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Health

This section of the Local Offer provides information on Health services for families and young people with SEN.

If you have any questions regarding any of the health services mapped in the Local Offer, and whether your child might benefit from referral, please discuss these with your GP or any of the existing health professionals involved with the care of your child.

 

General Health Services

Health services provided within the Stockton-on-Tees area are commissioned (purchased) by a number of different organisations, including:

• NHS England
• Clinical Commissioning Groups (CCGs)
• Council Public Health Departments.

Each commissioned service will have its own:

• agreed eligibility criteria (who can access the service)
• agreed referral criteria (how to access the service)

For information about those services offered through the Hartlepool and Stockton on Tees Clinical Commissioning Group Strategies and Plans click here.

Health Visiting/Public Health Nursing (School Nurse)

Within Stockton we are part of a wider 0-19 Wellbeing service that aims to protect and promote the health and wellbeing of all children and families in our area. We hope to transform the way that children, young people, families and communities are supported to maintain good health and well being. We will identify and address needs at the earliest opportunity and work with families to support them.

For further information and contact details on the 0-19 Growing Healthy Service please click on the first document link, in the Downloads section on the top right hand side of this page. 

Also, within the Downloads and External Links sections, on the right hand side of this page, click on The Eatwell plate Guide, and Institute of Health Visiting and 0-19 Facebook Page respectively for supporting information. 

Harrogate and District Foundation Trust provide Health Visiting/Public Health Nursing  services to all children and families living in the Stockton-on-Tees area. This is a universal service offered to all families and is commissioned by Public Health through Stockton-on-Tees Borough Council. The Council is also working closely with the Trust to develop and define a pathway which offers enhanced support to families who may be experiencing difficulty. 

Further information is available by clickking on the following web link:

https://www.hdft.nhs.uk/services/childrens-services/growing-healthy-stockton-on-tees/

Annual Health Checks

Learning Disability Annual Health Checks and Action Plans have been offered by some GP services for many years.  Sometimes families are not offered checks because the GP does not know that their patient has a learning disability or sometimes people choose not to have them because they do not understand how they can be helpful.

MENCAP have launched a campaign to improve awareness of how Annual Health Checks can be helpful.

https://www.mencap.org.uk/advice-and-support/health/dont-miss-out/dont-miss-out-annual-health-checks

Here are some ways that we can help improve uptake of these;

  • GP’s should consider offering the  Learning Disability  annual health checks enhanced service (if they do not already)
  • Professionals should notify the GP that the person should be included on the GP Learning Disability register and suggest suitability for an annual health check (if they are not currently receiving this service)
  • Special Schools and Community Paediatricians should promote the benefits of GP annual health checks with families of young people aged 14 and over.   Promotional materials are available through MENCAP. https://www.mencap.org.uk/sites/default/files/2017-06/AHC%20Easy%20Read%20Guide%20Final.pdf
  • Professionals should raise awareness that Learning Disability annual health checks can be helpful in teenage years to support with transition planning

The Transforming Care Approach

Transforming care is a national programme led by NHS England which is all about improving health and care services so that more people with learning disabilities and/or autism can live in the community, with the right support, close to home and have the same opportunities as anyone else

The programme of work will ensure that families are:

  • getting the support they need to live long and healthy lives
  • being treated with the same dignity and respect
  • having a home within their community
  • being able to develop and maintain relationships and
  • getting the support they need for to have a healthy, safe and fulfilling life. 

New ways of working are being established to help families get the right help at the right time.  One example of this is a greater focus on the Care-Co-ordination role to help families access and understand the offers of support available to them across health and social care systems. More details about the programme are set out here;

https://www.england.nhs.uk/learning-disabilities/

 

Education and Health Care Plans

Health, education and social care systems are working hard to work together to share pathways and processes that work together and are easier to understand.  An Education and Health Care Plan (EHCP) will help families work with professionals based on an assessment of individual need.  More details about EHCPs are here;

https://www.gov.uk/children-with-special-educational-needs/extra-SEN-help

 

Care Education and Treatment Reviews

Where children or young people are at risk of a hospital admission a Care Education and Treatment Review (CETR) may be called by the family or professional.  When a CETR is called this means that the family and professionals all get together to review the needs and requirements of the young person and decide on the best next steps by working together.  A clinical expert and a family member who has had similar experiences from another area will be present to help planning with fresh eyes. Here is a tool to help planning and understanding of the process;

https://www.england.nhs.uk/wp-content/uploads/2017/03/my-care-treatment-review-symbol-updated.pdf

The full toolkit on CETRs is available on the NHS England website here;

https://www.england.nhs.uk/wp-content/uploads/2017/03/children-young-people-cetr-code-toolkit.pdf

Transforming Care Children and Young People

The function of Transforming Care Partnerships is to work with people with a learning disability, autism or both and their families and carers to agree and deliver local plans for the programme.

