3 Year Essex (including Southend & Thurrock) Commissioning Plan for supporting the emotional & mental health
needs of children with learning disabilities (CAMHS LD) 2010 – 2013
This proposed commissioning plan aims to offer a phased plan to support the development of an integrated CAMHS LD care pathway across tiers 1-3 to support the emotional and mental health needs of children with learning disabilities. Whilst the table below prioritises the stages these need to be flexible in order to achieve the pathway in the current economic climate.
Within the Commissioning Plan there are three main themes
· Building the capacity of the current workforce in universal services
· Developing an equitable CAMHS LD workforce across Essex, Thurrock & Southend
· Developing an Integrated Care Pathway.
Funding for the majority of the proposed commissioning plan will be secured through the decommissioning of funded private organisations carrying out court assessments and speech and language assessments, through re design of current services and through ring fenced funds i.e. AHDC. In addition the business case for equipment resources versus medicines interventions will produce cost savings that are evidenced.
Additional commitment will be required but this is likely to be in year 2 (2011/12) & 3 (2012/13) and agreed through the CAMHS JCE.
The draft Final Report provides the background to the draft Commissioning Plan and your attention is drawn to Section 20 which outlines the key proposals to develop an integrated care pathway.
This Commissioning Plan should be considered in conjunction with the Aiming High for Disabled Commissioning Strategy for Essex CC and Southend and with the Children with Disabilities Strategies in Thurrock which describe opportunities for all children with disabilities and identifies
· Opportunities and funding arrangements for short breaks
· Wheelchairs and community resources / equipment
· Palliative Care
· Transition
· Parent Participation
· Direct Payments
It should be acknowledged that arrangements in each of the Local Authorities will differ. Therefore the draft Commissioning Plan will need to be developed in conjunction with other initiatives and each authorities own funding arrangements.
Priority / Service / Commissioning Priority / Resource Required / Funding Source / BenefitYear 1 / Year 2 / Year 3
1 / Universal / Increase the number of speech and language therapists across Essex, Thurrock & Southend to increase the capacity of the workforce and to offer consultation and training to other professionals.
Through the SLA with PCTs for children with statements / 1 wte per CDW Team.
Essex CC
Thurrock (0.5wte)
Southend (0.5wte)
£200k (Essex CC)
£20k each Thurrock & Southend. / O.5wte per CAMHS LD Team
Essex
£20K / Increase to 1wte per CAMHS LD Team
Essex
£20K / SENCAN Budget / Cost neutral –
Reduce funding to private sector for private SLCN assessments/reviews.
2 / Tier 3 / Merge the current resources allocated across North East And Mid Essex and redesign the Team as a CAMHS LD service across North Essex, offering capacity to include West Essex.
Develop year on year increase over 3 years.
Recommended wte per 100,000 pop. for CAMHS LD is 5 – 6 and for psychiatry input 0.5wte per 100,000 pop. / Core Team (0.5 wte Child psychiatrist,
1 Clinical Psychologist,
1 Specialist Liaison Nurse,
1 Salary Band 6 Nurse,
1 OT
1 Assistant Psychologist,
2 x SB 3 support workers plus 0.5 wte admin)
£350K / Increase core team by a further 0.5 wte psychiatrist
£60K / Core team to increase by 1wte Assistant Psychologist, 1 Salary Band 6 Nurse, Salary Band 3 Support Worker and 0.5wte admin.
£100K / £290K (plus £60K additional) transferring from Adult LD Commissioner to CAMHS Commissioners
Additional £60k and £100K for following two years to bring team to 12wte through PCT development. / Year 1 cost neutral – transfer of children’s LD budget from Adult LD Commissioner to CAMHS Commissioner.
Year 2 & 3 to be identified through reduction in health related out of county expenditure and funding of private sector psychiatric assessments through Public Law Outline funding.
3 / Tier 3 / Retain the South Essex CAMHS LD team and further develop capacity.
