Report To:Children and Young Peoples Health and Wellbeing Joint Commissioning Group
AGENDA ITEM
REPORT TO:CHILDREN AND YOUNG PEOPLES HEALTH AND WELLBEING JOINT COMMISSIONING GROUP
1 MARCH 2017
REPORT OF LYNN SPARREY, CHILDRENS COMMISSIONING PUBLIC HEALTH
SPECIALIST ASSESSMENT COMMISSIONING
1. SUMMARY
1.1The purpose of his report is to provide an overview of the current arrangements for the commissioning of individual specialist assessment work for children and their families.
2. RECOMMENDATIONS
2.1Further work to be undertaken to evaluate the types of work procured to date and the effectiveness of the intervention to consider if the delivery had the desired outcomes for the families involved and that the service was therefore cost effective.
2.2Consideration of the development and use of the existing workforce to deliver Capacity to Protect Assessments.
2.3Development of clearer pathways to the CCG and Health providers regarding the commissioning and provision of appropriate health assessment work.
3. BACKGROUND
3.1In September 2014 the Council invited prospective providers, through an open advert on the Pro Contract site, to be approved as a provider on a Framework for the provision of spot purchased specialist assessments and interventions for children and / or families with whom the Local Authority work.
At that time, the Local Authority spot purchased many of these specialist services from a range of providers on an ad hoc and needs led basis through the individual social workers, who often procured the services through recommendation from other professionals or from existing and known contacts.
The types of work purchased were very variable and included:
- The provision of clinical and therapeutic related work to support children and or adults demonstrating emotional and behavioral disturbances.
- Capacity to protect Assessments.
- The provision of clinical and therapeutic packages and full risk and psychological assessments of alleged offenders.
- Adult cognitive assessment in relation to the ability to parent.
3.2This initial attempt to establish a specific framework of providers was limited in its success due to the lack of responses from the market and the shortage of centrally collated knowledge of the range of assessment work which needed to be procured. The advert for the framework resulted in only a small number of responses with the following providers being accepted:
Barnardos
Core Assets
Five Rivers
ICIS
ISWA Ltd
Alliance Psychological Services
Alliance have since asked to be removed from the Framework as the work generally requested falls outside of their current business model.
3.3In March 2016, it was agreed that a process be undertaken to establish the views of other Tees Valley Local Authorities in the development of a Tees Valley Framework for the provision of these types of assessments. Agreement was subsequently reached with Redcar and Cleveland and Hartlepool to work jointly on this process. Middlesbrough and Darlington were to further explore the needs for this as a specific piece of work.
As the most common type of work commissioned was Capacity to Protect, the other local authorities subsequently felt that taking this issue forward for further development was not a priority area since this type of assessment was able to be delivered in house. Carer / Parent Risk Assessments were also not a concern as these were, at that time able to be provided free of charge in most instances by NSPCC.
The NSPCC has however now closed its local office making experienced and skilled workers redundant. Some initial discussions were held with other Tees Valley Local Authority commissioners and some of these workers to explore options around keeping their skills available. The outcome of these discussions was that the workers have since set up as self employed workers and were successfully approved and added to the Stockton Framework for the provision of specialist assessments in November 2016. They have only very recently started to quote for work
3.4Since the Framework was established, a total of 33 cases have been referred to Commissioning for quotes to be sought from the providers. Of the 33 cases, 13 were awarded to ICIS, 1 to Core Assets and 2 to Alliance whilst they were still participating in the process and 2 to Barnardos. Of the remaining cases, 5 did not proceed as alternative services were secured such as residential care or support from other services such as CAMHS or TEWV after further consideration of the referrals. 10 cases are still outstanding and waiting further information from providers or operational staff.
4. CURRENT SITUATION
4.1The most frequent work requested to be secured is Capacity to Protect, the next most frequent being Risk Assessments on parents / carers or young people themselves.
A small number of the assessments referred to Commissioners have been for a range of psychological therapies such as DBT, Anger Management, Attachment Disorders etcwhich were more likely to be the responsibility of health. After further clarification these were referred back by the Social Workers toTEWV and / or the CCG for consideration and were subsequently accepted. The failure to initially accept the referral seems to have been due to a lack of understanding of the needs of the client and the interventions thought to be required to address the issues.
