CHILDREN AND YOUNG PEOPLE’S
COMPLEX AND CONTINUING CARE
- INTEGRATION PROPOSALS
FEBRUARY
2011
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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)
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
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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
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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)
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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
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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:
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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
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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 rehabilitation home /school – savings not yet determined
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Who was involved ?
■ Senior managers across NCC and NHSN
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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
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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
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Risks/Potential problems
■ Human resource problems/risks
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Engagement of key individuals at time of structural and personnel
changes
Time and capacity to take ideas forward
■ Financial resource problems/risks
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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
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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.
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).
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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
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