There has been a greater focus on the Children and Young People more recently with regards to services and pathways to avoid children and young people being required to go into hospitals or residential placements.

Some of the key national drivers to improve outcomes for Children & Young People with learning disabilities and/or autism are set out below.

Building the Right Support

Building the Right Support was published in 2015 and sets out a clear framework to develop more community services for people with learning disabilities and/ or autism who display behaviour that challenges, including those with a mental health condition, and close some inpatient facilities. A supplementary document was published in September 2017 which has a greater focus on children and young people;

Developing support and services for children and young people with a learning disability, autism or both

https://www.england.nhs.uk/wp-content/uploads/2017/09/developing-support-services-children-young-people-with-learning-disability-1.pdf

Care education and Treatment Reviews

Care education and Treatment Review (CeTR ) standards have been set out to offer  a process for those at risk of admission or who have been admitted.  This should be read in conjunction with the Care and Treatment Review Standards.  CeTRs are for people whose behaviour is seen as challenging and/or for people with a mental health condition. They are used by commissioners for people living in the community and in learning disability and mental health hospitals.  The guidance is set out below;

https://www.england.nhs.uk/learning-disabilities/care/ctr/care-education-and-treatment-reviews/

The Lenehan Reports

The Lenehan report provides strategic overview and recommendations about the practical action that can be taken to co-ordinate care, support and treatment for children and young people with complex needs (and behaviour that challenges) involving mental health problems and learning disabilities and/or autism.

These are our children’ (January 2017)

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/585376/Lenehan_Review_Report.pdf

Lenehan offers further recommendations following a review of outcomes for children and young people in residential schools and colleges. 

‘Good Intentions, Good Enough?’ (November 2017)

https://councilfordisabledchildren.org.uk/help-resources/resources/good-intentions-good-enough-lenehan-review-residential-special-schools

Community Services

North Tees and Hartlepool Foundation Trust provide a range of Paediatric and Community Children’s Nursing Services for the local population in Stockton-on-Tees.

The service offers a range of clinics for children and young people from birth to 18 years old and depending on the clinic, a team of paediatricians, doctors, specialist nurses, speech and language therapists, community nurses or other members of the team are available for clinics as follows:

  • diabetes
  • epilepsy
  • endocrine
  • respiratory
  • feeding
  • general and urology surgery
  • general paediatrics
  • urinary tract infections
  • constipation
  • allergy
  • gastroenterology
  • neuro-disability
  • dietetics
  • neonatology
  • cardiac echo screening
  • BCG immunisations
  • speech and language
  • psychology for children and young people with diabetes
  • blood sampling
  • community visits for children and young people with complex health needs.

More information is available at:

https://www.nth.nhs.uk/services/childrens-outpatients/

Services for Young People between the ages of 18 and 25 are met by services in a different way. Turning 18 is a milestone for many young people, with lots of potential changes and as such physical health and wellbeing needs can change.


Hospital Based Services

Hartlepool and Stockton on Tees CCG commissions Children’s Paediatric Services from North Tees and Hartlepool Foundation Trust.

The children’s paediatric service is based at the University Hospital of North Tees. There is a team of doctors, nurses, nurse practitioners, health care assistants and specialists in care for children.

More information is available at:

https://www.nth.nhs.uk/services/childrens-ward/

https://www.nth.nhs.uk/services/childrens-day-unit/

Services for Young People between the ages of 18 and 25 are met by services in a different way. Turning 18 is a milestone for many young people, with lots of potential changes and as such physical health and wellbeing needs can change.