Extend the age range to 5 – 19 at year 2. / Increase core team by 1 SB 6 nurse and 2 x SB support workers
£80K / Increase core team by 0.5wte psychiatrist and 1wte OT
£100K. / Increase by 1wte assistant psychologist 1 SB6 nurse, SB3 Support Worker and 0.4wte admin
£100K / Current budget £197K
Investment of
Year 1 £80K
Year 2 £100K
Year 3 £100k / Investment to be funded through the reduction of health related out of county expenditure and private sector assessments.
4 / Tier 2 / The current CAMHS Tier 2 services to be realigned to take into account the needs of children with learning disabilities as per the recommended wte; this may be through the recruitment of the proposed increase or through skilling up the current workforce. Tier 2 should also include input to all special schools. / Increase 6wte (Essex CC)
1wte
(Thurrock and Southend)
Essex CC £240k
Thurrock
£40k / Additional
6wte (Essex CC)
1wte
(Thurrock and Southend)
Essex CC £240k
Thurrock £40k / Additional
6wte (Essex CC)
1wte
(Thurrock and Southend)
Essex CC £240k
Thurrock £40k each / Through the agreed CAMHS Tier 2 workforce plan in Essex.
Thurrock & Southend to determine budget
Source. / Fund through re-commissioning of Public Law Outline funding and reducing spot purchase of private sector psychiatric assessments in Essex CC.
Recommended wte per 100,000 pop. for CAMHS LD is 5 – 6
Southend to assess T2 CAMHS capacity independently of the Review
5 / Universal / Commission interagency training across disciplines and at multiple levels to develop a robust and skilled workforce to support children with learning disabilities, their parents/ carers and siblings across all tiers. / Provide CAMHS LD training opportunities to 1 member of staff per CDC, CDW, CFCS and CAMHS Team
(20 places)
£7K / Embed at year 3
Cost implication to be established in Yr 1 and 2 through developing new posts in CAMHS LD, SaLT and Ed. Psy posts / Essex CC LAA 2010/11 / Investment in universal services to support
· Early intervention and prevention.
· Reduce escalation and provide services closer to home at earliest opportunity.
Essex CC LAA 2010/11 budget which is already agreed.
5.1 / · Mental Health Awareness / Everybody’s Business online training to be adapted to include LD specific info & rolled out to all universal staff.
Resource required Train the trainer 1wte time limited
Mental Health First Aid Training for Tiers 1 & 2 recommendation 1.2 of the Essex Children and Young People’s Emotional Health & Well- being Strategic Implement-
ation Plan 2009 – 2012 (draft)
EssexCC
£105k / See Priority 5 / To be incorporated into the Essex CC CAMHS Workforce Development Post / Investment in universal services to support
· Early intervention and prevention.
· Reduce escalation and provide services closer to home at earliest opportunity.
Essex CCLAA 2010/11 budget which is already agreed.
5.2 / · Learning Disability Awareness, module to be developed and delivered by the CAMHS LD Teams. / See Priority 5 / To be embedded as a training requirement within the service specifications of T3 CAMHS LD services through the CAMHS Commissioner.
5.3 / · Speech language and communication, module to be developed and through the proposed increased capacity in Priority 2. / Personnel requirement linked to SaLT increase / See Priority 5 / To be embedded as a training requirement within the service specifications of SALT as part of the additional investment identified in priority 1.
5.4 / · Child development and the impact a learning disability has on the emotional, physical, psychological and social development. / Personnel requirement linked to ED . Psychology provision. / See Priority 5 / To be embedded as a training requirement within the service specifications of T3 CAMHS LD through the CAMHS Commissioner.
Consideration to be given to educational psychology’s capacity to support this.
5.5 / · A parents and carers training programme should be developed to meet their needs and linked to the AHDC commissioning plans and Early Years.
