Children and young people – reducing self-harm
We know that across South West London (SWL) we have a high number of children who are self-harming, and we want both to address and prevent this by developing consistent wellbeing support and early intervention. During summer 2018 we engaged children and young people and parents and carers, as well as teachers and schools to examine root causes of self-harm and poor emotional wellbeing, as well as to test potential solutions. In Richmond we heard from 128 children and young people, 341 parents and carers and 20 teachers.
Parents told us “We are desperate for help and we don’t know where to go.”
Children and young people told us “Groups are great because they help you feel more accepted and less likely to take frustrations about loneliness out on yourself”
“You can focus on friendships within activities”
Teachers told us “A lot of teachers are really lacking confidence when it comes to addressing or talking about mental health issues with children and young people. Improving their awareness and confidence (as well as their own wellbeing.”
We are doing
What we heard very clearly was that, whatever improvements are made, children and young people, their parents and carers and teachers need to be further involved.
We are developing an online list of services which shows the support available in our Borough.
We are developing a whole school approach which provides support to children outside of a medical environment
We are working closely with a group of schools to develop a whole school approach and to deliver mental health and wellbeing training to teachers and staff.
Parents of children with special educational needs and disabilities (SEND) living in North Barnes – Summer 2018
Castelnau Community Centre feedback to the CCG about the difficulties local patients were facing: “It’s really difficult for us to access support in this area, and we really need it.”
Working with the community centre and a local SEND charity, we have set up a parents’ co-production and information group. This will help the CCG to understand the difficulties facing parents so we can shape our services to work for people living in this part of the borough
The CCG ran an 8 week consultation between February and April 2017 on the following proposals for IVF and ICSI services Option 1 – No further change to existing service (women aged under 39 who do not have children and are in a long term relationship could continue to have one fresh and one frozen cycle of IVF on the NHS) and Option 2 – Change the access criteria for IVF so that it is funded in limited circumstances only (patients would need to meet the criteria in option 1 AND demonstrate exceptional clinical circumstances such as infertility following cancer treatment, or prevention of the transmission of chronic viral infections, such as HIV)
We listened to the views of patients, and to the Assisted Conception Unit at Kingston Hospital who advised that access should be based on clinical evidence associated with successful outcomes of fertility.
Many respondents suggested that the CCG consider other options, or further restrict the current eligibility criteria to maintain a level of IVF services in the borough. This option was also supported in discussions with the Assisted Conception Unit at Kingston Hospital who suggested that access should be based on clinical evidence associated with successful outcomes of fertility.
We listened to the views of local people and health professionals and agreed a third option, adding the following eligibility criteria to the current policy:
- No previous self-funded cycles of IVF
- Reduce the IVF age to <39 (the evidence shows that successful outcomes reduce with age)
- Reduce access to people with an AMH level of <5.4pmol/l (this is an indicator of fertility and below this level there is less likelihood of success).
The CCG has a substantial financial challenge and we have a duty to spend our funding wisely.
During 2017, we asked local people, for their views on proposals to change the access criteria to IVF (In Vitro Fertilisation) so that cycles are offered ‘on an exception only’ basis; to review prescribing of gluten free foods, vitamin D, baby milk and self-care medications which are now widely available at a reasonably low cost, both online and in local shops; for GPs to help encourage patients who smoke or have excess weight to make some lifestyle changes before they have surgery.
“There is a difference between lactose intolerance and cow’s milk protein allergy (CMPA). Children being misdiagnosed or delayed diagnosis puts a huge strain on the child and on the whole family. Specialists formulas are very expensive and will have a huge impact on low income families or vulnerable mothers.”
“The NHS shouldn’t be prescribing medication which is easily available over the counter for low costs, however there should be some exemptions for some older people, children and those on low income if it makes it difficult for them to manage their condition.”
“GPs should offer support to people who want to lose weight and give up smoking and make sure they are in good health before they have surgery, but surgery shouldn’t be refused to people who find it hard to lose weight or stop smoking. No one should be treated as a second-class citizen by the NHS and some health conditions make it hard to lose weight.”
“These proposals could lead to longer term costs due to the emotional and mental health impact on individuals and the knock-on effect onto primary care. Although this is only a small number of people, it has a significant impact on this group and their mental health can be impacted further by not being able to access NHS treatment. This will also impact more on people in lower income groups.”
We took the decision that gluten free food, vitamin D and self-care medications such as antihistamines and paracetamol will no longer be routinely prescribed. In response to the feedback on CMPA we will continue to support prescribing baby milk where appropriate with improved guidelines and education for GPs and other healthcare professionals.
Rather than making it a condition of having surgery, we agreed that GPs should encourage and support patients to be in the best health possible before surgery so that they will have the best outcomes.
Due to the potential significant impact of the IVF and ICSI proposals we decided to undertake an eight-week consultation on these proposals between February and April 2017.