Buckinghamshire County Council

Buckinghamshire Child and Adolescent Mental Health Services

Sue Butt, Operations Manager CYP Ravi Balakrishnan, Public Health Consultant Ann Spence, Senior Procurement Officer

Buckinghamshire County Council

Agenda

Welcome and Introduction - Sue Butt Risks / Needs / Demands - Ravi Balakrishnan Commissioning approach – Sue Butt Procurement information – Ann Spence Questions

Buckinghamshire County Council

Background

• Commissioned as an integrated service under pooled budget S75 agreement in 2009 • Prior to this it was delivered by multiple providers with multiple contracts across the county • The recommissioning process will commence in November 2014 with the plan to award the new contract in April 2015 • New contract will commence in October 2015

Buckinghamshire County Council

Survey responses – May/June 2014

285 respondents

Buckinghamshire County Council

Current Services – areas of good practice

• Helpline was perceived as useful by those aware of it • Positive experiences of treatment for many of those who access it • Some clinicians were cited as particularly helpful and accommodating

Buckinghamshire County Council

• • • • • •

Current Services – areas for development

Communication – helpline, feedback on referrals, ease of contact Collaborative/Partnership working across CAMHS, Social care, GPs, Schools, Other health professionals, Families Clarity and consistency about thresholds and process for access Waiting times for assessment and treatment Flexibility in service provision location and times Earlier intervention /prevention

Buckinghamshire County Council

Perceived gaps in provision

• • • • Paediatric Psychology support for developmental and physical health related issues Services for CYP who have a need for support but do not meet criteria for mental health services (threshold) Support post diagnosis for Families and young people with a diagnosis of autistic spectrum.

Perinatal mental health service

Buckinghamshire County Council Children & Young People Mental Health Risks / Needs / Demands in Buckinghamshire: an overview Dr Ravi Balakrishnan Consultant in Public Health medicine Bucks County Council

Buckinghamshire County Council

9,00%

Population makeup

Bucks % Eng %

8,00% 7,00% 6,00% 5,00% 4,00% 3,00% 2,00% 1,00% 0,00% <1 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

2011 census Total <19: 121,479 Boys <19: 62,125 (1 in 4 25.0%); Girls <19:59,354 (23.1%)

Buckinghamshire County Council

Ethnic Groups

Ethnic Group

White Mixed Indian Pakistani Bangladeshi Chinese Other Asian Black African Black Caribbean Other Black Other ethnic group

Boys % 80.5% 5.4% 2.4% 6.8% 0.3% 0.4% 1.7% 0.9% 0.8% 0.3% Girls % 80.1% 5.4% 2.5% 6.7% 0.2% 0.6% 1.7% 1.1% 0.8% 0.4% Total % 80.3% 5.4% 2.4% 6.7% 0.3% 0.5% 1.7% 1.0% 0.8% 0.3% 0.5% 0.5% 0.5%

Data source: 2011 Census (NOMIS, table DC2101EW)

Buckinghamshire County Council

Child Poverty & Lone Parents

•

Children in Poverty

One in ten (10.5%) children <16 years of age are living in poverty (2011), England average:20.6% (2011) •

Lone Parents

5.3% (2011) of households have lone parents with dependent children (England ave:7.1%) •

10,550

Lone parents with dependent children (Data source: ONS 2011 census (NOMIS, table KS105EW)

Buckinghamshire County Council

Learning Difficulty

Emerson, E. et al, 2008

Estimated prevalence in C&YP with LD for different age groups as follows: 5 to 9 years: 0.97%; 10 to 14 years: 2.26%; and 15 to 19 years: 2.67%. The Foundation for People with Learning Disabilities (2002): 40% prevalence for MH problems associated with LD.

Age group Ch CCG AV CCG Bucks Children with a learning disability

5-9 yrs 10-14 yrs 15-19 years 195 455 520 120 280 335 315 735 855

Learning disabilities with MH problems

5-9 yrs 10-14 yrs 15-19 years 80 185 210 50 115 135 130 300 345

Total: LD with MH problems 475 300 775

Buckinghamshire County Council

Looked After Children

• In March 2013:

400

C&YP in care • Rate: 34 per 10,000 vs national average 60 per 10,000 (43% lower) • 2008-13: Increased by 30.8% (from 26 to 34/10,000) compared to 11.1% rise (54 to 60 /10,000) nationally. • Over 50% placed outside the county (England average of 35%) • Strengths & Difficulties Questionnaire (SDQ):(Normal score range: 0-13). • Average score: 12.93 Vs England average of 14.8 in 2012/13 • One in four (26%) had a score of 18 or above (SDQ),indicate significant behavioural problems.

