NHS

Partnership Commissioning Unit

On behalf of

Hambleton, Richmondshire and Whitby CCG

Harrogate and Rural District CCG

Scarborough and Ryedale CCG

Vale of York CCG

CAMHS Briefing Paper

  1. Issues
  • Local Authority Disinvestment Plans
  • Tier 4 CAMHS
  1. Background – LA Disinvestment Plans

North Yorkshire County Council and the City of York Council formerly received an annual ring fenced CAMHS Grant allocation. This allocation was used as a partnership contribution to NHS commissioned tier 3 CAMHS services in line with policy directives for the joint commissioning of comprehensive CAMHS.

The grant ceased to be ring fenced in 2008 and was mainstreamed into other local authority grant baseline allocations. In subsequent years this amount has progressively decreased along with other LA central funding allocations. The requirement to achieve financial balance has necessitatedLA consideration of disinvestment plans. However there are no plans to reduce partnership contributions until 2014/15.

North Yorkshire County Council is proposing to reduce their partnership contribution from £500k to £400k pa, and the City of York Council is considering reducing their annual allocation by £41k. In addition to the requirement for achieving financial balance, both LA’s also wish to improve the governance and assurance arrangements for the use of their partnership contribution and also negotiate the inclusion of some bespoke services in the CAMHS service specification to support their organisational objectives.

3.Progress

The Partnership Commissioning Unit and the LA’s are consulting with CAMHS providers on a revised service specification to be agreed via the LYPFT and TEWV CMB’s and to take effect 1 April 2014. The work includes an impact analysis, work on the integration of health and social care pathways to ensure these are lean and consideration of the outputs from the TEWV CAMHS review. (This CCG clinical leads, the PCU and senior LAs officers were consulted as part of the review process.)

  1. Possible Impacts

LYPFT receive LA allocations from both NYCC and the CoY Council. The former is for the Easingwold locality and the Selby and District area of North Yorkshire. The consultation process will enable a judgement to be made on the likely impacts. At this stage the most likely impact will bea need to prioritise on clinical severity and impact at the possible expense of earlier intervention and prevention work. This may result in children and young people with less urgent needs waiting longer for appointments and those patients who are not thought to have mental disorder being excluded.

TEVW receive an allocation from NYCC for the locality teams based in the district council areas of Harrogate and Rural District, Hambleton and Richmondshire and the Scarborough, Whitby and Ryedale areas. The most likely impact will be a need to prioritise on clinical severity and impactat the possible expense of earlier intervention and prevention work. As with LYPFT this may result in TEWV referrals for children and young people with less urgent needs waiting longer for appointments, and those patients who are not thought to have mental disorder being excluded.

  1. Next Steps
  • Report to the commissioning partnership on the outcome of the consultation with providers (December 2013)
  • Seek the commissioning partnership approval for the revised service specification, and timetable for sign off at CMB (January 2014)
  • HRW, SR, and HaRD CCGs with NYCC to consider the outputs of the TEVW CAMHS review in the context of balance of provision against local need, the implications of the gap analysis, and consider future commissioning requirements.
  1. Tier 4 CAMHS Inpatient Care

NHS England has written to all CCGs to advise that there is a national bed shortage and they have experienced occasional difficulty in supplying access to a bed at the point of need. NHS England are responding to the supply issue through a mixture of additional case management and commissioning additional capacity.

The PCU have notified CCG clinical leads and children’s leads there is an interim risk in the event a patient needs hospital admission and there is no available bed. The likelihood of a risk event is small but the impact may be great, in particular in out of hours and weekends periods when there is not access to other CAMHS services other than the out of hours consultant rota. While this is a likely to be an infrequent event there have been two instances where this has occurred in North Yorkshire.

  1. Discussion

NHS England has not discussed other potential solutions to the bed supply issue with NHS providers or CCGs. For example there are effective evidence based community service models for the management of eating disorders that can reduce the need for inpatient care. The model is not commissioned in North Yorkshire but there are likely expected benefits in terms of quality and outcomes and efficient use of NHS resources.

The budgets for CCGs and NHS England were apportioned on historic community and inpatient activity. In the absence of other revenue opportunities any service improvement to reduce bed demand and provide better community services would need to be a collaborative approach between NHS England and the CCGs.

  1. Next Steps

PCU to meet with NHS England to discuss scope and negotiate actions for reducing the interim risk of supply failure, and to discuss the potential of a QIPP through augmentation of tier3 services to reduce bed demand (7/10/2013).

George Lee

Senior Commissioning Specialist – Children & Young People: CAMHS

7 October 2013

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