This decision follows on from decision number 18/00071 to end the current Section 76 agreement and establish a new agreement which reflects KCC as the commissioning lead for the KCC elements of the CYPMHS service.
In 2017, KCC jointly commissioned the CYPMHS with the local NHS. KCC invested £2.65m into the NHS contract via a Section 76 agreement. The new service has resulted in a significantly different clinical model, a large restructure and upskilling of the workforce and the implementation of a new data management system. However, demand for the specialist and targeted interventions have been significantly higher than expected and this impacted on the initial stages of the service transformation. A greater capacity has been allocated to the management of this demand and associated high waiting lists, particularly those across the neurodevelopmental pathway. Significantly this has impacted upon the delivery of the Local Authority funded services particularly the early intervention elements of the contract.
Whilst CCGs are now seeing improvements in the performance of the overall service, it has been apparent that some of the KCC funded elements are not achieving the desired outcomes. These challenges have included; significant underperformance in relation to numbers of young people receiving a service through the Early Help pathway and Kent Health Needs Education Service; lack of available performance data and dispute in relation to payment for the contract.
KCC remains committed to working in partnership with the NHS to manage the challenges and improve the contracting arrangements. Progress has been reported back to SCB and CYPE Cabinet Committee and a full options appraisal will be presented to CYPE Cabinet Committee on 15 November 2019.
The recommended option is to split the KCC investment in the contract as follows:
· £1.217m retained in the current contract for the LAC Priority Assessments and Harmful Sexual Behaviour interventions. These elements of the service require clinical interventions and oversight. Changes to the Section 76 agreement will enhance the oversight that KCC has on the performance of these services.
· £1.2m refocussed through a range of evidence-based and resilience-focuses interventions.
· Reduce the funding for the Kent Health Needs Education Service from the current £240k arrangement to ensure a focused approach to meet the needs of the school.
Other options considered were:
Decision type: Key
Reason Key: Affects more than two Electoral Divisions;
Decision status: Recommendations Approved
Division affected: (All Division);
Notice of proposed decision first published: 08/10/2019
Decision due: Not before 20th Nov 2019 by Cabinet Member for Integrated Children's Services
Reason: In order that the proposed decision can be published for a minimum of 28 days, in accordance with statutory requirements
Lead member: Cabinet Member for Integrated Children's Services
Lead director: Stuart Collins
Department: Education & Young People's Services
Contact: Karen Sharp, Head of Commissioning for Public Health Tel: 03000 416668 Email: firstname.lastname@example.org.
This is a county-wide service and any changes will be communicated to schools, police and health providers. Consultation will be undertaken with members at CAB in October 2019.
This was discussed at the CYPE Cabinet Committee meeting on 15 Nov 2019.
Financial implications: The KCC element of the contract is worth £2.65m per annum. The proposed decision will split the investment, with £1.217m retained in the contract and £1.2m refocused into alternative services/interventions. £50k designated to support KHNES and £190k of Dedicated Schools Grant refocused through the DSG High Needs Funding arrangements for KHNES. A financial audit of the KCC investment is currently being undertaken by the NHS. The changes to the Section 76 agreement will allow KCC to have clear oversight of the funding and performance of the remaining Authority Services. There is existing capacity within the service to undertake the recommended changes.
Legal implications: KCC have a duty, under Section 22 of the Children Act 1989, to safeguard and promote the welfare of each child we look after. Under Section 27 of the Act, local authorities are entitled to expect other authorities and certain NHS bodies to assist them in discharging their functions to children in need, looked after children and their parents and carers. Section 11 of the Children’s Act 2004 places a duty on a range of organisations and agencies to ensure their functions, and any services that they contract out to others, are discharged having regard to the need to safeguard and promote the welfare of children.
Equalities implications: An EQIA has been completed as part of the process and will continue to be reviewed as we progress the work.