Young People Health and Wellbeing Commissioning Group

AGENDA ITEM

REPORT TO CHILDREN AND

YOUNG PEOPLE HEALTH AND WELLBEING COMMISSIONING GROUP

16 MAY 2014

REPORT OFEARLY YEARS

AND COMPLEX NEEDS

MANAGER AND JOINT COMMISSIONING MANAGER

SPECIAL EDUCATIONAL NEEDS REFORM – JOint Commissioning

SUMMARY

The purpose of this report is to outline the implications of the Children and Families Act Part 3 –Children and Young People with SEN and disabilities and the potential role of the CYPHWBCG in contributing to meeting local joint commissioning duties.

RECOMMENDATIONS

The group is asked to:

•Note the content of briefing

•Support the recommendations:

1)Inclusion of a detailed examination of local SEN needs within the JSNA

2)Development of a joint commissioning statement

3) Provide advice on the new EHCP process and support the sign off of partner

engagement

4) Support the SEN project team to development local information that outlines clearly

the scope of SEN Personal Budgets and how families can access them.

DETAIL

1. Introduction

The purpose of this report is to outline the implications of the Children and Families Act Part 3 – Children and Young People with SEN and disabilities and the potential role of the CYPHWBCG in contributing to meeting local joint commissioning duties.

The group are asked to consider the implications and to take forward the recommendations.

2. Brief overview of the changes in relation to joint commissioning:

2.1 Joint commissioning – population level

Joint commissioning is a strategic approach to planning and delivering services in a holistic, joined-up way. It is a means for the different partners commissioning education, health and care provision, to deliver positive outcomes for children and young people with SEND. It offers partners a way to work together to deliver more personalised and integrated support resulting in better outcomes for the system, as well as the individual. A joint commissioning approach can also provide local area partners with an opportunity to redesign services across education, health and care in order to operate more effectively, both improving the experiences of children, young people and their families and making best use of local resources (Mott Macdonald, 2013).

Example of a joint commissioning cycle provided in the draft code of practice (April 2014) fig 1

Within the draft code of practice (April 2014) the scope of the joint commissioning arrangements is described as – ‘Joint commissioning arrangements must cover the services for 0-25 year old children and young people with SEN or disabilities, both with and without EHC plans. Services will include specialist support and therapies, such as clinical treatments and delivery of medications, speech and language therapy, Child and Adolescent Mental Health Services (CAMHS) support, occupational therapy, habilitation training, physiotherapy, a range of nursing support, specialist equipment, wheelchairs and continence supplies and also emergency provision…could also include highly specialist services …commissioned by NHS England.

LA, NHS England and CCG’s must make arrangements for agreeing the education, health and social care provision reasonably required by local children and young people with SEN or disabilities’

The arrangements for joint commissioning for children and young people with SEND will be informed by and draw on:

The local needs identified by Health and Wellbeing Boards in their Joint Strategic Needs Assessments; and
The agreed priorities of the Joint Health and Wellbeing Strategy.

Appendix 1 sets out the responsibilities of relevant groups in relation to arrangements for SEN and disabilities including joint commissioning.

Recommendation 1- The CYPHWBCG has agreed at a previous meeting to be the mechanism for executing this strategic duty on behalf of the Health and Wellbeing Board. The CYPHWBCG are asked to lead on the strengthening of the dataset contained within the current JSNA. It is recommended this is led by public health and a request is made to the Tees Public Health Shared service to review current JSNA content and ensure the use of the minimum dataset contained within the draft code of practice.

The joint commissioning arrangements need to set out how they will use local needs assessment to develop locally agreed shared outcomes for SEND, develop plans for how local provision is to be secured and who is responsible for securing it. Involvement of children parents and families in joint commissioning is also a requirement outlined within the code of practice and the arrangements must also establish a mechanism to resolve disputes between the different commissioning parties and individuals. These arrangements and services should be described in the local offer. CCGs must also work with the LA in the development and publishing of a local offer.

Recommendation 2 - It is recommended that CYPHWCG task the SEN reform project team to develop a joint commissioning statement describing how the arrangements will be delivered to be published as part of the local offer.

2.2Joint assessment, planning and individual commissioning

Joint commissioning must also include arrangements for

securing EHC assessments
securing the education, health and care provision specified in EHC plans
agreeing Personal Budgets

The Local Authority and CCG must also collaborate in determining the process for the creation of an Education, Health and Care plan by advising on what kind of education, health and care provision is reasonably required by the identified learning difficulties and disabilities which result in the child or young person having SEN. The Education, Health and Care plan will have to be approved by the relevant LA and CCG, and if approved each body must ensure that the support set out in the EHC plan is made available.

