Issue details

24/00011 - Kent County Council's contribution to the Children and Young People's Mental Health Service (CYPMHS)

Proposed Decision:

 

1.    Provide five months’ notice on 1 April 2024 to the Kent and Medway Integrated Care Board (ICB) of the withdrawal of investment for fast-tracked assessments for Looked After Children and Harmful Sexual Abuse from 1 September 2024.

 

2.    To continue to contribute the £150,000 annual funding for services to the Pupil Referral Units and Post Sexual Abuse; and

 

3.    Delegate decisions and necessary actions to the Corporate Director for Children, Young People and Education, or other Officer as instructed by the Corporate Director for Children, Young People and Education, in consultation with the Cabinet Member to implement the decision.

 

 

Background

 

Kent County Council (KCC) has a long-established partnership with the ICB, schools, and other agencies, to enable a “whole system approach” to improve children and young people’s mental health. The Children and Young People Mental Health Service (CYPMHS) is provided by the North-East London Foundation Trust (NELFT) and forms one part of this system providing specialist support. The service was procured by the ICB in 2017 with KCC making a financial contribution to fast-track assessments for Looked After Children (LAC) and for support to the Pupil Referral Units (PRU).

 

Strategic oversight of the contract has been in place through the Kent and Medway Children and Young People Programme Board and managerial oversight for our financial contribution has been through a Section 76 Agreement (S76) between KCC and the ICB, as lead commissioners.  The cost of the KCC investment into CYPMHS per annum is £1,267,000.  This is broken down into two elements:

 

·         £1,117,000 is the contribution to the ICB/NELFT contract for fast-tracked assessments for Looked After Children.

o    £1,000,000 LAC Priority Assessment

o    £117,000 Harmful Sexual Abuse

·         £150,000 is Services from Local Authorities

o    £50,000 Pupil Referral Unit

o    £100,000 Post Sexual Abuse

 

The current contract is due to end on 31 August 2024 (two-year contract extension currently operating) with the ICB looking to directly award for a further 12 months before recommissioning a like for like service with an up-to 13-year contract, commencing from September 2025, with transformational change embedded through the term.

 

Throughout the contract period, NELFT have consistently met and exceeded the performance target of the contract, and this has been demonstrated through the monthly data reporting. However, it has not been determined since 2017 whether Kent LAC, having received their initial assessment, are waiting the standard time for the start of intervention or not. It has not been demonstrated that a Kent LAC has a priority service over other non-LAC referrals. The funding is for a fast-track assessment, not fast-track intervention.

 

Work has been undertaken by KCC and the ICB to improve the data collection that is provided by NELFT and to understand how the KCC investment is utilised within the contract.  A workshop was held in September 2020 which looked at ways NELFT could provide additional data in relation to the number of LAC referrals that were Kent children.  As a result of this, the KCC Management Information and Intelligence Unit were able to match child level data with NELFT on several occasions.

 

In 2021, a deep dive was completed to identify any trends with cases that are declined by NELFT at the point of initial assessment. Although the deep dive did not conclude sufficient evidence to show whether LAC children are being treated more disproportionately than other vulnerable children accessing the CYPMHS, it did show that further consideration should be given as to whether to continue with the investment or to reinvest the £1m into an independent assessment service.

 

Associated with the LAC Priority Assessments is an additional funding of £117k to support meeting the needs of children and young people who present with Harmful Sexual Abuse.  The CYPMHS provides evidence-based interventions for children and young people who have been sexually abused or who exhibit harmful sexual behaviour.  KCC has historically contributed financially to support this however, there is no statutory mandated requirement to do so and as such no reporting mechanism.  These interventions are already part of NELFT’s complex/behaviour pathway; therefore, children and young people would continue to access services through that route.

