1
Background
1.1
In 2009 there
was consultation on specialised services for Wales, which
recommended improvements on how the NHS in Wales planned and
secured specialised services. Following this consultation, in 2010
the seven Local Health Boards in Wales established WHSSC to ensure
that the population of Wales has fair and equitable access to the
full range of specialised services. In establishing WHSSC to work
on their behalf, the seven Local Health Boards recognised that the
most efficient and effective way of planning these services was to
work together to reduce duplication and ensure
consistency.
1.2
Accordingly,
WHSSC is a joint committee of each Local Health Board in Wales. It
was established under the Welsh Health Specialised Services
Committee (Wales) Directions 2009 (2009/35). The Joint Committee
was a new arrangement and, brings Local Health Boards in Wales
together to plan specialised services for the population of Wales.
This is a fundamental change in the way these services are planned
and has required the creation of new systems and processes to
reflect these new arrangements. These have included completely new
corporate and financial reporting arrangements. WHSSC is a
“hosted body” and at the moment it is hosted by Cwm Taf
University Health Board.
1.3
WHSSC plans,
secures and monitors the quality of a range of specialised
services. The specialised services include mental health services,
which itself includes specialist perinatal beds.
1.4
In terms of
budget, every year WHSSC receives money from the LHBs to pay for
the specialised healthcare for everyone who lives in Wales and is
entitled to NHS care. The Chief Executives of those health bodies
are members of the Joint Committee who meet and decide how much of
their annual budgets will be allocated to WHSSC. The
Joint Committee is chaired by an Independent Chair who is appointed
by the Cabinet Secretary for Health, Wellbeing and Sport. The
amount of money which is allocated is based on the previous
year’s budget and what demands were made during a particular
year for a particular type of specialised service through an agreed
Integrated Medium Term Plan (IMTP).
2
Specialist
CAMHS Services
2.1
Current
Commissioning Arrangements
WHSSC is
only responsible for commissioning inpatient provision for CAMHS
(age 12-17 inclusive) on behalf of the seven local health boards in
Wales. Two Local Health Boards are commissioned by WHSSC to provide
this service for Welsh residents as follows:-
2.1.1
Betsi
Cadwaladr University Health Board (BCUHB) provides 12 beds on a
single ward for the North from the North West Adolescent Service
(NWAS) which is located at Abergele Hospital. A 2nd 7
bedded ward is not currently commissioned.
2.1.2
Cwm Taf
University Health Board (CTUHB) provides 15 beds for the South from
Ty Llidiard which is located on the Princess of Wales site at
Bridgend. These beds are provided flexibly over the 14 bed main
ward & a 5 bed high intensity area. This arrangement was
introduced in April 2015 following new investment by WHSSC in
excess of £600k.
2.1.3
In addition to
these beds WHSSC commissions services from other non NHS Wales
providers through a National Framework Agreement in the first
instance and then from other designated service providers on an
individual cost per case basis.
2.1.4
Access to all
inpatient beds is controlled by clinical gatekeepers who work in
the 2 NHS units. The responsible clinician in a Health Board will
refer a patient to the gatekeeper for an assessment and a clinical
opinion indicating the type and level of service will be
established. If an inpatient stay is required the gatekeeper will
consider if the patient needs can be met by the NHS service and
arrange the admission. The 2 NHS services do not provide services
for Forensic (Medium or Low Secure) patients or some specific
patient needs eg primary LD.
2.1.5
If the NHS
service cannot admit patient due to capacity or specific needs the
Health Board will identify a suitable placement from providers on
the National Framework and make referral. WHSSC will confirm
funding at the agreed daily bed rate to the provider by issuing a
patient placement agreement on receipt of funding request form
supported by letter from clinical gatekeeper.
2.1.6
If no
framework beds are available the same process is completed but
funding needs to be agreed at a daily bed rate on an individual
basis.
2.1.7
WHSSC is only
responsible for Tier 4 inpatient services but the new £7.65m
investment by Welsh Government has increased support to CAMHS
patients in the community and the enhanced community support
provision in LHBs has both reduced lengths of stay in inpatient
services and prevented inpatient admissions.
3
Inpatient
CAMHS Provision
3.1
NHS
Units
3.1.1
WHSSC pays the
provider Health Boards for the Inpatient CAMHS units as a contract
line of its Long Term Agreement. The contract is performance
managed throughout the year and reviewed on an annual
basis.
The
2017/18 contract values are shown below:-
BCUHB
– 12 bed NWAS service £2.766m
CTUHB
– 15 bed Ty Llidiard Service £3.694m
3.1.2
Since the
expansion of the community intensive treatment teams and the
introduction of the new flexible arrangements at Ty Llidiard the
number of out of area placements in the South has reduced
significantly.
3.1.3
The impact of
these teams in the North has been adversely affected by the
significant workforce problems experienced in both the inpatient
and community services in BCUHB. The inpatient service has been
operating on reduced bed capacity over the last 12 months but WHSSC
have agreed recovery plan with BCUHB and the service is expected to
increase its bed capacity back to commissioned levels over the next
few months.
3.1.4
The direct
consequence of these problems has been a marked increase
inout
of area placements from BCU with additional 6-8 patients in beds
over last 12 months.
3.2
Out of Area
Placements
3.2.1
A National
Framework Agreement for non NHS Wales CAMHS inpatient beds was
introduced in April 2015 following the success of an earlier
Framework for Adults with Mental Health & Learning
Disabilities. This Framework was signed off by the Minister and is
overseen by the Quality Assurance and Improvement Team (QAIT)
working on behalf of WHSSC and the LHBs. Providers on the Framework
agree to deliver services against set of standards and are audited
by QAIT to provide quality assurance of the services
used.
3.2.2
Whilst NHS
Wales does not have any secure CAMHS inpatient beds
thereis
a new Low Secure provider (Regis Healthcare) on the Framework whom
offer services within Wales at Ebbw Vale Hospital. The majority of
Welsh patients needing this level of care have been placed in Wales
with this provider since the inception of the
Framework.
3.2.3
The
total budget
for CAMHS out of area placements for 2017/18 is £2.752m with
a further £1.301m for Forensic patients in Medium or Low
Secure care.
3.2.4
In 2014/15
prior to the Framework Commencement and new investment WHSSC funded
6,392 beddays in out of area CAMHS beds. By 2016/17 this had
reduced significantly to 3,926 beddays a reduction of
39%.
3.2.5
It should also
be noted that 2,133 (54%) of the 3,926 beddays in 2016/17 were
provided by Regis Healthcare in Wales at Ebbw Vale
Hospital.
3.2.6
Over the 3
year period from 2014/15 to 2016/17 the number of beddays provided
in England has reduced by more than 70% from 6,392 to
1,793.
3.2.7
Further
details of the number and type of out of area placements are
attached in Appendix 1.
Section recovered as requested by Welsh Health Specialised Services
Committee