Education Committee and Health and Social Care Committee

Tuesday 27th October 2026

(began 2 weeks ago)

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10:02
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None Portrait Speaker 1
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Thank you.
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None Portrait Speaker 2
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Yeah. Thank you. So I'll just tell you a little bit more about TLC. So we're a relationships charity. So I suppose principally what that means is that we believe that every child and adult needs to be surrounded by a circle of safe, healthy, happy relationships. So 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. So all of our services across the country fall about that kind of belief in safe, healthy, happy relationships, but particularly around children and young people's mental health.

We do a range of deliver a range of services. So lots of counselling and therapy services, so predominantly for children and young people affected by domestic abuse. So either children and young people affected by domestic abuse in their own right as victims living in homes where there's domestic abuse or where they're starting to use harm in their own relationships, either against parents and carers or against intimate partners in relationships. We also, and for that will be providing counseling and 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, so that will be providing support for the children, young people themselves in school, but also for the wider parents and wider family around their young people's engagement in school, and also providing support as part of a whole school approach.

 So working with the teachers themselves. So that might be providing training for teachers, psychoeducation programs or providing clinical supervision for teachers. And then the final set of services that we deliver is a crisis mental health service called Safe Zones, which we deliver in Stockport. And that's for young people who have been assessed as not being bad enough to need support through the Cam service. There's a five year waiting list in the local area for Cam services, and actually that's 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.

 So that's the kind of range of services that we deliver in terms of the trends that we're seeing, I would say, and we're seeing increased demand and increased complexity of need in terms of what's coming through to us. And we're also seeing a change in that. Lots of parents and carers are really keen to get a diagnosis for children and young people. And actually what we're seeing is the kind of the need for services prior to diagnosis. And the diagnosis isn't the kind of shouldn't be the end goal for the child or young person. It's around putting support around them in terms of what they need as an individual rather than waiting for that diagnosis.

 And I would say that's a very specific change in the last couple of years in terms of what people, young people and children are coming to us with. Predominantly, that's around anxiety. It's showing up in lots of different ways. So different if they're living in a home where there's domestic abuse. And obviously you can understand what that anxiety would be around trauma, but it's also young people at the point of transition from primary to secondary, young people struggling with the impact of social media and what that means in terms of their friendship groups, but a real increase in anxiety in terms of how young people are presenting as well.
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None Portrait Speaker 1
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Thank you.
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None Portrait Speaker 3
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Yeah. So I we deliver mental health support teams and some other emotional wellbeing services. MHSTI think you may have heard before, we deliver on three core functions primarily is direct intervention. So that's our low intensity cognitive behaviour therapy whole school approach and advice and liaison. So primarily the NHS T functions within schools. So there's a really clear partnership work that happens within schools to embed the mental health expertise that come from MH t into the school context. So there's also an interlinked with specialist Camhs community providers. That's something that we've we've been really keen on developing further in terms of the, you know, the integration with the community to provision MH t works in terms of providing some of that expertise and whole school approach really is the prevention arm of, you know, enabling schools and mental health practitioners to really deliver some of that preventative work before a child or a young person becomes a referral.

 So the, the direct interventions, you know, that one of our kind of primary presenting needs is managing emotions and anxiety that's fairly prevalent and consistent across all our services. But children and young people don't often neatly fit within that. I think in terms of need, we see quite a lot of intersect in terms of both high and increasing demand, but often send neurodevelopmental needs, often their safeguarding trauma and family circumstances. And some of those need varies between schools. We see often maybe schools have really quite good provision in terms of mental health and wellbeing, and where we try to allocate resource is through our whole school approach, our audit process to really make sure we're really following the need rather than having need, rather than having children and young people try and fit within the system.

 So I think that kind of encapsulates what we do. Thank you.
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None Portrait Speaker 4
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So the well centres, as I said, is, 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 the the service model has been tried and tested in building an evidence base over the last 15 years in Lambeth and Wandsworth, and shows that it is able to engage with young people who. Who now. From recent reports like the the Fonagy review and so on, sort of calling the missing middle. Those young people who are often falling between the gaps of waiting lists for Camhs and not getting access to other services while they're on those waiting lists.

And so the well centre model is, is, you know, simple in that it is about joining up and integrating the ecosystem of support for young people much more clearly at a neighbourhood level, those youth workers that are trained up to be health specialists, part of this multidisciplinary team, are able to work with a much sort of greater risk, as it were, of, of, of the young people because they're working closely with GPS, but also with the Camhs teams, GPS, who, although they're not necessarily incentivized to focus on adolescents in their general typical sort of day to day work, have a real passion for young people in their community, and the team recognise that at that community level, if you engage with young people and young people's health now, then it creates this triple dividend return in that community and also a financial sense at the big picture policy level, because you're able to support the young people right here and right now.

