HERTFORDSHIRE PCT’S BRIEF FOR PBC GROUPS ON CHILDREN AND MATERNITY SERVICES

The purpose of this document is to identify the wide range of requirements that Practice Based Commissioners need to consider
when commissioning children and maternity services. The main focus will be the impact of policy, targets and statutory guidance on
the commissioning of the PCT provider services. Where needs data is available this will be included. The brief should be read in
conjunction with the PCT children’s commissioning team operational plan for 08/09 which gives a wider perspective on the
children’s commissioning agenda.

Policy/target/statutory Expectation on Needs analysis Impact on PCT For further

guidance
Aiming high for
disabled children
Published May 07 sets
out commitment to
improve services for
children with a disability.
CSR set out financial
commitment to deliver
Aiming High. PCTs
expected to invest in
services (letter written to
CEO )
commissioners provider services consideration by
commissioners
Commissioners have to Recent needs analysis Increasing numbers of Nascot Lawn respite
work jointly with in Herts concludes that disabled children are facility needs investment
partners to deliver there are 18,000 putting pressure on all to increase coverage
improvement in services children who are aspects of the children’s back to 14 night
for children with disabled. Further work provider services and fortnight.
disability. Expectation being undertaken on will continue to do so. Continence need to look
set out in operating children and parents The complexity of at potential of
framework and LAA that views. children is also developing a children’s
we will increase Main areas of unmet changing and the life continence service to
investment in services need challenging expectancy changes offer better quality to
especially short breaks behaviour with or have meant the overall children and reduce pad
(respite), transition, and without a mental health numbers of children are spend.
early intervention and need. increasing. Transition post need to
LD services. There is Level of disability look at development of
also expectation of link slightly higher than PCT staff needs to be transition posts to
to palliative care national averages but able to act as Lead support this key area of
strategy. DH data locally and professional for the aiming high
commitment reflected in nationally inconsistent children and participate Challenging behaviour
increased PCT budget due to different in effective multi-agency work being undertaken

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 although as yet no approaches to data planning arrangements. to develop pathway and
details on level of spend collection and investment plan via
expected. Child health definitions. CAMHS work
mapping will be used to CDC development – no
measure the increased CDC in east and north
investment needs resolving
Link to palliative care
strategy needed as
children cross over from
aiming high

18 weeks PCT will commission Increase in community Further work needed to

consultant led services paediatrics and address the 18 week
to deliver the 18 week therapies needed to issue when it is for all
RTT. Further ensure target met GP referred services
expectations will mean
that all services with GP
referrals will have to
deliver 18 weeks RTT
Child death review PCT will commission Expectation that 25 Safeguarding team National funding for 3
Statutory guidance in rapid response and children per annum will commissioned to deliver years
chapter 7 of working designated doctor die unexpectedly rapid response and
together function designated doctor
function
Looked After Children Commission services to Circa 950 children in Designated Dr post Dental – more work
Statutory guidance on provide designated Herts are LAC. All need within W Herts PCT needed to ensure
the provision of doctor function and annual dental check and establishment funded. consistent access to
designated doctor health and dental between 1 – 2 health dental checks
functions and health assessments for looked assessments per annum Investment in school

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assessments as part of after children. Local dependant on age. health service in 08/09
a multi-agency authorities are Initial assessments to enable health reviews
requirement to improve performance managed completed by Dr and to be completed
outcomes for Looked via APA process on reviews by nurses
After Children and Care health and dental
Leavers assessments.
JAR process also looks
at LAC children
Every child matters PCT has statutory duty 250,000 children in Universal services need PbC need to decide if
to cooperate in Herts. to operate in teams they wish to invest in
Framework for the children’s trust 82 children centres by around the child based universal 0-19 services
delivery of arrangements and 2010 and 38 extended on extended schools to meet the needs of the
improvements in integrated children’s schools bringing communities children in their
children’s services, services. services to localities communities.
underpinned by the Poor JAR outcomes Resources in HV/SN
children act 2004 which Current consultation on low due to lack of LGA are telling LA’s that
introduced children’s statutory guidance will investment and impact PCTs have the power to
trust arrangements, increase emphasis on of FRP remove HV/SN budgets
integrated children’s joint commissioning from PbC and the DH
services, LSCB’s, CAF across health and social have supported this in
and Lead Professional care as well and certain areas. Locally I
integration moving think this would be a
Increasing national towards joint provision backward step and
emphasis on ‘narrowing would prefer an
the gap’ integrated approach
across PCT and PbC
commissioners
Maternity matters Commission services to 13,500 babies born to HV service specification Further work being
Govt commitment to deliver the commitments Herts women. 3,500 needs to include: undertaken to look at

