Commissioning Childrens Community Health Services – Future by dfhercbml


									Commissioning Children’s Community Health Services – Future
management arrangements for the TPCT’s Children’s Providerside.

1. In November 2005 the Board considered a paper exploring a range of
   options for the future delivery and management of community children‟s
   services in Haringey.

2. The paper set out the context within which children‟s services are
   commissioned and delivered by the TPCT and took as its starting premise
   a commitment to working with partners to deliver services that are well
   integrated both horizontally – i.e. with local authority children‟s services
   building on the vision set out in “Every Child Matters” / the Children‟s Bill
   and vertically – i.e. across primary, community, secondary and tertiary
   children‟s health services.

3. A range of organisational delivery options were set out including:

   1. „Status quo’ option: HTPCT retaining direct management
       responsibility for the delivery of children‟s community health services,
       working towards further integration of TPCT provided services with
       Haringey Council services through Children‟s Networks (for universal
       services) and increased multi-agency integration of specialist services
       such as services for children with disabilities (co-location and aligned
       management structures / multi-agency referral and assessment

   2. Formal integration of services with Haringey Council: moving at
       a faster pace to develop formal integrated arrangements with Haringey
       Council, including formal pooled budget arrangements and secondment
       of staff, with Haringey Council as the lead agency. In this model
       HTPCT would retain employment and clinical governance
       responsibilities for children‟s community health services but would
       delegate day to day management responsibility for the delivery of
       services to Haringey Council. (This is the model currently in place for
       services for people with a learning disability through the s31 pooled
       providerside arrangement.)

   3. Transfer of services to NCL Children’s Partnership for Health /
       Great Ormond Street Hospital: this model was not presented as an
       alternative to developing increased integration with Haringey Council
       services but rather looks to Great Ormond Street Hospital to be the
       accountable health provider, ensuring staff are appropriately trained
       and supervised, with robust clinical governance arrangements in place
       to ensure high quality, effective health provision. The extent to which
       partnerships with Haringey Council are formalised in this model (as per
       option 2 above) or based more on alignment and joint protocols for
      assessment and delivery is flexible and could develop at an agreed
      pace between agencies.

      A ‘ hybrid’ model was also considered which would involve
      transferring the management of specialist children‟s services to GOSH
      management, with the TPCT and / or Haringey Council taking
      responsibility for universal services such as health visiting and school
      nursing services. (Option 3 b)

   4. Alternative provider models: brief consideration was given to the
      potential to develop a specialist PMS provider model or look to other
      potential providers. This was not felt to be viable in the short to
      medium term due to a range of factors including lack of clarity within
      National policy frameworks about how staff entitlements would be
      protected in this model.

4. HTPCT children‟s service staff were fully involved in discussions to develop
   the options described above and given the opportunity to express their
   views as to the preferred way forward through a series of open staff
   meetings held in September / October 2005. There was a strong
   consensus through this process in favour of continued close joint working
   with Haringey Council services and further development of aligned and
   integrated models underpinned by strong NHS clinical, professional and
   organisational support structures. The view of staff was that this would
   be best achieved through option 3 - extension of the partnership with
   Great Ormond Street to include all children‟s services currently provided by
   the TPCT.

5. In addition to providing a firm foundation for clinically excellent health
   services within an integrated community based model an extension of the
   partnership with Great Ormond Street also presents significant on going
   opportunities to improve integration of community and hospital based
   children‟s health services. The Partnership has already facilitated joint
   work on a number of care pathways – e.g. infectious diseases, epilepsy.
   The aim is to ensure that children and families receive care as close to
   home as possible with improved co-ordination of health assessment and
   treatment processes. It is clear that there is real potential for further
   streamlining of care pathways and improved joint working between clinical
   teams could deliver significant benefits in the medium term.

6. On this basis, this was the option presented to the Board as the preferred
   way forward in November 2005. It was recognised that in this model it
   would be important to be clear that the TPCT would retain full public
   health and commissioning responsibilities to ensure effective, high quality
   health services provision for children and young people.
7. In addition to integrating services as much as possible at the point of
   delivery („team around the child‟ approach) it is important that the TPCT
   commissions services in an integrated way to ensure that the health and
   well being of Children and Young People in Haringey is maximised. The
   TPCT has agreed in principle to developing joint commissioning
   arrangements for children‟s services with the first step towards this being
   a joint time limited appointment to develop a joint commissioning strategy
   and framework. Careful consideration will need to be given in this process
   to accountability and governance arrangements. It is likely that in the first
   instance we will look to align budgets and planning rather than looking to
   significant formal pooling of resources in the short to medium term.

8. Following a full discussion at the November Board meeting Board
   members asked that further stakeholder discussion be undertaken to
   enable an informed decision to be taken about the best way forward at a
   future date.

