Item 5.1

Partnership Commissioning Unit

Summary for Childrens Services

12 June 2014

Transitions
Update / Business proposal under development for an integrated health and social care transition to adult’s team, for children and young people aged 14 -25 who have Education and Health Care Plans. This approach will assure compliance with Children and Families Bill, the forthcoming Care Bill. It will also support compliance with Winterborne. The Steering group (executive) will meet in July to consider the options.
Emotional Health & Wellbeing Reference Group update and CAMHS strategy / Programme of meeting dates set for development of a draft implementation plan. This will require CCG and CTB approval. Group next meets in June to produce first draft by the beginning of July.
LAC update / Discussions with lead commissioners are underway to establish procurement framework for seeking additional health assessment capacity from the existing commissioned School Nursing Services. Formal negotiation through provider Contract Management Boards will follow.
A paper outlining a proposal for implementing the mandatory currency and tariff for out of area health assessments is enclosed for CCG considerations.
  • CCG are asked to approve the recommendations of enclosed paper marked 5.1a.

LTC update / A more detailed report which concludes the horizon scanning around Long Term Conditions is to be shared with CCGs shortly. The PCU and CSU has undertaken further disaggregation and analysis of the NHS Outcomes Indicator 2.3.ii unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s. Analysis and comparison across the 4 CCGs demonstrates that unplanned admissions are generally reducing and very clearly indicates areas where CCGs might wish to review the management of long term conditions locally to understand the variation.
One to One Midwifery / Officers from the 4 CCGs have agreed a collaborative response to One to One Midwifery regarding non-payment of invoices. Each CCG is also advising their member practices that referrals for maternity services should be within existing commissioning framework. An oversight of quality and safety issues to be maintained via local and regional networks.
ASD Adult and Children update / Autism Procurement
In April the PCU Management Board asked for a business case for procurement for a county wide adult autism diagnostic service and for a diagnostic service for children in the Vale of York CCG area. In the ensuing weeks the clinical lead for the VoY CCG has requested that the procurement be part of the forthcoming wider MH procurement. In addition the SRCCG has raised a request that adult autism and adult ADHD services be integrated into their mainstream MH services.
Following internal discussions within the PCU and with clinical leads suggest that there would be value in doing some further work on adult ASD and potential ADHD in terms of expected demand, cost, the scope of service and potential opportunities for additional benefits to patient outcomes and improving the clinical management of patients with ASD/ADHD and co morbid problems.
Issues:
  • Young Adults with ASD and ADHD do not have a clear transitions pathway to adult services. There is variation between services and CCG localities.
  • Moving from a spot purchasing arrangement toward a contracted service with a like for like provision may not deliver any patient and business benefits if access to care and services is not improved and part of the pathway.
  • Access to autism assessments should be via screening. More work is needed to define who would be eligible (likely to benefit from an assessment) and how local care pathways might operate. This will require more detailed work with primary care, social care and specialist providers.
  • There is a debate on whether ASD and ADHD should be an AQP issue or an integration issue, or a mixture of both and what the business benefits are for these.

C&F Act EHCP
sign-off and decision for sign-off of Health for EHCP / Education, Health and Care plan
NYCC and CoY request authorisation from the 4 CCG’s in respect of their Education, Health and Care plans. See appendix 1
  • CCGs to confirm their acceptance and authorise their use from a health perspective.
Local Offer
CCG’s to note that the PCU are working with LA colleagues in the collation of health services locally to be included in the Local Offer. The PCU are also assisting LA’s with the development of the maintenance schedule and have provided a guidance document for health providers to support the provision of quality information in the Local Offer. See appendix 2.
Joint Commissioning
The PCU are working with both Local Authorities to progress joint commissioning. The pilot project is for the Speech and Language Service.
Designated Medical Officer/Designated Clinical Officer
A mapping exercise has been completed to identify that there are 4 DMO’s currently in NY&Y provider services undertaking a historic role. Whilst the Code of Practice is still in draft format, it states that a DMO/DCO should [this indicates best practice] be identified. This could be more than one post in a variety of combinations. Included in their remit would be to ensure that CCG’s are meeting their statutory functions but also holding delegated authority in respect of EHCP’s
  • The PCU suggest that some of the roles of the DMO/DCO within the Code of Practice may align with the historic DMO roles currently. Where there are new functions e.g. the authorisations of EHCP, the PCU to explore as this would be a CCG delegated function.
  • The Children’s’ Team will be further reviewing the Children and Families Act to identifying to the CCG any further gaps and reporting back. Attention needs to be focused on the gaps created by the EHCP extending up to 25 years

Appendix 1

Appendix 2