Contact: Natalie Trentham; Ext 7166; [email protected]

1. Introduction

1.1 Hampshire's Child and Adolescent Mental Health Service, (CAMHS), Children's Trust is a partnership between Hampshire County Council's Children's Services Department and the Primary Care Trusts located within Hampshire. It was established as a national "pathfinder" Children's Trust in April 2004 and is underpinned by a pooled development budget and a S31 agreement, ratified by all partners' governing boards and committee structures.

1.2 The Children's Trust has a commissioning function and has two key aims:

· To improve CAMH services for children and young people

· To act as a pathfinder for integrated working, highlighting learning which can be applied across children's services.

1.3 When the Children's Trust was set up, it was envisaged that its development would be in two stages. The first would establish a planning and commissioning structure to support a Children's Trust approach which focussed on developing partnerships, clear governance, roles and accountability. Using this structure a commissioning cycle would be formulated to review services, identify needs and construct county and local improvement plans to inform the use of the CAMHS development budget. Commissioning processes would also include standardising arrangements, procedures, contracts and Service Level Agreements (SLAs); creating economies of scale, decommissioning, service re-design and joint ownership of improved outcomes for children and young people, which were measurable.

1.4 Stage 2 would further develop this work to create a wider commissioning trust which commissioned all tier 2 and 3 CAMH provision in Hampshire, underpinned not only by development money but by pooling all commissioned spend in these areas.

1.5 In 2005 the Children's Trust Board agreed that work should begin to establish the second stage of the Children's Trust and a small partnership working group was established. The group's work has focussed on mapping commissioning costs and SLAs for all CAMH services across the four tiers in order to identify potential budgets which could be pooled. CAMH work is often complex and the service is made up of a number of services, of which certain elements of their work could be classified as CAMHS, hence the colloquial phrase "CAMHS is everyone's business". It has therefore been complex and time consuming to agree across the partnership potential commissioning to be included in stage 2.

1.6 This report outlines the progress achieved in stage 1 of the CAMHS Children's Trust and proposals for stage 2.

2. Summary of Progress in Stage 1 of The CAMHS Children's Trust:

2.1 Over the last two and a half years, the Children's Trust has achieved the

following: The creation of a strategic planning and commissioning framework to ensure informed commissioning which includes representation from both commissioners and providers and ensures involvement of all professional groups, geographical areas and joint commissioning agencies and bodies across the four tiers of CAMHS.

2.2 The establishment of a commissioning cycle, based on the Audit Commission's

Performance Management Framework to ensure continuous improvement. This includes service mapping, audits, reviews, needs analysis, interpretation of national requirements and performance monitoring of all commissioned services.

2.3 The creation of commissioning processes using a lead commissioning model which

uses a standard SLA for CAMHS.

2.4 Service developments have included:

· The creation of an additional 37 posts within tier 2 and 3 services: focussing on early intervention and building capacity, in accordance with the needs analysis.

· A county-wide post abuse counselling service, in partnership with the NSPCC.

· A county-wide tier 4 day service pilot.

· A county-wide crisis intervention service, working across agencies, extending available provision until 10pm week days and offering a weekend rapid response which was not previously available. (Planned from October 2006).

· The creation of a county-wide participation process for children, young people and their families, co-ordinated by Hampshire Children and Families Forum, (HCFF).

· Service re-structuring is taking place to ensure a consistent and appropriate service for 16 -18 yr olds.

· Developments are underway across all partner agencies to implement a shared outcomes framework supported by a joint data base.

3. Stage 2 of the CAMHS Children's Trust / Next Steps:

3.1 Building on the success of the first stage of the children's trust, the

additional benefits of the second stage will be to:

· simplify, streamline and standardise the existing complex array of commissioning procedures, ensuring a consistent approach to commissioning;

· enable greater equity and focus on community needs and consistent monitoring of outcomes for children;

· enable economies of scale, creating greater efficiency and flexibility to purchase needs-led services which prevent duplication and unnecessary division between the agencies;

· increase early intervention, improve planning and create joint developments to address high cost non-county and in-patient placements, ultimately reducing the numbers of children requiring this level of intervention and cost in this area;

· enable partners to share commissioning costs for required targeted services which would be too costly to commission by any one agency alone;

· increase expertise in CAMHS commissioning with dedicated commissioning time to this service;

· inform wider developments within Children's Services and CAMHS across the country.

3.2 At the beginning of 2006 Hampshire County Council's Treasurer's Consultancy team undertook a project to map all CAMHS commissioned spend across the partnership. Each partner agency then sought agreement through their management boards to commit their CAMHS budgets for tiers 2 and 3 to a new pooled budget in order to establish a single commissioning body for community CAMHS across Hampshire. In June 2006 the Children's Trust Board confirmed their intention to establish the new partnership underpinned by a new S31 agreement from April 2008. It was recognised that the partners were going through a process of change and re-organisation and that the CAMHS partnership must be integral to these developments. For this reason it was agreed that a period of transition would be needed and that the existing S31 agreement should be extended until April 2008, in order to maintain existing developments, ensure that CAMHS funding was ring fenced and establish the new arrangements for the second stage of the partnership. The extension of the current S31 is in the process of being signed and sealed by all partners.

3.3 The new partnership will be underpinned by a pooled budget of

approximately £8,348,155:

· £1,983,279 from the Children's Services Department;

· £4,848,876 from the new Hampshire wide PCT and

· £1,516,000 from the existing Children's Trust.

3.4 Appendix I shows a summary project plan for the work required to establish the new partnership from April 2008.

4 Legal implications

4.1 The extension of the current partnership S31 agreement has been drawn up by the County Council's legal Department.

4.2 The creation of stage 2 for the Children's Trust will require a new S31 Health Act (1999) agreement. This will be informed by and drawn up through the County Council's Legal Department and PCT solicitors.

5 Financial implications

5.1 Section 3.3 of this report identifies the potential contribution for the County Council's Children's Services Department. This amount has been identified through work undertaken by the Treasurer's Consultancy Team. At this time the decision is to enter into negotiations with partners and a further report for decision will be taken to the executive member once a new agreement is proposed by partners.

6 Personnel implications

6.1 None.

7 Impact assessment

7.1 Needs analysis completed by the Children's Trust indicates that there are still variations in equality of access to CAMHS services across Hampshire. The second stage of the Children's Trust seeks to ensure one system of commissioning, informed by needs, ensuring greater equity in service provision.

7.2 The creation of the S31 agreement will include consultation with service users to inform a full impact assessment.

8 Crime prevention issues:

8.1 None.

9 Views of the Local County Councillor

9.1 The creation of a S31 agreement requires consultation. This work will include consultation with relevant county councillors.

10 Recommendations:

10.1 That the Executive Member endorses the proposal for the Children's Services Department to negotiate with partners to develop an agreement which will create second stage of the CAMHS Children's Trust: comprehensive commissioning for community based CAMHS services.

Section 100 D - Local Government Act 1972 - background documents

The following documents discuss facts or matters on which this report, or an important part of it, is based and have been relied upon to a material extent in the preparation of this report:

· Treasurer's Consultancy Team report mapping CAMHS commissioned spend across the partnership.

NB: the list excludes

1. Published works

2. Documents which disclose exempt or confidential information as defined in the Act.