Wigan Borough Clinical Commissioning Group is the statutory body responsible for commissioning local health services in Ashton, Leigh and Wigan.

Introduction

As the Greater Manchester Health and Social Care Partnership has become established it is clear that a considerable amount of Future in Mind transformation planning and commissioning is best done to scale across the GM footprint rather only at a single LA/CCG footprint

Some aspects of service planning and delivery will only support improved outcomes when commissioned and delivered more at scale.  The partnership has agreed that a GM transformation plan is developed by the end of March 2017.  This plan will incorporate objectives outlined in local plans and in turn local plans will need to reflect where planning and implementation will be at a GM or local level.

An overview of where GM planning and service development could be best achieved at a GM level is outlined below.

To read the latest update on Wigan's Children and Young People Mental Health Transformation Plans, download the document below.

Collaborative Commissioning

Across Greater Manchester (GM), a number of strategic groups, including GM Children’s and Maternity Commissioning Consortium, the GM Future In Mind Group, the Greater Manchester Mental Health Strategy - Children and Young People’s Mental Health Group, Association of Directors of Children’s Services (GM Children’s Services Review) have identified key areas of mental health and emotional well-being for children and young people as transformation priorities.  

A collaborative approach across the 10 Local authority footprints is enabling the sharing and implementation of good /best practice, development of consistent care pathways and quality standards, leading to improved quality and equitable services across GM.

Collaborative projects will deliver more efficient use of resources by commissioning and delivering some services at scale. The costs of Specialist CAMH Services are unlikely to be reduced, but efficiency will improved as a result of an implementation of THRIVE informed service delivery which will result in increased throughput.  Additional efficiencies will be delivered by reducing the numbers of professionals involved in complex families for whom managing risk is the primary support/intervention.

Transparency and Governance

Transparency and governance supporting the refresh of the 10 GM LTPs has been strengthened as a result of the developing alignment of the Greater Manchester (GM) Mental Health Strategy. An experienced commissioning manager chairs the GM Future in Minds Delivery (currently a consortium of all 12 GM CCGs/10 Local Authorities with representation from the Strategic Clinical Network, NHSE Specialised Commissioning and Public Health and has regular input from NHSE’s GM Assurance and Delivery Manager).

All CCGs have provided additional funding to enable the chair to be seconded into the GM Strategic Clinical Network to provide commissioning subject matter expertise and to provide expert advice within the context of an “honest broker” role

From April 2017 we will have a Greater Manchester Future in Mind Implementation group in place. Membership will include:

  • ·         CCG, Public Health, and Local Authority CYP commissioning leads
  • ·         NHS and independent sector providers – children young people and adult mental health services.
  • ·         Voluntary Faith and Community Groups representation
  • ·         Local Authority Children’s Services lead
  • ·         Children young people
  • ·         Parents/Carers
  • ·         Schools and Colleges (in time universities)
  • ·         Youth Justice lead for GM
  • ·         Mental health of LAC clinical lead
  • ·         A LA SEND lead acting on behalf of all 10 LAs/CCGs
  • ·         NHSE – specialised commissioning and GM Assurance and Delivery Manager.
  • ·         SCN – Clinical leads CAMHS/AMHS , commissioning advisor, network manager and quality improvement lead

Future Governance arrangements

Greater Manchester’s Health and Social Care Partnership will by, April 2017, establish a Children and Young Persons Board that will oversee a whole system transformation of GM’s children and young persons’ services. This board will be chaired by a senior officer from the partnership and will provide the governance for the GM Future in Mind Transformation plan.

Outcomes

We will collaborate with GM’s other local transformation partnerships to develop and implement a single performance and outcomes framework. The planned GM framework will draw from the best practice already developed by local transformation partnerships, and will be informed and shaped by the voices of children and young people. (Patient reported outcome measures)

The GM outcomes framework and dashboard will also be informed by learning from the children and young persons’ IAPT programme

We will continue to work with local transformation partnerships to peer review and challenge implementation progress, spending and impact of transformation ambitions.

Data

The availability of whole system accurate and timely information relating to commissioned and provided services remains a challenge.  Under the umbrella of the GM Health & Social Car Partnership we will contribute to the development of GM data systems that will improve both the quality and timeliness of available information.

The voice of Children Young People and their carers

Developing an effective voice for children and young people is a priority for our partnership and we use the learning from our engagement work to date to improve our local processes. With other GM Local Transformation Partnerships we will implement the recommendations of a report prepared by Youth Access that was commissioned by Greater Manchester’s Strategic Clinical Network, and establish a GM Future in Mind reference group for children and young people

Drawing upon effective children and young persons’ participation work developed across GM’s 10 local authorities we will work with colleagues from the 3rd sector to enable children and young people to have a strong voice in developing and implementing the GM transformation plan.  

We will work with parents and carers to develop a GM parent/carer reference group to ensure that they become effective stakeholders in helping shape the development review and delivery of services for children and young people

Transformation enablers

GM iTHRIVE hub

Along with GM’s other local transformation partnerships were are committed to the continued rollout and embedding of the Thrive Model to inform this whole system approach to improving access to information, guidance, advice and high quality treatment. In 2017, the Thrive model (i-Thrive) will start being  applied to the whole GM children and young persons’ system to help deliver improved access, reduced waiting times and help deliver clinical  efficiencies (more people seen within the resource envelope).

