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
in out 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
there is 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