Children Looked After Policy and Framework

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1 Children Looked After Policy and Framework 1 SUMMARY This policy/framework demonstrates how the NHS Islington Clinical Commissioning Group (Islington CCG) meets its corporate accountability for Children looked after. It provides guidance to NHS Islington CCG employees to enable them to fulfil their responsibilities with regards to Children looked after. Provides guidance in the CCG s commissioning roles to drive continual improvement of services for children in terms of equity, effectiveness, safety, timeliness, efficiency and child centeredness. 2 RESPONSIBLE PERSON: 3 ACCOUNTABLE DIRECTOR: 4 APPLIES TO: 5 GROUPS/ INDIVIDUALS WHO HAVE OVERSEEN THE DEVELOPMENT OF THIS POLICY: Martin Machray Director Quality and Integrated Governance All staff employed within NHS Islington CCG Lorraine Wiener Designated Nurse Child Protection and Children Looked after. Dr Rebecca Evanson Designated Doctor Children Looked after Dr Tony Wheeler Designated Doctor Child Protection Sabrina Rees - Head of Children s Health Commissioning Children s Health Commissioning Team Sheron Hosking- CAMHS Commissioner Children s Health Commissioning Team Jane Chapman Senior Nurse Martin Machray Director of Quality and Integrated Governance

2 6 GROUPS WHICH WERE CONSULTED AND HAVE GIVEN APPROVAL: ICCG Child Protection Committee 9 th July EQUALITY IMPACT ANALYSIS COMPLETED: Policy Screened Template completed 8 RATIFYING COMMITTEE(S) & DATE OF FINAL APPROVAL: 9 VERSION: 10 AVAILABLE ON: 11 RELATED DOCUMENTS: 12 DISSEMINATED TO: 13 DATE OF IMPLEMENTATION: 14 DATE OF NEXT FORMAL REVIEW: ICCG Quality and Performance committee 25 th August st Draft March nd Draft - April 2015 Final Draft - May 2015 Intranet Website ICCG Safeguarding Children Policy 2013 All CCG employees via intranet September 2015 September 2017 DOCUMENT CONTROL Date Version Action Amendments March st Draft April nd Draft Amended following comments received from Sabrina Rees and Sheron Hosking May rd Draft Amended following comments received from Dr Tony Wheeler August 2015 Final document Minor amendments following ICCG CP Committee meeting on the 9 th July 2015

3 Children Looked After Policy, Procedure and Framework September 2015

4 Table of Contents Page No. 1 Introduction Policy Aims Senior and Strategic Health Leads Designated Professionals Commissioning CCG Governing Body Assurance and Monitoring arrangements 16 7 Training Requirements 17 8 Bibliography/Related Guidance Appendix 1 Islington CCG Children s commissioning statement in relation to the commissioning of health services for children and young people 0-18 yrs Appendix 2 Children Looked After contacts Appendix 3 Islington CCG Children Looked After Structure Children Looked After policy and procedure, July2015 Page 4 of 27

5 NHS Islington Clinical Commissioning Group Children Looked After Policy, Procedure and Framework 1 Introduction, context and legal framework 1.1 NHS Islington Clinical Commissioning Group (Islington CCG) was established on 1 st April This policy, procedure and framework replaces any NHS North Central London policy on Children looked after which was current until 31 st March The pre-existing policy continued as the current policy following the formation of the Islington CCG. 1.2 This policy and procedure applies to all employees and members of Islington CCG. 1.3 In UK law, children in care are referred to as looked after children. A child is looked after if they are in the care of the local authority for more than 24 hours. Legally this could be when they are:- Living in accommodation provided by the local authority with the parents agreement The subject of an interim or full care order The subject of an emergency legal order to remove them from immediate danger Detained in a secure children s home, secure training centre or young offender institution Unaccompanied asylum seeking children It does not include those children who have been permanently adopted or who are on a special guardianship order. n.b. it should be noted that in response to user feedback, agencies in Islington use the term Children Looked After (CLA) rather than Looked After Children (LAC) which is the term used in statutory guidance etc. 1.4 The corporate parenting responsibilities of local authorities include having a duty under section 22(3)(a) of the Children Act 1989 to safeguard and promote the welfare of the children they look after, including eligible children and those placed for adoption, regardless of whether they are placed in or out of authority or the type Children Looked After policy and procedure, July2015 Page 5 of 27