 General practice is where we particularly embed the teams, because you're then able to focus on what the young people's concerns are, rather than just a specialist mental health only focus. The young people might also be concerned about their physical health, their sexual health, and so on. And so, yeah, that triple dividend return is a real focus for the team and for that community in healthier young people, healthier adults, and healthier children in turn. The model is, is again, a we're seeing in Lambeth alone, around 1000 young people coming through and referred each year. And that's due to the capacity.

 If if there was a wider focus on this integrated workforce, then there would be more young people to be seen. But it's about integrating with all of the other best practice in a community. So mental health in schools, teams, as Arjun's referenced, you know, everyone is doing amazing work and there are case studies of great practices that undoubtedly you've seen in your evidence, but often it's working in silos. And the health and wellbeing practitioner, this youth worker and health specialist is able to meet the young people where they're at, but also walk alongside them, whether that's in school or whether that's a young person who is avoiding school, they're able to see them in the home or in the community, in a cafe or a youth centre.

 And so that's the well centre model. It is meeting the needs locally around mental health currently. But actually when we started teenage pregnancy, sexual health concerns were some of the trends that were being seen in the adolescent cohort. And then obviously, we've seen violence and violence affecting young people being other trends as, as it were, that are affecting young people in our communities. And so the Well centre model is able to pivot to meet the needs of those young people and do it in a way that meets the needs of that missing middle cohort, who otherwise are often on the radar but not getting the support.
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None Portrait Speaker 1
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Thank you Jordan.
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None Portrait Speaker 5
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Lexi probably runs on really well from from John's talk there actually, because the missing middle is exactly where our services are based. We're directly not a clinical offering outward service. But I think when we look at sports based charities, you really have that brand attachment with the club. So automatically adds a bit of an engagement tool for young people. It acts as a motivator. We have numerous programs ranging across education, employability, health and wellbeing, and the whole model of what we try to achieve within them is a trend around looking at the complexity of the level that they're 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 incredibly close with Camhs locally through our engage programme. Engage is a program that supports children on the brink of exclusion or children that are struggling with their attendance. So we have a lot of children that access our provision, who are students who are mostly based school avoiders, and we look to them for a wraparound care around them and their family to make sure they're supported with the next steps into the community. Some of the trends that we see, it's really difficult.

 I think it's very place based, but the direct issues is around anxiety, school children struggling to even step foot in a school and that kind of, I suppose, making sure that we are providing that opportunity to the young people to really break down that step. So it doesn't seem so overwhelming when education is staring you in the face.
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None Portrait Speaker 2
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Yeah. Thank you. I mean, I suppose we absolutely believe that prevention is absolutely key and then intervening early. So trying to get to the stage that you're working with and supporting children and young people before they get to crisis. And we talk about all that. You know, we all talk about that all the time. And I think we've kind of won the battle on the fact that that's what we should be doing. But actually, unfortunately, it still isn't what's happening. And actually the majority of resources are still going to crisis interventions. So for us, things that have been most successful is where we've done work with schools and community groups, which is around a whole school partnership.

 So that's not just around offering intervention in school, but it is around doing assemblies, doing education programmes, working with the teachers, with the headteachers, and then offering interventions for young people. So it's actually, as a charity being completely integrated and embedded in that school environment. So we've got a couple of schools that I can think of where we've been in partnership with them for 5 or 6 years or maybe longer now. And actually we're seen as an embedded part of that school community and all of that destigmatizes that child or young person getting support, actually, that support is in school when they need it.

 They're not. It's about meeting young people where they are. I think the other key thing for us is not forgetting the support that needs to happen at home. So that actually, for young people going back into homes, the relationship with parents and carers and siblings is absolutely key. And actually, we've got to kind of hold the balance between we understand the confidentiality that young people need in terms of if they're accessing counselling, professional or therapy, but we also have to put support in for parents and carers. And again, if I think of an example that we've delivered in Salford, we've delivered over a number of years called this Healthy Schools Partnership that was doing exactly that.

It was that kind of whole school approach to the the school itself, support for individual children and young people, and also support for parents and carers, particularly thinking about that transition from primary to secondary. And I think all of that was focused on helping children, young people and parents support developing mental health challenges before they needed crisis intervention. So actually it was all about intervening early, but also giving children, young people the kind of coping mechanisms and parents and carers, the coping mechanisms that they can go back to. The other example, just that I'd pick up is, is actually a crisis intervention, which is safe zones.

 So, and it might feel strange to talk about crisis when the questions about prevention. But the key thing for that is really about the ability for children and young people to refer back in. So we've currently got, I think, 30 children and young people who've accessed the intervention and have gone away and are living their life. Maybe suicidal ideation is better, self-harm is better. They're engaging back in education and something happens in their life, which triggers to say, actually, we need some more support rather than having to start the process again, they can just refer back in and get and get support again to kind of get what they need.

 And I think that's also around it's not just the initial intervention, it's about how you stay the journey with the young person and parent and carer for as long as you need. So, so I think that's, that's the other element. I think sometimes we do simplify it or oversimplify it by thinking it's just about moving things from crisis to to early intervention. It's actually about sticking with young people for the journey for as long as you need, and actually also recognising that young people, like all of us, don't fit in a box. So actually, six sessions won't be enough for some young people.

