Transcript Slides CAMHS Webinar for Providers 10Oct2014
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.
Buckinghamshire County Council
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