Islington CCG Commissioning Statement in relation to the commissioning of health services for children and young people 0-18 years Introduction 1. Islington CCG funds a range of health services for children and young people aged 0-18 years 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 2015. 3. 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 and young people 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 ophthalmologists 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). From October 2015, Public Health will also be responsible for commissioning health visiting and Family Nurse Partnership. 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 Children s 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 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.
Who is the CCG responsible for funding services to? 8. This section refers to those services that CCG s commission, as referred to in paragraph 1 and Appendix A of this report. It seeks to address the issue of which CCG is responsible for funding such services. 9. The CCG s funding responsibilities are set out in Who Pays? Determining responsibility for payments to providers August 2013 1 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. 10. 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. 11. GP registration also determines the CCG s funding responsibilities in relation to children and young people with special educational needs and/or disabilities. Where an Education Health and Care plan identifies the needs for additional health input over and above the local offer, the funding responsibility rests with Islington CCG if the child is registered with an Islington GP 2. Different rules apply to out of area placements see para 13 below. 12. 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 13 below. Please also see the new guidance on the Health of LAC entitled Promoting the health and wellbeing of looked after children (2015) 3. 13. 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). 14. 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, August 2013 2 0 to 25 SEND code of practice: a guide for health professionals, September 2014 3 Promoting the health and well being of looked after children, Statutory guidance for local authorities, clinical commissioning groups and NHS England, March 2015
15. 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 an out of hours placement was made. Children may have multiple out of area placements in practice the determining factor is likely to be whether the child was registered with an Islington GP immediately before they became looked after on the most recent occasion of the child acquiring this legal status. What procedure should be followed in the event of a funding dispute? 16. 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. 17. 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. Commissioning Managers should refer to the Head of Children s Health Commissioning as needed. 18. Where a funding dispute with another CCG is likely to affect safeguarding, Commissioning Managers will be expected to discuss this with the CCG s Designated Nurse or Doctor for Safeguarding and to have recorded their advice in writing. 19. If it is felt that a child may suffer significant harm as a result of an unresolved professionals' dispute, London Child Protection Procedures and Practice Guidance, 5 th edition, 2015, Part B 2, 6: Professional Conflict Resolution should be followed 4. 20. 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. 21. If Commissioning Managers are unable to resolve a funding dispute with another CCG which does not relate to safeguarding, 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. 22. 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 4 http://www.londoncp.co.uk
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, in which case, paragraphs 18-20 above will apply also. 23. 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 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. 24. This commissioning statement will be reviewed annually through the Children s Service Improvement Group. Sabrina Rees, Head of Children s Health Commissioning Telephone: 020 7527 1771 Email: sabrina.rees@islington.gov.uk May 2015
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 Mainstream, accident and emergency, NHS walk in centres, urgent care centres, 111, out of hours and ambulance services General acute and non-specialist hospital care 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