Recommissioning of Community Health Services for Children and Young People[重新调试儿童和青少年社区卫生服务](PPT132)

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1、Re-commissioning of Community Health Services for Children and Young PeopleStakeholder WorkshopRe-commissioning of Community Health Services for Children and Young PeopleStakeholder Workshop2Introduction & WelcomeRichard Bailey, Deputy Head Joint Commissioning, NHS Nene CCG and NHS Corby CCG3Purpose

2、 of the Day Provide a briefing on what is being re-commissioning and why Explain the re-commissioning process Set out the opportunities to participate in the re-commissioning process Share with you information and data derived Offer the opportunity to delegates to share some early thoughts4Agenda 1

3、9.40.Why Re-Commission? Dr Emma Clancy 9.55.Re-Commissioning Process Judith Cattermole, Alison Shipley, Stephen MarksSummarise; Questions 10.15.Demographics; Needs AssessmentDavid Loyd-Hearn, Sian HealeSummarise; Questions 11.00.Tea/Coffee5 11.15.Table Top Tasks - Please ensure Tasks writtenJudith C

4、attermole 12.15Feedback Verbal: one key message to assist re-commissioning 12.35Next Steps & How You Can Get InvolvedRichard Bailey 12.40Panel Q&A 12.50Closing RemarksDr Darin Seiger6Agenda 2 Why Re-Commission?Dr Emma ClancyChildren and Young People Clinical Lead NHS Nene CCG7No Change Not An Option

5、 Growth in Need; Staff running to stand still Frustration from Young People and Parents Variability Access & Coverage across Northamptonshire Understanding (Clinicians; Service Users; Parents) Inability to align local authority and NHS Services Ultimately need to Service Fragmentation; Lessons from

6、Victoria Climbie & “Baby P” But Change also brings opportunity8Imagine a joined up approach with a locality flavour with services delivered in a place convenient for children, young people and families9Health & Local Authority Services Together in Children Centres, Schools and Communities10So That F

7、amilies could access GPs, Health Visitors, community nurses, mental health support etc. in one place Promotion of community involvement and activities Health is more family friendly: Its easier for patients to integrate into community and social schemes There is a reduction in isolation, fostering g

8、ood support networks and promoting physical, emotional and mental wellbeing11What Could We Do?GPs could: do child surveillance clinics immunisations for pregnant women and new-born babies drop in clinics for mums needing GP adviceHospital and Children Community Health services could: Run childrens o

9、utpatient clinic running Base community childrens nurses locally to help with admission avoidance work12What Could We Do Together? Offer a multi-disciplinary network including: Everything that children centres already offer Breast feeding support & midwives Learning Disabilities and special needs, c

10、ommunity paediatrics, secondary care, GP, Health Visitors, CAMHS, social services, voluntary sector Streamline and integrate health & wellbeing and so Meet all needs for families from pre conception to late teens and beyond Use the model to support the work we are doing to improve the care currently

11、 being given to Looked After Children (LAC)13Where Do We Start? Look at current services, infrastructure and estate Get feedback about what works well and where, and what could be done better/differently Use that to devise a centrally commissioned service using the best models and recreating them to

12、 fill gaps (e.g. community paediatric nurses in the North might be useful in the South) Flexing approaches to suit local circumstances Today is the start of that journey14Our Vision“Children and Young Peoples Community Health Services within Northamptonshire will put the voice of children, young peo

13、ple and their families at the centre of everything we do. Over the next 3 years and beyond, we will continue to improve community health services to ensure they are responsive, equitable and inclusive. Services will be available where and when they are needed the most. By working together we aim to

14、ensure children and young people are happy, healthy, safe and resilient, enabling a positive transition into adulthood.” 15The Re-Commissioning ProcessJudith CattermoleChildren and Young People CommissionerNHS Nene CCG, NHS Corby CCG, Northamptonshire County CouncilLead for Re-Commissioning Programm

15、e16Why are we doing this now?National and local drivers Legislative Changes - Pupils with Special Educational Needs (SEN) new Education Health and Care Plan (EHC) with effect from September 2014Drive for Personalisation and Personal Health Budgets (PHB)NCC- Review of Designated Special provision (DS

16、Ps)NCC- Devolution of funds to schools Safeguarding requirements to develop Early Help strategies and services.Recent OFSTED inspection of NCC and partners regarding Adoption and Fostering, Safeguarding and Looked After Children (LAC) services17Local Health ProvisionChildrens Community Health Servic

