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