6 of placement. This includes the promotion of the child s physical, emotional and mental health and acting on any early signs of health issues. 1.5 Under Section 10 of the Children Act 1989, CCGs and NHS England have a duty to comply with requests from a local authority to help them provide support and services to looked-after children which promote their health and well-being. 1.6 Although Children looked after have many of the same health issues as their peers, the extent of these is often greater because of their past experiences. Almost half of children in care have a diagnosable mental health disorder and two-thirds have special educational needs. Delays in identifying and meeting their emotional wellbeing and mental health needs can have far reaching effects on all aspects of their lives. 1.7 As described in the statutory guidance Promoting the health and well-being of looked after children the NHS has a major role in ensuring the timely and effective delivery of health services to children looked after. The Mandate to NHS England, Statutory Guidance on Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies and The NHS Constitution for England outline the responsibilities of CCGs and NHS England to children looked after (and, by extension, to care leavers). In fulfilling those responsibilities the NHS contributes to meeting the health needs of looked-after children in three ways: commissioning effective services, delivering through provider organisations through individual practitioners providing coordinated care for each child. 1.8 In conjunction with the London borough of Islington, Islington CCG contributes to the preparation of the Joint Strategic Needs Assessment (JSNA) and Joint Health and Wellbeing Strategy (JHWS) through the local Health and Wellbeing Board. In accordance with the statutory guidance on JSNAs and JHWSs, the Vulnerable Children Needs Assessment (which includes looked after children and adopted children) supports improving the health of looked-after children through commissioning plans. This takes account of information about those children placed out of borough. Children Looked After policy and procedure, July2015 Page 6 of 27

7 1.9 For the purposes of this document, as described in the Children Acts 1989 and 2004, a child or young person is anyone who has not reached their 18 th birthday. A child ceases to be looked after when they are either adopted, returned home, placed on Special Guardianship order or reach 18 years of age. Islington local authority has a dedicated service for care-leavers which continues to support children leaving care until they reach their 25 th birthday Islington CCG is accountable for its own children looked after structures and processes and is accountable for obtaining assurance re the arrangements in agencies from which they commission services This policy/framework should be read in conjunction with national and local guidance, primarily but not exclusively as listed below: Children Acts 1989 and 2004 Health and Social Care Act 2012 Children and Families Act 2014 The Care Act 2014 Statutory Guidance on Promoting the Health and Well-being of Looked After children 2015 ( DoH,DfE ) Looked After Children knowledge, skills and competence of health care staff Intercollegiate Role Framework ( RCN, RCPCH) 2015 NICE public health guidance 28 - Looked-after children and young people Issued: October 2010 last modified: April 2013 Safeguarding Vulnerable People in the NHS -Accountability and Assurance Framework. National Commissioning Board July 2015 Working Together to Safeguard Children 2015 London Child Protection Procedures (5 th edition) 2015, London Safeguarding Children Board Islington CCG/London Borough of Islington Children and Young People s Health Strategy Islington CCG Commissioning Statement in relation to Children and Young People 2015 Islington Plan for Looked after children and care leavers Children Looked After policy and procedure, July2015 Page 7 of 27

8 2 Policy Aims 2.1. To demonstrate how Islington CCG meets its corporate accountability (in conjunction with London Borough of Islington) for Children looked after To provide guidance to Islington CCG employees to enable them to fulfil their responsibilities for Children looked after The policy is specifically aimed at the continual improvement of services, through equity, effectiveness, safety, timeliness, efficiency and child-centeredness. 3 Senior and strategic health leads. 3.1 Islington CCG s Accountable Officer (Chief Officer) has responsibility for ensuring the health service contribution to promoting the health and well-being of children looked after is discharged effectively across the whole local health economy. This is operationally delivered through local commissioning arrangements. The Accountable Officer is a member of Islington CCG Governing Body. 3.2 The Director of Quality and Integrated Governance (Executive Lead for Safeguarding and Children looked After) reports to the Accountable Officer and is responsible for: Ensuring that the monitoring of commissioned health services for Islington s Children looked after (placed in Islington or outside the borough) takes place in conjunction with the London Borough of Islington through the CLA Health Sub Group, the Children s Services Improvement Group and the Quality and Performance committee which reports to the NHS Islington CCG Governing Body. Reporting any relevant risks or achievements regarding Children looked after to the Accountable Officer Drafting corporate media responses when required 3.3 The Islington CCG Governing Body lead for Children s Services has children looked after within her/his portfolio of responsibilities for commissioning services for the residents of Islington. Children Looked After policy and procedure, July2015 Page 8 of 27