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Substance misuse, Suicide, Self harm

BCC Survey 2013 (11-19 years) Smoke: 4% smoke cig once a week; 1% reported smoking shisha Alcohol: 50% had a drink in last month; 42% felt the effects of alcohol atleast once in last month Drugs: 17% have taken drug (Cannabis mainly) RU Diff Survey (2013) year 9 Smoking: 7%; Alcohol: 7% drink once a month; 3% drunk in the last week 30% Bullied at any time Substance misuse (

3 year period - 2010/11 to 12/13) • 50 hospital admissions for substance misuse, • Rate of 30.8 per 100,000 population aged 15-24 • 59% lower than the national average of 75.2

Self-harm (

3 year period - 2010/11 to 12/13) • 477 hospital admissions among young people aged 10-24 related to self-harm • Rate of 179.8 per 100,000 populations • 49% lower than the national average (352.3/100,000)

Buckinghamshire County Council

Prevalence of MH conditions

Pre-school children

Egger, H et al, 2006: Prevalence of any MH disorder: 19.6% Among 2-5 year olds:

AV CCG: 1,895 Ch CCG: 3,110 ASD

ASD prevalence rates based on Baird et al (2006) and by Baron Cohen et al (2009)

Area AV CCG Ch CCG Bucks All ASDs 9-10 years 750

285 465

ASDs 5-9 years

195 315

510

Buckinghamshire County Council Prevalence of MH Problems 5-16 years of age (2012)

Prevalence varies by age and sex Based on Green et al (2004) ICD-10 Classification of Mental & Behavioural Disorders with strict impairment criteria – the disorder causing distress to the child or having a considerable impact on the child’s day to day life.

Area Ch CCG AV CCG Bucks Age group

5-10 11-16

Total

5-10 11-16

Total MH Disorder

1,850 2,735

4,855

1,110 1,705

2,805 7,660 Conduct disorders 1,690 4,435

1,175 710 980

Emotional disorders

580

2,745

1,570

1,770

1,190

1,095 2,865

350 745

Hyperkinetic disorders 720 445 1,165

385 335 235 210

Less common disorders

315 335

650 400 1,050

190 210

Buckinghamshire County Council Prevalence of neurotic disorders (aged 16 to 19) Bases on Singleton et al (2001) has estimated prevalence rates Ch CCG AV CCG Boys Girls Boys Girls Bucks 2,220

400 960 265 595

350

125 85 85 55 70 210 50 130 50 165 35 105

460 355 470

70 220 50 130

150

40 50 30 30 670 1,485 450 920

3,525

Buckinghamshire County Council

Need for CAMHS services (Estimated vs Actual)

Kurtz (1996) Number of C&YP under 18 years who may experience MH problems appropriate to a response from CAMHS at Tiers 1, 2, 3 & 4

Area AV CCG Ch CCG Bucks Tier 1 Tier 2 Tier 3 Tier 4 Bucks

6,575 10,710

17,285

3,070 5,000

8,070

815 1,325

2,140 90

35 55 Referrals Accepted T2 Accepted T3 Signposted/ Inappropriate

2012/ 2013

3,086 787 1,238 1,061

2013/ 2014

3,795 1,397 1,431

Change %

22.9

77.5

15 967 -8.8

• • • • • • • • • • • • •

Buckinghamshire County Council

In brief

C&YP <19: 121,479; Boys: 62,125 Girls:59,354 Ethnicity: 2 in 10 are non-white / others 1 in 10 under 16 children living in poverty 10,550 (5.3%) Lone parents with dependent children LD with MH problems: Est 775 LAC: n= 400, increasing; 1 in 4 have SDQ 18 or more Smoking: 4%-7%; Drugs: 17% Hos Ad due to suicide & self-harm: < national average Perinatal MH need: est 2,500 Prevalence of MH disorders: Preschool: 5000; School Age:7,660 Prevalence of neurotic Dis (16-19 yrs): 3,500 Estimated CAMHS need Tier 2: 8,000 Tier 3: 2,000 CAMHS use (Oxford H): Tier 2: 1,397 Tier 3: 1,431

Buckinghamshire County Council

For more information

• National Child and Maternal Health Intelligence network http://www.chimat.org.uk/default.aspx

•

Joint Strategic Needs Assessment http://www.buckscc.gov.uk/community/knowing-bucks/joint-strategic-needs assessment/

• • • • • •

Sources:

General Practice (GP) registered patient counts aggregated up to CCG level Office for National Statistics mid year population estimates for 2012 (local authority report).

The Foundation for People with Learning Disabilities (2002).

http://www.chimat.org.uk/default.aspx

Oxford Health Foundation Trust, 2014 www.jcpmh.info

A model for integrated services for children and young people with mental health needs and their families and carers

Lisa Smart © MGA, 2014

Core principles

• •

Service must promote wellbeing Service must provide timely, effective assessment, treatment and support

•

Service must provide a seamless pathway or journey through all levels of CAMHS

© MGA, 2014

Key requirements

• • • •

Single point of contact for referral and assessment Key/link worker to stay with child, young person and family throughout the CAMHS journey Crisis support at home at weekends Flexibility for early evening / weekend provision

© MGA, 2014

Key requirements

• • •

Tier 2 service is expanded with specific service outcomes monitored to ensure that service pressures elsewhere do not encroach on this core work Tier 3 service community based and able to see children and young people in a variety of settings Fluid transition between tiers to meet changing need