17、es Two main providers - Northampton General Hospital (NGH) and Northampton Healthcare Foundation Trust (NHFT)Inequity and inconsistency and gaps - in terms of pathways and ease of access to specialist services Rising demand for specialist services High demand A&E services (children under five, self-

18、harm rates)Rise in the number of long term ventilated babiesRise in the number of inpatient mental health admissions Pressure on Home Care support/packages -children remaining in hospital once medically fit for dischargeImpact upon the quality of life for our most complex children and their families

19、 18Financial challenges Cost of A&E and inpatient admissions are tariff based and high Financial challenges impacting upon all organisations- need to develop more effective and efficient local services across agencies which avoid duplication ensure streamlined pathways improve outcomes value for mon

20、ey CAMH services were subject to a tender exercise and need to be re-tendered no later than 1st October 201419Joint Commissioning Opportunities NCC currently carrying out 2 major areas of re- provisioning SEN & Disability Designated Special Provision (DSP) review, EHC plans Re- commissioning Early H

21、elp and Prevention Services- Childrens Centres and Support Services to over 5sOpportunities to fully align commissioning activity now. 20EHC Plans and SEN Provision Review SEN Changes and Designated Specialist Provision DSP ReviewAlison ShipleyNorthamptonshire County Council EHC process supports chi

22、ld/family/schools with Local Offer if assessment or plans not agreed Greater personalisation Shorter process (20 weeks) externally facilitated Co-ordination of education, health and care needs & provision as required Reviewed annually Possibility of notional or real personal budgets Can be in place

23、0-25 if requiredEHC Process & PlansRoll out for NEW requests for statutory assessmentEHC process currently being offered to new applicants in Kettering, Corby, Wellingborough & East Northants.EHC process will be offered to other areas on: - 1st November 2013 - Daventry & South - 1st January 2013 - C

24、ountywideRowan Gate Special School trialling transfer of Statements to EHC Plans from November 2013EHC Roll Out The review was commissioned to evaluate: the diversity of provision in the countys Resourced Provisions (RPs) and SEN Unit provisions (Ups) the impact of the special/specialist provision o

25、n developing inclusive practice and improving outcomes for all children as well as those supported in special/specialist provision the cost of current special/specialist provision and its sustainability in the light of changes in funding mechanisms and current financial restraints SEN Provision Revi

26、ew - ScopeChildren and young people should access a wider range of opportunities locally, and a more personalised education offer, through the partnership working of schools with other schools, alternative providers and special/specialist servicesReview the Speech and Language Resourced provisions i

27、n partnership with the Nene and Corby Clinical Commissioning GroupsFfacilitate the provision of an all through Special School in the south of the county for ASD, SLD and PMLDSEN Provision Review implications for all commission bridging places for secondary aged young people for the LA to use for Day

28、 6 provision/assessment for permanently excluded pupils and for schools to commission, places for the assessment of pupils at risk of permanent exclusion or in need of specialist support for re-integration develop a continuum of provision across the county for BESD and Autism promoting partnership w

29、orking between special schools, SEN Units and mainstream schoolsSEN Provision Review implications for all establish satellite units who will work with an agreed number of primary school children at any one time to implement, under the supervision and guidance of the special schools, a range of provi

30、sion and programmes for primary pupils at risk of permanent exclusion or permanently excludedSEN Provision Review implications for all NCC in partnership with other stakeholders toreview and re-configure the capacity of centrally managed education services regain central responsibility for receiving

31、 direct notification from schools of permanent exclusions and arranging Day 6 provision for themcommission, from a range of providers, packages of education tailored to meet the needs of each permanently excluded secondary pupil, as close to their home as possiblere-commission/de-commission special/

32、specialist provision where necessary SEN Provision ReviewCentral services re-design review the funding arrangements for special/specialist provision ensure all provision is of high quality and value for money re-commission speech and language provision for children to establish an equitable county w

33、ide service (with Nene and Corby Clinical Commissioning Groups)Central services re-design Informal consultation held 7th June 2014 Formal consultation with stakeholders October December 2013 Cabinet January 2014 Implementation May 2014 onwardsSEN Provision Review - timescalesEarly Help & Prevention

34、for children and families in NorthamptonshireStephen MarksNorthamptonshire County CouncilTo enable children and families to access appropriate support as early as possible, to help them maintain their quality of life, prevent any problems getting worse and reduce the demand for high cost, specialist

35、 support services .Purpose All Families are able to maintain healthy and stable living conditions. All families are strong enough to manage stress over money, poverty & unemployment. All families can give and receive support from friends, neighbours and the wider community. All children and young pe

