Note: Some sections of this case study refer to clinical commissioning groups (CCGs). On 1st July 2022, integrated care systems (ICSs) took over statutory commissioning responsibilities in England, and CCGs were closed down. You can learn more about integrated care systems (ICSs) here.
Case study summary
With a population of nearly 1.2 million and a geographical boundary that includes two clinical commissioning groups (CCGs) and one county council, strong leadership and a commitment to working together are essential to making Transforming Care work for children and young people.
To make this happen Hertfordshire County Council and the two CCGs have jointly funded two new posts. One a senior commissioning manager and the other a care education and treatment review (CETR) lead.
The joint funding makes it easier for colleagues in health, education and social care to work together and means the work has dedicated resources rather than being part of another job. This has helped the work for children and young people catch up on the progress made with adults within the Transforming Care Partnership and means that all age groups are considered.
Keys to the success of the Transforming Care offer to children and young people include:
Coproduction where the local area works very closely with the parent carer forum and children and young people on all these issues, including policy and commissioning.
Well organised and well attended CETRs with all agencies involved, in community and inpatient settings. This keeps the number of children and young people going into hospitals low and the stays of those who do go in are kept short. Training for CETRs has also been done in all community teams.
Young people have said:
The panel heard me and what I want.
I am reassured I will get the right support post discharge.
I am pleased someone is looking at my care who is not involved in my care.
Why was there not a CETR before I came in to hospital it all feels a bit late.
I really enjoyed showing people around the hospital, my bedroom and my care plan.
The clinical expert gave the hospital some really good ideas about how to support me leaving hospital.
Parents have said that they have found the process helpful, one saying that she had moved from feeling alone and unheard to feeling like she had an active role in planning for her child. In relation to one case the chair of the CETR said:
I felt assured that the relevant professionals were working in partnership with one another, the young person and his parent and the hospital admission is likely to no longer be required and the young person will be supported and be able to remain at home with his family.
Active dynamic registers and a risk stratification process which recognises that by the time someone is in crisis it is too late for early intervention and prevention. More detailed work on data is being planned to see for example if risk factors can be identified.
Early intervention and prevention services – Hertfordshire also has a Positive Behaviour, Autism, Learning Disability and Mental Health Service (PALMS) service that is a specialist service for children and young people whose needs are too complex for child and adolescent mental health services (CAMHS). A recent review of PALMs received the following feedback:
PALMS quickly assess the needs of the family and put positive support and strategies into place to make sure the family receive the most effective support. The service also keeps the person who made the referral up to date.
The fact that they work in the home is really important. As an educator it is not something I am able to do. Having a professional that can work with the child and the whole family in the home setting is invaluable.
Special educational needs co-ordinator.
PALMS have been a breath of fresh air. They all “get it” and really support my daughter well. Their support in converting to EHCP has been invaluable as the focus is now firmly on my daughter’s autism rather than the behaviours she has exhibited in the past.
I feel that PALMS was the first agency to take the whole family into account. They listen to everyone in the home to help us all not just my son
A member of the team came with me to the team around the family meeting at school and explained my daughter’s condition and how to support her.
Short breaks with and without assessment. For children and young people in the Transforming Care group, the local authority offer overnight short breaks and a new residential living offer has been commissioned.
Complex cases management panel which provides a dynamic, solution focused, integrated approach to care planning for some of the most complex children and young people. There is a consultant psychiatrist who sits on the panel to provide clinical expertise and the CAMHS Tier 4 commissioning manager is also present to give real time status updates. This panel reflects the shared responsibility for children and families in Hertfordshire.
Strong governance – Transforming Care has its own governance structure and is also part of the 0-25 SEND governance arrangements. There is now a 0-25 Transforming Care Programme Board, jointly chaired by the local authority and CCG, whose aim is to make sure that the programme delivers high quality effective services to improve each aspect of the care pathway which includes:
- Early identification
- Preventative services
- Personalised care planning
- Preparing for adulthood (PfA)
- Integrated personal commissioning
For more information contact Kate Barker, Assistant Director for Maternity, Children and Young People’s Commissioning, East & North Herts Clinical Commissioning Group (ENHCCG), firstname.lastname@example.org or Marion Ingram, Operations Director Specialist Services – Hertfordshire County Council, Marion.Ingram@hertfordshire.gov.uk.