© MGA, 2014

Key requirements

• • • ‘Bridge builder’ role to ensure a transparent journey with adequate mapping and signposting to appropriate complementary or alternative service provision Cross CAMHS workers to develop service provision to at risk and hard to reach groups All services to follow the improving psychological therapies service transformation agenda – accessibility, participation, measuring outcomes, evidence based practice © MGA, 2014

Children and young people’s good mental health promoted, and services delivered in partnership Education and Social Care services © MGA, 2014

Assessment Intervention Pre-identification Provision of high quality materials to inform parents and the wider workforce about CAMHS Participation workers Link workers Adult mental health liaison Training on identification for the wider workforce Identification Consultation could lead to assessment by Tier 2 or Tier 3 practitioner Consultation could lead to other service provided by other agency Consultation – with worker or CYP and family

SINGLE POINT OF ENTRY

Tier 4 assessment Tier 3 assessment & formulation Tier 2 Assessment Evaluation Crisis Team CRISIS Weekend home based support Core function – treatment: 3 • • TIER 3 family therapy • • • • • • • • • • harm CBT play therapy Emergency assessment for self TIER 2 based assessments supporting to manage CYP in Tier 1 where appropriate. Consultation appointments Autistic Spectrum Disorder • Transition to adult services agencies where appropriate • Prevention Supporting tier 1 staff in initiatives to promote positive mental health, universally Supporting early identification of MH needs by training universal/ tier 1 staff Link worker Evaluation of child or young person’s progress against personal goals and decision regarding next step no further intervention required further assessment indicated further intervention *Tier 4 *Tier 3 *Tier 2 *Tier 1 © MGA, 2014

• • • •

Key changes in the specification

Single point of access for consultation AND assessment Extension of Tier 2 role and related skills, knowledge and experience requirements Link worker role to support child, young person and family on their journey Fluidity between Tiers 2 and 3 with the possibility of accessing interventions flexibly across tiers © MGA, 2014

Buckinghamshire County Council Procurement Information

Ann Spence Senior Procurement Officer Finance & Commercial Services

10 th October 2014

Buckinghamshire County Council

The Procurement Process

• • • • •

E-Procurement Procurement Approach Invitation to Tender (ITT) Tender Timetable Key points

Buckinghamshire County Council e-Procurement

• The Council will be using the South East Business (SEBP) Portal ( https://www.businessportal.southeastiep.gov.uk

) to publish and facilitate this procurement opportunity.

• Providers must be registered on the SEBP in order to obtain details about and express an interest in this opportunity.

• All documentation must be submitted electronically via the SEBP.

Buckinghamshire County Council

• •

Procurement Approach

The Council is seeking a single integrated contract in view of the proposed service model and S75 pooled budget across Buckinghamshire County Council, and Chiltern and Aylesbury Vale CCGs. • • • The Council will accept bids from providers considering bidding as: A Single Provider A Lead Contractor, with Sub-Contracting Arrangements; or A Consortia bid

Buckinghamshire County Council Contracting Options

• • • • •

Lead Contractor, with Sub-Contracting Arrangements

A lead organisation may bid for the procurement opportunity.

The lead contractor will be responsible for the day to day management of the contract and will be the organisation that holds the contract with the Council.

The lead contractor may sub-contract various services to smaller, specialist providers, to undertake work on their behalf.

Only the lead contractor is accountable to the Council. The Council will be seeking to understand the sub-contracting arrangements at the tender stage. •

Consortia Bid

A number of providers become a single legal entity to enable them to bid for procurement opportunities.

Buckinghamshire County Council

The Invitation to Tender (ITT)

•

The ITT consists of:

• • • • • • • • •

A Set of Instructions Evaluation Criteria Specification Terms & Conditions Pricing Schedule Method Statement Confidentiality Agreement – TUPE Organisational Information Questionnaire Form of Tender

Buckinghamshire County Council

Invitation to Tender

• • • • • •

ITT issued Period for Q and A’s Tender Return Evaluation Presentations Award Decision

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Timetable

• • • • • •

Issue Tender Tender Return Presentations Award Recommendation Contract Award Contract Start mid to late Nov 2014 mid January 2015 early February 2015 early April 2015 mid April 2015 1 st October 2015

Buckinghamshire County Council

Key Points

• • • • • • •

Both parties should have one identified point of contact All information is issued to all providers at the same time Both parties should provide clear, easy to read documents Provide double sided documents Cross reference any additional material you provide Keep to deadlines – we cannot accept late tenders Don’t presume we know what you do or can do – Tell Us

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Networking Opportunities

• In order to facilitate networking opportunities we are asking providers whether they wish us to share their contact details with all those who are interested. • Email your contact details by 31 st October 2014 to [email protected]

Buckinghamshire County Council Any Questions?

Buckinghamshire County Council

Commissioners are seeking your views on:

• • • Contracting approach • single integrated contract • 5+2 year contract Financial Incentives – CQUIN is 1.5% - we would like to place greater financial value on key performance indicators. Commissioning model Please email your thoughts to [email protected]

by 19 th October 2014