Contact: Hilary Hickmore, Ext 6213, [email protected]

1. Summary

Background:

1.1 In April 2004 Hampshire County Council (Social Services and Education Departments) and the seven Hampshire Primary Care Trusts established phase 1 of Hampshire's Pathfinder Children's Trust for commissioning Child and Adolescent Mental Health Services (CAMHS). This was underpinned by a Section 31 agreement, which was in place for 3 years and renewed for a further year in April 2007.

The partners proposed the creation of a CAMHS commissioning Children's Trust for the following reasons:

1.1.1 To develop and improve services and outcomes for families, through improved commissioning arrangements and joint investment. It was generally acknowledged that CAMH services needed greater investment in Hampshire;

1.1.2 To ensure a strategic approach to planning and development, through shared work and learning;

1.1.3 Pooling of funds would enable the partners to work together to commission services and reduce associated costs;

1.1.4 To ensure greater equity and consistency of services for CAMHS users across Hampshire,

1.1.5 To link Hampshire's work to the National Service Framework for child and maternity services, as the only CAMHS Children's Trust in England;

1.1.6 To help shape the future of children's services and share learning with other Children's Trust pathfinders;

1.1.7 To secure additional funding for this area of work, including a pathfinder grant.

1.2 The CAMHS trust has been successful in delivering on these intentions and the current partners, Hampshire County Council Children's Services Department and Hampshire Primary Care Trust, wish to move the CAMHS trust to phase 2 of its operation posed in the section 31 agreement, i.e. to embrace the commissioning of more CAMHS tier 2 and 3 services from a larger pooled budget.

Tier 4

Adolescent psychiatric in-patient provision and day service, residential specialist schools and placements


Tier 3

CAMHS Social workers, clinical psychologists, psychiatrists, art therapists, psychotherapists, nurse therapists, community therapists, educational psychologists, adolescent mental health specialists, substance misuse workers, leaving care teams, YOT mental health workers, paediatrics, occupational therapists, early intervention psychosis service, community mental health team and other adult mental health pre 18 provision (eating disorder, perinatal services, transition social workers),

Tier 2

Behaviour support teams, primary mental health workers, family support workers, educational psychologists, inclusion social workers, education welfare officers, Portage Plus, school counsellors, voluntary CAMHS agencies, Connexions personal development PAs, YISP workers, substance misuse workers, primary health care, TYS


Tier 1

Universal, eg, GPs, schools, health visitors, school nurses, teachers, voluntary agencies, nursery nurses, youth workers, Connexions PAs

1.3 The Health Act 2006 has updated the legislation, so that this now requires a section 75 agreement to be drawn up. Section 75 provides for agreements between local authorities and health authorities for the discharge of their functions through a pooled budget.

2. Recommendations

The Executive Member for Children & Families is asked to:

a) Approve - the partnership arrangement with Hampshire PCT through a S75 agreement establishing a pooled fund to be used for commissioning CAMHS services in Hampshire

b) Agree - that the Director of Children's Services will have delegated responsibility, for services developed through the use of the pooled budget, and for the Director or his nominated officer to be a member of the CAMHS Trust Board with delegated authority to vote on behalf of the County Council on decisions made by that Board.

3. The S75 Agreement

3.1 It is proposed that the partners take further steps along the incremental approach to joint commissioning of CAMHS. The S75 agreement therefore builds on the first phase of development. It is planned that the partners work together to move towards a comprehensive commissioning Children's Trust for CAMHS which takes full responsibility and accountability for all CAMHS commissioning in the county, beyond the new development funds, and which has an infrastructure to support it. It is therefore intended that this S75 agreement supersedes the current section 31 agreement, and embraces within the pooled budget all commissioning funds for the services set out in schedule 2 of the agreement. These comprise specialist CAMHS teams, dedicated therapists for children looked after and Youth Offending Teams mental health functions. This will only be done with the full agreement of both partners, based on successful delivery of the CAMHS action plan, and with key targets relating to all relevant performance management frameworks.

Key elements of the agreement:

3.1.1 The S75 agreement will be for an initial 3 year period, with a renewal process specified for further period(s) unless terminated under the terms of the agreement.

3.1.2 The creation of a joint pooled budget made up of CAMHS baseline service funds and new development funds for CAMHS from Hampshire PCT and the County Council.

3.1.3 The creation of a CAMHS Trust Board consisting of lead officers from each of the partner agencies, with delegated responsibility for services developed through the use of the pooled budget. The Board will be chaired in rotation by each partner agency on an annual basis.

3.1.4 The Board will ensure quarterly reports are submitted and available to PCT Board and members of the County Council on request. This would include annual report to members.

