LIVERPOOL CASE STUDY

This is one part of the core source document from which a range of multi-media materials will also be produced to support the road shows. The case study is based on interviews held on 19-20 January 2012, with service commissioners, providers and users. The interview material is augmented by a range of documents created and gathered by Cernis since 2008, in working with Liverpool CAMHS on their strategic needs assessment, workforce development and user participation.

Liverpool CAMHS has been provided by a mix of voluntary and statutory services since 2002-3.The NHS provider, Alder Hey Children’s Hospital Trust, has to date provided most of the specialist and highly specialised (Tiers 3 and 4) CAMHS, while early intervention in emotional health and well being has been provided mainly by voluntary organisations.

Liverpool’s commissioned early intervention in mental health and emotional well being services have included the following:

VCS Statutory

Spinning World (Refugees and asylum seekers) Haven project (Refugees and asylum seekers)

Young people’s advisory service (YPAS):

Drop-in Counselling GYRO (LGBT young people)

Behaviour support team (BEST)

Working Together – early years

ADHD Foundation

Merseyside Youth Association (MYA):

Mental health promotion training Fun, Youth, Involved (FYI)

Barnado's action with young carers

THE JOURNEY

Story of how the VCS came to play such a vital role in the shaping of Liverpool CAMHS.

From interviews with

Lisa Nolan, CAMHS joint commissioner, and

Damian Hart, VCS provider and former commissioning secondee.

Liverpool PCT.

The journey shows how a combination of seizing and creating opportunity was used. Much of what happened early on was not part of a grand plan, but rather the organic growth of the VCS providers under the stewardship of an imaginative and determined commissioner. Three commissioners are mentioned here – the first was important in initiating the idea of developing the VCS in CAMHS. The next commissioner is of the longest standing and has continued to foster the development of the VCS in the face of sometimes fierce opposition. The third person, who was seconded into the PCT on a time limited contract, brought fresh eyes, enthusiasm and a sure understanding of what the VCS needed in order to feel equal to their partners in the statutory provider.

DATE EVENT/OPPORTUNITY STORY RESOURCES

2002 Local report on transitions and non stigmatising services was published by external consultancy Phoenix

The CAMHS commissioner, CM, was ex VCS and understood the sector.

She formed a strategy group, focusing on how to bridge the gaps identified by the report.

Used external consultancy

Very beginning of government spending on CAMHS (modernisation grant)

A local organisation, the young people’s advisory service (YPAS) had visited 42

nd Street

in Manchester and made some changes as a result:

Became more integrative in delivery Increased its age range, from 16-25, to 10-

25 YPAS expanded.

2003 A national programme (DH) of workforce development in mental health was building momentum, with early work on the CAMHS workforce.

LN became the new joint CAMHS commissioner and used the national workforce programme as a resource with which to develop training for the VCS.

The training aimed to develop the competence and confidence of the VCSOs, to be more on a par with the statutory provider workforce.

2004 The CAMHS element of the national workforce programme gained momentum and offered support to workforce projects.

The training was developed by Mersey Youth Association (MYA) and called Mad, Bad and Misunderstood.

Tapped into national funding

Unforeseen events:

The statutory provider had a partnership with a national organisation in delivering services to refugees and asylum seekers. The national partner unexpectedly went bust.

The commissioner picked up on the issue and funded the shortfall, using the opportunity to create partnership working between the statutory provider and a local VCSO also working with young refugees.

Barnados had been involved in the strategy group from the start. Their funding stopped.

The PCT picked up the commissioning of Barnados.

2007 The local authority had been commissioning and providing a service for children and families with ADHD, following a local review. The ADHD Foundation became a charity.

The PCT supplemented the funding for ADHDF. Although ADHDF was seen as an anomaly, it was based on social capital model and had a heavy emphasis on parenting.

2008 Burgeoning young people’s participation movement – the beginning of VIK at YoungMinds and national standards, conferences, raised interest.

Building on existing strengths in partnerships across the VCS, the commissioner started to develop a framework and more formal model. A young people’s board and a parents and carers board were established, hosted within the VCS, with clear lines of communication into commissioning, to influence the commissioning agenda. This led to young person trainers, peer mentors. The VCS supported the statutory providers in new ways of involvement.

Opportunities Challenges

2009 Local needs assessment work uncovered previously unknown vulnerable groups, such as travellers, parents in prison, war veterans.

The commissioner led a value for money unit cost analysis across all child and adolescent mental health services – statutory and VCS providers.

Found VCS better value for money and missed appointments were higher in statutory provider.

Review of all Liverpool CAMHS

Started to develop a strategic care pathway for CAMHS. It showed the involvement of both VCS and statutory CAMHS at different levels of intervention.

External consultancy

2010 The Equality Act Used the Act (definitions of protected characteristics such as age, gender, etc) to examine whether services were appropriate, accessible and acceptable. Used the opportunity for shared learning and good practice across the board – VCS and statutory

Used Puzzledout.com (online feedback tool)

Vacancy in PCT commissioning team

Commissioner seconded DH from the local VCS into commissioning. DH worked to strengthen VCS by de-mystifying and building confidence in:

Clinical governance Information management and governance Outcome measurement

Linked into the CAMHS Outcomes Research Consortium (CORC).

Used Connecting for Health (DH initiative)

DH established joint action learning sets. The VCS grew in confidence and competence. VCS and statutory provider worked together leading to more mutual respect, greater shared language

Fed into Social Care Institute of Excellence (SCIE) best practice toolkits - transition

From the action learning sets came:

Joint needs assessment tool CAMHS data set to inform outcomes

measurement

Had to make sense, remove health jargon and be understood by LA members, VCS workers, young people, etc.

Fed into national steering group and working group on Payment by Results (PbR)

2011 Continued work on the care pathway, developing the Outcomes Strategic Map. On the pathway only services that were needed to meet outcomes were shown. This became the basis of plans for service procurement. The active VCSOs could form a consortium to tender for all early intervention CAMHS in the city.

2012 Changes in government spending and policy take effect

All procurement plans shelved as re-structuring takes place.