9 3.4 The CCG clinical lead for Children s Services is supported in this role by the Children s Health Commissioning Team which is based within the local authority and works to the CCG Director of Commissioning. The work of this team is covered by a Section 75 Partnership Agreement between the CCG and the Council and is part of the Children s Trust arrangements known locally as the Islington Children and Families Partnership. 4 Designated Professionals 4.1 The terms designated professionals and named professionals denote professionals with specific roles and responsibilities for safeguarding children and for Children looked after, as defined in national statutory guidance Working together to Safeguard Children 2015: A guide to inter-agency working to safeguard and promote the welfare of children. The term designated doctor or nurse for Children Looked After denotes professionals with specific roles and responsibilities for Children Looked After including the provision of strategic advice and guidance to service planners and commissioning organisations. National guidance regarding these roles can be found in: Statutory guidance re promoting the health and Well-being of Looked After Children 2015 DoH,DfE and Looked after children: Knowledge, skills and competences of health care staff Intercollegiate Role Framework May As part of its authorisation, Islington CCG is required to identify a senior paediatrician and senior nurse to undertake the commissioning role of Designated Professionals for Children Looked after. Islington CCG has retained the services of the Designated Doctor for Children Looked after in Islington (through a Service Level Agreement (SLA) with Whittington Health).With effect from March 2015, the Islington CCG Designated Nurse (Child Protection) post includes the roles and responsibilities of the Islington CCG Designated Nurse for Children Looked After. The job descriptions for designated professionals meet the standards and requirements outlined by the Looked after children: Knowledge, skills and competences of health care staff Intercollegiate Role Framework May 2015 Royal College of Paediatrics and Child Health and the Royal College of Nursing (2015) Children Looked After policy and procedure, July2015 Page 9 of 27

10 The Designated Doctor (CLA) works as part of the provider CLA health team which is co-located with the local authority CLA team. 4.3 The Designated Nurse and Doctor for Children Looked after provide a vital source of professional advice on Children looked after matters to:- Islington CCG Governing Body via the Executive Lead and the Governing Body Children s Lead The Children s Health Commissioning Team (Islington CCG/London Borough of Islington) London borough of Islington Children looked after social work lead Named professionals for safeguarding children in provider Trusts. 4.4 In discharging their responsibilities the Designated Professionals undertake the following functions: Provide advice to ensure the range of services commissioned and contracted by Islington CCG take account of the need to promote the health and wellbeing of children looked after. n.b. details of the groups of children looked after for whom Islington CCG has commissioning responsibilities are given in the Islington CCG Commissioning Statement in relation to the commissioning of health services for children and young people 0-18 yrs. (2015) see Appendix 1. Provide advice on the monitoring of any aspects of provider contracts which relate to Children looked after. In conjunction with the Children s Health Commissioning Team, the London Borough of Islington Public Health Team, the London Borough of Islington Service to Children looked after and the Children s Active Involvement Service (CAIS), ensure that the perspective and views of children, young people (Children looked after) and their carers inform the design and delivery of local health services for children looked after. Provide advice, support and clinical supervision to the Named/lead Children Looked After professionals in the Islington provider Looked after children health team. Membership of the Corporate Parenting Board in conjunction with other health service planners/commissioners. Children Looked After policy and procedure, July2015 Page 10 of 27

11 Provide advice on the health priorities of the Islington CLA health plan which are monitored (via the CLA health sub-group) by ICCG Children s Services Improvement Group and the Islington Corporate Parenting Board. Provide professional advice in Children looked after processes in line with local procedures and national guidance. Ensure the regular qualitative audit of CLA health reviews. Review and evaluate the practice and learning in relation to Children looked after from all involved health professionals and providers commissioned by Islington CCG as part of any relevant Serious Case Reviews (SCR) or other management reviews. This would include ensuring that opportunities for sharing relevant best practice and learning are maximised between the workers in the Borough-based CLA health team provided by the local health provider (Whittington Health). Provide an annual report and regular assurance as required to Islington CCG Governing Body, via the Islington CCG Children s Services Improvement Group and Quality and Performance Committee. 4.5 Designated professionals are performance managed by and accountable to the Director of Quality & Integrated Governance/Executive Lead for Safeguarding and Children looked after (Islington CCG) in relation to their designated functions. 4.6 The Designated Nurse and Doctor for Children looked after are professionally accountable to the Director of Quality & Integrated Governance/Islington CCG Board Nurse member. The Designated Doctor for Children looked after will have a professional relationship with the Islington CCG Clinical Director 4.7 Designated professionals should participate regularly in support/supervision groups or peer support networks for specialist child protection and Children looked after professionals at a local, regional and national level according to professional guidelines. 4.8 Islington CCG will ensure establishment levels of Designated professionals for Children looked after are proportionate to the size,complexity and rate of Children looked after in the local resident population and seek assurance that Provider trusts have appropriate numbers of Named/lead professionals in post. The CLA Children Looked After policy and procedure, July2015 Page 11 of 27

