ensuring that collaboration is incentivised, ensuring that those young people do not fall through the gaps, that they are not left in limbo any more. That is the opportunity that we need to be able to change going forward.
Jordan Letts: The only thing to add is that that is the exact cohort that we are working with. The missing middle are the young people that we can divert from those additional services. It is a lot. We tend to get those young people before they reach any point of crisis and hopefully with that we can then make sustainable change with them. It goes hand in hand with early intervention, the idea of the missing middle.
Michelle Hill: I think that the Young Futures hubs are a brilliant opportunity as long as they are delivered in partnership with the volunteer and community sector, recognising that some of the young people that the hubs will want to reach are the young people that the sector is already reaching and engaging. There is an opportunity, if they are delivered in partnership, to be able to turn things around in a different way.
There are things to consider, for instance the location of the hubs. We know what has happened with youth services over the last few years. Lots of areas do not have youth clubs that people can go to. So Young Futures hubs must be attractive to a young person, somewhere that they want to be seen and where they want to engage. I know that some are going to be digital and some will be in person. I think they are going to be important but make sure that that all those services are wrapped around the young person when they go in so that they are not having to go to different places. There is a real opportunity here but it needs to be through engagement with the sector and that being a real partnership.
Darren Paffey: Any other thoughts before I go on to my final question?
Chair: I think Caroline Johnson has a supplemental on that question before I bring you in on your next one.
Do you see that nationally or is it just a local issue? How do you think it could be solved so that people are not waiting for a prolonged period because of the age at which they are referred?
John Poyton: NHS England came out with their transition review earlier this year recognising that there is a secondary care cut-off at 16 and mental health services at 18. That is why the Well Centre model has always been about supporting young people across those vulnerable transitions because otherwise that is exactly, as you say, where young people fall through.
General practice is there for all young people and adults at any point in their life course. You are absolutely right. There are issues. The NHS England report into the transitions recognised that the Well Centre model was a way of ensuring it joins up where there are otherwise those gaps, but I think not enough services are being commissioned to support young people across the divide or those gaps in transition. You are quite right.
Jordan Letts: All I have to add on that is that a lot of the time in education, transitions are seen as that kind of Year 6 to 7 period but actually, as you referenced, the Year 11-onwards transition is as significant.
We do a lot of work in the NEET population in Northamptonshire. We work with the 23% of the children who are NEET, supporting them on to the next stage in their lives and careers. We have fantastic partnerships with Northampton College and Tresham College that look to pick up children wherever they are at, very similar to our early intervention programme but looking at how we can then support young people into employment and getting them meaningful jobs at the end of the route as well.
Arjan Bains: All I will add is that one of the structural problems is that organisations can all be meeting their own KPIs and commissioning requirements, yet children and families will still be experiencing a poor service. CAMHS can be behind its threshold, a school can be doing its escalation and a child can still be left without getting the right help. Maybe we want to be looking at pathway-level accountability rather than at just the organisational.
When we are trying to judge the children’s outcomes, we need to look beyond contract or commissioning performance to properly understand whether children are repeating their stories and whether outcomes are equitable. I think that is challenging in the commissioning structure at the moment but deepening what accountability looks like across all pathways will be really important to give us assurance.
Michelle Hill: Really quickly, I think the challenge for the system at the moment is the way it is structured. The support you can access in school up to year 8, primary school and secondary school, the points of transitions are difficult but to children and young people, it does not really matter. If you are 15 or 17, the support that you might need can go across all of that.
As a parent of two teenagers, I don’t want my children to suffer when they are at a point of transition and all of a sudden they are classed as an adult rather than a child. Then it is about how we develop and design the system around them and grip the child and young person in the middle rather than saying that those imaginary boundaries are there because of where the funding is or where pathways are. This is important. It is about how we take a relational approach to children and young people and group things around it, and have the opportunity to do things a little bit differently.
Arjan Bains: We have a specialist team. We take quite a lean approach with our MHST model with our leadership, so we were able to develop a specialist team and some specialist roles. One of those is the quality and engagement practitioner, who does not have to do all of that one-to-one work that takes up the majority of the time. They can focus on meeting partners, going into schools, working with school councils, getting some of that pupil voice, focus groups with teenagers—I think teenagers are our lowest-referring cohort—and trying to get some of their voice for what they want a service to look like.
It can be challenging to really hear what they want, but I think we do what you said we did. We try to keep constant communication. We try to integrate with schools, particularly the whole-school approach and the audit process that you follow.