Improving Health and Wellbeing through Sport

Physical activity and playing sports helps you stay in shape, teaches you how to organise your time, boosts friendships, and builds relationships with your peers and adults. Through athletics, you gain skills that can best be acquired on a court, track, or field. Participating in sphysical activity and sports improves your health in many ways. To be a good athlete, you must take care of yourself and this gets you thinking about what to eat and how to treat your body to achieve peak performance levels. Below are organisations that are determined to help children and young people with SEN or disabilities improve their health and wellbeing through physical activity and sport.

Youth Sport Trust are a national children's charity who are passionate about creating a future where every child enjoys the life-changing benefits that come from play and sport. They pioneer new ways of using sport to improve children and young people’s health and wellbeing and give them a brighter future. They work to give every child a sporting start and provide a sporting chance to children and young people with special educational needs and disabilities.

To find out more about Youth Sport Trust and how sport can improve children and young people's health and wellbeing please click here.

MIND for mental health has produced a booklet that covers how being active is important for physical and mental health, and explores which sports or exercise may be best for you, how to overcome common barriers, potential risks and how to plan your routine safely.

To access the booklet please click here.

 

Child Brain Injury Trust

The Child Brain Injury Trust was established by a group of health professionals in 1991 to research and provide information regarding the effects of ‘traumatic’ injury on a child’s developing brain.

Parents of children with acquired brain injury were keen to become actively involved with the charity and over time the emphasis on the work changed.

Today the Child Brain Injury Trust is the leading voluntary sector organisation providing emotional and practical support, information and learning opportunities for families and professionals affected by childhood acquired brain injury across the UK.

The Trust works across England, Wales, Scotland and Northern Ireland and have a dedicated team of professional staff and volunteers who give their expertise, commitment and energy every day.

Families continue to be involved in the development of the charity and they continue to be amazed and enlightened by their resilience and strength.

If you would like further information on the Child Brain Injury Trust please click here.

Emotional Health and Wellbeing and Mental Health

As our health and education services evolve to meet mental health needs in the general population, it is important that equal consideration is given to those children and young people who may have a mental health concern and SEND.

Young Minds are leading the fight for a future where all young minds are supported and empowered, whatever the challenges. They are working to make sure they get the best possible mental health support for all children and young people so they have the resilience to overcome life’s difficulties.

Anna Freud National Centre for Children and Families are a children's mental health charity and have been developing and delivering pioneering meantal health care for over 60 years. Their vision is a world where children and families are supported effectively to build on their strengths and to achieve their goals in life. They continue to promote resilience and wellbeing in children, young people and families, as they have for over 60 years. Find out more about the Anna Freud National Centre for Children and Families by clicking here

Services for Young People between the ages of 18 and 25 are met by services in a different way. Turning 18 is a milestone for many young people, with lots of potential changes such as going to University, getting a job or leaving home, and as such mental health and wellbeing needs can change.

If specialist mental health services’ are still required after turning 18 to reach goals, then adult services will support people into adulthood and beyond.

More information is available at:

https://www.tewv.nhs.uk/services/moving-on-transition-from-child-and-adolescent-mental-health-services-camhs-to-adult-mental-health-services-amhs/

Should you want further information on mental health and wellbeing please click here, and for an extensive directory of Mental Health Services that you can turn to for help please click on the 'View All Services' above. 

Drug, Alcohol and Substance Misuse Services

North Tees and Hartlepool Foundation Trust provide drug, alcohol and substance misuse services to the Stockton-on-Tees population. Alcohol nurse specialists assess, treat and offer advice to patients who are admitted with alcohol related problems and refer onto community alcohol support services if it is required.

The teams work alongside a team called DART who are drug and alcohol health workers employed by a Stockton based community alcohol team called Lifeline.

These teams work with staff, patients, families and community organisations to ensure that a patient who is brought into our hospitals with an alcohol related problem is supported and safe in and outside of the hospital.

The Service works with patients to help them recover and lead healthier lifestyles by promoting either safe drinking or by not drinking alcohol.

More information is available at

https://www.nth.nhs.uk/services/alcohol-nurses/

Physiotherapy

What is Physiotherapy?

Physiotherapy is a therapy that works to help people move about and lead as active a life as possible. Physiotherapists who work with children often look at how their motor skills are developing and give advice on how to encourage good development and how to improve skills. Physiotherapists also work with children who have certain conditions or disabilities to help them keep their muscles and joints in the best condition and to help them to be active.