 That might be what some need, but that opportunity to come back when they need it is really important. So I think that's a key thing I'd highlight.
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None Portrait Speaker 7
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Thank you.
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None Portrait Speaker 7
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Thank you John.
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None Portrait Speaker 4
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With the well centre model, I mean, we're looking deliberately looking at embedding that into general practice because it's right there in the heart of the community. You know, mental health in schools. Teams are absolutely brilliant at what they do. And there's but there's 3000, three and a half how many 3000 ish secondary schools in England. There's 6500, 7000 GP practices. And so what I'm really interested in is shifting the dial, as it were, and making general practice much more accessible to young people, in which case it needs a more youth friendly front door. The world centre has got this evidence base of proving that it can do early intervention and meet young people where they're at, with their families, with their parents or or on their own or with their friends, and can do that early intervention.

But also importantly, when if young people have been in crisis, as Michelle says, when they are back home, whether they've ended up in the emergency department, whether they've ended up in police custody or in the youth offending institutions, you know, all of these different crisis places, young people might end up with an underlying mental health condition. When they come back home. They're back on the doorstep of general practice. General practice currently is not a particularly youth friendly like shop window, as it were, if we're using that analogy. But by embedding this youth work health specialist workforce, there's a eminently scalable model to support every single constituency that has general practice within it to meet the young people upstream preventatively, but also downstream to reduce the likelihood of.

 Re re traumatization and crisis. So that's where we're looking at prevention . Upstream. General practice, again, are often seeing parents and children when they're worried and concerned. And but those young people often then don't understand how to sort of engage and navigate a pretty complex system. So I think what we're seeing is there's some pretty small incremental shifts to improve that access. And with a with a greater youth friendly workforce of youth work in general practice means that in essence, you're opening the door and allowing young people to come in.
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None Portrait Speaker 4
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Yeah. No you're quite right. And so the reason that we set up the charity with the strategy to look at scaling best practice is, is from our evidence base in Lambeth, where by embedding youth workers that are trained to work as a multidisciplinary team means you don't have to just then suddenly send those young people from pillar to post general practice. You're right. Currently, it's not about putting more weight or responsibility on the shoulders of GPS, who are obviously working to support the whole population. It's about recognising there's an opportunity, rather than just signposting or referring that young person, or telling them to self refer or refer them to Camhs, and then then being on a 2 or 3 year waiting list.

 It's about recognising that there's an opportunity to partner with the the youth sector. There are plenty of youth organisations again, in the community, but it's the fact that those are often not collaborations or partnerships that are created. The reason that I set up the Well Centre charity is to take a model that has an evidence base that is quoted in the recent Fonagy review on page 421, if that's helpful, to show that you can actually have a model. That means when a young person comes through and sees their GP, they actually scaffold the trust that they've built in getting to understand the young person's needs to their colleague, their youth worker, their health and wellbeing practitioner, rather than then in one sense, young people often feel a referral is a sense of rejection because they're told you're too big a deal.

 You need to go somewhere else to see an expert. And actually, that can be done in a community, in a neighborhood. 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. And it prevents that. Yeah, unhelpful referral pathway.
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None Portrait Speaker 7
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Jonathan.
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None Portrait Speaker 5
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Thank you. So I would say for our organisation, early means different to a lot of people. We've taken a real focus of actually going into primary schools and working with young people before situations escalate. I think a lot of the time we look at early intervention as a prevention of spend further down the line, but the reality of that is actually young people can be supported in a different way. Engage is a prime example of that. It's children who are based on Camhs waiting list, and they then come to us for support. That support can be as small as youth work, actually, mentorship, assisting young people onto that next step of what they want in life.

 And the majority of those children that we had last year in that provision no longer needed the support of Camhs. So they were actually taken off Camhs waiting lists as a result of the work that we did with them. It wasn't rocket science. It was ultimately giving children an opportunity, not putting in an hour intervention around a therapy session or a counselling session, but actually 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 actually feel part of something. For me, belonging, accountability for children is a huge thing, and I think when children actually feel that in an organisation and want to see the support that's going to be given outwards, children naturally, then then can see that.

 Obviously for some that isn't the case and they do need additional support. But I think our provision is a real easy way to actually shortlist those children that need that additional support, and those children who potentially can come off that waiting list.
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None Portrait Speaker 7
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Thank you.
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None Portrait Speaker 4
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I mean, I think that there's it's timely. There's, you know, there's a reports and reviews coming out, you know, sort of with the recent ADHD and autism Review. And obviously we're all, I'm sure, eagerly awaiting the Melbourne review and focus on, on needs after the budget. Undoubtedly. I think that all of the 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. There is an ecosystem of support. Those young people are are known to their GPS, at least registered with whether they've been seen for a while.