You look at all the different areas of culture in the school, and pupil voice is really critical and hearing them out about what they want to see. There are really popular things around toilet facilities in school, and schools may hear that. Do they do anything about it? There may be a bit of a drive between mental health services looking at mental health within school, and we get this pupil voice that gives a bit of a drive for school to implement ways of working that can really support wellbeing.
We have a strategy for trying to get further outreach, get some engagement and participation from those who access services. Through our parent work, we have emails and parent groups that can inform how we are delivering the service better.
Jordan Letts: Based off of feedback from young people, it has always been a big part of our charity and organisation to make changes to the programmes. I think being quite a small charity in comparison to some here, you can make those changes relatively quickly if young people voice them. The voice of the child throughout our whole service is incredibly important and if we can make their experience slightly better, we will do that as part of the journey and process.
Even this year, we have made adaptions and changes because of qualifications that they wanted to achieve while they were with us. In the year, we have then put in ASDAN qualifications, so young people now leave with life skills, as a result of the communication that they gave to us. With some young people it is really hard to get their voice, because they don’t necessarily know what they want, either, but I think if you provide that safe space for them to be able to communicate, the likelihood is that you will be able to make good developments to your services.
John Poyton: I was just going to jump in and agree that co-design is key. It has to be funded, though. I think that often it is left to the voluntary sector and the youth work organisations to do that, and they do it naturally and they do it very well, as Jordan said, by listening to young people, but often it is not funded.
Young people’s lived experience, as we all know, is absolutely key, as is the lived experience of the professionals looking to support the young people so that we have that diversity of thought around the table in co-designing, but it is often not funded. It is an afterthought from a commissioning point of view. Youth workers are absolutely well placed to ensure that they properly co-design, not just consult with young people. There has to be a recognition of that co-design and then giving the organisations and the commissioners responsibility to be able to fund and react to what is co-designed.
Michelle Hill: It is hard to define whether it has become harder. I think it has always been hard—whether it is that we are more aware of some of the challenges and how those present now. A lot of it can be led by the communities that you live in.
If you are in a small primary school and move to a much bigger secondary school, you have known the teacher, you are a known person, and then you come in and you are in a crowd of hundreds and you get lost. I think it is also really hard as a parent and carer. There are all those differences that you go through about: is it safe for a child to walk by themselves? What does that mean with street safety? Is this the time that you give the child a mobile phone, seeing as they are going to be navigating to school by themselves? Then what are the rules that you put down about social media use? Do they have to check in and check out when they get to school and what does that look like?
For me, it is the support pre and post-transition that is really helpful for the young person themselves but also for the parents and carers to help them navigate that transition together, and then making sure that the young person does not get lost. When they are coming back from year 6 to year 7, they will be hearing different things, experiencing different people. Also as a parent you navigate it differently, because you have often gone from being parked at a school gate where you have known other parents and carers, to all of a sudden you don’t have that school WhatsApp group any more, you don’t know where to contact and you don’t know the person’s house that they are going to stay at that night and what that means. I think support for parents and carers in this is really key.
The schools are often really good at this. They understand how to do the welcome meetings, they have got the introductions for parents and carers, but they can still lose young people in this and can certainly lose what is going on at home. I think it is around just gripping that support pre and post-transition to make sure that nobody gets lost in the process.
Arjan Bains: We have partnered with an organisation called Breathe in Birmingham and they carried out a wellbeing census, looking at some wellbeing factors in primary and secondary schools. It brings into something called school connectedness and how it is very strongly linked to wellbeing. Higher connectedness was strongly associated with wellbeing in both primary and secondary school. I think it gives evidence around protecting some of that whole-school approach work, and MHSTs and services have and should be thinking about belonging, relationships, school culture and pupil voice, not only the individual treatment. Individual treatment can take a bit of a bias if that is the outcome that is really strongly measured for access.
On transition points, I think these are really predictable prevention points and opportunities for us to identify vulnerable pupils early, prepare families, prepare schools, and provide some of that targeted transition support. We know where they are, where they happen, and some of the learning from Compass is that local delivery needs to be flexible and we need to meet the needs where they are, and these transition points are that. When we look at expanding coverage or nominal access, we need to really think about that resource allocation, particularly on these predictable points.
