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North East Essex Clinical Commissioning Group and Essex County Council;Children and Young People Strategy 2015-2018.

CONTENTS.

1.0Executive summary

2.0Background

2.1Scope

2.2National Policy and Guidance

2.3Local Policy and Guidance

3.0Models of care

3.1Current model

3.2Proposed model

4.0Vision and Objectives

4.1Vision

4.2Values

4.3High level outcomes

4.4Operational objectives

4.5Service user engagement

5.0Workforce planning

6.0Providing safe care

7.0Finance

8.0Delivery

9.0Governance

10.0Conclusion

11.0References

12.0Appendices

1.0 Executive Summary

North East Essex Clinical Commissioning Group (NEE CCG) and Essex County Council (ECC) Children and Young People strategy 15/18 outlines both organisations’ plans to influence the whole of North East Essex (NEE)health and care economy through integrated working, bringing the expertise of clinical commissioners together with public health, social care, education and early intervention commissioners.

The overarching aim for driving forward children’s services in NEE is to secure good outcomes for children, young people and families by continuing to improve the quality of services, concentrating on safety and working towards better satisfaction.. Services need to be delivered in an appropriate setting by skilled professionals with the required level of expertise and training. All children, young people and families should be provided with equitable services that meet their individual needs and wishes.

This strategy has been developed to facilitate the commissioning and provision of excellent health, care and education services that are comprehensive, inclusive, flexible and responsive to the clinical and social needs of children, young people and their families. It supports the objectives of the Essex Health and Wellbeing Strategy thatevery child has the best start in life and that residents make better lifestyle choices and have the opportunities needed to enjoy a healthy life.

2.0 Background

Children and families should be able to access high quality, clinically effective and consistent support that enables them to maintain their own health and well-being better throughout the life course.

In line with article 24 of the United Nations Conventions on the rights of the child (UNICEF 1990) children have the right to good quality health care and information to help them stay healthy.

Both the CCG and ECC recognise that early access to health and care and evidence based supportenhances positive outcomes for children and young people enabling them to enter adulthood successfully and better maintain their health and wellbeing.

The National Service Framework for Children and Maternity (Department of Health 2004) highlighted the need for commissioned services to be designed and delivered around the needs of children and families.

Services should be child centred and look at the whole child not just the illness or the problem. This enables services to pick up any problems early, take preventative action and ensure children and young people have the best possible chance to realise their full potential.

National guidance from the Royal College of Paediatrics and Child Health (RCPCH 2014) identified 5 priorities for 2015 that will support the improvement of children and young people’s health outcomes:

  • Prevent children and young people from becoming unwell, act early and intervene at the right time.
  • Tackle child health inequalities.
  • Reduce the number of child deaths.
  • Make the NHS a better place for children and young people.
  • Involve children and young people in decision making on health and wellbeing issues.

All children and young people will receive Universal services, such as maternity services at birth; health visiting and children’s centre in early years; school and youth services for older children and primary care throughout their childhood and adolescence. Universal services seek, together with parents and families, to meet all the needs of children and young people so that they are happy and healthy and able to learn and develop securely. Universal services are provided as of right to all children including those with additional and intensive needs.

However, some children, either because of their own additional needs or because of less advantageous circumstances will need extra help to be healthy and safe and to achieve their potential. We want to offer help and support to these children and to their families, in a voluntary way that does not leave them feeling singled out as different and that builds their capacity to manage and live healthy and stable lives.

The CCG and ECC endorse and encourage the use of the Essex Family Support windscreen and the guidance set out in the Essex Effective Support for Children and Families document (Essex Safeguarding Children Board 2013). This supports those working with children and families to ensure that individual needs are identified and families afforded the right level of response from universal services through to specialist or high level, targeted intervention (see figure 1).

2.1 Scope

For the purpose of this strategy, children and young people are those aged 0-18 years of age (The Children Act 1989).

In line with the Children and Families Act (2014) children and young people with special educational needs and/or disabilities (SEND) will be classified as those 0-25 years of age.

