At our December board meeting, we were able to welcome our two newest Board members, Dr Nicky Williams and Dr Jonathan Chappell. It was a packed agenda, including some important items that we needed to have in depth discussion about.

Our child and adolescent mental health service (CAMHS) was the first topic under discussion. We are adopting a new model for our service; the model is based on best practice and has been nationally recognised as best in class. Any discussion of young people in Wandsworth has to recognise that ours is a borough of differences. Autistic spectrum disorder is the most common diagnosis in Wandsworth.
We have more children in poverty than the national average and poorer children are three times more likely to have mental health issues. The figures don’t stop there. We also have more than the national average of children leaving in homeless households and double the London average of children under 20 excluded from school. One in 10 children are likely to have a mental health episode by the time they are 16.

Our child and adolescent mental health services are commissioned jointly between the CCG, Wandsworth Borough Council and NHS England. The service features four tiers of care which recognise the needs of young people with different conditions and at different stages in their life. The family GP service is the first tier; tier two is centred on schools and community; tier 3 involves hospital and community services for people with moderate to severe mental health problems and then tier four covers highly specialised services.

We have been trying to improve services over the last few years to make the pathway better and simpler for children and young people. Everyone gets referred to and triaged by a tier 2 service; this change has helped to improve access and waiting times into tier 2 and tier 3. We are also extending the service to cover everyone age 0-25, so that young adults do not miss out on key services, particularly looked after children, children leaving care and young offenders. You can read more about the priority areas and how we are going to address these in our board report: Wandsworth children and young people mental health strategy 2014-16.

Next Sandra Iskander, our Director of Corporate Affairs, Performance & Quality presented a board paper on system resilience in winter. The start of winter always signals problems for emergency, urgent care and out of hours services. We have funded a number of tried and tested services to cover the winter period to improve and increase the capacity in services facing increased demand over winter. We've also commissioned reports to look at how and why people visit A&E and how we can improve discharging people from A&E.

St George's provides care to patients who are very seriously ill. Some of the cases are attributed to the new helipad and its status as both a major trauma unit and a stroke centre. And quite simply, like other London hospitals, St George’s A&E is having to cope with more and more people coming through its doors.

There is a lot of information that we already know about people attending A&E. We need staffing to be more carefully monitored on winter wards and we also need more specialists, as the wait for medical opinions and diagnoses is one barrier to moving patients on within the hospital. Last year, Wandsworth was the number one borough for discharging patients effectively. We recognise that we have to work extra hard this year to discharge patients locally and we continue to work closely with our hospitals and community services to ensure patients have the support they need upon discharge. The board also discussed how patients expect to be seen quicker and in a more convenient way. In response, we have invested in opening GP surgeries for longer hours so people can see a GP.

Finally, there are huge changes on the horizon for how primary care will be commissioned and delivered. CCGs have the opportunity to join NHSE and co-commission primary care in the future. We have been talking to GPs across the borough to develop a vision for how we want services delivered in the future, and how we want to work with NHSE to improve primary care. Our members felt that we are ready to start joint commissioning with NHSE and then look at working towards delegated commissioning in the future. We will need to make changes to our constitution quite quickly if we are going to be able to push forward with this. The board decided to pursue joint commissioning in the first instance, subject to finances and the allocation we are given from NHS England. In the New Year, we plan to talk to patients and get their feedback around the co-commissioning agenda.

Next, Carol Varlaam, our lay member on the board for patient and public involvement, talked about how the proposals put forward by the South West London Collaborative Commissioning are being scrutinised by a large and committed patient and pubic engagement group, of which Carol is a member. You can read about the SWLCC case for change here. Carol talked about the need to disseminate information about why we need change across South West London, and not just Wandsworth – we were all in agreement with Carol.

We covered quite a lot of ground in our end of year meeting. We also had some questions from the public; we aim to answer all questions and post them on our website alongside our board papers here.

Have a restful break,

Nicola