John Poyton: Like you said, we all know that year 6 to year 7 is a huge, vulnerable gap, and schools are always looking to create that better transition, but young people will undoubtedly fall through the gaps. I don’t think that we all necessarily know yet what the data is telling us. Absence jumps most between year 7 and year 8, not necessarily from year 6 to year 7. We have got to find ways to understand what the data is telling us. At the moment, schools publicly publish their persistent and severe absence and illness, but there is not a national data set looking at emotion based school avoidance and what that might look like.
I am very happy to share our research into what schools are seeing, but again, primary to secondary, we know it is a massive gap. Where else are the services that support those transitions, whether it is year 6 or 7 or it is the 16-year-old cut-off in secondary care or the 18-year-old transition? I would argue again that the health system and general practice needs to be joined up with the education system to help support the young people falling between the gaps at all those different vulnerable transitions.
Jordan Letts: The only point that I would add is around the communication of agencies speaking to each other. When we first started the Engage programme, we had a huge issue with health talking to education and education talking to health. That has significantly improved as a result of this work, because we need to communicate with both.
On those transitions, we actually piloted a programme over the summer to work with 100 girls who were accessing a secondary school. It was a mixed secondary school. The whole journey of that is to look at the datasets. We will only find out probably in the new year how that cohort of 100 girls actually perform against their peers with whether their attendance is higher and whether their attainment in lessons is higher.
We really wanted to target the issue. A lot of the time we see these issues coming up, and there is not always the forward momentum for organisations to try to target it and see how they can get themselves involved with it. We have tried to do that this year, and hopefully it will have really big success and then we can try to roll it out to more schools in Northamptonshire as well.
Michelle Hill: I think it is just that approach of what we talked about with the Healthy Schools partnership. That was a brilliant example in Salford, which was around children and young people at point in transition, delivered across a number of different schools, funded through the voluntary community sector and also through integrated care. That was around support for the child but also the parent and carers. It was all about mapping the transition for the young people that the school identified were least likely to make the transition well. It was about putting support in and then following those young people through until they were embedded into the new school environment.
Often secondary schools already have feeder primary schools, don’t they? They happen already, but this is a bit more active than that. It is not just a generic open day for everybody; it is some targeted interventions for young people you think are going to struggle. It is relatively short—it is until young people make that transition—but it is about recognising the impact of parents and carers on that as well. It is both the primary and secondary school working together with health and education to say, “What can we put in for those young people we are most worried about?” I think that is key.
What are all of your experiences of working within that ecosystem, the really good practice of where it is self-reinforcing and also any negative experiences you have seen where maybe the voluntary sector is fighting with itself or there is not that collaboration, that I think Michelle and John both pointed to, between the funding organisations and the voluntary sector? It is a question about that whole ecosystem. Michelle, shall we start with you?
Michelle Hill: I think there are some real examples of brilliant practice. Let’s start with the positive. I think about some bold commissioners who have done things really differently. The example that jumps out to me straightaway is an Alliance contract that we are part of and have actually been part of for 10 years now, which is amazing in the sector in itself. That is six voluntary sector organisations and the local authority as key partners. It takes away that competition about people competing with each other. It is all around those organisations working together for the best of that community.
It is an Alliance contract, so there is no traditional lead or subcontract; we are all in it together. For the first five years of the partnership, commissioners sat around the table as an equal partner through a leadership model. Now the relationships are so developed that we don’t need that kind of formality, but we are only as good as how we work together. That has been absolutely key for doing things differently and has removed the barriers between commissioner and provider, which I think has been brilliant.
There are some very good examples with devolved Administrations. I am thinking about combined authorities where, as part of the sector, you have a voice in the strategy development. You understand the conflict about being a provider but also being a specialist in this space. I think particularly about our work with children and young people.
I sit on Greater Manchester’s gender-based violence board as an expert in this work, so I was able to shape the strategy. There are some brilliant examples of the sector working collaboratively, and by the sector, I mean voluntary community sector, local authority sector and statutory sector.
Also, sadly, there are examples where that is not the case, where the sector is pitted against each other to bid for small pots of money. Particularly with things like national insurance increases and the increases in national living wage, there is an expectation that the sector can just carry that and there will not be inflationary increases every year in contracts, which means that what you are delivering is actually less and less for less resource. Sometimes it is still a very traditional provider-commissioner relationship, which misses the expert voice in the room.
There are some brilliant examples, but there are also some where commissioners are not as bold and are much more traditional, more patriarchal, and we lose the expertise of doing things together. It would be wonderful if there was a way of taking that bold commissioner approach to partnership, that understands the confines we are all working with but says that we should all be here to try to achieve the best things for children and young people, and we should be able to do it from that belief. It would be brilliant if we could drive that bit forward and lose some of the non-successful commissioning practices.
