Agenda item 13

Castle Point & CCG Governing Body held on 30th March 2017

Title Update on: Mental Health & Learning Disability Services; General Community Services (inc Integration), and Primary care Co-commissioning

Submitted by: Kevin McKenny

Prepared by: Kevin McKenny / Yvonne Campen / Sipho Mlambo / Maureen Fitzgerald / Ashley King

Status: For Noting

Executive Summary i) Recommendations

The Governing Body are asked to current position on the contract performance and the key service developments across four key core service areas overseen by the CCG’s Integration and Transformation Team at Month 10. This includes: Mental Health (inc Learning Disability); General Community services, Primary Care Co- commissioning, Children’s Services and Transformation Programme. The Governing Body is asked to review and offer comment and discussion on any aspects presented.

ii) Overview The ‘Integration’ team encompasses all those non-acute core services that we commission as a CCG. These can be grouped under the following headings:

 Mental Health & Learning Disability services;  General Community Services;  Primary Care Co-commissioning;  Children’s Services.  Integration & Transformation Programme (including Better Care Fund pooled budget encompassing emerging integrated transformation commissioning opportunities)

iii) Key issues

The Key Issues within each area are summarised below:

Mental Health & Learning Disability services: Contract negotiations were successfully completed by national deadline of 23rd Dec 2016. This sees the SEPT contract split into 3 separate contracts:

 Specialist Mental Health (South ) – help facilitate proposed merger;  General Community (‘Out of Hospital’) Services), for South East Essex, and;  Rawreth & Clifton (Dementia Nursing Homes).

Critical elements dominating negotiations included:

 future investment in IAPT and target delivery  Investment in Early intervention in Psychosis (EIP) requirements;  the provision of s136 suites and staffing  PICU and Learning Disability inpatient activity;  The transition of Rawreth & Clifton Wards to (Dementia Challenging Behaviour) Nursing Homes

A key challenge was building the contracting negotiation arrangements for 2017/18 in light of the proposed merger of Essex acute mental health providers, SEPT and NEPT. There will remain two contracts at the outset of 2017/18 however we needed to develop contract in partnership where possible to ensure smooth novation next year.

There is also specific reference in this report to those Essex-wide work streams that are specifically related to 24/7 mental health crisis care and s135, s136 amendments to the Mental Health Act (see Appendix 4)

A full work plan was in place for 2016/17 with 2017/18 work plan currently being finalised. As well as the core ‘business as usual’ activities, significant transformation is being planned for 2017/18 and beyond, in line with recently published Mental Health Strategy (for Greater Essex) and 5YFV for Mental Health with focus on primary care and community services.

Perinatal Mental Health Services: A successful Pan-Essex collaborative bid led by North East Essex CCG, with support from CP&R CCG has secured investment for expanding Perinatal Mental Health Specialist Community Teams across Essex over the next 3 years. The bid proposed enhancing and extending the current South East Essex service into South West Essex, and developing a new community service in North Essex where is currently only a specialist Mother and Baby Inpatient unit.

IAPT: The Q3 figure for access is 3.32% against the target of 3.75% for the quarter and equates to a gap of 96 patients for Q3 (based on local data). The recovery rate has seen an improvement with an October figure of 59% and a November figure of 49 % against a target of 50%.

General Community Services: The Governing Body approved the mainstreaming of Care Coordination service into 2017/18 contracts. Paper focuses on progress on core schemes including: Care Coordination, Geriatrician and End of Life alongside

Social Prescribing and Carers Support.

Primary Care Co-commissioning: Includes summary of key Primary Care Committee discussions and decisions. The successful submission of CCG’s plan to deliver the ‘GP Forward View’. Key highlights include starting to see impact of the Enhanced Service for Care Homes and issuing Local Enhanced Service for Avoiding Unplanned Admissions and increased focus on use of Electronic Frailty Index (EFI) in primary care and linking high risk patients to Care Coordination services. The project looking to develop the locality ‘GP Enhanced Access Hub’ is progressing a pace working in collaboration with wider STP and Essex LMC.

Children’s Services: Includes core contractual discussions and key work streams including ASD assessments and Maternity services, 0 – 19yr pathway work and QIPP programme for 2016/17. Commissioners are working in partnership with Southend CCG to consider proposals on future ASD provision..

