Purpose

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

Decision:
 
As
Cabinet Member for Integrated Children’s Services, I agree
to:
 

i)          
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.
 

ii)         
Continue to contribute £150,000 annual funding
for services to the Pupil Referral Units and Post Sexual
Abuse.
 
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.