Arjan Bains: At an operational level, similarly, we see really good professionals work hard to make integration and partnership happen. I do not think that should necessarily happen out of good will. We should commission for integration, have the ambition that integration happens, not commission and then hope. The goal would be that services should not have to work around their thresholds and KPIs to have partnership with other services.
Having some of that cross-accountability will be key. That is across organisations, different KPIs and commissioning requirements. For commissioners to allow services to have that flexibility is critical to ensure that resources are able to be responsive to changing needs. That can happen, rather than treating every school in every locality uniformly.
John Poyton: Michelle referenced the idea that the alliance contracting means that you create equity in the ecosystem. I think that is key and there are good examples of that, but too often commissioners are commissioning a siloed specialist service that is not as joined up. There are great opportunities for joint commissioning across local authority and the ICBs to then think about how everyone works well together, because there is a lot of goodwill in the sector and the system, but often it is not joined up.
There is in-kind support, but it is down to personalities and individuals who are really passionate about young people in their community and it is not necessarily jointly funded. In Lambeth, we have some good examples of GPs working together with the youth workers, who are health specialists, but also with CAMHS, who recognise that to support young people with high levels of risk, you need to sit down together to support each other, but it is not funded or commissioned. It is people going above and beyond.
Again, there are child health hubs across the country with paediatricians, CAMHS, GPs, the voluntary sector, but it is not necessarily commissioned. I think that the integrated neighbourhood team approach will be an interesting one, but I do not think it has been fleshed out fully as to what that will look like in the landscape. That is where I would want to see the youth sector, youth workers in the community, working alongside health and education at a local neighbourhood level.
If we can find a way of ensuring the voluntary sector is not given small pots of funding to deliver a year at a time, or maybe 18 months at a time, if you are able to bring them in as innovation partners with the commissioners but also with the statutory organisations, I think you create a much better landscape for sustainable impact for young people in the community or neighbourhood where they are.
Jordan Letts: The only thing I will add—and I don’t want to just repeat what everyone else has said—is that on the contract lengths, it is hard to sustain workforce. We have commented on how hard it is to get people into the organisations; to then work on year-to-year contracts is incredibly challenging. It does not provide any reassurance or guarantee to the charities at all. In Northampton we have the Reach Collaborative. We are not part of that at this stage, but it is a very similar group of organisations. I love to see that because you do not want one organisation being foul of another one being really successful. I know that one of their pains is the longevity of contracts and not having the reassurance level of how long things will last.
We have talked a lot about this, but on integration between different points in the ecosystem, what have you seen that has worked well and has not? I will also add another question around accountability: how do we make sure that the accountability metrics are there to incentivise an integrated flow between different providers almost seamlessly to the user?
Jordan Letts: In our world, it is just making sure that connectivity is there with all services. At the start, it definitely was not. We have worked tirelessly to make sure that we have the progression routes embedded for young people and their families. We are starting to develop work more into families, because we have this big idea that children are with us for five hours a day, but what are they up to for the other 19 hours? Unless we can work with the children and families as a whole, are we going to solve some of these problems for the children and young people?
Our sector and work is relatively different to a lot of the guys here, but I think it is also building on where we see the gaps in services for children. We have targeted around half-term interventions and children being able to access something there, using either the free school meals programmes or looking at the integrated care board to fund CAMHS specific hubs. Our journey is encapsulated in that, making sure that the communication levels are there for children, but also for families, so that we offer a very clear service.
John Poyton: I absolutely agree with your premise that there should be no wrong door for young people and that young people should not have to learn how to navigate incredibly complex systems and services. This summer, we launched an alliance for like-minded organisations across the voluntary, health and education sectors and the policy space, those who are interested in adolescent health. It was interesting to find those delivering best practice in their communities across the country, but where they all have the same premise. They want to join up and ensure that there is no wrong door.
There are great examples of that happening but they are often isolated teams working with the young people, but without the opportunity to shout about it. Your question is great to raise that, as with this inquiry. In east London, there is amazing work between a housing association and GPs in the Health Spot, working with young people and meeting them. Down in Cornwall, there is amazing work between GPs developing their own well centre model with local social prescribers and youth workers. There is the project in Stockton-on-Tees called Footsteps, where GPs and youth workers are working together. There are absolutely organisations looking to ensure that it does not matter whether the young person reaches out and asks for help in the education setting or in the community, with their youth work organisations or in the health system. We have to ensure that there is a responsibility on us, as the adults in the room, to join up and collaborate together.
