Tier 4 Review Findings Margaret Murphy 5 November 2014 - - PowerPoint PPT Presentation

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Tier 4 Review Findings Margaret Murphy 5 November 2014 - - PowerPoint PPT Presentation

Aug 26, 2023 139 likes •358 views

Tier 4 Review Findings Margaret Murphy 5 November 2014 www.england.nhs.uk Commissioning Tier 4 CAMHS Services Following passage of HSC Act responsibility for commissioning tier 4 CAMHS inpatient services and some highly specialised ASD

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www.england.nhs.uk

Tier 4 Review Findings

Margaret Murphy

5 November 2014

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www.england.nhs.uk

Commissioning Tier 4 CAMHS Services

  • Following passage of HSC Act responsibility for

commissioning tier 4 CAMHS inpatient services and some highly specialised ASD services transferred to NHS England from April 2013 (became so-called prescribed services)

  • Some Tier 4 CAMHS previously nationally commissioned

– bid for Tier 4 CAMHS children’s units to be nationally commissioned

  • Pre April 2013 – variable arrangements for much of Tier

4 – from ‘spot purchasing’ to areas where groups of PCTs/SCG collaborated to commission the care pathway

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www.england.nhs.uk

The Tier 4 Review

  • Commissioned by the specialised

commissioning oversight group (SCOG) within NHS England to provide more accurate picture

  • f the current usage of Tier 4 and issues for

inpatient services

  • Focus on Tier 4 CAMHS for practical reasons

although with an understanding that Tier 3 and social care issues impact

  • Aim was to describe the current situation and

analyse data from providers and commissioners to inform any further work

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Reasons for the Review

  • Concerns re quality/safety in some

providers

  • Concerns re access (i.e. capacity,

availability, timeliness, distance from home for some children and young people)

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www.england.nhs.uk

The method

  • Independent steering group
  • Data collection and analysis was led by the

CCQI

  • A survey was sent out to all inpatient CAMHS

providers in England – where possible compared 2012-13 and 2013-14 data

  • Ten area team leads who look after specialised

commissioning also completed 10 case studies following patient journeys (100 in total)

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www.england.nhs.uk

How many beds are there in England?

  • In 2014 - 1264 beds identified in the report commissioned by NHS

England

  • These are:

618 General CAMHS 232 Eating disorders 141 Low secure 92 Learning disability 92 PICU 47 HDU 42 Medium secure

  • An additional 65 un-commissioned beds nationally (mostly over 13s

general CAMHS and ED)

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Who was admitted?

Case history information – number of cases Yes No Don’t know Young Person had had a previous Tier 4 admission 38 60 2 Young Person was known to social services 47 53 3 Looked After Child 13 87

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What’s their primary diagnosis?

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Length of stay

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Main Issues for Inpatient CAMHS

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Referrals

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Admissions

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Bed Occupancy

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Main reasons given by provides for inappropriate admissions

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Delayed discharges

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Most common causes of delayed discharges

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Bed closures during 2013

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How many young people travel out of area for a bed?

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Out of area placements

  • No reliable data from the old commissioning

arrangements to compare with

  • Those who travelled over 100 miles were

predominantly from large geographical areas with limited bed provision – this would have been the same before the change to specialised commissioning

  • Of 37 from commissioner case studies admitted
  • ut of area, 13 required a specialist bed
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What has happened since the review ?

  • Appointment of case managers – evidence that they have

improved ‘flow’ through the system

  • Increase in number of general and PICU beds in areas identified

as being underprovided

  • Weekly update shows there are now more beds available

nationally although there are fluctuations in need experienced by areas and in particular fluctuations in sub speciality needs

  • Introduction of standardised referral / access assessments (to

ensure greater consistency)

  • Weekly update shows there are now more beds available

nationally although there are fluctuations in need experienced by areas and in particular fluctuations in sub speciality needs

  • Co-commissioning pilots
  • Future in Mind
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Why eating disorders transformation ?

  • Evidence that effective community treatments
  • BUT still reliance in many areas on inpatient care
  • COULD WE BOTH IMPROVE OUTCOMES and

MAKE MORE EFFECTIVE USE OF INPATIENT CAPACITY ??