 

If KCC does not continue investing into the CYPMHS, there is no evidence to suggest that this would result in a reduced service, however the initial assessment time for Kent LAC would increase from two to four weeks. Once assessment has taken place all children and young people access the service based on a clinical need. It has always been acknowledged that children and young people access the service based on risk and clinical need.

 

In addition to the LAC element, KCC contributes £150k per annum for the Pupil Referral Unit (PRU) which incorporates support for Post Harmful Abuse as part of NELFT’s complex pathway work.  The PRUs aim is to provide continuity of education for pupils who are unable to attend school due to health needs.  This includes:

 

·         An education support service to schools for young people with physical medical conditions; and

·         An education outreach service for young people with mental health needs.

 

There are six PRUs in Kent.  There are approximately 20 children in each.  The units operate in term time only.

 

Options

 

Option 1     Continue with the current level of investment £1.117m/year.

Option 2     Negotiate a reduced contribution.

Option 3     Give notice to the ICB of withdrawal of £1.117m investment and reinvest in an independent assessment service.

Option 4     Enter into a new arrangement with the ICB to support a new LAC Network for Kent and Medway.

Option 5     Give notice to ICB of withdrawal of £1.117m investment.

Option 6     Agree to continue funding for a further 12 months.

 

The recommended option (Option 5) is to give notice to the ICB of the withdrawal of the £1.117m contribution for KCC.

 

Securing Kent’s Future

 

This meets Objective 2 in Securing Kent’s Future: Delivering savings from identified opportunity areas to set a sustainable 2024/25 budget and MTFP

 

 

Decision type: Key

Decision status: Recommendations Approved (subject to call-in)

Notice of proposed decision first published: 20/02/2024

Decision due: Not before 20th Mar 2024 by Cabinet Member for Integrated Children's Services
Reason: To allow 28 day notice period required under Exeuctive Decision regulations

Lead member: Cabinet Member for Integrated Children's Services

Lead director: Ingrid Crisan

Department: Education & Young People's Services

Contact: Christy Holden, Head of Children's Commissioning Email: christy.holden@kent.gov.uk or 03000 415356.

Consultation process

The Children’s and Young People Cabinet Committee considered and endorsed the decision on 6th March 2024.

Consultees

The proposed decision is due to be considered at the Children’s, Young People and Education Cabinet Committee on 6 March 2024

Financial implications: Kent County Council’s Medium Term Financial Plan for 2025/2026 has identified a saving of £1.2m for NHS contribution. This proposal largely delivers the required saving forecast required. If KCC withdrew its investment in line with contract renewal with the ICB ending on the 1 September 2024 this would deliver additional savings for 2024/2025 financial year of £558.5k with a £1.117m saving in 2025/2026. The funding contribution for the PRUs would continue at £150k per annum.

Legal implications: The NHS holds a statutory duty to provide a CYPMHS service under the NHS Long Term Plan 2013/2014 which set out the priorities for expanding Children and Young People’s Mental Health Services over the following ten years. This included a commitment to expand mental health services through schools and colleges so that an extra 345,000 children and young people aged 0-25 can get support when they need it, in ways that work better for them. KCC does not hold a statutory duty to deliver the service to fast-track assessments for Looked After Children or for the provision of Harmful Sexual Abuse interventions, however it does for services to the PRU’s as stated in The Education (Pupil Referral Units (Management Committees etc. (England))) Regulations 2007 (as amended by the Pupil Referral Units (Miscellaneous Amendments (England)) Regulations 2012.

Equalities implications: Equalities implications Kent’s LAC may have to wait longer for initial assessments. The contractual target for routine assessments to be completed within four weeks of accepted referral is 45%. August 2023 data reports 54.78% (data includes Medway). There would be no impact on Kent LAC receiving a service. Children and young people will continue to access Harmful Sexual Abuse interventions through the complex/behaviour pathway managed by NELFT. Data Protection Implications Children and young people will continue to access Harmful Sexual Abuse interventions through the complex/behaviour pathway managed by NELFT.

Decisions