And obviously there's schools, there's the voluntary sector, there is the youth justice system, like you say , again, the youth work model that sort of intersects across the the all of the experts that you have on the panel today is a really interesting opportunity. I think often we see best practices looking at the team around the child, which obviously is is about looking at us all collaborating. But often young people feel when they are known to lots of services, they can feel and they feed back that they're they're often going from appointment to appointment and being asked the same sets of questions.

I think what's really interesting is just to pivot , to look at who is the trusted adult or key worker that the young person recognises, and then look at that ecosystem of support, pivoting to support the key worker. Now, that may well be the teacher. It could be the youth worker, it could be the GP, the social worker, the youth offending team officer. But it's about us collaborating as a team. I think that there's all the will in the world. I just think that often there's this perverse incentive for organisations to count the numbers of young people that they're working with and, and not to then collaborate.

And so I think that there there's an opportunity to encourage that within general practice, for example, there aren't really any incentives to ask GPS to think about the young people because they're so busy focusing on other crisis points in their population. And so I think that youth work is an ideal example where we can look at that role being the relational, not only the relational rapport building, trusted adult role with the young person and with the family, but also becomes a conduit or an integrator themselves in the community to join up between schools and the other parts of the system.
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None Portrait Speaker 2
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Can I just add to that? I completely agree with everything that John said, and I think it is about partnership being different and being generous and collaborative. And, and actually the commissioning system isn't set up like that in lots of occasions at the moment, voluntary sector organisations who often have really good relationships with children and young people are often pit against each other to bid for competitive pieces of work. Actually, a lot of the system, the voluntary sector and commissioning system is set to incentivise young people being put in boxes and counted as kind of bums on seats.

 And actually, I think the way forward is exactly as John says. It's around that kind of partnership where we meet young people where they are best. So actually in familiar settings for them, often non-clinical settings. And then it's the relationship exactly as John said, with with a trusted adult. And actually that trusted adult could be parent carer, could be teacher, could be youth worker. But it's then around wrapping the support around that trusted adult that they need, which and they don't need to be somebody who's clinically trained. They don't need to be a counsellor, they don't need to be a therapist, but they might need to know what interventions are appropriate for that young person.

They might need safeguarding support for them. They might need access to clinical supervision. They might just need somebody to talk to, to offload at the end of a difficult, challenging session with a young person. So I think it is about doing something really quite fundamentally different in terms of seeing the system changing around the young person, rather than us expecting young people to navigate different referral mechanisms, mechanisms and go from place to place. And I think the other thing that often the system does is retraumatize young people at the moment, and we ask young people to retell their story over and over again and to put themselves in different assessment criteria.

And actually, this should be about us working collectively as a partnership so that young people don't have to keep retelling their story, don't have to keep sharing that trauma. And actually, we can just wrap things around the young person. So yeah, just to build on what John said.
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None Portrait Speaker 7
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Thank you.
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None Portrait Speaker 5
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Yeah, absolutely. So when we originally set the programme up, it was to work with young people in the criminal justice system. The idea of the programme was to support that real transition for children and meet them where they were at. At that point. We spoke locally to the Integrated Care Board, who saw a real issue locally with children that were on waiting lists and not being seen for a number of years. So we developed the programme offered to be quite different, so the student to staff ratio was massively reduced. There's now three students to one member of staff.

 The idea of the provision is actually to support children with wherever they're at in that day. So they'll come to us instead of going to school. So they'll spend the full five hours of a school day with us, and they'll do activity based things like trampolining. But what that is supported with is youth workers is a qualified counsellor who kind of assists with the provision just to really try and build that relationship with the children. So it's not a, oh, you're going to go into a dark room to have counseling or therapy. Actually, we can do that on a trampoline.

We can do that on a walk. You can do that at the stadium. You can kind of break down those barriers that actually the anxiety point of it isn't accessing what that looks like day to day. We've had children referred into the programme who haven't left their bedroom. And actually the first bit of the induction, we've actually taken the induction to them. So we've taken the induction to where they where they're comfortable and where they're safe, and then steadily kind of building that up over time. Some of the incredible success stories of it is actually looking further and seeing children who weren't leaving their bedroom now accessing full time mainstream education.

 So it's not I think sometimes we look at the system and go, oh, there's all these issues. Our biggest issue right now is actually looking at we don't have waiting lists across any part of our service at all. But then we look at our Camhs waiting list and there's 26 children waiting for the support. So actually this becomes a money money challenge. And actually how much money can be allocated to it. Kind of on the last question we spoke about early intervention. Early intervention is exactly that. Hopefully we're preventing people coming up the stream. But ultimately, if there was more of an investment into the early intervention programme, we'd be able to support more of the children in that list.
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None Portrait Speaker 3
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Yeah, no, certainly. And I think there's been kind of conversations in terms of community provision organisations, both, you know, voluntary Camhs and otherwise in doing active navigation and screening assessment. These are information gathering processes. But active navigation is I think we've learned that it's very relational in terms of either with Camhs, we've got a really good collaboration in our service with Camhs Branching Minds, where it's a it's a physical front door where professionals can do some of that thinking together, really understand the child, prevent some of those rejected referrals, and that ends up in a gap, prevent having to retell their story.