36、ople do well in education and this gives them the skills they need to find work. All families maintain good health and well being for happier, healthier lives. All parents support their childrens healthy physical, emotional, learning and social development. All families maintain stable and good qual

37、ity family relationships. Outcomes for Children & FamiliesTier UniversalSpecialistSpecialist Universal Costs savings generated by reduction in volume (Stock and Flow)Prevention / earlier intervention (Stage not age) Helping You to Help yourselfHelping You when you cant help yourself Prevention and D

38、emand Management CurrentFutureEarly HelpEarly HelpTargeted PreventionTargeted PreventionEarly Help Forum Areas:Statutory and priority services forNCC Early Help and Prevention Commissioning Childrens Centre Services (under 5s) Supporting Services Interpersonal Violence Services Youth Provision Servi

39、ces for young people with challenging behaviours ParentingKey Target Dates Supporting Services Tender Launch of Invitation to Tender Mid October 2013 Tender will close late November 2013 Tender evaluation and moderation December 2013 to January 2014 Award of tender late-Jan 2014 to mid-Feb 2014 Mobi

40、lisation, transition and implementation Mid Feb to May 2014 Services commencement date June 2014Key Target Dates Childrens Centre Services Tender Pre Qualification Questionnaire opens - Late Oct 2013 PQQ closes - Early Dec 2013 Launch of Invitation to Tender - Mid Dec 2013 Tender will close - Early

41、Feb 2014 Tender evaluation and moderation - Mid Feb / Early March 2014 Award - Late March / Early April 2014 Mobilisation, transition and implementation - April to late July 2014 Services commencement date Late July / early August 2014Other joint commissioning opportunities Regional Specialised Comm

42、issioning neonatal pathways, High Dependency, Acquired Brain Injury (ABI) specialist rehabilitation and Tier 4 Inpatient CAMHS etc. Public Health Renewed focus on emotional well being as underpinning poor health outcomes Further opportunities to align approaches with Alcohol and Substance misuse, se

43、xual health etc. Police and community safety initiatives focussing on prevention- opportunities for closer collaboration Safeguarding improvement plans opportunities to consider a more joined up approach40Service Redesign AreasEmotional Wellbeing & Mental HealthSEN and DisabilityAcute, Complex & Con

44、tinuing CareKey InterfacesNCC- Early Help NCC- Social CareNCC Educational PsychologyClinical Commissioning Groups- Adult Mental Health Commissioning Youth Offending Service (YOS) Key InterfacesNCC- SEN and Disability EHC/Provision ReviewCCGs- Adult LD commissioning CCGs Community Services (Long Term

45、 Conditions) Key InterfacesA&E and Acute HospitalsNCC- Social CareAcute Paediatric Services CCGs Community Services What services will this involve?Universal & Targeted Emotional Wellbeing ServicesYouth Counselling services Post sexual abuse counselling servicesLesbian Gay Bisexual Transgender (LGBT

46、) support servicePsychology support for children with medical needsSupport to schools for Behaviour Emotional and Social Difficulties (BESD) services Support to Hospital and Outreach Education (HOE) servicesEducational Psychology support for mental health Talk out Loud anti stigma programmeWorkforce

47、 reformChildrens Centre baby room project Domestic abuse support to parent/ child Parent/Carer participation Video Interactive Guidance (VIG) and Theraplay servicesSleep servicesBereavement serviceHomestart 42Linked (NCC funded)TAMHSADHD support serviceYouth counselling servicesHomestartWhat service

48、s will this involve?Specialist CAMHSCrisis and Home Treatment Community Tier 3 CAMHSPrimary Mental Health Workers (PMHW)Services for children and young people with Learning Disability LAC serviceSocial Worker in CAMHSYouth Offending Service Community Psychiatric Nurses (YOS CPNs)43What services will

49、 this involve?SEN and DisabilitySpecial School Nursing Physiotherapy Occupational Therapy (OT)Speech & Language Therapy (SLT)Continence servicePaediatric AudiologyChild Development Centre (CDC)Community Team for People with Learning Disability (CTPLD) - up to the age of 2544What services will this i

50、nvolve?Acute, Complex & Continuing CareChildrens Community Nursing Admission Avoidance Generic Community Nursing Specialist Community NursingCommunity PaediatricsLAC health servicesComplex and Continuing Care home support packages45Recommissioning areas do not include Health Visiting and Mainstream

