AGENDA ITEM 10
TRUST BOARD
Tuesday 27 November 2007
PAPER
FORMAT
Procurement of Child and Adolescent Mental Health Services and Community
Children’s Services
To inform the Trust Board of developments in relation to Child and
Adolescent Mental Health Services and Community Children’s Services and
to determine a view from the Trust Board as to whether the United Bristol
Healthcare NHS Trust should submit a bid to provide these services for the
next 5 years.
A one-off briefing paper.
THE BOARD IS
ASKED TO:
Note the contents of the paper, to consider questions in item 5 of the report
and agree way forward.
PURPOSE
1
Background
1.1
Currently the Child and Adolescent Mental Health Services and Community Children’s
Health Services are provided by 4 main providers, namely the United Bristol Healthcare
NHS Trust, North Bristol Trust, Bristol Primary Care Trust and South Gloucestershire
Primary Care Trust.
1.2
There is increasing recognition by Bristol Primary Care Trust that agencies will improve the
five key outcomes for children if health works in close partnership with other agencies.
1.3
Previous children’s reviews by both Bristol Primary Care Trust and South Gloucestershire
led to recommendations that services in South Gloucestershire should transfer to that
Primary Care Trust and North Bristol Trust services should transfer to the United Bristol
Healthcare NHS Trust. This was in line with the Bristol Health Service Plan for
centralisation of children’s services at United Bristol Healthcare NHS Trust. These
arrangements were put on hold for various reasons, including infrastructure issues,
reorganisation and reduction of Primary Care Trusts and uncertainty regarding the future of
a Primary Care Trust as provider.
1.4
Bristol Primary Care Trust has reconsidered the provision of Children’s Services and has set
out a plan for the future procurement of Child and Adolescent Mental Health Services and
Community Children’s Health Services by a competitive contestability process.
1.5
Bristol Primary Care Trust believes this proposal will present an opportunity to address
existing inequalities for all children across Bristol.
2
Services included
2.1
Currently the United Bristol Healthcare NHS Trust have a funded establishment of 157
whole time equivalent staff with a budget of just under £6m to deliver a portfolio of services
within Community Children’s Health and Child and Adolescent Mental Health Services.
The combined services of the 3 existing providers we are told equates to 700 staff and a
budget of £20m per year for 5 years.
2.2
The current services that are included with this portfolio are:
Community Child Health:

Community Paediatricians
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AGENDA ITEM 10
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School Health Nursing
Child Health Records
Community Occupational Therapy
Community Physiotherapy
Audiology
Speech and Language Therapy
Learning Disability
Tyndall’s Park Children Centre for pre school children with complex needs /
disabilities
Child and Adolescent Mental Health Services:

Tier 2 – Primary Mental Health Specialists
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Tier 3 – Speciality Multidisciplinary Teams
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Tier 3 – Provision for Youth Offending Team
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Tier 3 – Provision for Paediatric Liaison
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Tier 4 - Prison In-reach Service
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Tier 4 – “Lumsden Walker House” Day Assessment Service for 5 – 12 year olds
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Tier 4 – Young People Drug Treatment Service
2.3
North Bristol Trust provide similar services with the exception of Audiology but, in
addition, provide a Tier 4 Inpatient unit for Adolescents.
2.4
Bristol Primary Care Trust is a provider for Health Visiting Services and Learning Disability
Services.
2.5
There are a few service areas that are presently being considered in the context of potential
exclusion from this process. These are:
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Audiology – this has interdependencies with the Ear Nose and Throat department
Tier 4 Child and Adolescent Mental Health Services – we are awaiting
recommendations from the Tier 4 Child and Adolescent Mental Health Services
South West Review
Community Children’s Health for South Gloucestershire Primary Care Trust – the
Primary Care Trust will decide whether these services will be part of the
contestability process at end of October 2007.
3
Approach
3.1
The Women and Children’s Division have consulted widely with staff in open forum
meetings and through attendance at staff meetings to inform staff of the process and to hear
their views as to where services could best be managed and what is best for children, young
people and families.
3.2
Following discussion at the Divisional Management Board we agreed to put forward 2
scenarios for consideration.
4
Options for consideration
4.1
Scenario A
This approach recommends competing to provide all of the above services for Child and
Adolescent Mental Health Services and Community Children’s Health services.
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This scenario fits strategically with Bristol Primary Care Trust’s vision of rationalisation of
providers and the expectation that improved joint working will improve key outcomes for
children. As an organisation with children as our core business, the Division is well
equipped with clinical and managerial expertise as well as a governance framework to
support this expanded portfolio of services.
However, the potential impact of this scenario is that it will involve a significant and
complex change management process for three organisations merging to one. There are also
longstanding concerns in relation to infrastructure issues within the existing 3 organisations
in relation to historical underfunding, accommodation and the need to put into place an
Information Management framework fit for purpose.
4.2
Scenario B
This approach recommends not bidding for any of the Child and Adolescent Mental Health
Services and Community Children’s Health Services.
This scenario ensures the Division does not become destabilised by a range of services
which may potentially be a significant financial risk and allows us to focus on provision and
delivery of acute services.
The impact of this scenario is the loss of an integrated model of providing services from
primary care through to tertiary and quarternary services. We will be reliant on purchasing
services in relation to Paediatric Liaison, Child Protection and care of children with complex
disabilities.
5
Questions for Trust Board to consider
5.1
Does the Trust Board see Child and Adolescent Mental Health Services and Community
Children’s Health services as part of the Trust’s core business?
5.2
Should the United Bristol Healthcare NHS Trust tender for Child and Adolescent Mental
Health Services and Community Children’s Health services?
5.3
Should the future service model require resources to support the infrastructure to ensure
deliverability of the service, will the Trust provide the financial support?
5.4
Will Trust Board agree to project management support for the Division to complete the
invitation to participate document to bid for these services which is due 22 February 2008?
Prepared by Geraldine Johnstone, Divisional Manager, Women’s and Children’s Division
20/11/07
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