Transformation: The CCG currently commissions its community services – adult, children, physical and mental health – utilising a range of traditional activity counts, performance indicators and information requirements. In order to move toward the vision of integrated care, and the improvement of outcomes, there is a need to change this contracting relationship and form.

Early work around outcomes has been started, with the development of the contractual arrangements to be progressed through the contract management process. Whilst this will look different to existing arrangements it will be important to manage the risk associated with the transformation through the creation of robust transitional metrics. Future reports will provide progress updates.

iv) Associated papers

Nil

TITLE: Update on: Mental Health & Learning Disability Services; General Community Services (inc Integration), and Primary care Co-commissioning

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1. PURPOSE

The purpose of this paper is to provide the Governing Body with a Month 10 update on some core service performance and service developments for key areas of responsibility within the CCG’s Integration and Transformation Team. This includes: Mental Health (inc Learning Disability); General Community services, Primary Care Co-commissioning, Children’s and Transformation Programme. The Governing Body is asked to review and offer comment and discussion on any aspects presented

2. BACKGROUND

The ‘Integration’ team encompasses all those non-acute core services that we commission as a CCG. These can be grouped under the following headings:

 Mental Health & Learning Disability services;  General Community Services;  Primary Care Co-commissioning;  Children’s Services.  Integration (including Better Care Fund pooled budget encompassing emerging integrated transformation commissioning opportunities)

MAIN BODY OF REPORT

3. Mental Health, Learning Disabilities Commissioning Update

A comprehensive MH/LD work programme is in place for 2016/17. The work streams are set out in: the Service Development Improvement Plan (SDIP) embedded in SEPT contract; our QIPP plans, and; the remainder included in the team’s work plan. Key areas of focus that the Mental Health Commissioning team wish to highlight are as follows: 3.1 Mental Health Strategy and Transformation

3.1.1 24/7 Crisis Care Transformation

This year sees a major focus on improving the mental health crisis pathway. CCG have been given the mandate to oversee this programme of work on behalf of Essex, Southend and Thurrock CCGs.

Mental Health Crisis Care has wide stakeholder involvement including many key partners across Essex including; , Essex County Council, East of Ambulance Service, SEPT, NEP, Public Health, Pan-Essex CCGs, Primary Care and GP representatives and 3rd Sector organisations.

RAID

The RAID team is currently funded to provide a core 24/7 psychiatric liaison and assessment service. Centrally funded non-recurrent psychiatric liaison money was recently used to enhance the 24/7 model which enabled the operation of the dedicated Mental Health Suite pilot within the Emergency Department (ED) at SUHFT. The operation of the Mental Health Suite enables the ED to discharge patients to the care of the suite and thereby reduce delays in the ED in addition to improving patient experience.

South East Essex CCGs have now confirmed commitment to fund the RAID team to the level required to operate the Mental Health Suite until 31 March 2016. The amended RAID service specification is has undergone contract variation into 2016/17 with funding for the MH Suite element included and this is now included within the 2017/18 contract.

South Essex CCGs worked collaboratively across the New Year period to produce an Urgent and Emergency Care bid to NHS England for psychiatric liaison funding to enhance capacity and interventions and BTUH and SUHFT in line with the CORE 24 model. The bid was supported by the STP leaders and submitted in mid-January. The outcome is due around the end of March 2017. If funds are available this will improve the response times for psychiatric assessment in SUHFT A&E and facilitate further psychosocial interventions and follow up where relevant.

Section 136 legislative changes

Legislation in relation to Section 136 detentions will come into effect from April 2017. The most significant changes include the almost total restriction on the use of police custody suites as a place of safety for any person detained under S136 of the MHA, with the exception of adult cases where there is extreme violence and this is yet to be defined. Police custody suites must never be used as a place of safety for persons under the age of 18. In addition, the 72 hour timeframe within a place of safety will reduce from 72 to 24 hours.

There are significant and multiple risks impacting relevant agencies and those individuals in crisis. The risks associated with the 136 suite lack of capacity combined with increased demand for suites include:

 increased police conveyances to A&E when suites are unavailable  increased clinical risk associated with delayed access to the appropriate setting  reputational risk for the health and social care system and Essex Police.

There has been significant multi-agency collaboration and planning lead by Thurrock CCG in preparation for these changes. The operational focus has included:

 a coordinated refurbishment of all Essex 136 HBPOS (Health Based Places of Safety). This is on schedule to finish in the summer and will increase compliance and robustness of the environments.  Development of a centralised coordination of available HBPOS across Essex. This is due to become live.