12 Designated Nurse is a direct employee of the Islington CCG, the Designated Doctor is not directly employed by the CCG, these duties and responsibilities are through a Service Level Agreement between the Provider, Whittington Health and the CCG. See Appendix 2 for contact details of Designated Professionals. See Appendix 3 for structure charts. 5 Commissioning 5.1 Islington CCG will work with London Borough of Islington and other local CCGs to commission and ensure co-ordinated and integrated services for Children Looked After. It will contribute to the development, implementation and monitoring of the health priorities as outlined in the Islington Plan for Looked After children and care leavers and ensure that the health needs of Children looked after are addressed through Priority 9 (vulnerable children) of the Children and Young People s Health Strategy (Islington CCG and London borough of Islington). 5.2 The CLA health team are provided by Whittington Health as part of the block contract and that there is a Service Level Agreement between Islington CCG and Whittington Health covering the role of the Designated Doctor. The following table provides an outline of staffing working within the CLA health team: ROLE WTE Designated Doctor, Associate Specialist, Community Paediatrics 0.5 Named Nurse CLA 7yrs and under (responsible for managing the two other 1.0 Nurse Health Advisers) Nurse Health Adviser CLA yrs, Immunisation lead 1.0 Nurse Health Adviser CLA 16+yrs, Sexual Health and Smoking cessation 0.8 lead Band 4 Administrator 1.0 Children Looked After policy and procedure, July2015 Page 12 of 27

13 5.3 Islington CCG also resource the Islington CAMHS Team for CLA to provide a designated mental health service to Islington s population of CLA aged Children living or attending School in Islington can also access other teams in Islington Community CAMHS where this better meets their need. Services offered: A range of assessment and psychological therapies to CLA living in or attending School in Islington and those living out of borough (but within Greater London) when it is not possible to access CAMHS locally. Attendance at team around child and other professional meetings to contribute a mental health perspective to care planning. Individual and Group Consultation to Social Workers in the CLA Child Care Teams x 3, Fostering and Adoption teams. Training for Islington s Foster Carers, Adopters and Professionals working with Islington s CLA. Co facilitating Fostering Changes, a 12 week parenting skills group programme for Islington Foster Carers. Strategic work, including attendance at Being Healthy Sub Group, Multi agency CLA Service Meeting and Performance Meetings in Children s Social Care, as required. The following table provides an outline of staffing working within the CAMHS CLA health team ROLE WTE Team Leader (Family & Systemic Psychotherapist) 0.8 Family & Systemic Psychotherapist (0.2 independent commissioning) 0.7 Clinical Psychology (0.5 funded by Fostering Service) 1.0 Child & Adolescent Psychotherapist 0.5 Educational Psychotherapist 0.5 Assistant Psychologist 0.1 Child & Adolescent Psychiatrist 0.1 Islington s Health Commissioner also delegates a small budget to Islington CAMHS for the commissioning of a mental health service for Islington s CLA, who are placed out of the borough, meet the threshold for CAMHS, but are unable to access a service from the local services. Children Looked After policy and procedure, July2015 Page 13 of 27

14 5.4 National contracts for health service provision will provide the means to prescribe the requirements for children looked after and service specifications drawn up by Islington CCG will include clear service standards for promoting the health and wellbeing of children looked after, consistent with the local and national guidance and procedures. By monitoring the service standards of all providers, Islington CCG will assure itself that the required standards are being met in Islington. The main vehicle for doing so is the CLA Health Sub Group. 5.5 The CCG s clinical lead for Children s Services is an Islington GP and is a member of the CCG Governing Body. The clinical lead for Children s Services also chairs the Children s Services Improvement Group which is the forum for discussing strategy and commissioning in relation to children s health services and works across the CCG and the Local Authority. The Children s Service Improvement Group is a subgroup of the CCG Strategy and Finance Committee. 5.6 The Clinical Lead for Children s Services is supported by the Head of Children s Health Commissioning who works across the CCG and Local Authority under a Section 75 Partnership Agreement as part of the Children s Trust arrangements known locally as the Islington Children and Families Partnership. 5.7 Funding responsibilities and Procedure to be followed in the event of a funding dispute are set out in: Who Pays? Determining the Responsibility for Payments to Providers, (NHSE August 2013) This document includes a section covering Children Looked After and Care Leavers. Please also see Appendix 1 Islington CCG Children s commissioning statement in relation to the commissioning of health services for children and young people 0-18 yrs Islington CCG will ensure that all providers from whom they commission services have comprehensive and effective single and multi-agency policies and procedures to promote the health and well-being of children looked after, consistent with current local and national guidance. Children Looked After policy and procedure, July2015 Page 14 of 27

