Current funding and policy environment

NHS

NHS Commissioning

Board

Monitor (economic regulator)

Clinical Commissioning Group

Department of Health

CQC (quality)

Providers

Public Health

England

(Local health improvement

in LAs)

Local authorities (via health & wellbeing boards)

HealthWatch

Local HealthWatch

• NHS commissioners supported by a new NHS Commissioning Board which will authorise CCGs, commission some services including primary care, and host clinical networks and senates

• Most NHS care commissioned by Clinical Commissioning Groups

• All NHS providers to become Foundation Trusts

• A stronger role for local authorities in shaping services, with new responsibility for local population health improvement

• New Health and Wellbeing Boards within each higher tier local authority area

• Core membership includes : DCS, DASS and one local councillor, DPH, Clinical Commissioning Groups and HealthWatch – with option for more

• Mutual obligations on Councils and NHS commissioners for joint strategic needs assessment (JSNA) and joint health and wellbeing strategies (JHWS) – in partnership

• Expectation that HWBs are involved throughout the NHS commissioning process – so commissioning plans are in line with the JHWS

• Joint commissioning and integrated provision promoted• HWB to have a duty to involve users and the public in the JSNA and

JHWS• HWB will introduce local democratic legitimacy • Local HealthWatch will bring a stronger voice for patients and the

public - including children and young people

• Launched by Secretary of State on 26 January 2012• Forum chaired jointly by Professor Ian Lewis and Christine

Lenehan• Will seek to ensure that the outcomes measured are the ones that

matter most to children, young people and their families and the professionals that support them

• Will describe how different parts of the system will contribute to delivery of these outcomes.

• Working in partnership with children and young people to shape their local services

• improving the workforce through training in best evidence based practice - CBT and Parenting for 3-10 year olds (for emotional disorders such as anxiety, depression and behavioural problems)

• Developing session by session outcome monitoring • Supporting local areas to improve their infrastructure to collect and

analyse the data to see if children and young people are getting better. 

• Building on established local relationships • Enhance supervision and monitoring of outcomes• Maximise the value of investment• Deliver quick and visible change• Optimise local flexibility

• £8M per year for 4 years. (2011/12-14/15) The £32M budget is non recurrent.

• In 2012-13 there is the opportunity to join the project either by– linking to an existing collaborative where the HEIs are based in 

London, Reading or Salford– or, in areas of the country which cannot easily reach an existing

collaborative, the project is seeking to appoint up to two new Learning Collaboratives. 

• Partnerships can include the voluntary and statutory services  

• Training and ‘backfill’ for staff– Trainees– Supervisors– Managers/leaders

• Funding for service development, IT infrastructure, participation, accreditation

• Creating change agents within CAMHS• Funding for a further year for data capture across the service

• PbR was introduced in acute health care settings in 2003. • PbR is currently being adapted for CAMHS.• This will be central to the future commissioning of CAMHS.• The aim is for clusters and care pathways to be agreed and

implemented by the end of 2014• a tariff-based system links a preset price to a defined unit of output

activity (or currency)

1. Should children be placed into clusters characterised by the same level of resource allocation, or on the basis of sharing a common diagnosis, problem/need formulation, or care package?

2. How should we take account of the fact that CAMHS provision often involves input from agencies outside health, in particular social care and education?

To accommodate for complexity and risk, proposed that each cluster has 2 levels – low or high complexity

Cluster for Resource Allocation

 Need based on extent & severity of presenting

problems

Examples Complexity LevelBased on contextual

factors requiring more service management

Examples of the Intensity of Treatment (based on NICE guidance)

1 = Limited need e.g. Mild depression, mild anxiety, mild conduct problems

Low Likely to be around 6 sessions with mental health professional, plus liaison & review meetings

High The higher the complexity, the more likely the need for consultation/inter-agency working/involvement of other professionals and possibly the longer the case-work. Plus liaison & review meetings e.g. up to 8 sessions

2 = Moderate need 

e.g. Moderate depression, moderate anxiety, moderate conduct problems

Low Likely to be around 12 sessions on average with mental health professional. Increased likelihood than lower clusters of medication as part of therapeutic package. Plus, liaison & review meetings

High The higher the complexity, the more likely the need for liaison, review meetings/consultation/ inter-agency working/ involvement of other professionals and possibly longer case work.

3 = Severe need e.g. Severe depression, severe anxiety, severe conduct problems

Low Likely to be around 12-24 sessions with mental health professional. Increased likelihood than lower clusters of medication as part of therapeutic package. Liaison & review meetings.

High The higher the complexity, the more likely the need for consultation/ inter-agency working/ involvement of other professionals and possibly longer case work

4 = Extensive need e.g. Anorexia nervosa, emerging personality disorder, or psychotic episode

Low Intensive outreach, day patient or inpatient care, timescale unspecified, for review at fixed intervals. Increased likelihood than lower clusters of medication as part of therapeutic package. Inpatient stay/intensive work. Liaison & review meetings

High The higher the complexity the more likely the need for liaison, review, consultation/interagency working/involvement of other professionals. Face to face meetings.

To accommodate for complexity and risk, proposed that each cluster has 2 levels – low or high complexity

Cluster for Resource Allocation

 Need based on extent & severity of presenting

problems

Examples Complexity LevelBased on

contextual factors requiring more

service management

Examples of the Intensity of Treatment (based on NICE guidance)

5 = On-going need  

e.g. ADHD, on-going psychosis management

Low Less frequent treatment offered over a longer period of time, reviewed at fixed intervals. Liaison & review meetings

High The higher the complexity, the more likely the need for consultation/ inter-agency working/ involvement of other professionals. Face to face meetings. Liaison & review meetings

6 = Specialised assessment need

e.g. Neuropsychological or developmental assessment

Low Likely to be more than 4 face to face meetings for assessment with child and parents, school visit, plus liaison & review meetings.

High Likely to be more than 4 face to face meetings for assessment with child and parents, plus additional liaison with school and visit, adult mental health services and social care, interdisciplinary meetings &follow up review meetings

7 = Uncertain need (this does not imply uncertain diagnosis)

e.g. Initial presentation of mild depression/anxiety

Low Watchful waiting up to 4 weeks, including consultation to other professionals, liaison & review meetings.

High Watchful waiting, includes increased amounts of consultation to other professionals, liaison & review meetings.

Proposed ways forwardTesting of the provisional cluster structure using:

1. Consultation – with CAMHS services, healthcare providers and non-healthcare providers etc. Trying to gauge how the clusters fit with clinical experience.

2. Retrospective / Exploratory analysis – using large datasets currently being collected, to see how far the actual data supports the suggested clusters.

3. Pilot clustering - using a basic algorithm with new cases at different CAMHS sites to refine clusters and allocate resources that will eventually lead to development of tariffs.

• loss of 3.3 billion from public funders by 2015• static growth in individual and corporate giving• vcs gets £13.9 billion from government, 79% is contracts for

services• About 3% of government funds go to small/medium

organisations, rest to large charities• Sustainability weakened - in 2009/10 voluntary organisations

spent 99% of all incoming resources• Inflation biting, grants reducing, spending up• Social investment talked about but not market ready

• Threat to VCS independence• Compact compliance patchy• 5% reduction in staff in 2010/11• Volunteering numbers down• Demand for services has increased• Big Society policies have failed to engage voluntary sector

GETTING IN TOUCHWebsite: www.youngminds.org.uk/bondEmail: bond@youngminds.org.ukTelephone: 020 7089 5050