 Design of an OPEL based escalation process to alert the system where there are HBPOS capacity issues.  AMHP prioritisation of HBPOS MHA assessments to reduce delays A significant mitigation is the extension of Street Triage from 1st April, increasing from 8 hours to 16 hours per day. This will reduce the number of inappropriate detentions.

A key outstanding risk is the agreement of the five acute hospitals to the Essex Police ‘handover protocols’ that have been developed in the event that police convey individuals due to lack of HBPOS capacity. Acute hospitals are at various stages in planning local responses to this situation. CPR and Southend CCG have met with SUHFT to identify local plans required to be operationally prepared. Figures in recent months have indicated HBPOS capacity issues in less than 10 cases per month across Essex. This is currently the only indicator for forecasting activity, however Thurrock CCG are exploring how to model and predict activity to inform the system.

Street Triage

Street Triage is collaboration between SEPT, NEPT and Essex Police to provide a mental health professional to work alongside the police to respond to calls likely to lead to a S136 detention. This model has a number of system and patient benefits and has been successful in reducing the number of S136 detentions and thereby the demand for 136 suites. Operating hours are extending to 10am-2am across Essex from 1st April 2017.

A multi-agency work stream has formed under the Criminal Justice Commissioning Group in Essex County Council to focus on sustained future commissioning and a service model for Street Triage across Essex from 2018/19. It is proposed that Essex Criminal Justice Commissioning Team commission a re-modelled Street Triage service as part of an integrated model with Criminal Justice pathways from 2018/19. Engagement with CCGs and unitaries is ongoing, and an initial service specification has been produced along with proposed co-commissioning principles. ECC hope that the co-commissioning approach and service specification can be approved through all CCGs by May 2017 in line with procurement timetable.

3.1.2 Recovery College

The South East Essex Recovery College, which is now called Recovery Empower Achieve Community Hope (REACH) had a very successful launch in January and was opened by Cllr Judith McMahon the Mayor of Southend on Sea. Reach has now seen over 100 students and the curriculum is being expanded with more courses.

The primary purpose of REACH is to improve resilience and self-management, supporting people to achieve their aspirations. REACH aims to reduce dependence on mental health services by supporting self-management and increasing wellbeing and confidence.

In its initial phase, REACH will aim to support people using secondary mental health services. This will support a transformation agenda, freeing up resources locked in expensive secondary mental health services and enabling investment in recovery and prevention, based in primary care. Plans are underway for a launch in late January.

3.1.3 Perinatal Mental Health

Progress is underway to develop one central Specialist Community Perinatal Mental Health Service across Southend, Essex and Thurrock using funds from a successful bid to NHS England. The service will provide expert care and treatment in the community for perinatal women with severe mental illness. They will work across a complex range of partnerships covering the 7 CCGS and 3 local authorities to develop referral pathways to interface with this tier 3 service. The roll out of service delivery will be phased at a differing pace according to locality starting points.

Governance structures are now established to support the implementation of these funds and recruitment is underway. A service specification has been developed in collaboration with stakeholders and women with lived experience and is currently in the contracting process. A communication statement is in draft aimed at informing professionals on the current status of implementation and managing expectations on the eligibility and phased nature of operations.

Finances are held centrally by North East Essex CCG as the CCG leading the bid with the service funded through this until 2019/20, beyond which NHS England expects CCGs to sustain funding. Quarterly reports are to be submitted to NHS England on the progress of implementation.

3.1.4 Early Intervention for Psychosis

In line with national access targets for improving waiting and access times to specialist early intervention services, a South East Essex business case has been developed to propose investment in supporting services to meeting waiting times and improve the compliance of care packages with NICE guidance. The investment was agreed in the contracting round for 2017/18 that sees the creation of comprehensive EIP service in place in South Essex from 1st April 2017.

One of the new posts has now been recruited to and recruitment is now underway for the other posts relating to the new investment. Links have been made with Health Education England (HEE) to confirm what training can be accessed by SEPT and what training needs to be developed locally or in partnership with other Trusts.