15 5.9 Islington CCG will ensure that promoting the health and well-being of Children looked after is integral to the quality and safety of all provider and commissioning arrangements, and that there is evidence of robust audit arrangements of e.g. quality of Health assessments and reviews. This will be reported to the CLA health sub-group (which reports to Islington Corporate Parenting Board and to Islington CCG Children s Services Improvement Group) Islington CCG will monitor the service standards of NHS Provider Trusts and contracted service providers to ensure they meet the required Children looked after standards. This will occur through the CLA Health Sub Group, the Children s Services Improvement Group and the Clinical Quality Review Group meetings with each provider Islington CCG will ensure that staff working in the GP Out-Of-Hours (OOH) services, Walk-in Centres and Urgent Care Centre provision that the CCG is responsible for commissioning are informed about how to access advice from relevant Designated and Named professionals for Children looked After Islington CCG will ensure that relevant partner agencies have easy access to paediatricians trained in examining and assessing children looked after and that holistic examinations/assessments are undertaken in accordance with the Statutory guidance for promoting the health and welfare of looked after children 2015.The Designated Doctor for Children Looked After will exercise discretion to agree arrangements for Health assessments which best meet the needs of individual children Islington CCG will support NHS England in their responsibility to ensure that Primary Care provision has robust systems and practices in place to promote the health and well-being of Children looked after Through their contracting arrangements, Islington CCG should ensure that independent and third sector providers deliver services that are in line with Borough level obligation and should ensure they apply the same standards and requirements Children Looked After policy and procedure, July2015 Page 15 of 27

16 as for NHS providers with respect to promoting the health and well-being of children looked after. 6. CCG Governing Body Assurance and Monitoring arrangements 6.1 The Children looked after responsibilities and priorities of Islington CCG will be coordinated through the CLA Health Sub Group. Quality and assurance is reported through the CCG Quality and Performance committee to the Islington CCG Board of Governors. The Children s Services Improvement Group (chaired by a member of Islington CCG governing body) will also receive the CLA annual report. 6.2 One of the key duties of the Children s Services Improvement Group is to align the priorities from the Health and Wellbeing Strategy, the CCG s Commissioning Framework of Strategies and the QIPP 4 year strategy with the London Borough of Islington strategies that relate to children and families. 6.3 To evidence compliance with Children looked after requirements; an Annual Health report for Children Looked after and other reports by exception will be provided by the Designated Doctor and Nurse for CLA to the Islington CCG Quality and Performance Committee and Governing Body. Monthly reports on key Children looked after metrics will be included in Islington CCG s integrated performance report. 6.4 An annual report on Children looked after will be taken to the Islington CCG Child Protection Committee as part of the Committees annual cycle of commissioned services reports. 6.5 The implementation of action plans arising from CQC or other inspections of Child Safeguarding and Children looked after services will be monitored via Islington s CCG Child Protection Committee, the CLA Health Sub Group and Children s Services Improvement group. 6.6 The Patient Safety Manager within the North and East London Commissioning Support Unit will be updated on any open Serious Incidents (SI) relating to a Child looked after for whom Islington CCG has commissioning responsibilities. Any such Children Looked After policy and procedure, July2015 Page 16 of 27