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improvement in set out in maternity women deliver outside - comprehensive role of MH services in
maternity services. matters. of Herts but require local antenatal contact care pathway may
Range of actions NICE have produced community services. by HV service impact on investments
required by end of 2009 clear guidance on Increasing birthrate of - HV service role in to MH services and HV
including choice of pathways 6% higher than bloodspot services
delivery and Ensure HV service nationally increase. screening
improvement in commissioned is able to Increase - HV role in HV services need to be
antenatal and postnatal provide comprehensive disproportionate in older comprehensive at a level to enable them
services service to support women and women support to meet the demand of
DH promoting the role of women and families where English isn’t first postnatally increasing birthrates
HV service in home language (12%). including MH
visiting as part of their Both providers received assessment
review of HV services poor HCC reports
Benefits of HV service
being developed also
impact on breastfeeding
rates, obesity rates and
family support

Investment in 2008/09

Children’s palliative PCT have to write a Data difficult to Children’s community Keech SLA in place
care strategy and link with determine work started nurses provide part of a work ongoing to
After the review of existing adult networks in data analysis joint approach to end of increase value of SLA
children’s palliative care life care Discussions beginning
in 2007 the DH have Next stage review will with Iain Rennie about
produced there mention this and need their community
response which sets out to create a children’s services which we
the requirement for the palliative care network receive but don’t fund.
PCT to have a strategy for EOE

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for children with life
limiting illness and Increased investment
increase investment in expected
children’s palliative care
services.
Breastfeeding – vital Need to ensure levels of HV role key to the HV resources needed
signs breastfeeding meet delivery of improved
national targets rates of breastfeeding at
6 weeks
Emotional Health and Operating framework Work ongoing to look at Universal and targeted Additional school health
well-being of children clear about the need to need but disability services provide posts in west would help
– Operating framework have an emotional needs assessment elements of emotional support the strategy and
health and well-being indicates this is an area health and well-being further work being
strategy of increasing need undertaken to look at
tier 2 model that is very
This has begun as we successful in east and
expand our CAMHS north Herts.
strategy to reflect this

This will include and

investment plan for later
in 08/09 and beyond
National Service Expectation that PCTs Analysis of services All the services are PCT in discussion with
Framework for will commission services shows many differences currently only CSIP regarding the
children, young to deliver improvements in services approach to commissioned to age 16 support for delivering
people and maternity in children’s services. 16-19 year olds. Work to be undertaken chapter 8 of NSF
10 year plan to improve Specific work needed to in 2008/09 to assess
services. look at 16-19 services impact on services and
especially those cost the increase where

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 services for children identified.
with complex needs.
This is likely to be one
of the issues raised
within the Darzi work on
children’s services

Childhood obesity Ensure the High levels of School health service To enable the reduction
measurement part of the commissioning of the overweight and obese undertake the childhood in obesity planning and
PCT vital signs and also childhood obesity children across Herts measurement service delivery needs
target in LAA. measurement with some areas programme to be introduced in
Expectation in 09/10 programme significantly above 08/09. PbC groups are
that PCTs will be Ensure plans in place to national average. Investment in 08/09 to asked to give views on
expected to also show develop comprehensive increase establishment the introduction of a
reductions on rates with approaches to manage to enable programme to dedicated dietetics
targets set to deliver the rising levels of be undertaken without service which would
reductions childhood obesity significant reduction in include an increase in
services (as happened dieticians and also small
in 07/08) amount of resource for
resources and venues to
Total cost in SLA 20k run programmes
for West Herts PCT
school health services Total investment for year
per PCT 80k with 40k
required for 08/09
HPV vaccine PCT has to commission c 6,500 girls per annum School health service to Some national money
Introduction of HPV services to deliver the needing vaccine be commissioned to but SH service to be
vaccine in autumn 08 vaccine deliver commissioned to deliver
service

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