Arjan Bains: My thinking is that I want to avoid a framework dominated by intervention counts for assurance. I know I said this earlier, but if everybody was accountable for only their part, there is nobody accountable for the whole. When we look at a child’s journey, their outcome should be the thing that is judged on whether integration is happening; has there been steps up, stepping down, continuity; has the experience been positive for the family, even if there has needed to be a shift between organisational service? There needs to be a closer look at some of that data. That needs to drive improvement as well as just assurance.
Arjan Bains: Definitely, yes.
Michelle Hill: I totally agree with what everybody has said, but just to add, examples where it has worked well is where services are co-located, so it does not matter if the person is employed by the local authority or the school or voluntary sector. The young person just experiences that as an integrated team. That is harder to do than it sounds, because it has to be about a shared team culture. You should do things where the team works well together and it is about the focus on the child or young person. I think our best practice is where that happens and there is a real co-location.
Also things that make this work are where there is a real understanding of roles and remits, and a recognition that they are different. It is okay that they are different, but you need to understand and be clear on what those are, and that in the partnership working you are clear on the expectations. On accountability, for me where it has worked best is where there is some shared leadership. It is not just that teams, keyworkers and frontline staff are integrated, but there is a sharing of leadership and accountability for that across organisations. That often comes down to data and information sharing protocols. That is the non-sexy side of this, but it is important to make sure that it works.
To have shared systems as much as possible is important so that it is not around data being aligned to just one organisation, it is around what works for the young person and the family. That is where it works best. I think through all of that is the importance of shared values and saying, as a partnership, these are the values that we are working to and this is what we are going to do about the tricky conversations, because there are always going to be tricky conversations in partnership.
On the alliance contracts, we were always clear that the trickiest conversations were around money, and we had an agreement that we would never do that offline or out of the room in side conversations. We always took an approach to open-book accounting as a partnership. That is a real challenge to do when people account forecast recovery differently, people’s pension processes are different, people’s salaries are different.
It was being able to model some of those difficult conversations that meant the partnership was around the people we were there to serve, not about ourselves as organisations. I think there are a few mechanisms that we can put in around shared systems, open-book accounting, shared leadership, information sharing, that make integration much more straightforward and successful.
Michelle Hill: We have. We are very fortunate in that it is a partnership that has been working for 10 years. It is not children and young people specific; it is across the whole population, so that also helps. Across the organisations, there is an information sharing agreement that has been in place and refined over multiple years. That means that we are focused on the population that we are serving. It is also an equal pain and gain share mechanism, so we are only as successful as the partnership.
There is no direct relation to each individual organisation, and we leave our organisational hats at the door. That is an important mechanism; in that partnership we are only as successful as the alliance is. Whatever TLC contributes is great, but TLC will never be front and centre of that partnership, and neither should it, because the partnership is there for the people we serve. It has been a good example, but it has been 10 years in the making with some very difficult conversations along the way.
Jordan Letts: Talking for myself, we have to learn more about what that journey is. We have to understand how that works in reality. Sometimes big things are changed, and you do not know how the process is going to work until you are further down the line. It is an exciting time for us when we look at neighbourhood teams as well, especially in Northampton where we are sat. There is a big opportunity around the neighbourhood teams to support people on the ground. I know that a lot of charities are more national or are on a larger scale, but our focus is on that. I think it is going to provide more opportunity to us.
Michelle Hill: Our experience is the same and different. We are an organisation that started in Manchester, grew across the north-west, and has then grown across the country. I think the changes with ICBs is both an opportunity and a challenge. It is a real challenge in the fact that commissioners, who often knew the work really well, have sometimes had to move on, so you are having to rebuild relationships with people who are very new to the sector and the role.
I also think the neighbourhood approach is great in lots of ways but is challenging for organisations that work across neighbourhoods. In Greater Manchester, we work in all 10 local authorities. Each local authority is made up of lots of different neighbourhoods. That is an awfully high number of meetings that we need to sit in to make sure that we are getting a voice at the table for relational support for children and young people.
That takes a lot of infrastructure, so there is then a challenge about how you build the infrastructure to be able to engage in those communications and meetings, when the majority of your time should be spent on doing frontline delivery. The changes that are happening are a challenge and an opportunity.
