Care and Treatment Reviews Task and Finish Group Updates for Commissioner Network

1. Care and Treatment Reviews Task and Finish GroupUpdates for Commissioner Network 7 October 2015

2. Original scope of Task and Finish Group • To learn from our experiences of the previous CTRs and explore how they will become business as usual (BAU) • To support the development of the pre-admission (or ‘community’) CTRs and look at how these can be rolled out • As part of the above, to develop registers of patients at risk of admission to an inpatient facility (abbreviated to ‘at risk registers’) • Now revised to ‘To look at how existing patient registers can be used effectively to identify individuals at risk of admission to inpatient services, and to support pre-admission CTRs’

3. Key aspects related to CTRs

4. Our proposal: identifying individuals who are at risk of admission to inpatient services • London CCGs are happy that the existing processes and documentation are sufficient to identify individuals at risk of admission to inpatient services • As a region, we do not believe that developing new registers is required or will provide enhanced outcomes for patients • Instead, NHSE will require CCG and LA assurance that they have the processes and documentation in place, including joint CCG-LA registers

5. Our proposal: pre-admission (community) CTRs • Pre-admission CTRs should take the form of a rigorous CPA/CTR review. They will be used where a service user is identified as strongly or potentially at risk of admission to inpatient services • The CCG will have oversight of this meeting and an external Clinical Expert and Expert by Experience will be organised • Where the CCG does not wish to implement these additional elements of a CTR into the rigorous CPA, it will be for the CCG/LA to justify this position in discussion with NHSE

6. Other actions to be taken to strengthen CTRs • Communication, capability and development • We need to increase awareness of the market, the services available in the community, and building services around the individual • We need to increase understanding of the role of the care coordinator • We should look at accessing other networks (e.g. psychiatrists) to influence, educate, engage • Provider role • CCGs often face issues around compelling providers to deliver CTR outcomes, given they are not stipulated in current contracts • Where In order to improve provider performance, NHSE will set up NHSE-CCG-provider meetings • NHSE will identify those providers who are slowest to discharge patients • Children • The next priority is to look at the processes for 16+ and transition

7. Collaborative commissioning Task and Finish GroupUpdates for Commissioner Network 7 October 2015

8. Scope of Task and Finish Group ATU placements – patient numbers, costs and potential collaborative work Respite and domiciliary care for complex needs – good practice, how are particular need of people with learning disabilities met, potential for information sharing and collaboration, development of care requirements for domiciliary care service Development of specification for enhanced community team – to support admission avoidance and effective discharges

9. ATU placements • 16 CCGs fed back on their ATU placements • The current range of costs is shown below • We will share cost information across all CCGs who have responded – other CCGs are invited to share their own information

10. ATU placements: by provider Cambian CNWL Cygnet Danshell Glencare Herts PiC Sequence SLAM

11. Enhanced community teams • Several CCGs have developed (e.g. Enfield, Southwark) or are developing enhanced community teams • Across London, different CCGs are at different stages in terms of integrated community teams • The opportunity to develop an enhanced team raises the issue of collecting data/evidence to show potential benefits and benchmarking the level of service. Question: How many areas are currently considering developing this service and are willing to share information?

12. Action for CCGs • Break into five regional areas to discuss opportunities for information sharing or collaboration around: • ATU placement commissioning, improving quality and costs • Respite and domiciliary care for complex needs • Development of enhanced community team specification • Feed back to the room on your discussion and opportunities for your sub-region or the Task and Finish Group

13. CCG groups North and Central Enfield Barnet Harrow North West Hillingdon Haringey Waltham Forest Redbridge Brent Camden Islington Hackney Havering Ealing Barking & Dagenham Tower Hamlets Newham Central London City H&F Hounslow WL North East Greenwich Lambeth Southwark Wandsworth Richmond Bexley Lewisham Merton Kingston South West Sutton South East Croydon Bromley