 And that's really key to make sure children and young people, families are finding the right support and professionals are coming together. If I can add about the workforce part. Yeah, please, please. I think, you know, I think it's a challenge across the piece. And we, you know, I think it's one of our kind of most practical considerations, particularly with further expansion. And I think with, with mental health support teams, I think that there needs to be a little bit more than just having more education, mental health practitioners, but there's significant infrastructure that goes around that, both in terms of leadership, clinical supervision and the professional development of practitioners.

 I think if we want for people to stay in an NHS team or mental health, they need to be able to see a career. So certainly pay professional development. I think when we get to 100% coverage, I think there's potentially concerns that the, you know, is there going to be further investment for people to progress? We've developed sort of volunteers who kind of progress into trade paid roles. We have a trainee sort of trainee band six role. So as they kind of be one year post qualified, they get developed. And then once they've hit two years, they can go and do the supervision course.

 I think if there's, you know, a national workforce strategy that goes along with expansion, I think that will kind of make that sustainable workforce effective. And yeah, I think that needs to, to happen. I think if we continue expanding without having that consideration, I think we'll hit a quality bottleneck, particularly with staffing. And if there's we're seeing higher need and demand and complexity, that capability needs to be built in the workforce.
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None Portrait Speaker 4
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I think that I mean, as Arjun's talked about, you know, the children's wellbeing practitioner and the Mental Health in Schools team is a is a brilliant example of creating a workforce and training up a workforce. What we're looking at in the world centre and in our pilot sites across the country, down in Cornwall or up in Stockton on Tees is, is, is very much the need to ensure that there is a training programme to create a new workforce for the health and wellbeing practitioner. The youth work health model can work very well in general practice and across the community, but it does need a training programme to both be able to recruit and then know that you can train up this, this team who are able to work as part of this multidisciplinary.

 So I the well centre is not looking to be a provider. It's looking to share a model. And absolutely workforce development is key. We know I'm sure many have talked about it in previous sessions, but over the last 16 or so years , there's been a loss of 1200 youth centres and 4500 youth workers. You know, those youth workers scattered far and wide, I'm sure, into lots of different roles. It's not about us using rose tinted glasses and just trying to put that straight back in. As it was. It is about recognising where is that workforce and actually how can they be trained up?

Or how can the new a new workforce be trained up so that they have one foot in the community and one foot in the health system, and create a workforce ? That is absolutely about integrating the brilliant work happening in the youth sector, the education sector and the health sector.
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None Portrait Speaker 3
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I think schools and school staff, they're, they're in a, in a critical role. I think, you know, we see that they, they wear lots of hats in school. There can often be a therapist there working on education. They're there, you know, you know, supporting wellbeing. I don't think the expectation is that school staff will become therapists. I think it's our responsibility to bring the expertise in school. I think school could certainly be upskilled in terms of support, you know, supporting children, maybe upskilling in terms of their identification, bringing in the expertise when that's when that's appropriate.

 I think particularly with prevention. And I think, you know, with particularly with maybe trauma, we think about social media use. I think we, I think, you know, last year in Birmingham, we did whole school approach had about 52,000 attendees at over 1000 different activities that happened over the year. And it's difficult to say what the impact of some of that prevention was. You know, maybe it's this assembly of practitioner had done or a workshop that put a little nugget of information that that develops some of that resilience in a child that maybe prevents harm down the line.

 And, you know, there's also the presence talking about mental health and wellbeing, developing some of the tools children and young people need. I think it's an important element to, to protect. And if the, you know, we talk about early intervention and the purpose of those three functions are really interdependent. And for schools and school staff that advice, you know, signposting that consultation is it provides some of that safety net for school. And, you know, for them to be able to support children but not feel like they need to be the therapist or practitioner.
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None Portrait Speaker 2
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Yeah. Just to add to that, because I think I suppose our experience of delivering work for children and young people affected by domestic abuse has got some kind of learning there. So, I mean, I think our view is that you've got to be an expert in that work to be able to do that. You've got to understand what domestic abuse is, how it shows up for children, 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're living at home and domestic abuse is still happening at home?

 And what does that mean for safeguarding? What's the relationship with the protective parent? There's so many things there that we think, actually, it needs to be a specialist who's going in to do that work. And actually then I think the role of the school is often to enable that to happen in a, in a safe space, rather than to provide the support themselves. So then it's about partnering with specialist services in the voluntary and community sector. But I completely echo what you said, but the biggest headache of my life really is trying to get funding to sustain that in different parts of the country.

And we've got some brilliant examples of best practice in different parts of the country, but we end up pulling money from sometimes through home office funding, sometimes through integrated care boards, sometimes through places like Children in Need, in charitable trust funding. And it really is a kind of hopscotch approach to funding, which it really shouldn't be, because these are children, young people who are already living with trauma. And actually we're trying to enable their mental health to be better so that they can engage and have fulfilling lives. And I've just pulled up some of the stats.