John Poyton: I certainly concur that it is a huge challenge. I have a long list of passionate GP champions for young people in their communities or neighbourhoods who really want to partner with the voluntary sector youth work organisations on their doorstep, and they struggle to find the funding, whether that is because the ICBs have had to make huge cuts and merge or because the integrated neighbourhood team funding has not yet rolled out.
I think there are great opportunities to create local best practice. There is the will on the ground, but you are quite right that the funding is not necessarily there yet. That is where general practice needs to be joined up with CAMHS commissioners and local authorities to ensure that we create a much better web to catch young people who are otherwise falling through the net.
Arjan Bains: I do not have much more to add. I agree that there is certainly challenge from the relationships with our commissioners with the uncertainty in some of those changes, but we see some positives. The Government’s commitment to 100% roll-out of MHSTs gives some assurance, at least for the longevity of MHSTs, and it certainly provides a bit of a drive in making sure that delivery is of quality.
Michelle Hill: As an organisation, we are incredibly supportive of the Government’s position on social media. For us, it is working through how we work with young people who are maybe 14 to 16 now and already using social media, seeing things, and having reactions to what that might mean for them and their phone use in the future, but also for us, particularly the work that we do with children and young people affected by domestic abuse. It is talking to young people about how social media may play out in the relationships they have, what is healthy and not healthy, and how they present themselves online.
I am thinking about things that are common language now for young people. The use of Snap Map is an example to be able to trace where young people are, or the filters that are shared through Snapchat, or the Snapstreaks that people want to have. There is a whole point of education that needs to happen with young people that we are having to put into all of our programmes in a slightly different way, to keep young people safe but also to think through how they manage that themselves, what the relationship is with parents and carers, what do they do when they see stuff they don’t want to see? Maybe they feel that they do want to see it, but it opens up conversations they did not think they need to have.
The use of social media has to be completely integrated into all of our programmes now, and I suspect will be for the future, to be honest.
Arjan Bains: I think phone use and social media is certainly becoming a very important factor in the emotional health and wellbeing landscape. For delivery at Compass, some of the work we have had our peer and health relationship practitioners do is around the self-regulation of phone use. Where children have upskilled in being able to self-regulate their phone use, we are able to see some positive association in their wellbeing on that.
Technology could potentially remove friction in a lot of ways, but I think there would be a bit more nuance around social media necessarily being attributed to poor mental wellbeing. We see a lot of young people now find support and connection through online communities. Those elements could be advocated for, but there are elements around digital resilience and safety with harmful materials. Those are things that schools, practitioners and professionals need to ensure young people are upskilled in the harmful elements of social media.
John Poyton: Certainly the ban removes harm, but it does not necessarily add a layer of support. I think that we still have to focus on what the support mechanism is for young people if a ban is coming in and that harm is removed. Those young people still need support. My concern is that we will not know until this happens, but are we at risk of creating a further vulnerable transition?
We have talked about year 6 to year 7; do we then find that we need to put more support in place for young people once they become 16 or 17 and then what is that digital resilience, how have we supported them, particularly at a time when—whether it is the health system or elsewhere, with adults there has been a real pivot to look at digital offerings for support, advice, guidance and the like. I support the ban, but I am very interested in what that support looks like for those young people.
John Poyton: Again, I think we have to ensure that we do not assume that a ban takes away exploitation and vulnerabilities. The Well Centre model is about ensuring there is a trusted adult or support for the young person to reach out when they ask and have a concern and ensure that they do not have to work out what door to go through.
I am very happy to write a little bit further, but I think exploitation, whether it is from peers or adults, is going to then pivot and find other ways. We need to make sure that young people have the opportunity to reach out to trusted adults either way, because we will undoubtedly see a pivot in the way that young people’s communities are exploited in future.
Jordan Letts: I completely support it as well. For me, it is how we are going to work with young people who this is going to affect quite significantly. A number of children use this as a platform to communicate with one another. It is probably not the right way to look at it that everything on there is bad. Sometimes communicating with family and friends is something that children need to be able to do, so it is how we can advocate for them doing that in a safe manner and also support children with what that looks like in relationships and positive relationships.
Michelle Hill: What I am going say is not surprising. As an organisation that runs lots of programmes for children affected by domestic abuse, we were surprised that that was not more prominent. There was a real gap in the work that we do with children and young people affected by domestic abuse, the trauma that they experience, and also how that shows up in the long term for them, not just at the point that they experience the trauma but how that experience can be retraumatising as they go through adolescence, and when they start relationships themselves for the first time. The role of trauma and vicarious trauma is important to pick up through this work.