3.1.5 Dementia Diagnosis Pathway – South East Essex

Southend CCG has led work with SEPT to develop an improved diagnostic pathway for people with suspected dementia. This will include aligning the current Southend Hospital and SEPT MAS clinics alongside improved interfaces with dementia pathways. It will also include a rebranding message moving away from ‘Dementia’ with more of a focus on ‘Memory’. A presentation on the proposed South East Essex models is arranged form 16th November.

3.1.5 SEPT / NEP Merger

The CCG are engaged in the SEPT / NEP Clinical Merger Board deliberations so that transformation can be embedded in development plan for the merged organisation. The full business case developed by SEPT/NEPT is currently with NHSI for consideration. The final decision will be taken in March 2017.

3.2 South Essex Partnership Trust (SEPT) Contract

The contract activity at M10 is reported and been presented to Finance and Performance Committee

3.2.1 2017/18 Contract Negotiations:

SEPT contract negotiation for 2017/18 was successfully completed within national timelines of 23rd Dec 2016. Three contracts were signed: Specialist Mental Health; Community (Out of Hospital) Services, and; Rawreth Clifton Dementia Nursing Homes.

At this stage it is agreed that there will still be two contracts (SEPT and NEP) at 1st April 2017. As part of the preparation for the merged organisation, we have been collaborating closely with North Essex CCG (host for NEPT contract). The commissioning intentions were closely aligned with the Five Year Forward View for Mental Health and Essex Mental Health Strategy. Key issues that impacted final contract deliberations included:

 IAPT Investment and Target delivery  Delivering ‘EIP’ requirement  S136 Suite provision and staffing  Bed management (with focus on PICU and LD beds)  Ward Closures and Reinvestment  Rawreth and Clifton post 2017/18

3.2.2 Re-registration of two Dementia Wards (SEPT):

Two acute inpatient units (Rawreth and Clifton) are being re-registering to become Continuing Health Care nursing home units managing dementia (including challenging behaviour). CQC visited the units on 14th Jan 2016 as part of the re-registering process. CQC identified environmental changes required pre-registration which impacts on ‘go live’ date. The revised time scale for the CQC re-registrations is late Jan 2017. However, patient transitions are now taking place.

A key risk to the transition is the ability to secure primary medical cover when they transition to nursing homes. The CCGs in South East Essex are attempting to secure an Enhanced Service with a local GP practice for each unit. This is proving challenging and putting the ‘go live’ date at risk. However, the mobilisation of patients from other units continues as planned.

3.2.3 Mental Health Tariff & Payment System (PBR):

Mental Health Tariff & Payment System (PBR) - MH Cluster reporting is developing with increasing confidence in the activity information. MH Cluster based reports are now regularly available every month and are a part of regular contract performance management in 2016/17. These include key indicators of Data Quality, Activity, Case Load and Service Quality. 2017/18 will see a continuation of this work with further development on; the care clusters and outcome based models.

Data Quality is the main focus of the first stage in developing our intelligence around this new system. Progress is being made to reduce the relatively high percentage of patients not yet clustered.

3.2.4 Improving the Dementia Diagnosis Rate

The additional work outlined in the latest action plan is on-going. Commissioners are putting together a proposal to NHS-England for dedicated funding for specific work around case finding, diagnostics and register updates. If agreed the work will have 4 components:

 Care home scoping, validation and update of QOF registers  Review of SEPT MAS service register compare with GP QOF registers and update where appropriate  Scoping/Case finding within community services using system 1 – update of QOF registers where required  Review of Southend General Hospital (SGH) Dementia register (or equivalent) compare with GP QOF registers and update where appropriate

Based on a previous similar project it is anticipated that this work will see the rate improve by at least 3 to 4 percent to reach over 60%.

3.5.4 Recovery of IAPT Trajectory

The Q3 figure for access is 3.32% against the target of 3.75% for the quarter and equates to a gap of 96 patients for Q3 (based on local data). The recovery rate has seen an improvement with an October figure of 59% and a November figure of 49 % against a target of 50%.

The IAPT data is now showing less variance between the local and national data.

4. Community Services

No significant changes to contracted service lines from last month.

As part of 2017/18 contract negotiation, Commissioners and the Provider (SEPT) will be working to revise the format of activity reports to better align reporting to patient outcomes. We have also identified specifications that are key to transformation plans and system redesign in 2017/18. This work is part of the overall transformation journey for community services as we move towards outcome based commissioning (see section on transformation).

The following table sets out the progress on the key areas of service development articulated in the Month 10 report.

