Lincolnshire’s integrated commissioning key achievements
- following Lincolnshire ICB’s stage 7 maturity matrix submission to NHSE at the end of 2023, Lincolnshire is the only area rated green, good overall for ICB SEND maturity across the 11 ICS within the midlands region
- there is strong and close working with Lincolnshire Parent Carer Forum (LPCF) as strategic partners; ensuring user experience helps shape and inform co-production of current service delivery and future planning of system developments
- LCC commission a well-informed Liaise - Lincolnshire’s SEND information, advice and support service (SENDIASS) sits at arms length to the local authority and health services, trained in SEN and disability law, working to national minimum standards. Liaise provide confidential and impartial information, advice and support to CYP with SEND and their parents or carers
- LCC children's strategic commissioning service work to ensure providers comply with the SEND code of practice and Children and Families Act 2014, including keeping the SEND local offer updated with their service information
- LCC has been the provider of the children’s 0-19 health service since 2017; funded through the public health grant. Health service locality teams work alongside early help, social workers and midwifery services. Delivery includes a specialist CYP community continence service commissioned by the ICB
- Lincolnshire has protected its 48 children’s centres, delivering a number of services to support CYP with SEND in their early years including:
- best start Lincolnshire early years services; with a focus on inclusive early learning activities
- early support learning provision; specialist support and a short break specifically for children with disabilities (CWD) and their families
- early years locality team practitioners
- ten children’s centres are also designated family hubs providing universal and targeted support for CYP and families
- family hubs’ funding is being utilised to increase the capacity of the perinatal mental health peer support service, commissioned by the ICB, to support mild to moderate perinatal mental health concerns and increase the offer through the Lincolnshire recovery college. In addition, a parent-infant mental health project led by LPFT to work across Child and Adolescent Mental Health Services (CAMHS) and Healthy Minds Lincolnshire, in partnership with the council’s health visiting service and other relevant professionals, to determine, introduce and strengthen an enhanced offer for children up to the age of two years
- children’s services are also utilising the family hubs’ funding to implement a speech and language pilot to provide early speech and language support by speech and language assistants for targeted work with Lincolnshire children aged three to four years
- integrated commissioning arrangements are in place for extended communication and language provision (ECLIPS) to deliver enhanced plus (primary school element) and ECLIPS (secondary school and further education element) to support development of CYP speech, language and communication needs
- the package of specialist online information and support workshops for families and professionals to better support CYP with sensory processing difficulties (SPD) has been extended with further developments continuing over 2024
- integrated commissioning arrangements are in place to provide specialist nurse training for education settings, transport providers and short breaks’ staff for CWD
- LCC and the ICB have pooled funding arrangements in place to support CWD in short breaks residential care
- Lincolnshire has well established, multi-agency processes and partnership working in regard to monitoring autistic CYP or those with LD who are at risk of being admitted to a specialist mental health or LD hospital
- LPFT provides management of an all-age dynamic support register (DSR) on behalf of system partners, which is used to monitor actions being taken by partners involved in their health, education and social care to avoid admission under the Mental Health Act. Continuing escalation of their behaviours can trigger multi disciplinary team or care education treatment review (CETR) processes to review what more could be done as a system to avoid admission. Fortnightly meetings are held, including representatives across health, social care and SEND, to review CYP on the DSR
- as at the end of November 2023, Lincolnshire had no admissions of autistic CYP or with LD since April 2023, and no inpatients since September 2023, against a trajectory of three
- a CYP key-working offer went live in Lincolnshire from April 2023, providing support for autistic CYP or those with a learning disability (LD), who are at risk of being admitted into hospital. The service initially supported those aged up to 18 providing key-working support to more than 90% of eligible CYP in Lincolnshire. It recently expanded to the full offer, supporting young people aged 18-25. The service aims to give CYP and their families the right support at the right time, to ensure systems within the community are responsive to meet their needs in a personalised and holistic way
- during 2022-23 and since April 2023, Lincolnshire has undertaken training and promotion of the DSR with mental health professionals, implementing the CYP key-working offer with improved multi-agency monitoring and processes in relation to CYP at risk or inpatient. It is calculated that eight CYP have avoided admission in quarter two, 2022-23; de-escalating DSR rating from red to green
- LCC is delegated the lead commissioning function for CYP mental health services on behalf of the ICB; formal integrated commissioning arrangements have been in place for over 10 years. LPFT is rated outstanding by the care quality commission (CQC) for its specialist community mental health services for children and young people, and provide most mental health services for CYP funded through a pooled budget between the ICB and the council.
- an all-age autism community support hub is currently being established and will start delivering support in 2024. The hub will provide support to the voluntary, community and social enterprise (VCSE) sector in Lincolnshire to strengthen, grow and develop more autism community support provision for CYP, adults and their families, regardless of diagnosis. They will also provide advice and signposting to people of all-age in Lincolnshire who are seeking support around autism
- there is a joint programme of work supporting the transforming care programme for CYP with learning disabilities or autism who have a mental illness or whose behaviour challenges services, as well as joint process between mental health and social care, including reviewing and improving CETR and s117 aftercare processes
- Lincolnshire schools forum continues to support the funding of the behaviour outreach support service (BOSS) and the autism and learning difficulties (ALD) service (also known as working together team) from the high needs block of the dedicated schools grant (DSG). Both services were recommissioned in September 2022 and have a strong focus on early intervention and prevention, building resilience across Lincolnshire mainstream schools; maintained and academies, increasing inclusion and promoting a collective responsibility to improving Lincolnshire pupils’ social, emotional wellbeing and mental health concerns. These services work as part of a child-centred, multi-disciplinary team approach in order to reduce the risk of behaviours escalating that may compromise pupils’ attendance and learning
- there are fully embedded pathways in place within LCC future4me service to ensure priority access to the CYP complex needs service for 0-18 year olds in custody at time of writing their resettlement plans. The complex needs service brings together education, health and care professionals into one team discussion
- LCC is lead commissioner on behalf of the East Midlands region for the SEND mediation advice, mediation and disagreement resolution contract. The DCO and LCC work closely with the contract provider to ensure joint arrangements include understanding of the legislative SEND EHC process, providing a statutory independent, unbiased and effective mediation service to support families as early as possible to resolve any disputes to prevent the need for escalation to tribunal
- joint development work has taken place to ensure full NICE compliance of the 0-16 social communication pathway
- full implementation of Lincolnshire young voices (LYV); a pan-disability participation group of young people with SEND who research and then act upon issues faced by Lincolnshire CYP with SEND. LYV is funded by LCC with their engagement activity funded by ICB. The group collaborates with services and organisations within multiple sectors across the system to raise awareness of SEND, improve service provision and inspire change. LYV are led by both LCC SEND team manager and ICB DCO for SEND, with two paid young people as co-chairs with a committee membership of around 15 young people who all have lived experience of SEND
- LYV have created an award winning elearning programme for professionals working with CYP with SEND, called ”A rough guide to not putting your foot in it”. Launched in 2022, it won the national association of special educational needs award. The training is available on the Lincolnshire Safeguarding Childrens Partnership website