Arjan Bains: I agree with Michelle. There is an intersection of trauma with other aspects of mental health and emotional wellbeing. I think that was not as broadly explored as we would have liked, and it certainly has an impact on functioning, particularly with young people as they progress through some of those transition periods. It is early identification in trauma informed practice, awareness and practice. Organisations need to be more trauma informed about how their services are delivered to children, young people, families and their interactions with parents and schools. There is certainly a lot more work to do in that and we hoped the report would support further improvements in this area.
John Poyton: I suppose even at 600 pages, the report was going to have gaps. Like I say, I was very pleased that it referenced the Well Centre along with other opportunities for best practice. I think it did identify that it cannot be down to diagnosis and CAMHS services meeting the needs of young people. It referenced that general practice needs to be part of the picture. This is the universally accessible place on the doorstep where young people live.
John Poyton: No.
Jordan Letts: No, I do not have anything to add, other than what has been said already.
Michelle Hill: I think that no wrong door is one of those things that is easy to say. Fundamentally most people will agree that you want somebody to access support. You want them to be able to go anywhere to get that support. Having the systems and infrastructure behind that to enable it to work is much more complex. There is a really important role for the specialist voluntary community sector in that, but to do that it needs to be funded. This is a point that Arjan mentioned before. It cannot be that it is just goodwill that enables that to happen; it has to be something that is designed in as part of the system. Having the voice of the voluntary community sector from the very beginning of designing solutions is critical.
Arjan Bains: We cannot have diagnosis be the price of entry. Where we are seeing more complexity, there needs to be capability within the service and our workforce. That requires investment and continued professional development. Some of the learnings around being able to locally bring in specialist expertise, put them into the right place where the needs are, are that that is a challenge and there needs to be autonomy within services to be able to do that. That is the most consistent learning that we had, building up capability and making sure that is at the point of need.
John Poyton: There just needs to be more support for young people, either while they are waiting for diagnosis or to support them either side of that, whether they need a diagnosis or not. That needs to be joined up across health, education and in the community.
Jordan Letts: The only point that has not been mentioned is on looking at what will follow this. I see it as quite an exciting opportunity for organisations to hopefully pilot programmes but also look at multi-year funding as an opportunity off the back of it. I think it is fine highlighting these challenges and issues, but what are we going to do about it? What will be the delivery mechanisms that make change for young people? I am excited to be part of that, but also to make sure we are consulted locally as well.
Michelle Hill: For this I would recommend what the review says. It is important that they are co-partners, but I think that is around trying to be as much of a level footing as possible. That is talking to the sector at the beginning when design is happening, including the sector in bold, collaborative commissioning with shared targets, longer-term contracts. It is the sector having a role in strategy as well as delivery, and also accountability. It is shared accountability, systems, reporting and leadership.
Michelle Hill: It can be a risk, but it can be well mitigated if it is done well. It is an adult-to-adult relationship between the voluntary sector and the statutory sector. It is understanding the full cost of recovery that the sector needs to be able to participate. If you need a leader around the table, that needs to be part of it. It is understanding that the sector has a specialist voice and knowledge and is often a really good way of engaging with children and young people. As long as all those things are brought to the table and discussed openly, it can be done as a successful partnership.
Michelle Hill: I think there is a lot to be said for that. The sector has some real specialism and a route into communities, and that being on equal footing with established ICBs—I am on the board of the alternative provider collaborative in Greater Manchester, which is social enterprise organisations coming together to have a different provider collaborative that is not statutory provided, just because of the sheer reach of people we have across the sector. There is a lot to be said for making that more formal.
Michelle Hill: I think so. It was something that was in favour a few years ago and if done well, it has real benefit. The key difference for me has been the changing of the relationship between the different parts of the sector, and the fact that the focus is all on what we are trying to achieve and not the organisational boundaries that we come with. It recognises that we have to learn and respect those, but the focus is on the future.
John Poyton: The voluntary sector is often at the provider end of the transaction. There are different, more innovative ways to deliver procurement. Procurement for the voluntary sector is often done in exactly the same way as an organisation might buy soap or toilet rolls. That is not the way to bring the voluntary sector into a commissioning relationship as an innovation partner, often the organisation in the community that understands it and the young people best. It is not about putting the responsibility on their shoulders and taking it away from those holding statutory responsibility. I agree with your point that it is about shared responsibility, being in it collectively together, not just funding the voluntary sector often too little without full cost recovery and not bringing them on board as the innovation partner.