3.1.5 The continued commitment to the joint planning structure which ensures informed commissioning across Hampshire.

3.1.6 Contracting of services will remain with each of the partners. All governance arrangements and risk management therefore remain with the partners as at present. (See Planning and commissioning below).

4. Functions of the Children's Trust

4.1 The CAMHS Trust will have a strategic commissioning function and continue the joint commissioning of provision for CAMHS. The CAMHS Trust will cover the county of Hampshire, creating a planning structure for commissioning of CAMH services for children 0-18 years.

4.2 Hampshire commissioners and providers of CAMH services have agreed a joint CAMH strategy setting out the objectives for the development of the service over the next three years.

4.3 It is proposed that the CAMHS commissioning group will work in partnership with the CAMHS Strategy Group and Local Implementation Groups to undertake analysis of need and service mapping, to inform the creation of county and local improvement plans. These will identify priority areas for spend and service development, based on local and county needs. The county improvement plan will be submitted to the CAMHS Trust Board for approval and funding, through the pooled budget.

4.3 Commissioned services funded through the pooled budget will be agreed by the partners, who will identify the appropriate partner to enter into contractual arrangements with providers. The CAMHS Trust will not enter into contracts / service level agreements in its own right, in order to prevent a two tier system of commissioning for CAMHS and to ensure that clinical and organisational governance remains within the control of partner agencies.

4.4 The commissioning structure will continue to be supported by a small infrastructure of a county CAMHS strategy manager and a CAMHS Commissioning manager, a partnership coordinator post and administration officer, together with part time support from partners for communications, finance, data analysis and learning and development functions, working on behalf of the partners. The infrastructure is funded from within the pooled budget.

5. Corporate priorities

5.1 The proposals in this report support the County Council's corporate priorities and address the CYPP and LAA priorities regarding increased availability of mental health services, notably to enhance outcomes, access, timely engagement and reliability of provision across the continuum of need, for children and young people up to 18 years of age with mental health needs.

6. Consultation

6.1 Consultation has been undertaken with stakeholders, through the existing structural groups, and via a stakeholder conference in November 2007.

7. Legal implications

7.1 The Agreement under Section 75 of the Health Act 2006 replaces an existing agreement under Section 31 of the Health Act 1999 (now repealed). The proposed Section 75 agreement complies with the Regulations issued in respect of such partnership arrangements and provides an operational tool for the delegation of functions between the Council and the Trust to provide for lead commissioning and the setting up of a pooled budget to facilitate that commissioning through agreed shared aims, outcomes and targets Each partner retains statutory responsibility for their functions carried out under the pooled fund and the Section 75 agreement includes governance arrangements which address accountability and monitoring arrangements.

8. Financial implications

8.1 Partners will contribute the agreed commissioning budget for CAMHS tier 2 and 3 services.

8.2 From April 2008 the pooled budget will amount to £2,577,000 (excluding management costs, overheads and any surpluses carried forward from 2007/08 ), based on services agreed to date, as set out in the table below:

8.3 During the course of 2008/9 further service commissioning funds will be contributed to the pooled budget as detailed analysis of service figures is completed. Service commissioning funds to be contributed are as follows:

Specialist CAMHS, New Forest and Southern Parishes of Eastleigh

NH specialist CAMHS

SE specialist CAMHS

Winchester, Andover and Eastleigh CAMHS

8.4 Other CAMH service commissioning funds may be added subject to future agreement between the partners, reaching an overall phase 2 pooled budget of the region of £8 million.

8.5 Partners will make all reasonable endeavours to maintain provision of the interdependent services, which are those contributing essential parts of the care pathway, which are not funded from the CAMHS trust pooled budget.

9. Personnel implications

9.1 None

10. Impact assessment

10.1 Race and equality impact assessment has been considered in the development of this report and no adverse impact has been identified. All services commissioned via the CAMHS Trust are required to deliver services with a view to enabling access to all vulnerable young people including ethic minorities.

11. Crime prevention issues

11.1 The approval of section 75 agreement for the joint commissioning of CAMH services will contribute to the crime prevention agenda, through enhancing access to services for those young people where crime is a part of a set of behaviours born out of a lack of capacity to engage in education and leisure within school, family and community, on account of unmet emotional needs and associated behavioural difficulties.

12. Views of the Local County Councillor

12.1.1 Contact with Local County Council Members will be made during more detailed consultation on specific elements of the strategy.

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.

NB: the list excludes

Published works

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

Comprehensive CAMHS Commissioning Trust Section 75 agreement and associated 6 schedules.

Appendix

The diagram below shows the structure of the Comprehensive CAMHS

Commissioning Trust:

CAMHS Commissioning Group