Scheme Driver for Change and focus of Progress redesign in 2016/17

Care Co- This is a person-centered, pro-active The evaluation of the care coordination ordination approach to bringing health and social service was positive and following care services together around the governing body approval has been needs of service users. Team is mainstreamed into core services. supported by GP lead for each locality (who chairs weekly MDT) and has Phase two has commenced with weekly been enhanced with recent provision of MDTs being held in Canvey to test out the dedicated community pharmacists MDT model for those patients with rising aligned to team. /moderate risk of frailty Aim: Identify our high risk vulnerable patients and ensure they are assessed by integrated multi-disciplinary team and have plan of care that best meets their needs and keeps them well, independent and out of hospital as long as possible.

Community Secure dedicated Community Geriatrician Geriatrician service model working in Following notification from BUTH that they partnership with 4 x locality GPSWIs 5. were withdrawing their offer to provide a community geriatrician service we have been seeking alternative options.

Negotiations are currently underway with NELFT who have identified a willingness to provide a service; discussions are at an early stage but progressing well.

Improving End of Working through South East Essex GP lead (Dr Peter Long) Has resigned his Life Care Locality Group for Palliative Care and post as Macmillan GP and expression of End of Life deliver agreed a work plan interest have been sought from GPs aimed at better identifying people who across CPR. are at the end of life and deliver improved co-ordination of care and The additional EOL case manager’s reduction of unnecessary admissions capacity secured through the 16/17 into the acute setting. CQUIN has been shown to have a positive impact. The number of patients Plan sees increasing numbers on on the PCR and actively case managed EOL< registers, all providers on has increased at a faster rate with the Systm1; increasing community additional resources in place. Funding presentations at weekly MDT; has been secured to mainstream the developing family/carer crisis line; and additional capacity going forward improved care planning

A pilot will commence in April 2017, the aim of the pilot is to understand whether the demand is there to enhance the out of hours nursing provision.

The Better Care Fund (BCF) provides the opportunity for Essex County Council and the CCG to jointly commission services from pooled funding

The following table sets out recent service developments commissioned in partnership with ECC.

Scheme Driver for Change and focus of Progress redesign 2016/17 Social Prescribing Canvey association of Voluntary From the period of March 2016 to February services with the support of the CCG 2017 the service has seen 337 referrals. will be providing a Social Prescription’ Although this is below the initial activity service for the population of Castle planned we are confident that the numbers Point & Rochford. will continue to increase.

The service is a person centred, Self-referrals continue to be the main community focused service that source of referral (35%), involves co-ordinators who act as a Police are the second largest with 16% conduit between health, social care befriending third with 14% reablement third services and wider with 12%. community/voluntary services to The majority of referrals are being directed improve the health and well-being of to community and voluntary sector services. clients. Other key areas that individuals are being directed to include:  Befriending  Carers support services  Community transport  Support groups  Social Groups

According to the Manchester New Economy Model (a tool that has been requested by ECC to use) the cost avoidance is approximately £417,370 across health and social care.

Since launching the outreach sessions in the local libraries we have secured representation in another GP surgery, The Hollies Surgery Benfleet.

We have also provided practices with a breakdown of their patient’s usage of the service and the reasoning for contacting the service.

Following a short evaluation of 150 clients who accessed the service, 104 of those individuals stated that they would have attended their GP surgery for the advice provided by CAVS. Carers Support There are an estimated 19,318 informal carers in and The Carers Support pilot has been running Rochford making up 11% of the in 2 practices for 6 months and the population and of this total 23% emerging themes form the early data are provide over 50 hours of care per very positive outcomes. Both practices week. This service will support GP have seen a doubling of the number of practices to identify those carers, many carers on their carers registers and of whom are not known to services, accessing services and work with those carers to ensure they are able to access the help and Phase 2 of the pilot to commence Feb 2017 support they need to maintain their with roll out to Canvey. own health and wellbeing and continue to meet their caring commitments.