What can I do to help my child’s motor skills develop?

There is lots you can do to encourage motor development, for example taking your child to clubs such as swimming, dancing, team games or martial arts, or to soft play or the park.  

What can I do if I think my child needs Physiotherapy?

If you are concerned that your child has a difficulty, you will need to be referred to the Physiotherapy service by a professional.

People you can approach include:

·         Your child’s GPs

·         A health professional that your child is already known to such as their Consultant, Occupational Therapist, Health Visitor

·         The school nurse attached to your child’s school

·         Preschool education services or Early Support Workers

·         Your child’s social worker

They will need to refer to us by filling out a form about your child.  

When may a child with a difficulty need to see a Physiotherapist? 

If you have a concern about how your child is developing, you should firstly speak to either their Health Visitor or GP. They may wish for your child to be seen by a Physiotherapist for an assessment:

·         If a child is missing their motor milestones

·         If a child is in pain when they move

·         If a child moves around in a very different way to other children 

·         If a child has a disability or condition which means they need help to keep their joints active and healthy

What are common conditions Children’s Physiotherapists see?

·         Toe walking

·         Developmental Delay

·         Cerebral Palsy

·         Muscular Dystrophy

·         Genetic conditions

·         Musculoskeletal conditions  eg fractures, sprains, Osgood Schlatters

·         Chronic Pain conditions

·         Prematurity

The CCG commissions services from North Tees and Hartlepool Foundation Trust to provide a team of children’s physiotherapists and therapy assistants provide the highest standard care, ensuring that not only health needs of the child are considered but also the family, social, emotional and educational needs for children up to the age of 18.

The service comprises clinical specialists, specialised physiotherapists and assistants who provide an integrated acute and community service for inpatients, outpatients and within the community.

Children receive physiotherapy within a variety of settings including hospital wards, a range of physiotherapy-led outpatient clinics, nurseries, children’s centres, specialist and mainstream schools and within the family home.

In the hospital staff work in a variety of areas which include the special care baby unit, post natal and children’s wards and physiotherapy outpatients.

In the community staff work in the patient’s homes, schools, nurseries and health care centres, providing specialist advice treatment and support to children and their families and carers. These children tend to have long term and sometimes complex physical needs and the aim is to maximise the child’s potential in all areas of life. Treatment may include hands-on therapy, positions for play, postural and 24 hour management plans, equipment provision, and rehabilitation / management programmes

More information:

https://www.nth.nhs.uk/services/childrens-physiotherapy/

Some of the Physiotherapy for Children and Young People who are attending special schools is commissioned by Hartlepool and Stockton on Tees CCG and provided by South Tees Foundation Trust.

South Tees Foundation Trust has a specialist team working into special schools and offer specialist assessment, advice and treatment to children and young people who have delayed or impaired functional skills associated with a wide range of difficulties.

Assessment and treatment is tailored to meet the child/young person’s functional difficulties. Individual therapy plans are developed in conjunction with the family/carers and integrated into daily activities.

More information is available at:

https://www.southtees.nhs.uk/services/physiotherapy/paediatric-physiotherapy/

Services for Young People with disabilities between the ages of 18 and 25 are met by Health services in a different way by adult services. Hartlepool and Stockton on Tees CCG commission Physiotherapy services for people aged over 19 from North Tees and Hartlepool Foundation Trust. The adults Physiotherapy Team work with adults from 18 years of age to assess, treat and provide advice and education to patients, their families and their carers if following injury, illness or disability. The adults physiotherapy service supports with the management of pain, help recovery, maximise independence and prevent unnecessary admission into hospital.

More information is available at:

https://www.nth.nhs.uk/services/physiotherapy/

Occupational Therapy

What is Occupational Therapy?

Occupational Therapy aims to enable children and young people (CYP) to become as independent as possible and maximise their potential in their daily lives. The main occupations of a CYP include play/ leisure, learning to take care of themselves and participating in school. OTs use therapeutic techniques and sometimes specialist equipment to help children/young people become as independent as possible with everyday activities such as self-care, school work and play. 

When may a child with a difficulty need to see an occupational therapist? 