17 cases will also be reported to Islington CCG s Child Protection Committee and Children s Services Improvement Group. 6.7 The Designated Professionals for Child Protection/Children Looked after will ensure that NHS Islington Clinical Commissioning Group is represented on appropriate NHS Provider organisations internal committees to enable assurance with regard to internal monitoring standards for Children looked after. This will also enable constructive challenge and appropriate support to each organisation. 6.8 The Designated professionals will attend the Clinical Quality Review Groups (CQRGs) for each provider Trust when Children looked after is on the agenda. 6.9 Islington Local authority submits an annual statutory return to the Department for Education (DfE) in relation to Children looked after. Islington CCG will ensure that data re the relevant health indicators for this report is made available in a timely manner The key health data required by the Department for Education relate to the uptake and timeliness of the following interventions for those children who have been looked after continuously for at least 12 months:- Percentage of children who have had their annual Health assessment Percentage of children whose immunisations were up to date Percentage of children who have had their teeth checked by a dentist 6.11 In addition to the above, annual data is also submitted to the Department for Education on the average scores for the Strengths and Difficulties Questionnaire (SDQ) for Children looked after (aged 5 to 16 years) in line with Statutory guidance. 7 Training requirements 7.1 The competences specifically needed by healthcare workers to promote the health and well-being of Children looked after within the healthcare system are described in Looked after children: Knowledge, skills and competences of health care staff Intercollegiate Role Framework May 2015 Children Looked After policy and procedure, July2015 Page 17 of 27

18 7.2 The Designated Nurse CLA will seek assurance from healthcare providers with regard to staff training compliance. Children Looked After policy and procedure, July2015 Page 18 of 27

19 6 Bibliography/ Related Guidance Children Act 1989 Children Act 2004 (Section 10 and 11) Care Quality Commission (Registration) Regulations 2009 Health and Social Care Act 2008 (Regulated Activities) Regulations 2009 Health and Social Care Act 2012 Children and Families Act 2014 Statutory Guidance on Promoting the Health and Wellbeing of Looked After Children:2015 DfE & DoH Working Together to Safeguard Children 2015 Looked After Children Intercollegiate Role Framework Knowledge, skills and competence of healthcare staff 2015 Published by Royal College of nursing and Royal College of Paediatrics and Child health Safeguarding Vulnerable People in the NHS -Accountability and Assurance Framework. National Commissioning Board July 2015 Looked-after children and young people - NICE public health guidance 28 Issued: October 2010 last modified: April 2013 London Child Protection Procedures (5th edition) 2013, London Safeguarding Children Board Service Level Agreement between Islington CCG and Whittington Health regarding Designated CLA Roles (2013/14) Islington Plan for Looked after children and care leavers London Borough of Islington Islington Children and Young People s Health Strategy London Borough of Islington and Islington Clinical Commissioning Group. Islington CCG Children s commissioning statement in relation to the commissioning of health services for children and young people 0-18 yrs Appendix 1 Children Looked After policy and procedure, July2015 Page 19 of 27

20 Appendix 1 Islington CCG Children s commissioning statement in relation to the commissioning of health services for children and young people 0-18 yrs Introduction 1. Islington CCG funds a range of health services for children and young people aged 0-18 yrs and their families. These include community audiology, paediatric therapies, services for children with disabilities, children s community nursing, community paediatrics, community child and adolescent mental health services and acute (hospital) services provided by Whittington Health, UCLH and other general hospitals. 2. The CCG does this in accordance with its Children and Young People s Health Strategy which was drawn up in conjunction with the local authority. This was signed off by the CCG Governing Body in January The table on page 18 of the strategy illustrates the complexity of commissioning arrangements that currently exist in relation to the commissioning of health services for children in Islington and this is attached as Appendix A. 4. The CCG is interested in all services used by children and young people in the Borough, particularly those commissioned through the NHS. It therefore seeks to maintain links with NHS England, which is responsible for commissioning GPs, dentists and opthalmologists as well as more specialist services including CAMHS inpatient care and specialist acute provision, either in general hospitals or in specialist (tertiary) hospitals. The CCG is starting to work with NHSE on the co-commissioning of GP services.. It has also expressed an interest in co-commissioning CAMHS inpatient care but at the time of writing this report NHSE has not pursued this. 5. The CCG is also interested in the provision of other health services to the population of children and young people in the Borough. It therefore works closely with Public Health within the Local Authority in relation to the health services that they commission. These are generally universal health services such as health promotion, school nursing and sexual health services, as well substance misuse services (which include both universal and targeted elements). Who does the commissioning? 6. CCG s were established under the Health and Social Care Act (2012) and are clinically driven. The CCG s clinical lead for Children s Services is an Islington GP who is a member of the CCG Governing Body. The clinical lead for Children s Services also chairs the Service Improvement Group which is the main forum for discussing strategy and commissioning in relation to children s health services. This works across the CCG and the Local Authority. The Children s Service Improvement Group is a subgroup of the CCG Strategy and Finance Committee. 7. The clinical Lead for Children s Services is supported by the Head of Children s Health Commissioning who works across the CCG and Local Authority under a section 75 partnership agreement and a small Children s Health Commissioning team that includes a Participation Officer who focusses on the engagement of children and young people and their parents and carers in the commissioning of services that affect them. Children Looked After policy and procedure, July2015 Page 20 of 27