5 Co-commissioning of Primary Care

The areas highlighted below are summary of some of key co-commissioning work areas this year to date

5.1 Service Developments

5.1.1 Care Homes

The Committee approved an Enhanced Primary Care Service for Care Homes. Mobilisation Group is in place meeting fortnightly to oversee roll out. Phase 1 is complete (covering all Rayleigh locality) and Phase 2 commenced Sept 16 and sees the roll out to cover the large number of care homes beds in Benfleet. This includes the two largest homes in CPR (Elizabeth House and Godden Lodge) in Benfleet. This went live w/c 10th Oct 2016

Key complexities have arisen that have delayed start and ability to secure 100% coverage with original timeframes. These included:

 effectively mapping practices to care homes, and;  Patient registration issues  Unique challenge of Benfleet (high care home bed numbers and local of uptake from local practices)  Coverage for Rawreth (becoming nursing home in April 2017)  Lack of GP interest in ES in Rochford and localities Phase 1: At the 1st July, we had secured coverage for 217/828 beds (26%) covering all of Rayleigh locality and large home in Rochford locality.

Phase 2: The solution for Benfleet Care Homes will see Greensward providing ES service for all 450 beds. This service is currently live in the following homes:  Elizabeth House  Godden Lodge  Oakdale Residential Home  Hopes Green Care Home The total number of beds covered is 318 (70%). Resident engagement for Stafford Hall and Goldenley will be carried out in April 2017 with the proposed launch in May 2017. The total number of beds covered in Benfleet at this point would be 396 (88%).

Phase 3: We have now received confirmation from Ashingdon Medical Centre that they were unable to recruit to a GP to provide coverage for the Rochford Homes. We are now seeking alternate solutions for the 146 beds remaining in Rochford with existing practices in the locality. Due to the current issues being experienced in Canvey Island the next steps will be determined following the outcome of expressions of interests received.

5.1.2 APMS Reviews and OOH Reviews

CP&R CCG have one APMS practice (Leecon Way) that is now subject to bi-annual reviews (next due mid-Oct).

5.1.3 Contract Variations 2016/17

Month Variation June 2016 DR Ozturk joining Great Wakering Medical centre

Partnership June 2016 DR Waiwaiku retiring August 2016 June 2016 DR A Khan joining The Hollies partnership Oct 2016 Dr Cyrus retiring from Oaklands Practice

5.1.4 Closed Lists

The Primary Care Committee have approved the following closed lists to date:

 DR P A Patel has closed list following CQC review  DR Kahil (Essex Way) has closed list application approved for 6 months

5.1.5 PMS Review – Transformation Funding

The Clinical Executive Committee and Primary Care Committee supported the launch of a Challenge Fund on 1st Sept 2016. We requested innovative ideas from existing providers of General Practice services in Castle Point and Rochford that are aligned to our strategic aims for primary care namely:

 Building a consistent level of high quality provision for primary care  Building a responsive and accessible primary care service  Building an integrated model for primary care across a number of practices  Building greater self-care management amongst their patient population  Building a more robust primary care workforce

We received four locality bids by 4th November which were reviewed by panel established to review and score bids. Three bids were successful and presenting to Primary Care Committee on 21st Nov 2016 for approval. These include:

 Practice Pharmacist for Canvey Island  Practice Pharmacist for Benfleet  Practice Pharmacist for Rochford  Emergency Care Practitioner for Benfleet  Advanced Nurse Practitioner (for LTCs) in Benfleet

The CCG will be working with localities to mobilise these initiatives in Jan 2017.

5.1.6 Local QOF

The above has been mobilised as a pilot in one CPR CCG practice (Audley Mills). The scheme sees the replacement of the bulk of QOF requirements with the completion of 3 x local patient clinical audit.

5.1.7 Replaced Unplanned Admissions DES with Local ES

The Primary Care Committee has approved the pilot of a local Enhanced Service to replace the national DES for unplanned admissions. This has been issued to all practices. Uptake has been slow linked to issuing in-year, so efforts to target and support practices to make informed decision.

5.1.8 CCG Plan for delivering GP Forward View (GPFV)

In line with national Operational Plan requirements for 2017/18, the CCG has completed and submitted our plan for delivering key requirements of the GPFV published in Spring 2016. This will inform the primary care transformation work plan for 2017/18 and beyond.

The ‘GP Enhanced Access Hub Project’ is progressing a pace working in collaboration with colleagues across the STP footprint and Essex LMC. The two weekly project group is pulling together specification, workforce model and possible contracting structure for this service model.