When this difficulty is impacting on their performance or development of skills.   Occupational Therapists offer advice and work with CYP in many ways:

 

·         Sensory processing difficulties 

·         Difficulties with age appropriate activities of daily living (such as dressing, brushing teeth, washing hair)

·         Assessment and provision of equipment to CYP at home and school

·         Assessment and provision of upper limb splints

·         Assessment of motor skills which are important foundations for future skills

·         Assessment of visual motor integration skills (hand eye co-ordination)

What can I do if I think my child may benefit from seeing an occupational therapist?

If you are concerned that your child has a difficulty, seek support from your health visitor, school nurse, GP and/or SENCO. 

The CCG commissions services from North Tees and Hartlepool Foundation Trust to provide a team of specialist children’s occupational therapists and therapy assistants will provide assessment, treatment and advice to children and their families in a range of locations including home, school or hospital clinics. The service assess and treat children who have long term health needs or problems with movement and co ordination.

The Service will make sure your child reaches their potential. We know how important it is to you and your child for them to become as independent as possible either with self care, activities of daily living, in school, in play, leisure and for them to be safe and have better mobility and co ordination.

The Service work alongside other professionals involved with your child to ensure a holistic approach to treatment and assessment.

More information available at:

https://www.nth.nhs.uk/services/childrens-occupational-therapy/

Services for Young People with disabilities between the ages of 18 and 25 are met by Health services in an appropriate way. Hartlepool and Stockton on Tees CCG commission Occupational Therapy services for children and for people aged over 19 from North Tees and Hartlepool Foundation Trust. The Occupational Therapy service works with children and adults to provide assessments, treatment and advice and information to help them from having to be brought into hospital, hospice or residential care.

More information available at:

https://www.nth.nhs.uk/services/occupational-therapy/


 

 

 

Speech and Language Therapy

What is Speech & Language Therapy? 

Health care practitioners and professionals can provide assessment, advice and intervention for children who have difficulties communicating (understanding and/or expressing their needs), or have eating, drinking and swallowing difficulties.

How do I know if my child has a difficulty with speech, language or communication?

·          Missed milestones

Children typically develop certain skills at certain age ranges.  Appearing to develop some of these skills later than expected can be a sign of a missed milestone. However it is worth noting that all children are different and that there is a very wide range of ‘typical’ development.  

·         Unusual or poor quality of speech

·         Stutter

·         Doesn’t appear to use the right words

What can I do if my child has a difficulty with speech, language or communication (SLC)?

There are lots you can do to encourage development of Speech, Language or Communication.  If you are concerned that your child has a difficulty, the first person you should speak to is either your health visitor or teacher. They will have had specific training in order to offer advice and some intervention.  

When may a child with a difficulty need to see a speech and language therapist? 

 Many children will experience difficulties with their communication at some point in their life. Most of these children will make progress naturally, others may benefit from advice and support from their health visitor/ nursery/ school.  Some children however will need some specific support from the Speech and Language Therapy service.

North Tees and Hartlepool Foundation Trust deliver Speech and Language Services to children and young people of Stockton-on-Tees on behalf of the CCG.

The Service works with children and young people, from birth to 19 years old, who have speech, language and communication needs or difficulties with eating, drinking and swallowing.

As well as occurring on their own, these difficulties are common in children who have other diagnoses such as autism spectrum disorder, learning difficulties or cerebral palsy. Speech, language and communication needs might include difficulties in:

  • making the sounds needed for your speech to be understood by other people
    • putting words and sentences together to ask for something, tell a story or hold a conversation
    • making sense of what other people say to you
    • understanding and using body language and eye contact

A child or young person might also be:

  • stammering, where sounds or words are repeated or a lot of effort is needed to produce them
  • avoiding talking in certain situations
  • speaking with a persistently unusual voice quality, which might sound croaky, breathy or hoarse

As well as working directly with children and young people the service support their families and carers, their teachers and other adults around them. The service aims to help children to develop their best possible communication skills, taking into account their individual abilities and needs.  Most importantly we look at the impact of the communication difficulty on the child, their life and their family, aiming to find ways of reducing the impact as much as possible.

