Working Draft - revised 21^st May 2007

Protocol between Hampshire County Council and the Hampshire PCT for joint commissioning services to those with complex needs

1. Introduction

1.1 This draft protocol sets out the arrangements for partners to consider joint commissioning for service to those with complex needs. Partners may move towards creating a joint budget to provide additional sources of funding for the most complex cases by an analysis of those circumstances where existing service provision or purchasing budgets are exceptionally unable to meet assessed needs.

2. Background

2.1 The existing arrangements for considering joint commissioning for services to those with complex needs are based upon a number of different formats of assessment and upon different arrangements for the former PCTs to consider making a contribution towards the costs of services based upon the medical needs of individuals. These arrangements may have included establishing any continuing care or palliative care responsibilities of the PCT. There is also an agreement in place regarding the provision of equipment and aids and to children with disabilities and for access to joint stores.

2.2 There is no agreed national guidance available on the continuing care responsibilities of NHS bodies for children, such as exist for example for adults and the elderly which sets out how service costs may be shared based upon descriptors of need and medical conditions. Further guidance is anticipated in the future.

2.3 Some areas of Hampshire have developed use of a multi agency toolkit to guide assessment, which included a scoring system to assist partners in considering how service costs may be shared. Whilst these toolkits have assisted partners in developing joint working and assessing needs they have not proved to be a realistic way of considering how costs may be shared.

2.4 These arrangements have led to a situation where there has been inconsistency of approach across Hampshire and as the management arrangements within the Hampshire PCT and the County Council are implemented an opportunity exists to review the position and to confirm a single approach to assessments and the consideration of shared funding.

2.5 It is proposed that this protocol extend to include how the County Council considers the allocation of budgets for children's social care and education services to individuals and consideration of NHS support in appropriate circumstances.

3. Scope

3.1 The aim of the proposed protocol is to guide colleagues in considering if the County Council and the Hampshire PCT should develop a new process to replace a number of existing processes, such as continuing care and JENI, and make a shared contribution to the costs of care to individuals with complex needs in those circumstances where local services to support children are not available or are insufficient to meet the needs of the individual.

3.2 For example, the PCT would usually purchase or provide services to individuals, based on their health care need, in their own homes or in secondary care services locally, and subject to the rights of patients to choose how their treatment is provided. This responsibility continues if the care was needed in a residential care or education setting away from the family and includes arrangements between PCTs, for example where a child may be registered with a GP outside the family PCT area. In circumstances where the PCT cannot purchase or provide care or treatment within their existing service framework the PCT will consider commissioning additional services or may make a contribution towards the costs of care in relation to assessed health care needs. The same principle applies to the responsibility of the County Council to provide for the educational needs of children, for example when in hospital, or to provide support to families and carers within their homes when caring for children with special needs. Similarly the County Council will consider how budgets for care and for education should be used when considering residential placements for those with special educational need.

3.3 Over time it is anticipated that joint commissioning arrangements would include a broad range of situations where responsibility is shared across agencies, for example for drug treatments and for commissioning services to vulnerable children and young people.

3.4 The guiding principle is that in the majority of situations where children have complex needs there will always be a shared commitment to providing services and the protocol offers guidance on the nature of assessment and the process for reaching agreement, together with arrangements for determining responsibilities where agreement cannot be reached locally.

3.5 This shared responsibility included parents, and the partnership is typically one involving the County Council and the NHS in determining the support parents need to meet the needs of children and young people.

4. Focus

4.1 Shared service arrangements will be relevant in a broad range of circumstances where parents are seeking additional support to their care of children with complex needs, potentially cost sharing may be relevant in the following circumstances.

· Where care or treatment is required away from the family, or parents or carers are seeking residential or foster parent care, including respite and shared care provision

· Where there is a statement of educational need and provision in a special school is indicated

· The child has a technological dependency

· The child has a life limiting condition

· Where the child needs access to care or treatment that is not usually purchased, provided or commissioned by partners

· Access to Joint Exceptional Needs funding (JENI)

5. Assessments

5.1 In order for partners to consider if service costs should be shared or if additional services should be purchased or provided a number of assessments will be required. A modular approach should be adopted which prevents the need to undertake additional assessment and which is based upon material available to partners in carrying out their responsibilities.

These could include

· Section 17 assessments

· SEN statements, which include a statement of medical needs

· A care plan for children looked after, which will include an education plan and a health care assessment

· A health assessment where not available via children looked after or within an SEN statement

· A transition plan for any young person aged over 14 years

6. Process

6.1 The process to consider jointly providing or purchasing services to those with complex needs is based upon the principle of support to joint working at a local level, with reference to an interagency group in those exceptional circumstances where local agreement cannot be reached.

6.2 Joint working across agencies to share assessment, agree priorities, to make commitments to provide services and provide support to partners underpins the objective of partners to ensure better outcomes for all children and young people.

6.3 The process for partners to consider shared funding of services is based on 4 steps with an emphasis on reaching agreement at the point closest to the consumer and always with their appropriate participation and any necessary assessments.

· Joint working arrangements between practitioners on a case by case basis, including the role of lead professional within CWD teams

· Multi agency case planning meetings involving local managers to commit to the necessary resources, including the use of the CAF and Team Around the Child discussions supported by Locality Teams. At this level the PCT may be represented by service providers who may need to refer to PCT commissioners if additional resources are required

· A county wide group to consider those situations where suitable care can not be provided locally even with additional packages in place, including funding for expensive residential care placements

· A county wide panel to consider any cases where agreement can not be reached at a local level, involving a PCT commissioner, a Social Care manager and the appropriate Education Manager, including the County SEN team as necessary

7 Implementation

7.1 This papers sets out in summary form the principles and processes on which services may be jointly commissioned for children and young people with complex needs.

7.2 Subject to the views of partners more detailed guidance and systems will need to be put in place along with the necessary training and monitoring.

· Draft paper for discussion developed by

Jane Nind - PCT

Clare Messenger -PCT

Sally Pastellas -PCT

Howard Firth -HCC

Lucy Butler -HCC Adult Services

Phil Butler - HCC, SEN team

Colin Hardy - HCC

· Revised 21^st May 2007 following discussion at the Joint Commissioning Group on the 9^th May 2007.

May 2007