6. Children’s Services

6.1 South Essex Partnership Trust (SEPT) Community Services Development – Paediatric Liaison Function

CCGs Children’s Commissioners and SEPT Children’s Services Leads have established an agreed overarching aim for the Paediatric Liaison Function which is defined within a specification for the 2017 – 2018 contract. The aim of the function is to ensure there is safe and robust communication and continuity of care between community children’s services (SEPT Children’s Community Health Services and Universal Health Services including School Nursing and Health Visiting) and secondary care.

In response to the 2016-2017 Service Development Improvement Plan with SEPT and in preparation for the 2017 – 2018 contract year, children’s commissioners and SEPT service directors produced an Integrated Paediatric Community Nursing Service bringing specialist nursing and community nursing into an integrated model of care as an enabler to recognising and capturing improvements to health outcomes for our Children and Young People who are able to have their care needs met at home. The new integrated paediatric community nursing model will commence from April 2017.

6.2 Autism Spectrum Disorder

Southend and Castle Point and Rochford CCG children’s commissioners are collaboratively reviewing and developing commercial and contractual clarification from known providers in order to evaluate and present an options appraisal as a solution to the ASD waiting list.

6.3 Maternity Services

Essex Success Regime leads for Maternity have been identified and planning will now commence to meet the expectation for an established Local Maternity Services vision by October 2017 which will inform future planning for service development.

6.4 Paediatric Diabetes Pumps

Three high priority patients from Castle point & Rochford CCG have been identified for insulin pump therapy. The commissioning case for a Paediatric Diabetes Pump service as a development of the existing model from Southend University Hospital Foundation Trust is expected to be presented through CCG governance in February 2017. Additional investment and activity has been identified for prescribing of pump equipment and will be demonstrated within the case.

6.5 Special Education Needs and Disabilities (SEND)

A Pilot programme has been agreed between all agencies concentrating on One Planning to support the statutory EHC process. This pilot commenced January 2017 to ensure the best outcomes for children families and the professionals that contribute to the statutory EHC process . The pilot process will be evaluated post six months and will be presented to the SEND Strategic Governance Group for recommendation going forward.

Commissioners have been in discussion with Essex Education Commissioners to understand the impact on NHS therapy services as a result of school expansions plans commencing September 2018.

6.4 QIPP

The currently identified schemes are detailed in the table below:

Scheme Brief Description Impact

Clarification and strengthening of health and social care 0- 19 pathways and services for children with non complex needs in line with the Public Health 0-19 pathway and ECC Childrens 0-19 pathway (PH, CCG & ECC Quality and Cost Reduction Scheme: A&E attendances early help services. This will focus on integration and integration) assumed at improving use of primary and community services with a particular focus on the 14-19yr olds to address current gaps in service for this cohort

Reviewing the hospital liaison function currently commissioned in the community contract with a view to Childrens A&E Liaison Quality and Cost Reduction Scheme: A&E attendances better supporting the interface between community and A&E services and pathways

Review of children's community therapy services and pathways currently commissioned within the Community Quality and Cost Management Scheme - manage Children's Community Therapies integration and Acute contracts with the aim of clarifying the local increased demands within existing budget offer, integrating pathways , aligning to SEND and addressing over/underperformance and gaps

Castle Point & Rochford CCG in collaboration with Southend CCG have agreed to develop a Children’s Acute QIPP focussed on the Paediatric Assessments Unit.

7. Transformation Programme

The CCG has aligned its contracting arrangements for 2017/19 with SEPT with the strategic direction being pursued by the CCG. The contracts – Community and Mental Health – are structured in a way to provide greater emphasis on transformational change as opposed to the historical bureaucratic burden of traditional NHS Contracts.

In particular the community contract is structured in a way that will enable continued re- design of out of hospital models of care during the first nine months of 2017 leading to new ways of monitoring and performance management in the second half of the 2017/18 financial year.

This contract will need to enable the continued progress towards creating an environement that incentivises integrated care.

In addition work continues with ECC for them to align elements of county-wide spend on a CCG footprint. It is envisaged that during 2017/18 a place based budget and spend report is developed to understand the utilisation of (in-scope) public resources across the patch.

8. CONCLUSION

The purpose of this paper is to provide the GB an update on some core service performance and service developments for five of the key areas of responsibility within the CCG’s Integration directorate. This includes: Mental Health (inc Learning Disability); General Community services, Primary Care Co-commissioning, Children’s Services and Transformation Programme. The GB are asked to review and offer comment and discussion on any aspects presented.