CHILDREN AND YOUNG PEOPLE’S COMPLEX AND CONTINUING CARE - INTEGRATION PROPOSALS

1. CHILDREN AND YOUNG PEOPLE’S COMPLEX AND CONTINUING CARE - INTEGRATION PROPOSALS Children and young people with mental health needs, complex disability/ learning disability and physical illness. A number of these children may be CLA and have a statement of educational needs (SEN) FEBRUARY 2011

2. CONTEXT – Why was this required. Background information: Continuing care – Health needs that are highly complex, unpredictable, intense and enduring arising from mental health, disability or physical illness. Complex care – Presenting needs are such that they require a support package requiring input from health, education and social care agencies to ensure the maintenance of care. - CLA

3. CONTEXT – Why was this required. Background: Continuing Care process highlighted the lack of joined up processes: • Governance/Strategy & Planning – lack of clarity regarding respective responsibilities, authority and governance of the decision making processes. Lack of joint strategic planning • Specialist Assessment Processes – range of specialist assessments. Lack of a multi agency assessment and plan of care. • Core Assessment • SEN assessment • CLA planning • CPA for CAMHS • Specialist Health assessments • Highly specialist – Continuing Care assessment

4. CONTEXT – Why was this required. Background: • Decision making/ planning forums – number of panels: • Placement panel LA • SEN panels • CC panel • Complex needs panel No clear pathway to link up so decisions being taken in isolation. • Procurement/ Contract arrangements - Number of spot purchase agreements. Separate contracting process LA and health (PCT)

5. What we wanted to achieve- Benefits • Improved outcomes for individual children • Integrated specialist assessments to meet the social, educational and health needs of children and young people. • Development of robust multi agency plans and decision making to meet need. • Improved multi agency monitoring and review of care packages and placements. • Efficient, effective multi-agency pathway for decision making

6. What we wanted to achieve - Benefits • Build ‘multi –agency needs analysis’ of young people with complex/continuing care needs through a shared data base to include: • All children who have met the threshold for continuing care. • All children placed outside of the county by the LA or NHSN • All children in non LA or NHSN provision within county. • All children who have complex/ acute needs requiring a community package of support • Children who are being discharged from YOT services where complex needs have been identified

7. What we wanted to achieve - Benefits • Improved joint strategic planning/commissioning • Use integrated needs analysis to inform commissioning strategy aimed at developing local services. • Align /pool resources across NCC and NHSN to commission local services • Improved procurement and contracting arrangements • Integrate contracting and procurement across NCC and NHSN with procurement lead identified • Develop shared quality and performance standards for procured services • Financial efficiencies • 150 children currently spend in region of £10,000,000 • Improved individual planning – 4-5 children saving £1,000,000 • Develop local services- fewer out of county/ greater chance of re-habilitation home /school – savings not yet determined

8. Who was involved ? • Senior managers across NCC and NHSN • NCC- SEN and Disability Manager • NCC Psychology and Inclusion Manager • NCC- Contracts/Procurement Managers • NCC- CLA Manager • NCC -Fostering and Adoption Manager • NCC - Area (locality) manager • NCC- CAF and Integrated Working Guidance lead • NCC – Youth Offending Service (YOS) Manager • NHSN Joint Commissioning lead • NHSN – Complex and Continuing care commissioning lead • NHFT – Specialist CAMHS managers •  CAMHS/ Disability Partnerships and JCG’s • Paper taken to these forums and then to individual organisations

9. How we did this • Multi agency conference • Raise the awareness of Continuing Care framework and process • Raise awareness of the need for multi agency decision making in meeting the needs of children and young people with complex/continuing care needs. •  Steering group • Developed proposals, action plan and timescales • Highly Complex Needs Panel • Meet individual needs effectively • Monitor/review individual needs collectively – resolve issues • Collate information to inform strategic planning

10. Risks/Potential problems • Human resource problems/risks • Engagement of key individuals at time of structural and personnel changes • Time and capacity to take ideas forward • Financial resource problems/risks • Identifying the financial envelope within each organisation to align/pool • Economic climate – cut backs may make organisations less likely to commit to pooling resources to commission integrated services • Commissioning Structural problems/risks • Move to GP commissioning – future of children’s health commissioning still not finalised – proposals to move activity to NCC • NCC proposals regarding adult/children’s commissioning • Regional Commissioning of Tier 4 inpatient and Crisis Home Intervention and Treatment service.

11. Support for proposals • Guidance from DOH - New National Framework for Children and Young People’s Continuing Care. • Establishing the Responsible commissioner Guidance (DOH April 2006 Amended April 2007 for CLA out of Area Placements) • Northamptonshire’s Strategy for Emotional Well Being and Mental Health 2010-13 • Northamptonshire’s Aiming High for Disabled Children Strategy 2009-2011 • NCC and NHSN proposals to develop a Children and Young People’s Integrated Commissioning Unit (NHSN and NCC).

12. Next Steps • Highly Complex Needs Panel • Refine paperwork and pathways between all panels • Shared database • Agree dataset • Training programme • Roll out across all organisations • Specialist services • Integrated Working Guidance • Joint commissioning strategy • To be developed • Integrated procurement teams • Part of plans for Integrated commissioning unit