The Service also aim to help educate the wider population to understand and promote children’s language and communication development, and we provide training and support to a wide range of professionals who work with children.

https://www.hdft.nhs.uk/services/speech-language-therapy/paediatric-speech-and-language-therapy/harrogate-rural-district-speech-language-therapy/

Services for Young People with disabilities between the ages of 19 and 25 are met by Health services in a different way by adult services. Hartlepool and Stockton on Tees CCG commission Speech and Language Therapy services for people aged over 19 from North Tees and Hartlepool Foundation Trust. The adults Speech and Language Therapy Team work with adults from 19 years of age who have speech, language or communication needs or difficulties with eating, drinking and swallowing. In addition speech and language and other therapy services are provided by multi-disciplinary Community Learning Disabilities Teams which are provided by Tees Esk and Wear Valleys Foundation Trust.

 More information is available at:

https://www.nth.nhs.uk/services/adults/

http://www.tewv.nhs.uk/site/content/Care-&-Treatment/Learning-Disabilities/Adult-Learning-Disabilit

CAMHS (Child and Adolescent Mental Health Service)

CAMHS (Child and Adolescent Mental Health Service)

CAMHS - Child & Adolescent Mental Health Service is provided to the Stockton-on-Tees population by Tees Esk and Wear Valleys Foundation Trust

The Service works with Children, Young People and their families, up to the age of 18 years old who are experiencing mental health problems / complex emotional and behavioural difficulties offering assessment, treatment and diagnosis.

The team has a wide range of professionally registered practitioners including Psychiatrists, Clinical Psychologists, Mental Health Nurses, Occupational Therapists, Social Workers and Primary Mental Health Workers.

Referrals can be made by Young people, families and professionals who feel that a child or young person is experiencing emotional, behavioural or mental health problems.

https://www.tewv.nhs.uk/services/

In addition there is a CAMHS team specifically for Children and Young People with a diagnosed Learning Disability to ensure that the needs of children and their families are met in the most appropriate way. The learning disability child and adolescent mental health service (LD CAMHS) provides a range of specialist health services to children and young people, aged between 0-18 years, with a wide range of learning disabilities (mild, moderate and severe) and their families. In addition to their learning disability, the referred child or young person will be experiencing significant mental health problems or complex needs.

More information is available at:

https://www.tewv.nhs.uk/services/stockton-community-team-camhs/

The On My Mind link below is for the new national CAMHS website for service users. Please click on the link to be taken to the website.

On My Mind - aims to empower young people to make informed decisions about their mental health and wellbeing. 

Children/young people presenting with mental health difficulties are assessed using the following criteria:

·         Severity

·         Persistence

·         Complexity Risk of secondary disability

·         Risk of impairment for the child's development

·         Presence/absence of protective factors

·         Presence/absence of risk factors

·         Presence/absence of stressful/social/cultural factors

The specialist CAMHS health team includes a range of professionals and case discussions take place to ensure the right professional is seeing the child/young person at the right time. The professionals who work in specialist CAMHS are all experienced in working with children/young people with moderate to severe mental health difficulties.

The team includes:

·         Psychiatrists

·         Mental health nurses

·         Psychological services including clinical psychology, psychotherapy, family therapy, counselling and art therapy

·         CAMHS practitioners from a range of professional backgrounds.

Some children/young people need to see a member of the specialist CAMHS team over a longer period of time for a therapy programme, whilst some may benefit from a shorter intervention and some may need follow up support around medication. All CAMHS interventions support the child/young person in meeting their goals.

Mind-Ed

Introduction to Mind-Ed

We know that our Transforming Care cohort often present with complex needs and are more pre-disposed to mental health conditions.  Equally what we hear is that those supporting young people who have autism and/or learning disability sometimes feel ill prepared or skilled whereby young people present in distress or with behaviour that challenges.

Mind-ed is an e-learning tool led by Health Education England.  It is funded by the Department of Health and Education and is quality assured by clinical experts.

https://www.minded.org.uk/

By clicking on the above link you will have access to a free resource aimed at both families and professionals.  It is suited for use by schools, children’s care homes, health professionals, social care, Grandparents, advocates and many more.  It offers specific modules around autism, learning disabilities and behaviour that challenges

Please share this resource widely to help families, wider workforce, volunteers and advocates to be best prepared and skilled to support young people with Learning Disabilities and/or Autism.

Continence

The CCG is responsible for the commissioning Level 2 Paediatric Continence services that covers all children from birth to 19 years with continence problems, including children with learning difficulties and physical disabilities.