 So we we've worked with 2300 children and young people in the last few years across Greater Manchester affected by domestic abuse, providing counselling in schools, 100% of them had an increase in self-esteem, 87% improvement in coping with anxiety and 91% improvement in low mood and depression. That's not in a clinical environment that's working with children and young people in community and education settings, but it's being provided by specialists who understand domestic abuse in its entirety. And I think that's absolutely key. And there's a real danger that we miss that if we're not careful by seeing young people as a wider group.

And actually there's loads of differences with young people that we need to think through.
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None Portrait Speaker 7
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Thank you very much.
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None Portrait Speaker 2
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Yeah. So a couple of different examples. So there's some about what we've just done ourselves as an organisation, which is around that kind of waiting. Well, and actually for some young people who are waiting, what support can you put on while they're in a waiting list? So to make sure the young person still gets a relational approach, and that can be for the young person themselves or for parents and carers, there's some uncomfortableness about that. So for some of our services that's around parents and carers who can afford to pay for access to support and who then choose to pay for private therapy while they're on a waiting list.

Because the danger being that by the time they get to the top of that waiting list, they'll actually have fallen out of being a child and then 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's huge parts of the population that we're not serving in that approach. So that's that's part of it as an organisation recognising that for people who are waiting, you still want to offer high quality interventions. And then as an alternative, the safe zone service, which I've mentioned in Stockport that I think has actually done this really well.

So that's five voluntary sector organisations working together, recognising that the waiting time for Camhs in that area is five years, and that's about young people who are presenting at a statutory service. So that might be a it might be. Camhs and then they're assessed as being in needing support, but they're not going to get to the top of the Camhs waiting list. So they're then stepped across to one of those five voluntary sector organisations. So it's a step across approach rather than a step down service. So they get a different intervention when they're stepped across as if they're on a waiting list.

 But it does mean that they get something and that's the service where they can re refer back in as well. So I think two different examples. I think Safe Zones has worked incredibly well for those young people who are risk assessors with a need, but they're not going to get to the top of the Camhs waiting list. But then we've we've kind of innovated and put something else in for people who can afford to pay so that they're not just waiting on their own, they've got some support while they're waiting.
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None Portrait Speaker 5
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Thank you.
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None Portrait Speaker 3
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We have a specialist team, so I think we take quite a lean approach with our MH T model in terms of 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 doesn't have to do kind of all that 1 to 1 work. That takes a majority of the time. They can focus on me and community partners going into schools, working with school councils, getting some of that pupil voice focus groups with teenagers. I think teenagers are kind of our lowest referring cohort and trying to get some of their voice in terms of what they want a service to look like.

 And it can be challenging to, to, to really hear what they want. And, but I think we, we do, as you said, we did, we tried to keep constant communication. We tried to integrate with schools, particularly whole school approach and the audit process that you follow. You look at all different areas in terms of culture and school, and pupil voice is really critical in terms of, you know, what do they and hearing them out in terms of what do they want to see, you know, a really popular things around toilet facilities in school and schools may hear that.

 Do they do anything about it? But I think maybe there's a bit of a drive between mental health services looking at mental health within school. And we get this people voice that gives a bit of a drive for school to implement, ways of working that can really support wellbeing. But we, we have a strategy in terms of trying to get further outreach, get some engagement, participation from those who access services and sort of through our parent work. And we have emails and parent groups that can kind of form, form how we're delivering the service better.
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None Portrait Speaker 9
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Thank you.
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None Portrait Speaker 1
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So you've.
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None Portrait Speaker 2
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Hard to define as it become harder. I think it's always been hard. And whether it's that we're more aware of some of the challenges and how those present now, I think, you know, a lot of it can be led by the communities that you live in. And whether you're in a small primary school, moving to a much bigger secondary school, you know, is it that you're, you know, you know, the teacher, you're a known person. Then you come in and you're, you know, you're a crowd of hundreds and you get lost. But I think I think it's also really hard as a parent and carer as well.

 So I think there's all those differences that you go through. But, you know, is it safe for child to walk by themselves? What does that mean in terms of street safety? Is this the time that you give the child a mobile phone? So they're going to be navigating school by themselves actually. Then what are the rules that you put down about social media use? And do they have to check in and check out when they get to school? And how does that what does that look like? So I think for me, it's the support pre and post transition that's 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 doesn't get lost.

 So when they are coming back from from year to year seven, you know, they'll be hearing different things, experiencing different people. And also as a parent, you navigate it differently because you've often gone from being part of a school gate where you've known all the parents and carers to all of a sudden you don't have that school WhatsApp group anymore, and actually you don't know where to contact and you don't know the person's house that they're going to t that house that night. And what does that mean? So I think support for parents and carers in this is really, really key.