Arjan Bains: Yes. I think alongside that expansion, we certainly need to scale workforce capability in those areas. I am thinking about the EMHP workforce that go to university, learn the trade of mild to moderate interventions. I do not think they will be as fully equipped as they could be to deliver quality outcomes in special schools without being able to make the adaptations necessary, having the expertise in clinical infrastructure and oversight for them to work. I agree with further investment in capability.
Arjan Bains: There are clear vulnerabilities that happen in special schools, and needs that could be met. We know that there is a variation of needs across schools. When we looked at some of the data in Birmingham, there were five secondary schools that had over 20% in the low wellbeing group. There needs to be local flexibility in the allocation of staff capacity and understanding. Some of the complexity of cases requires a little bit more time and oversight. There would potentially be a drift towards the more complex and moderate cases.
John Poyton: I am going to jump in and say that it cannot be about putting more responsibility on an isolated workforce of brilliant children’s wellbeing practitioners. It has to be about creating multidisciplinary teams. You have to have CAMHS and GPs working alongside youth workers, CWPs or health and wellbeing practitioners to ensure that young people get the support that they need, but also the workforce are not holding undue risk and responsibility.
Jordan Letts: Personally, in our example, it is. I am not speaking on behalf of everyone, but in the provision that we have, there is open communication. There was not at the start, but we have been on that journey around learnings, so we have definitely seen a positive turn.
Michelle Hill: I think it is different in different parts of the country. With different restructures that are under way, understandably there is sometimes a focus on dealing with restructuring and reorganisation that means in some areas it is more difficult to get people around the table. There are some great examples of great practice; there are also some areas where multiagency work is deprioritised, understandably but with a loss to the community.
John Poyton: We are really pleased to be working with King’s College London’s CAMHS Digital Lab. Professor Johnny Downs and his team have their myHealthE platform that looks at supporting those on CAMHS waiting lists and ensuring that there is much greater support available. I am very happy to write to the panel, because I know we are short on time, but certainly that collaboration—and then being able to look at the data and where the young people are missing on the radar. The risk with digital solutions is obviously if we are looking at phone bans and the like, what is put in place digitally, as we said before, that young people maybe then are not able to access.
Josh Fenton-Glynn: Yes, that is a good point. Thank you. I can see Michelle wants to jump in.
Michelle Hill: I will be really quick. Just with a slightly different hat on, I am part of the national Charity AI Task Force and also chair the large charity AI subgroup. It is a group of organisations across the country working to use AI-enabled tools to make things more efficient. The focus there is on efficiency and leanness, rather than on direct delivery of clinical interventions, but what that is enabling is that we put more time into things that have to be humancentric. As a relationships charity, the importance of relationships in this, people to people, is important. Using AI is brilliant, but it has to be done ethically and from a humancentric point of view.
Josh Fenton-Glynn: I think fundamentally, if we get AI right, it frees up time for people to have relationships rather than tries to manage relationships.
Michelle Hill: Thank you, I will pick two. First, around the formal integration of the voluntary and community sector from design in solutions around mental health in children and young people. Second, that services meet young people where they are now and recognising that the sector often is where those young people engage.
Arjan Bains: I think prevention and early intervention, sustained upstream investment in that area. Not only further investment but how it is delivered is important; model fidelity does not necessarily mean model uniformity. The second part of that is scale what works and not necessarily what is easiest to standardise. As Michelle said, trying to end those cliff edges, the integration between shared early help, community provision and specialist CAMHS.
John Poyton: The two things that I would want included in the mental health strategy before Christmas is a real focus on the workforce development of youth workers who can work with one foot in the community and one foot in the health system, particularly primary care. It is not waiting for young people to reach a crisis point and end up on a CAMHS waiting list. Also, I think it is absolutely crucial that general practice is commissioned to focus on young people and not just pass them from pillar to post or refer them on to specialist services, so that young people can be held and supported by a multidisciplinary team in their neighbourhood.
Jordan Letts: My one that is different to that is to focus on transition, looking at what that looks like in reality, and then what can be done about it, targeting that 16-plus population.
Chair: Thank you so much. It has been really fascinating for the Committees this morning to hear about your work and the results you are delivering for children and young people, and about the systems and models that underpin that.
We have been short on time; we are always short on time. If there was anything that you were not able to get across to the Committees in the time that we had this morning, please write to us afterwards. We very much welcome that. That brings our session for this morning to a close.