The current pathway has recently been reviewed and a new service pathway is in development to ensure a seamless service is in place to support the needs of children and young people with an anticipated implementation date of September 2018. There is an interim solution being put in place to ensure that Children and Young People requiring an urgent assessment/re-assessment for products will be carried out.

The new service will be a nurse led service offering level 2 assessments and interventions for continence problems, this will include constipation and both day and night time wetting. The service will have a pathway from level 1 provision (within the 0-19) and into the level 3 (paediatrics).

Currently services to those Young People aged between 18 and 25 can receive continence services from the Continence Advisory Service which is delivered by North Tees and Hartlepool Foundation Trust.

More information is available at:

https://www.nth.nhs.uk/services/continence-advisory-service/

Hospices

Hospice Services are commissioned on an ad hoc and needs assessed basis for individuals as required.  The CCG commission hospice services for children and young people eligible for children’s continuing care on an individual basis to meet the individual needs of the children or young people. These respite services and end of life services are provided by Zoe’s Place up to the child’s 6th birthday or Butterwick House from birth – 25 years. Butterwick House offer sibling support, family support services including counselling and holistic support to the family. 

Services for Specific Conditions

Health services provide a range of specialist services including paediatrics, social worker, health visiting, clinical psychology, speech and occupational therapy and physiotherapy. In addition there are a range of specialist services commissioned by the CCG (and NHS England) for the Stockton-on-Tees population which include (but is not limited to):

·         Asthma

·         Diabetes,

·         Epilepsy

·         Special community dental service

Personal Health Budgets

A child or a young person aged up to 18 years of age in receipt of Children’s Continuing Care (CCC) or a young person over the age of 18 years in receipt of Continuing Healthcare (CHC) have the legal right to a personal health budget (PHB). A PHB details the support an individual needs to meet their health and wellbeing needs and all children and young people who are eligible for children’s continuing care are offered this option. A support a plan is devised in partnership with the child, young person and their carers to outline their health outcomes and the support required to achieve them.

Children and young people in receipt of an Education, Health and Care (EHC) plan have the option to request a personal health budget for support to meet their health outcomes outlined in their EHC plan. Children and young people in receipt of an EHC plan do not have the legal right to a personal health budget and the CCG can decline the request if existing commissioned services can meet the health needs of the child or young person.

Due to the historic way in which health services have been commissioned, the CCG has to consider how we can give you a PHB whilst ensuring the service or services you have requested are not already commissioned through NHS arrangements to ensure we do not double fund services.

When we receive a PHB  request we look at alternative ways of meeting your needs such as; why does the service available not meet your needs i.e. does the service you are requesting have restricted opening hours or delivery locations which means it cannot meet your needs. By working with the provider we can look to improve these elements and meet the needs of the local population in a flexible manner.

As we move forward, routinely review services and through working with our providers we will look at how services are funded and this make agreeing more Personal Health Budget’s easier for children and young people who are have an EHC plan.

More information is available at:

http://www.hartlepoolandstocktonccg.nhs.uk/personal-health-budgets/a

Patient Advice and Liaison

The CCG is responsible for providing services to meet the needs of the local populations and all services have a responsibility to continually improve the services provides.

There are complaints processes for the NHS Trusts who provide services on behalf of the CCGs.

More information is available at the following websites:

Clinical Commissioning Group (CCG)

Hartlepool and Stockton-on-Tees CCG is the NHS organisation that coordinates the delivery of health services on behalf of everyone living in Hartlepool and Stockton-On-Tees. We are a membership organisation made up of 36 GP practices across the area that covers a population of nearly 300,000.

More information is available at:

http://www.hartlepoolandstocktonccg.nhs.uk/

Designated Clinical Officer (DCO)

The Department for Education and the Department for Health have produced Statutory Guidance for organisations which work with and support Children and Young People (CYP) who have special educational needs or disabilities (SEND) in January 15. The Code of Practice sets out guidance on Part 3 of the Children and Families Act 2014. One of the provisions described within the Code of Practice is around the identification of a Designated Medical Officer or a Designated Clinical Officer.

There has been a DCO recently appointed to the CCG as of 1st June 2018 who is working across the Hartlepool, Stockton and Darlington Local Authority boundary areas. Ruth Kimmins, DCO, can be contacted through Hartlepool and Stockton on Tees Clinical Commissioning Group on 01325 621407.