 I actually think schools are often really good at this. They understand how to do the kind of welcome meetings. They've got, the introductions for parents and carers, but actually they can still lose young people in this and can certainly lose what's going on at home. So I think it's around just gripping that support pre and post transition to make sure that nobody gets lost in the process.
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None Portrait Speaker 9
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Thank you. Arjun.
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None Portrait Speaker 3
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Yeah. So we partnered with an organisation called Breathe in Birmingham, and they carried out a wellbeing census and looking at some wellbeing factors within both primary and secondary schools. And it brings into something called school connectedness and how it's very strongly linked to wellbeing and higher. Yeah. Higher connectedness was was strongly associated with wellbeing both in primary and secondary school. And I think it gives evidence around protecting some of that whole school approach work. And, you know, sites and services have should be thinking about belonging, relationships, school culture, pupil voice, not only kind of the individual treatment and individual treatment can take a bit of a bias.

 If that's the, the, the outcome that's really strongly measured in terms of access. I think in terms of transition points, I think these are really predictable prevention points and opportunities for for us to identify vulnerable pupils early, prepare families, prepare schools and provide some of that targeted transition support. And I think we know where they are, where they're where they happen. And I think one of some of the learning from compass is, is local delivery really needs to be flexible and we need to meet the needs where they are. And these transition points are that I think, you know, when we look at expanding coverage or quite kind of nominal access, I think we need to really think about that resource allocation, particularly on these predictable points.
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None Portrait Speaker 9
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Thank you John.
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None Portrait Speaker 9
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Thank you.
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None Portrait Speaker 2
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Yeah. I mean, I think there's some there's some real examples of brilliant practice. I think let's start with the positive. I think about some really kind of bold commissioners who've done things really differently. The example that jumps out, jumps out to me straight away is an alliance contract that were passed off. We've actually been part of for ten years now, which is amazing in the sector in itself. That's six voluntary sector organisations and the local authority as key partners. So it takes away that kind of competition about people competing with each other. It's all around those organisations working together for the best of that community, and it's an alliance contract.

 So there's no traditional lead, there's no traditional lead or subcontract. We're all in it together. And for the first five years of the partnership, commissioners sat around the table as an equal partner, as an equal partner through a leadership model. And now the relationships are so developed, we actually don't need that kind of formality. But it's we're only as good as how we work together. So that's been absolutely key for doing things differently and has removed the kind of barriers between commissioner and provider, which I think has been really brilliant. And again, some really good examples with like devolved administrations and like thinking about combined authorities where actually as part of the sector, you've got a voice in the kind of strategy development.

 So they understand the kind of conflicts about being a provider, but also being a specialist in this space. So I think about particularly 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. So some brilliant examples of the sector working collaboratively and and by the Secretary and voluntary community sector and local authority sector and statutory sector. Also sadly, examples where that isn't the case, where the sector is pit against each other for it to bid for small pots of money, where particularly with things like National National Insurance increases and the increases in national living wage wage, there's an expectation that the sector can just kind of carry that.

 And actually there won't be inflationary increases every year in contracts, which means that what you're delivering is actually less, less and less for less resource. So sometimes it is still a very traditional provider commissioner relationship and which misses the expert voice in the room. So there's some brilliant examples, but there's also some where commissioners aren't as bold, are much more traditional, more patriarchal, and we lose the expertise of doing things together. So yeah, it would be wonderful if there was a way of taking that kind of bold commission approach to partnership, which understands the kind of confines that we're all working with, but actually says we should all be here to try and achieve the best things for children and young people, and we should be able to do it from that belief.

So it'd be brilliant if we could drive that bit forward and, and lose some of the, the non successful commissioning practices.
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None Portrait Speaker 4
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I mean, I think that that Michelle referenced the, the idea of the, the alliance contracting means that you create equity amongst that ecosystem. And I think that's really key. And there are good examples of that. But again, too, too often I think, yeah, commissioners are commissioning, you know, a siloed specialist service that isn't as joined up, but there are great opportunities for joint commissioning across the local authority and the Icbs to then think about how everyone works well together, because there's a there's an awful lot of good will in the sector or in the system, but often it's not joined up and there's sort of in-kind support, but it's, it's down to personalities and individuals who are really passionate about young people and their community.

 It's not necessarily jointly funded in, in, in, in Lambeth. We have some really good examples of, you know, GPS working together with the youth workers who are health specialists and 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's not funded or commissioned. It's it's, you know, people going above and beyond. Again, there are child health hubs across the country with paediatricians, Camhs, GPS, the voluntary sector. But again, it's not necessarily commissioned. I think that the integrated neighbourhood team approach is going to be a really interesting one, but I don't think it's really fleshed out fully as to what that's going to look like in the landscape, but that is where I would want to see the youth sector, youth workers in the community, working alongside health and education at a neighbourhood, local neighbourhood level.