The development of a partnership with the Anna Freud Centre to develop a GM I-THRIVE Hub (hosted by the GM SCN) that will provide additional capacity to lead a whole system approach to transforming services for children and young people.

Quality Improvements

Out of Hours and Crisis Liaison Service

One of the central tenents of the GM Mental Health and Wellbeing Strategy is to improve access, which is responsive and holds clear arrangements that connect people to the support they need at the right time. As a consequence, a priority has been established to introduce access to 24:7 Mental Health provision and 7 Day Community Provision for CYP.

To deliver this priority, a whole system approach is required that includes bringing together commissioning, simplifies the provider system, includes involvement from the independent and third sector and holds children and young people and those who care for them at the heart of change. This whole system change has already started and will continue into 2017/18

We will continue to support the development of a GM Out-of-hours and Crisis Liaison Service (including extension of RAID to under 16’s) that will be accessible to all children and young people in crisis (not just those with a perceived mental health crisis.) We will work with GM’s local authorities and mental health services providers to develop a GM wide multi-agency offer that is informed by single GM standards and GM wide trusted processes and tools.

Improved access to advice and support

We will support the implementation of the iTHRIVE framework at a GM level and support an iTHRIVE informed co-production of a GM E platform that will provide advice information and access to on line counselling or support for children young people and their carers.

We will be advised by children and young people so that any offer is both credible and acceptable to young people.

Utilising best practice from GM’s 10 local transformation partnerships we will collaborate with the other partnerships to develop the capacity of GM’s third sector and independent sector to develop standards and pathways for children and young people to quickly access evidence based interventions in non clinical settings. Efficiencies will be achieved by commissioning to scale and monitoring done at a larger than single LA footprint

Age and Developmentally Appropriate mental health services for young people

This is a service delivery priority for the GM partnership and with our CAMHS and adult mental health provider services and other key stakeholders including young people we will begin to co-design age and developmentally appropriate mental health services for our 0-25 year old population

In the short term we will across GM support the implementation of agreed transition arrangements between CAMHS and AMHS and work with adult mental health commissioners to develop ADHD and Community Eating Disorder Services for adults.

Community Eating Disorders

We will continue to support the development of a GM CED offer that is delivered via an alliance of clinical providers that enables staffing skills and expertise to be shared across the 3 GM “cluster teams”

ADHD

We will continue to support the implementation of the agreed GM standards underpinning the delivery of ADHD services for children and young people and we will work with the service providers to ensure that the best practice developed at a local level is delivered at scale across GM.

In Patient (T4) offer for GM -Place Based Commissioning

The provision of mental health inpatient beds for GM’s children and young people is a priority for GM’s partnership. A GM wide task and finish group including specialised commissioning team has been established and has drawn together an alliance of NHS and independent sector providers who are collaborating to develop a GM offer.

We will continue to support the principle of one CCG providing commissioning expertise on behalf of GM

Vulnerable Groups

We will collaborate with GM’s CCGs and LAs to scope where a GM wide response to the needs of the following vulnerable groups will improve outcomes/quality and provide system wide efficiencies.

  • Mental health services for LAC. Those adopted and care leavers
  • Young people involved with the youth justice system
  • Children and young people who have LD – cognitive impairment and/or developmental disorders
  • C&YP who have Adverse Childhood Experiences
  • C&YP originating from minority communities
  • Transgender C&YP

Schools colleges

We will work with other local transformation partnerships to identify the best current practice in supporting schools and colleges to identify and help students who have challenged emotional well-being and mental health and develop an offer for GM schools/colleges

Early evidence from pilot sites across Gm suggests a shift in referrals to CAMHS, with GP referrals reducing and schools direct referrals increasing and the overall number of inappropriate referrals declining. There is still further work to be undertaken with schools to incorporate self-care for non-service users as part of a whole school approach to mental health – and expanding the CAMHS school link to more schools.

Workforce development

The importance of ensuring that organisations have the right workforce with the right skills and knowledge to deliver effective services is recognised by all and is a key ingredient in creating system transformation through building an effective workforce

With other local transformation partnerships and the GM workforce development team we will collaborate to develop a whole system skills audit that maps onto the iTHRIVE framework

To achieve this we will utilise workforce audit and development tools developed by some partnerships and to use The Self Assessed Skills Audit Tool (SASAT to facilitate the whole work force planning (not just services providing what have historically been regarded as CAMHS T2 and T3 services

Summary

 

Work has commenced through the GM Children and Young Peoples Mental Health Board to review current provision from a range of perspectives; to scope best practice across the region and beyond; to consult widely with all stakeholders; and to connect with associated transformational processes e.g. GM Crisis Concordat, Mental health Liaison Strategy, Local Transformation Plans, Childrens Services review, Youth Justice Review and NHSE CAMHS Tier 4 redesign review, and the GM Transformation Plan will reflect this range of interdependent workstreams

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