(Links to section 11) / See Priority 5 / Aiming High for Disabled Children / AHDC are facilitating the Early Support Parent Workshops. Key elements are understanding their child’s disability, services they encounter and empowerment so that they are central to decision making, including shaping services.
AHDC have funded the initial Early Support Parent workshops I,2009/10 and it is identified in the 2010/11 commissioning plan for Essex CC.
Please refer to Thurrock & Southend AHDC Strategy’s for specific plans.
6. / Tier 2/3 / Provide additional post re-commission Public Law Outline resource to develop court assessments at Tier 3 CAMHS with specialist LD skills / 1 wte clinical psychologist
Essex CC
£100k. / Essex CC Public Law Outline £100k / Fund through re-commissioning of Public Law Outline funding and reducing spot purchase of private sector psychiatric assessments
7. / Specialist / Confirm funding to support specialist healthcare needs of children with learning difficulties or disabilities through Specialist Healthcare Task Training / 3 wte
Essex CC
£195k / Essex CC & PCTs Aiming High for Disabled Children
£195k / Essex CC Funding agreed for 2010/11
8. / Universal / Develop continence resources to support children with disabilities through the PCT Continence Advisors / Purchase 50 sensor boxes per PCT (£5K x 5)
Purchase 150 bed mats (£1.5K x 5)
£25k Capital
£7.5k Revenue / Replace 10
Sensor boxes(£1K x 5)
Purchase 50 bed mats
£500 x 5)
£5k Capital
£2.5k Revenue / Replace 10
Sensor boxes(£1K x 5)
Purchase 50 bed mats
£500 x 5)
£5k Capital
£2.5k Revenue / Aiming High for Disabled Children through PCTs / To support early intervention and prevent escalation of problems later in childhood, reduce likelihood of bullying, reduce likelihood of family breakdown and parental ill health. Increase opportunities for mainstream activities.
9. / Tier 2/3 / Support practitioners to develop sleep therapy specialist skills to offer support and training. / 1 trainer in each CAMHS LD Team (£1K x 2)
£2K plus accommodation and travel
£5k maximum to be confirmed / £5k / Investment to support
· Early intervention and prevention.
· Reduce escalation
· Increase emotional resilience of parents/carers
Essex CC LAA 2010/11 budget which is already agreed.
10. / All / Scope out current database facilities across health & local authorities to enable shared access to health and social care data information sharing (short term)and future opportunities based on corporate direction of travel (long term) in relation to the health, social care and educational needs of children with disabilities. / Task and finish group to scope out.
Essex CC
£60k Project Manager £100k Capital / To be funded by Essex CC Aiming High for Disabled Children 2010/11 allocation / · To provide earlier access to information through shared database.
· Joined up service delivery
· Reduction in duplication
· Increased opportunities for children and young people.
This service is already available in Southend.
11. / All / Parent participation, Parent council developed through AHDC –Families Acting for Change; this is critical to service re-design / encapsulated AHDC Core Offer standards and AHDC Full Service Offer. Also publications / information for CYP and their families. / £100k (January 4th 2010) / Aiming High for Disabled Children
Essex CC
£100K (please note it was requested that this was reduced but I have not got this information) / · Ensure that parents have access to information that is timely and are signposted to appropriate services.
· Access to effective and efficient services.
· Opportunity to provide and contribute to service re-design
12. / All / Care pathway for children and young people with ASD/ Aspergers to be agreed with a pathway into the appropriate CAMHS/CAMHS LD service and aligned to the Autism Bill. PCTs should consider the ASD Pathway developed in SW Essex and determine if this should be adopted across Essex. / This will need to be considered alongside the emerging Action Plan for the Autism Bill due in early 2010. / Unknown until guidance is publicised.
Please note SB stands for salary band and is the NHS banding.
Supporting the emotional and mental health needs of children with learning disabilities: Commissioning Plan (Final Report Version 2)
(Draft CAMHS LD Commissioning Plan Version 6)
Eastern Development Centre (16 Feb 2010)