51、School NursingWhat is the timeline ?Timeline Activity July October 2013 Needs assessment and service review Phase 11st October 2013 Current Providers service 1 years noticeOctober December 2013 Service re-design Inform and engagement events- market testing -future specification developed Phase 2 Jan

52、uary 2014 June 2014Procurement process begins June 2014 New provider identified Phase 3 June October 2014Transition to new provider 1st October 2014 New provider operating Phase 41st October 1st April 2015Post transition implementation1st April 2015Post transition review and lessons learnt46Change P

53、rocess Services currently delivered are valued and will continue to be required- build upon the areas of good practice and an opportunity for new models of delivery Staff will feel anxious and unsure we do not want to lose staff - ensure effective communication throughout the process TUPE transfer c

54、onditions will apply. Provider organisations will have a responsibility to ensure staff are fully briefed about what this means for them Parents will feel anxious this is an opportunity ensure equitable and consistent service delivery- new service models should be responsive to parent and childs nee

55、ds47Programme GovernanceChildren and Young Peoples Re Commissioning Clinical Board EWB&MH key stakeholders Young Healthy Minds PartnershipSEN and Disability key stakeholdersDisabled Children and Young People Partnership Acute complex and continuing care key stakeholders Healthier Together 48Children

56、 and young peoples re-commissioning Project steering group Parent/Carer Co-production Confirm & ChallengeChildren and young People Co-production Confirm & ChallengeStakeholder GroupsCorby CCGNene CCGJoint Commissioning BoardLSCBNCYPBBHealth & Wellbeing BoardSummary 49Need to Re-Commission ServicesOp

57、portunities from Re-Commissioning ServicesLarge Agenda with Tight TimescalesCommitted to An Open ProcessQuestions?50Demographics & Needs AssessmentDavid Loyd-Hearn, Commissioning Lead Children & Young People Emotional Wellbeing & Mental Health Sian Heale, Commissioning Lead Children & Young People S

58、EN, Disability, Acute, Complex and Continuing Care51Demographics of Children and Young People in Northamptonshire52Needs Analysis - Demographics The following figures are taken from various sources across the NHS, County and District Councils, Provider Partners, and Central Government Agencies. Wher

59、e prevalence figures or indicators of need are sourced, these are taken from national and international research papers and applied to the population as at the 2011 census. These figures change on a regular basis dependent on demand for services and are therefore intended to give a perspective on th

60、e key trends affecting children and young people services across Northamptonshire.53Needs Analysis - Population Demographics Northamptonshire has a population of 691,952 of which 171,736 (24.8%) are children and young people aged 0 to 19 years We can expect 1000 more children living in Northamptonsh

61、ire each year up to 2020 There were 9,229 births in 2011 of which 21% of births were to mothers born outside the UK Around 24,000 children in the county live in poverty, which is approximately 1 in 6 children, ranging from 21% in Northampton to 6% in South Northants 75% of the children in poverty li

62、ve with a lone parent 50% of families in poverty have a child aged 0-454Needs Analysis- Population Demographics Education: % of pupils achieving 5 A* to C GCSE grades: Northamptonshire 55.0% (Corby 47.0% to South Northamptonshire 71.2%) Employment: % adults in employment: UK (70.1%) and Northamptons

63、hire (76.8%) Physical activity: Adult participation in 30 minutes, moderate intensity sport: England 36.0% Northamptonshire 34.0% (Wellingborough 23.1% to Northampton 37.1%) 55Starting Well promotes wellbeing of both parents and infants Programmes to support secure attachment with parents and carers

64、 Breastfeeding support Supporting good parenting skills 1930 parents accessed parenting programmes including 379 parents of children with special education needs and 1243 parents with particular needs (1000 of who accessed Service Six) 46,012 children aged 0-4 Pre-school and School Programmes 44.8%

65、of 3 and 4 year old children benefit from early education places in Northamptonshire (England 47%) 97% of under 5s attending pre-school programmes (for Northamptonshire (England 86%) c108,000 children attend school c4000 children and young people have statements 3.4% compared to England average of 2

66、.8% Variable local provision of school based social emotional learning programmes which result in net savings of 84 for each spent (DH, 2011) 105 pupils 0.1% were permanently excluded (2011/12)Children and Adolescents Vulnerable Groups Looked after children (by the state) - 5 fold increased risk of mental disorder (Meltzer et al, 2003) (768 in Northamptonshire) Children with learning disability - 6.5 fold increased risk of mental illness (Emerson and Hatton, 2007) Special educational need (OR 3.