The Code recommends that partners should ensure there is a responsible individual to support the CCG in meeting its statutory responsibilities for children and young people with SEN and disabilities, primarily by providing a point of contact for local partners, when notifying parents and local authorities about children and young people they believe have, or may have, SEN or a disability, and when seeking advice on SEN or disabilities.

The DCO provides the point of contact for local authorities, schools and colleges seeking health advice on CYP who may have SEN or disabilities, and provides a contact (or contacts) for CCGs or health providers so that appropriate notification can be given to the local authority of children under compulsory school age who they think may have SEN or disabilities. The DCO can support schools with their duties under the ‘Supporting Pupils with Medical Conditions’ guidance. The DCO would not routinely be involved in assessments or planning for individuals, except in the course of their usual clinical practice, but would be responsible for ensuring that assessment, planning and health support is carried out. Some CCGs may delegate key decisions to the DCO (for example, agreeing the health services in an EHC plan).

The DCO should have an appropriate level of clinical expertise to enable them to exercise these functions effectively, and should be designated as the DCO in their job description. There may be one DCO for several CCGs and local authorities, where there are joint arrangements or shared commissioning responsibilities, and given the age range of EHC plans from birth to 25, the DCO may need to liaise with colleagues outside paediatrics.

The role of the DCO is to:

·      Maximise outcomes for CYP with SEND by working to improve quality of life, school absences, secondary mental and physical health conditions, personal autonomy and engagement in further education and employment

·      Play a strategic role in relation to the SEND agenda, developing, improving and influencing service design and delivery

·      Provide an expert resource for CYP health information, guidance, reassurance and support for families and professionals

·      Attend multi agency panels and support decision making on the basis of clinical judgement

·      Challenge and approve packages for CYP with SEND

·      Co-ordinate and pull together information from various services involved with the CYP (current and historic involvement)

·      Develop processes for the quality assurance of the finalised EHCPs and the input from Health Colleagues

·      Undertake trend analysis for the CYP cohorts and identify commissioning gaps to inform future commissioning

·      Make and follow up safeguarding referrals

·      Liaison with professions from health providers both internally and externally to ensure that all relevant health information is available to support EHC decision making at panel and provide longer term specialised and strategic oversight

Care and Treatment Reviews (CTRs) & Care, Education and Treatment Reviews (CETRs)

Care and Treatment Reviews (CTRs) and Care, Education and Treatment Reviews (CETRs) are part of NHS England’s commitment to transforming care for people with a learning disability, autism or both. Since 2015, thousands of CTRs have been carried out. They are helping to reduce the number of people going into these hospitals - latest figures show that 80% (four out of five) of community CTRs have led to a decision not to admit someone to hospital.

A new e-learning programme has been designed to support people who carry out or support C(E)TRs telling people about the history of CTRs and what makes a good CTR. It also prepares people for going into a secure unit and what to expect. It was developed with experts by experience, commissioners and clinicians who have been involved in CTRs. This e-Learning programme is for expert advisers - both experts by experience and clinical advisers, commissioners, provider services and other professionals, tribunal and legal services, and health and social service staff. Access the CTR e-learning without registering via open access.

There are a number of resources to help with CTRs:

My CTR planner -this booklet helps before, during and after the CTR.  It is about consent, planning a CTR and what happens next. People can either fill it in on a computer, or print and fill it in by hand.

www.england.nhs.uk/publication/my-care-and-treatment-review-planner/

 

My care and treatment review booklet - this booklet tells you all you need to know about CTRs.

www.england.nhs.uk/publication/my-care-and-treatment-review/

 

The policy for care and treatment reviews changed in March 2017.

www.england.nhs.uk/publication/care-and-treatment-reviews-policy-and-guidance/

 

This booklet is about becoming an expert by experience as an expert adviser on care and treatment reviews.

www.england.nhs.uk/wp-content/uploads/2017/04/expert-experience-info-symbols.pdf

 

Parents at Bringing Us Together have written a guide for family carers which offers further help and advice about CTRs.

http://bringingustogether.org.uk/a-family-survival-guide-care-and-treatment-reviews-ctrs/

 

Care and treatment reviews – The policy for care and treatment reviews changed in March 2017. See the latest policy:

www.england.nhs.uk/wp-content/uploads/2017/03/easy-read-care-treatment-review-policy.pdf

 

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