2.2 National Policy and Guidance

There are many pieces of legislation and guidance that, as commissioners, we are aware influences our practice. We have outlined those that are integral to our strategy below:

  • The Children Act (1989)
  • UN Conventions rights of the child (1990)
  • Adoption and Children’s Act (2002)
  • The Children Act (2004)
  • National Service framework for children and maternity services (2004)
  • Mental capacity act (2005)
  • Statutory Guidance on promoting the health and wellbeing of looked after children (2009)
  • No Health without Mental Health National Strategy (2011)
  • Health and Social care Act (2012)
  • Working Together to Safeguard Children (2015)
  • Children and Families Act (2014)
  • Children’s Health Outcomes Forum. Commissioning in the new NHS for children, young people and their families
  • RCPCH.2014. Making the UK’s Child Health outcomes comparable to the best in the world- a vision for 2015.
  • NICE Clinical Standards
  • NICE Quality Standards.

2.3 Local Policy and Guidance

Local information and guidance are essential to ensure the focus of this strategy reflects the needs of children, young people and their families across NEE. The CCG maternity strategy 2015-2018 will have clear links with the priorities for children and young people ensuring that commissioned services promote a seamless approach to health and care needs from pre-birth to the transition to adulthood.

The ECC outcomes framework and theChildren,Young People and Families Plan delivered in NEE by the North Essex Children’s Partnership Board has been incorporated into the content of this strategy ensuring that objectives are consistent across the economy. The plan’s objectives are:

• Children and young people will reach their full potential

• Children and young people will be supported by strong families

• Families will be given early help to assist them in managing their difficulties

• Children and young people will not be disadvantaged by being in care

• We will protect children and young people from harm

• Children, young people and their families will influence what we do

• Services for children, young people and families will be improved by us working together

Additional local guidance that’s has been considered as part of the development of this strategy includes:

  • Southend, Essex and Thurrock Safeguarding and Child Protection Procedures (2015)
  • North East Essex Five year strategic plan 2014-2019.
  • ESCB Effective Support for Children and Families in Essex (2013)

3.0 Models of care.

3.1 Current model

Children’s health, well-being and care cover’s an extensive range of services and pathways. Following the Health and Social Care Act (2012) children’s health commissioning arrangements are split across a number of commissioning organisations.

The challenge is to work effectively with commissioning and delivery partners across tiers to find new ways of commissioning services that reduce demand on higher cost and specialised services and promote earlier intervention, self-care where appropriate, care closer to home and improved outcomes for children and families.

This includes considering demand across sectors and pathways, understanding the outcomes and experiences of children and families in navigating services and finding ways to commission locally and across Essex that improve the efficiency of our system.

We know that children and young people with social, care or education needs can often receive intervention and support from a variety of services. This can mean that the services provided to families become fragmented with minimal joint working. We want to ensure that where possible, children, young people and their families receive services that work together with the best interest of the child in mind. Figure 2 shows the number of different services a child, young person or family might have contact with at any one time.

Figure 2

3.2 Proposed model of care.

Traditionally health and social care has been commissioned around the needs of the service, rather than the needs of people. This has led to children and families receiving fragmented care, delivered by many different organisations. Some care is duplicated, some care is missing.

NEE CCG and ECC will commission joined up services based around the needs of the individual. As well as improving the quality and experience of care, we will be able to make the most of our budgets and resources for the benefit of the population of NEE, now and in the future. We will work together to promote integration across the health and social care systems to ensure that services are planned and commissioned in an integrated way, putting children and families at the centre.

Where required we will work with NHS England to review the pathways for children and families where there may be more than one commissioning body responsible for an element

of provision. This will ensure that pathways of care should be consistent, accessible and equitable.

Through the analysis of local information, national guidance and by working effectively across boundaries we will be confident in identifying the correct priorities for children and families in NEE.

3.3 Trends

Area / Trend
Demography /
  • Around 58,000 0-18 year olds in NEE
  • Growing total population with increase in birth rates affecting maternity services.
  • Growing proportion of 0-4s are from BME backgrounds, possibly affecting patterns of health needs.

Health inequalities /
  • Out of 326 local authority areas, Tendring is ranked 86th most deprived in England.
  • Out of 326 local authority areas, Colchester is ranked 205th most deprived in England.
  • Differences in outcomes for children and young people in Tendring and Colchester: lower life expectancy at birth and higher child poverty rates in Tendring.

Children with complex needs /
  • 258 children with a disability/sensory impairment known to social care (as of Nov 2014)
  • 1,500 active statements of Special Educational Need: near the Essex average.