 And I think that if we can find a way of ensuring the voluntary sector aren't given funding, small pots of funding to deliver, you know, a year at a time or maybe 18 months at a time if you're able to bring them in as innovation partners with the commissioners, but also with the statutory organisations, then I think you create a much better landscape for sustainable impact for young people in the community or the neighbourhood in which they are.
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None Portrait Speaker 4
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I absolutely agree with your, your premise that there should be absolutely no wrong door for young people. And the young people shouldn't have to learn how to navigate incredibly complex systems and services. This summer, we launched an alliance for organisations, like minded organizations across the voluntary sector to the health sector, education and the policy space, those that are interested in adolescent health. And that was really interesting to to find those delivering best practice in their communities across the country. But where they all have that same premise, they want to join up and ensure that there is no wrong door.

 There are great examples of that happening, but again, they are they are often isolated teams working with the young people, but without the opportunity to to shout about it. And so it's great. Your question to, to, to raise that as, as with this inquiry, you know, in East London, there's an amazing there's amazing work between a housing association and, and GPS in the health spot, working with young people, meeting them in downing Cornwall. There's amazing work between GPS developing their own well centre model with local social prescribers and youth workers. There's a project up in Stockton on Tees called footsteps that are GPS and youth workers working together, so there are absolutely organisations looking to ensure that doesn't 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've absolutely got to ensure there's a responsibility on us as the adults in the room, to join up and collaborate together.
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None Portrait Speaker 10
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The urgent.
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None Portrait Speaker 3
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Definitely. Yeah.
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None Portrait Speaker 10
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Yeah. Michelle.
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None Portrait Speaker 2
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Yeah. I mean, I agree with what everybody said, but just to add, I think examples where it's worked really well is where services are co-located. So it doesn't matter actually if the person's employed by the local authority or the school or the voluntary sector, the young person's just experienced that as an integrated team. To say, that's actually harder to do than it sounds, because it's got to be about a really shared team culture. You've got to do things where the team works really well together, and it is about the focus on the child or young person.

 But I think our best practice is where that happens. And there's a real co-location. I think also things that really make this work is where there's a real understanding of roles and remits and a recognition that they're different and that's okay, that they're different. But you need to be understanding and clear on what those are and that in that partnership working, you're also clear on the expectations. And then I think in terms of accountability for me, where it's worked best is where there's some shared leadership. So it's not just that teams and key workers and frontline staff are integrated, but there's actual sharing of leadership and accountability for that across organisations.

 And that often comes down to data sharing and information sharing protocols, which is the non-sexy side of this, isn't it? But it's actually really important to make sure that it works and as much as possible to have shared systems. I think that's really important so that then it isn't around data being aligned to just one, one person, one organisation. It's around what works for the young person and the family. And I think that's where it works best. And I think through all of that, it's the importance to shared values. And actually just saying as a partnership, these are the values that we're working to, and this is what we're going to do about the tricky conversations, because there is always going to be tricky conversations in partnership.

 And I think around the Alliance contract, we were always really clear. The trickiest conversation was around money, and we had an agreement that we'd never do that offline. We'd never do that out of the room. Inside conversations. We always took an approach to open book accounting as a partnership, which is a real challenge to do when people count full cost recovery differently. People's pensions processes are different, people's salaries are different. But it was actually been able to model some of those difficult conversations, which meant that the partnership was around the people we were there to serve, not about ourselves as organisations.

 So I just think there's some a few mechanisms that we can put in around shared systems, open book accounting, shared leadership, information sharing. Then actually integration is much more straightforward and successful.
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None Portrait Speaker 10
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Interesting.
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None Portrait Speaker 1
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I will go to Jess.
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None Portrait Speaker 2
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Yeah, I mean, as an organisation, we're incredibly supportive of the government's position on social media. I would say for us, it's around working through how we work with young people, both young people who are maybe 14 to 16 now, who are already actively using social media, seeing things and are 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, young people affected by domestic abuse is, is really around talking to young people about how social media may play out in the relationships they have and what's healthy and what isn't healthy, and how do they protect themselves online.

 And I'm thinking around things that are just kind of common language now for young people. So like the use of snap snap maps as an example, to be able to trace where young people are or the filters that are shared through Snapchat and the like, you know, the, the snap streaks that people want to have. Actually, there's a whole point of education that needs to happen with young people that we're then having to put into all of our programmes in a slightly different way, both 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 that they don't want to see?

Or maybe they do feel like they don't want to see it, but actually when they it opens up conversations they don't think they need to have. So for us, the kind of use of social media has been something that has to be completely integrated into all of our programmes now. And I think, and I suspect will be for the future, to be honest.
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None Portrait Speaker 12
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Thank you. I don't.
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None Portrait Speaker 12
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Thank you John.
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None Portrait Speaker 12
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Thank you. Arjun.
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None Portrait Speaker 12
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Thank you John.
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None Portrait Speaker 12
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Thank you. Arjun.
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None Portrait Speaker 1
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Thank you John.
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None Portrait Speaker 1
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Thank you. Arjun.
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None Portrait Speaker 1
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Thank you.
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None Portrait Speaker 1
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Thank you.
11:58
None Portrait Speaker 13
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And Jordan.
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11:58
This debate has concluded
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