21 Who is the CCG responsible for funding services to? 1 8. The CCG s funding responsibilities are set out in Who Pays? Determining responsibility for payments to providers August and this should be referred to for further detail. The general rule is that Islington CCG funds health services for children and young people who are registered with an Islington GP. As of March 2014, this totalled approximately 43,400 children and young people including some children and young people living in other Boroughs, usually near the Borough boundary. 9. Some children and young people who live in Islington are registered with a GP in another Borough. The CCG is generally not responsible for funding health services to these children. 10. If a child has an Education Health and Care plan led by the London Borough of Islington and the child is registered with an Islington GP then Islington CCG is responsible for agreeing and funding the health element. Different rules apply to out of area placements see para 12 below. If a child has an Education Health and Care plan led by another Borough, then that CCG area is responsible for agreeing and funding the health element. 11. Islington CCG funds health services to children looked after by Islington Council or other local authorities who have an Islington GP. However, different rules apply to out of area placements para 12 below. Please also see the new guidance on the Health of LAC entitled Promoting the health and wellbeing of looked after children (2015) The Who Pays guidance describes out of area placements as being where the CCG or a local authority, or both acting jointly, arrange accommodation for a child or young person in one of the groups listed a) d) below in the area of another CCG (or in in the case of Wales, a local Health Board). The general rule applying to these placements is that in these circumstances the responsible CCG is the originating CCG i.e. the CCG which made or was involved in the making of arrangements for the child to be accommodated out of their area, or the CCG which was responsible for the child when the arrangements were made (if made by the local authority alone). As a matter of good practice, the originating CCG should notify the CCG in whose area a child has been placed. The rules on out of area placements apply to: Looked after children and children leaving care Pupils with special educational needs attending residential special schools Children with continuing healthcare needs requiring residential care who are not looked after children Young adults with continuing health care needs the originating CCG only remains responsible for the continuing healthcare, not any other services. The Who Pays guidance has sections in relation to each of the above; please refer to this document for further detail. 1 Who Pays? Determining responsibility for payments to providers Aug Promoting the health and well-being of looked-after children, Statutory guidance for local authorities, clinical commissioning groups and NHS England, March 2015 Children Looked After policy and procedure, July2015 Page 21 of 27

22 Islington CCG jointly funds with Education and Children s Social Care some placements for children with complex needs either as a result of social, emotional or mental health problems or complex disabilities or a combination of these. The responsible health commissioner in such cases of children looked after is Islington CCG if the child was registered with an Islington GP immediately before they became looked after. What procedure should be followed in the event of a funding dispute? 13. The CCG s starting point is that children and young people s health should not be jeopardised because of a funding dispute. This means that there may be instances where the CCG agrees to start funding health provision although it considers this to be the funding responsibility of another CCG. In such instances the Head of Children s Health Commissioning will seek agreement from the Director of Commissioning to this course of action, which would be without precedent i.e. other patients could not claim parity as such situations would need to be considered on a case by case basis. 14. The CCG will expect that all reasonable attempts are made to try to resolve such disputes at the lowest organisational level i.e. Commissioning Managers will be expected to try to resolve disputes themselves first before referring upwards. 15. If it is felt that a child may suffer significant harm as a result of an unresolved professional s dispute, the London Safeguarding Children Board Child Protection Procedures Part B 2, 6: Professional Conflict Resolution should be followed. 16. Where a funding dispute with another CCG is likely to affect safeguarding, Commissioning Managers are expected to have discussed this with the CCG s Designated Nurse or Doctor for Safeguarding and to have recorded their advice in writing. 17. If Commissioning Managers are unable to resolve a funding dispute with another CCG, they will refer to the Head of Children s Health Commissioning who will discuss this with the Director of Commissioning and put the CCG s position to the other CCG in writing, copying in the Director of Commissioning. If the dispute is still not resolved the Director of Commissioning will contact their counterpart and try to gain agreement. If unsuccessful the Director of Commissioning will contact NHSE and consider taking legal advice. 18. If a funding dispute with another CCG is likely to affect safeguarding, the Head of Children s Health Commissioning will ensure that the Clinical lead for Children s Services is notified about the circumstances and will seek further advice. The Director of Commissioning will ensure that Islington CCG s Head of Quality is notified and with the agreement of the Clinical lead, the Director of Commissioning will ensure that this matter is referred to the Director of Safeguarding and the Safeguarding Children Board, both in Islington and the other CCG s local area. 19. If the funding dispute is with the London Borough of Islington or another Local Authority (as may be the case with step down arrangements from CAMHS inpatient care and/or the funding of joint funded residential or community packages for children with complex needs) the Director of Commissioning will ensure that the Director of Children s Services in the relevant authority is notified of this dispute. In such instances it is highly likely that safeguarding would be affected. Thus the above paragraph applies also. 20. Where the CCG is involved in a funding dispute regarding a Child Looked After, the CCG s Designated Doctor for Children Looked After will be notified and consulted. If such Children Looked After policy and procedure, July2015 Page 22 of 27