Vulnerable children and families /
  • Child protection: as at November 2014, higher rate of accepted referrals into social care than the Essex average.
  • Number of children with child protection plans 147 in November: highest rate per 10,000 in Essex
  • Nov 2014: 171 Domestic abuse incidents reported in which children are affected: highest rate in Essex
  • Young carers make up 2.4% of the NEE carer population however 12% of young carers were doing so for more than one parent.
  • The under 18 conception rate in Colchester is similar to that across England; however the rate in Tendring was significantly higher.
  • At 31st March (2014) there were 569 looked after children. Of this number 364 originated from NEE, 112 were placed in NEE by other Essex Social Care teams and 93 were placed by other local authorities.
  • Another 171 children and young people who entered and/or left the care system during this time frame.
  • NEE has the highest number of LAC compared to Greater Essex.

Other local issues / Overall, the 0-18 population had the second highest number of attendances across Essex at A&E in 2013/14.

NHS NEE CCG.2013. Clinical commissioning group profile-children and maternity. Essex. NEE CCG.

4.0 Vision and Objectives.

4.1 Vision.

All children and young people should lead healthy, happy and stable lives from pre-birth onwards and achieve their potential. As partners we will work together to enable children, young people and their families to choose well and manage their health and well-being wherever possible. Where children and young people need ongoing or additional help or where vulnerable young people and families need additional intensive or specialist support they will access effective, co-ordinated service and care from skilled professionals.

4.2 Values

The shared vision for children and young people is underpinned by a number of key values the CCG and ECC believe are vital for the future of children’s services based on what local and national guidance and legislation tells us.

  • Children young people and families, where possible, will be encouraged and supported to look after their own health and care needs
  • Services will be centred on children, young people and families and will be high quality, evidence based, cost effective and sustainable.
  • Children and young people in NEE will get the best start in life.
  • Children and young people will receive seamless and integrated services that support transition to adult services when required.
  • Young carers will receive the support they need.
  • Children, young people and families will be encouraged to shape the future of health and care services.

4.3 High Level Outcomes

Emotional Wellbeing and Mental Health.

The resilience, wellbeing and mental health of children and families are essential to their wider health, stability and progress. Mental health is everybody’s business and all organisations working with children and families have a role to play in promoting good resilience and emotional wellbeing whilst taking responsibility for identifying emerging needs and supporting young people to access the correct support at the earliest possible stage.

Where young people have higher level or increasing needs, they should access effective, timely support that is focused on improving their mental health outcomes. All CCGs and Local Authorities across Southend Essex and Thurrock are jointly re-commissioning an integrated emotional wellbeing and mental health service for children and young people. The core outcomes are:

  • More children and young people will have good mental health
  • More children and young people with mental health problems will recover
  • More children and young people with mental health problems will have good physical health
  • More children and young people will have a positive experience of care and support
  • Fewer children and young people will suffer avoidable harm
  • Fewer children and young people will experience stigma and discrimination:
  • Improved emotional wellbeing, emotional intelligence, resilience and self- esteem for children, young people, their families and carers
  • Reduced inappropriate use of A&E to access EWMH services
  • Vulnerable groups such as LAC, Fostered/Adopted, leaving Care, on the edge of Care, with Severe Learning Disability who have emotional wellbeing and mental health needs and their families and carers receive appropriate evidence based interventions from EWMH services.

Autistic Spectrum disorder (ASD)

Autism is a lifelong condition that affects how a person communicates with, and relates to other people. It also affects how a person makes sense of the world around them. There are three main areas of difficulty common to all children, young people and adults with Autism;

  • Social communication (problems using and understanding verbal and non-verbal language such as gestures, facial expressions and tone of voice)
  • Social interaction (problems in recognising and understanding other people’s feelings and managing their own feelings)
  • Social imagination(problems in understanding and predicting other people’s intentions and behaviour and imagining situations outside their own routine).

Children and young people with ASD often experience a range of cognitive, learning, language, medical, emotional and behavioural problems. Approximately 70% of people with ASD will have a diagnosis of at least 1 other physical or mental health problem such as epilepsy, depression, sensory impairment, self-harmful behaviour, dyspraxia and motor co-ordination problems. These problems can significantly affect the individual’s quality of life leading to social vulnerability and increased dependency on health and social care services.