4.2The total amount known to have been spent on completed work secured via the framework from the Section 17 budgets over the period of the operation of the framework is approximately £75,000.
In addition to the above, 14 further cases are known to have been referred and awarded directly to ICIS by Social Workers without the involvement of Commissioners. The amounts paid for this work are unknown at this point but as ICS generally quotes a minimum of £2,800 - £3,200 for each piece of work therefore it may be reasonable to assume that the minimum overall cost of this work would be in the region of £40,000 - £45,000.
As information on these specialist work spends is variable and can be subsumed in other related work and budgets then the above figures may be conservative and could be higher. Also in some instances further work is recommended by the provider often resulting in substantial additional costs being incurred and these costs are also not included.
5.ISSUES FOR FUTURE CONSIDERATION
5.1When externally commissioned specialist assessment work is required, the Social Worker must secure approval for this from their Team Manager as this is funded from the individual teams Section 17 budget. All requests should therefore be reviewed by the managers to ensure that the work requested is appropriate and relevant,and that there are not alternative ways of providing the service, before quotes for the work are sought.
However, the clarity of some of the initial requests for work can be variable and operational staff are at times having to make judgements on what they feel are the most appropriate interventions for families without any initial clinical oversight or triaging.
Similarly, when the quotations for work are returned from providers there is no clinical support to help social workers or commissioners evaluate their proposals leaving providers in a strong position in terms of the levels of interventions offered, the amounts charged and recommendations on any additional future follow up work.
5.2Consideration needs to be given to closer involvement of health colleagues to support the initial referrals for specialist assessments to ensure that the appropriate interventions are being requested and that pathways into alternative health care have been fully explored.Where the interventions should be delivered by health or other more appropriate agencies then the access and pathways need to be clearer to minimise any misunderstanding of what is or is not available to families.
5.3In addition, the quality or effectiveness of the commissioned pieces of work are not currently subject to any independent overall evaluation after the interventions have been delivered,to enable analysis of the work provided to ensure best practice and value for money, and support from other partners such as health colleagues, where appropriate, would be beneficial.
5.4The use of the limited provider framework that was established in Stockton has been helpful in that it has enabled someco ordination of the types of quotes requested and a clearer understanding of the work involved. Consideration has been given to refreshing this framework using traditional procurement routes, however due to the under development of this market locally, this may not produce the required increase in providers that would offer more options to the Council.
6.RECOMMENDATIONS
6.1A clearer understanding and evaluation of the effectiveness of the work that has been commissioned and the parameters of the work that we should be purchasing should be considered to enable the commissioning of specialist work to be effective and appropriate. This would also underpin the development of any future framework in that the authority would be able to be more specific about the types of providers required, the levels of qualifications, experience and training,and associated costs to deliver the procured work.
6.2Consideration should also be given to the method of delivery of some of the interventions currently commissioned – i.e Capacity to Protect. This is delivered internally by most other local authorities and given the costs of purchasing such services externally this may provide substantial savings to the Council. However this would have implications for the current workforce in terms of workload. Capacity to Protect Assessments may require a period of intense work with the family which may not be easily absorbed into current workloads. However delivering internally may also provide some development opportunities for staff and longer term availability of expertise.
6.3Clearer pathways to the CCG / Health for the commissioning of appropriate health assessment work also needs to be established. Some of the assessment work requested should have been provided by Health but unclear pathways and service options have resulted at times in external work resources being sought.
5. FINANCIAL IMPLICATIONS
5.1None at this stage. Further work to be undertaken with finance and procurement.
6. LEGAL IMPLICATIONS
6.1None as yet – review processes and longer term plans around the delivery of these interventions will identify any possible legal issues that need to be addressed.
7. RISK ASSESSMENT
7.1None undertaken at this stage in the process.
8. CONSULTATION
8.1No external consultation required. Consultation will take place as appropriatewith all stakeholders including the corporate Finance and Procurement and the CCG.
Name of Contact Officer:Lynn Sparrey
Post Title:Children’s Team Manager – Commissioning, Public Health
Telephone No:01642 528451
Email address:
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