9. On this basis further discussion with stakeholders has been undertaken
   during the early part of 2006. This included a formal discussion of the
   options at the Children and Young People‟s Strategic Partnership Board
   (which sits within the Haringey Strategic Partnership Structure). CYPSP
   members expressed broad support for an extension of the partnership
   with Great Ormond Street, on the basis that all partners continued to be
   signed up to the priorities set out within the Children and Young People‟s
   plan and to work within established partnership structures. The discussion
   paper was also circulated to a wide range of stakeholders through the
   CYPSP consultative structures. A meeting was arranged to discuss the
   paper but was not held due to lack of attendance. In general the view
   expressed by the CYPSP appears to be reflective of broader stakeholder
   views. It would probably be fair to say that stakeholders are more
   interested in „what‟ and „how‟ services will be delivered, as opposed to
   organisational delivery and accountability structures.

10. It would also probably be fair to say that the discussion paper on the
    financial savings programme within Children‟s services and the recent JAR
    inspection has meant that full engagement in the discussion about
    organisational delivery options was impaired. On this basis it is proposed
    that further ongoing discussion with stakeholders is built in to ongoing
    work to progress the final preferred model. The Board is asked at this
    stage to approve further work to develop proposals for a transfer of
    services to GOSH / NCL Children‟s Partnership for Health (see below) and
    further opportunities for stakeholder involvement will be built in to
    decision making processes as work progresses.

11. Clearly the Great Ormond Street Hospital executive management team
   has been fully engaged in discussions about potential ways forward as set
   out above. However the GOSH Board will need to make a decision in its
   own right as to whether it wishes to further extend its organisational
   responsibilities into the delivery of the full range of children‟s health
   services in Haringey. Following ongoing internal discussion of the options
   the TPCT understands that GOSH executive management team will
   recommend „option 3‟ to its Board (based on the approach set out below),
   assuming this is the TPCTs final preferred way forward. This fits with the
   vision originally developed by GOSH in establishing the NCL Children‟s
   Partnership for Health and offers a number of potential benefits to GOSH
   in its long term strategic development.

12. Based on the above the following way forward is proposed:

            Step One: Development of a commissioning strategy setting
             out overall vision / principles and service delivery model for
             community child health services. This strategy will be
             developed working closely with PBC commissioning
             collaboratives and wide range of stakeholders and will build on
             priorities set out with CYP plan and the principles set out in
             “Every Child Matters”.
             Target completion date: January 07.
             Director Lead: Helen Brown, Director of Strategy and

            Step Two: Development of a detailed commissioning
             specification for community child health services including
             activity and performance targets and monitoring / performance
             management arrangements. Again PBC collaboratives will be
             engaged in the development of this specification.
             Target completion date: June 07.
             Director Lead: Helen Brown, Director of Strategy and

            Step Three: Shadow management arrangements for TPCT
             children‟s providerside services to be transferred to GOSH.
             Target date: October 07.
             Director Lead: Deborah Goodman, Director of

            Step Four: Full transfer of management responsibility for all
             current HTPCT children‟s services to GOSH.
             Target date: April 2008.
             Director Lead: Deborah Goodman, Director of

            A project team and governance structure to oversee steps 3 and
             4 will be agreed and established.
             Target date: November 06.
             Director Lead: Deborah Goodman, Director of
    Full discussion with staff and stakeholders will be built into all four
    stages described above. Where appropriate formal consultation will be

    Board approval will be sought for key decisions at the appropriate points
    in the process described above.

13. The Board seminar session on the 12th July provided an opportunity to
    debate the potential opportunities and risks presented by the options
    described above and the proposed approach and timescales set out.

    In broad terms the Board was supportive of the proposed way forward
    i.e. transferring all TPCT employed Children‟s service staff to GOSH
    employment to a target timescale of April 2008.

    The following points were emphasised in the discussion:

           Clear assessment of any risks associated with the change needs to be
            undertaken and mitigation strategies developed. Robust risk
            management arrangements will be built into project delivery

           It is important that a clear commissioning strategy, specification and
            commissioning / performance management arrangement is put in
            place to provide a clear framework for future service delivery.

           The fundamental importance of universal / preventative and public
            health elements of children‟s community health service provision
            within the overall model needs to be clearly recognised and
            mechanisms put in place to ensure that this facet of service provision
            is safeguarded within future delivery structures.

    It was noted at the seminar that no formal tendering process is required
    in relation to the proposed change in service provider given that services
    under discussion are NHS clinical services and will be provided by an
    NHS provider organisation.

14. The Board is asked to approve:

            Transfer of HTPCT Children‟s Services to GOSH by April 2008.
             (Subject to continued discussion and formal consultation as
             appropriate with staff and other stakeholders. Subject also to GOSH
             Board confirming their support to the proposal.)

            Implementation of proposed project delivery structures described in
             outline at paragraph 13 above.
      Regular update reports will be provided to the Board on progress.

Helen Brown
Director of Strategy and Performance.

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