23 a dispute arises in relation to a young person being considered at either the CAMHS Tier 4 Panel that considers step up and step down arrangements from CAMHS inpatient care or the Islington Joint Agency Panel that considers joint funding of children with complex needs, the CCG Designated Doctor for Children Looked After will be asked to attend these meetings. 21. This commissioning statement will be reviewed annually through the Children s Service Improvement Group. Sabrina Rees, Head of Children s Health Commissioning Telephone: April 2015 Children Looked After policy and procedure, July2015 Page 23 of 27

24 Appendix A - Commissioning Responsibilities in relation to Child Health National NHS England Specialist health services, including some mental health and acute care pharmacy and ophthalmic services Regional / Sub- Regional Local Department of Health / Public Health England NHS England Local Area Teams Collaborative groups of CCGs and Local Authorities Islington Clinical Commissioning Group (CCG) Islington Local Authority Schools National public health campaigns Health protection nationally and locally Immunisation and Children s screening Children s public health for under-5s (including the Healthy Child Programme, Health visitors and Family Nurse Partnership (moves to LAs in 2015) Primary care, including GP s contracts Work together to increase the effectiveness of commissioning health and public health services for key groups over a wider area than a single borough GP Out of Hours services Mainstream acute emergency and elective services and walk in clinic Outpatient services Locally commissioned services for general practice Medicines management for all ages Community health services including: community audiology, paediatric therapies, health services for children with disabilities, children s community nursing, community paediatrics and community child and adolescent mental health services Health of Children Looked After team and Health input into the Youth Offending Service (excluding sexual health and substance misuse workers in both who are commissioned by Public Health) Children and young people s public health services for 5-18 year olds (including the Healthy Child Programme) Health promotion initiatives School nurses Health Visitors and Family Nurse Partnership from Oct 2015 Drug and alcohol services Sexual health service Children s Social Care including Early Help Services and services to support disabled children and their families Housing, Planning, Leisure Outreach services from special schools to support children with special educational needs in mainstream schools Funding contributions to CAMHS services and Speech and Language therapy Children Looked After policy and procedure, July2015 Page 24 of 27

25 Appendix 2 Islington Clinical Commissioning group Children Looked After leads NHS ISLINGTON CLINICAL COMMISSIONING GROUP LEAD TITLE LEAD NAME CONTACT INFORMATION Islington CCG Accountable Officer CCG Governing Body lead for Children ( including Safeguarding children) Director of Quality & Integrated Governance Alison Blair Dr. Katie Coleman Martin Machray Designated Doctor for Children Looked After Dr. Rebecca Evanson Tel Designated Nurse for Child protection and Children Looked After Lorraine Wiener Children Looked After policy and procedure, July2015 Page 25 of 27

26 Appendix 3 Islington CCG Children Looked After Structure From 1 st April 2015 Chief Officer Director of Quality & Integrated Governance Designated Nurse Lorraine Wiener Designated Doctor Rebecca Evanson Children Looked After policy and procedure, July2015 Page 26 of 27

27 ICCG Children Looked After Governance Chart from 1 st April 2015 London Borough of Islington ICCG Governing Body Islington Health and Wellbeing Board ICCG Quality & Performance Committee Islington Corporate Parenting Board ICCG Children s Services Improvement Group ICCG Child Protection Committee Children Looked After Health sub-group (chaired by Designated Doctor for Children Looked After, ICCG) Children Looked After policy and procedure, July2015 Page 27 of 27

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