There is an emerging complex needs panel for Stockton (CMAP) where Education, Health and Social Care will be brought together to discuss and agree joint individual packages. This panel will provide a mechanism for the most complex cases. The work of the panel should feed into joint commissioning.

The wider process for EHCP agreement is still currently being mapped and developed through the EHCP work stream. However it is envisaged that the current SEN High Needs panel will be reconfigured as part of the decision making process and will deal with requests for EHC assessments and decisions on plans, including sign off by the LA and partner agencies

The code of practice states that ‘The CCG as commissioner will often have a limited involvement in the process (as this will be led by clinicians from the services they commission) but must ensure that there is sufficient oversight to provide assurance that the needs of children with SEN are being met in line with their statutory responsibility. The CCG will have a more direct role in considering the commissioning of a service that does not appear in the Local Offer to meet the complex needs of a specific individual, or in agreeing a Personal Budget’

The co-ordination of health information as part of the EHCP process will in the main be delivered through the Designated Medical Officer role currently provided by North Tees and Hartlepool Foundation Trust Community Paediatric Team.

Designated Medical/Clinical Officer

The Designated Medical Officer (DMO) will support the CCG in meeting its statutory responsibilities for children and young people with SEN and disabilities by providing a point of contact for local partners, when notifying parents and local authorities about children and young people they believe have, or may have, SEN or disability. and when seeking advice on SEN or disabilities. The DMO can advise schools with their duties under the ‘Supporting Pupils with Medical Conditions’ guidance. The DMO would not routinely be involved in assessments or planning for individuals, except in the course of their usual clinical practice, but would be responsible for ensuring that assessment, planning and health support is carried out. The CCG will delegate agreeing the health services in an EHC plan unless there is additional resource required or a request for a personal health budget.

Recommendation 3 – The CYPHWBCG provides advice as the new EHCP process emerges and supports the sign off of partner engagement

3. Personal Budgets

3.1 Development of personal budgets for children as proposed will have an impact on future commissioning arrangements. A personal budget refers to the budget that will be made available should a parent/carers of a child or young person with an EHCP plan request one.

The code of practice states that ‘Partners must set out in their joint commissioning arrangements their arrangements for agreeing Personal Budgets. They should develop and agree a formal approach to making fair and equitable allocations of funding and should set out a local policy for Personal Budgets that includes a description of the services across education, health and social care that currently lend themselves to the use of Personal Budgets’

Recommendation 4 – CYPHWBCG supports the SEN project team to development local information that outlines clearly the scope of SEN Personal Budgets and how families can access them.

Name of Contact Officer:Jane Harvey

Post Title:Early Years and Complex Needs Manager

Telephone No:01642 527191

Email address:

Name of Contact officer: Emma Thomas

Post title: Joint Commissioning Manager – Children

Telephone number: 07747457985

Email address

Agency / Key responsibilities for SEN or Disability / Accountability
Local authority / Leading integration arrangements for Children and Young People with SEN or disabilities / Lead Member for Children’s Services and Director for Children’s Services (DCS)
Children’s and Adult Social Care / Children and adult care services must cooperate with those leading the integration arrangements for children and young people with SEN or Disability to ensure the delivery of care and support is effectively integrated in the new SEN system. / Lead Member for Children and Adult social care, and Director for Children’s Services (DCS), Director for Adult Social Services (DASS).
Health and Wellbeing Board / The Health and Wellbeing Board must ensure a joint strategic needs assessment (JSNA) of the current and future needs of the whole local population is developed. The JSNA will form the basis of NHS and local authorities’ own commissioning plans, across health, social care, public health and children’s services.
This is likely to include specific needs of children and young people with SEN or disabilities. / Membership of the Health and Wellbeing Board must include at least one local elected councillor, as well as a representative of the local Healthwatch organisation. It must also include the local DCS, Director of Adult Social Services (DASS), and senior CCG and Director of Public Health.
In practice, most Health and Wellbeing Boards include more local councillors, and many are chaired by cabinet members.
Clinical Commissioning Group / To co-operate with the local authority in jointly commissioning services, ensuring there is sufficient capacity contracted to deliver necessary services, drawing the attention of the local authority to groups and individual children and young people / CCGs will be monitored by NHS England.
CCGs are also subject to local accountability, for example, to the Health and Wellbeing Board for how