Designated Clinical Officer - Knowsley 2021
Executive Summary
The Designated Clinical Officer [DCO], will work 30 hours, four days equivalent. The DCO is supported by a deputy clinical officer [DDCO], two days equivalent and a Lead, two days equivalent. This will be reviewed as needed.
This paper sets out the DCO role in Knowsley and the background for this, based on statutory requirements of the role and national research on models for delivery.
Background
The 2014 Children and Families Act recognised and sought to address the problem of typically poor outcomes for children and young people with , including those around quality of life, school absence, secondary mental and physical health problems, personal autonomy and involvement in further education and employment.
The Act provides a statutory framework and a significant degree of flexibility to decide how to implement this to best fit local systems and cohort needs. Overall, the aim of the Act is to improve the outcomes for all children and young people with and the way children and their families are supported.
The overall responsibility of the DCO is to ensure we follow these principles:
1. We embrace the principle of placing the voices of Children, Young People and families at the centre of our planning, commissioning and review. No decision about me without me.
1.1 We actively seek the views, wishes and aspirations of local people, ensuring that service users participate in our decision making.
Note: A child is a person under compulsory school age, while a young person is over compulsory school age but under 25. A person is no longer of compulsory school age after the last day of summer term during the year in which they become 16 (Section 83(2) of the Act).
This distinction is important because once a child becomes a young person they are entitled to take decisions in relation to the Act on their own behalf, rather than having their parents take the decisions for them. This is subject to a young person ‘having capacity’ to take a decision under the Mental Capacity Act 2005.
1.2 Children and Families must be a central element of the implementation plans for Transforming Care, CAMHS Transformation, Integrated Personalised Commissioning and Section 19 of the Children and Families Act.
2. Joint commissioning - Section 26 of the Children and Families Act .
The framework also places requirements on local authorities and partner organisations – including CCGs – to work together to improve outcomes for children and young people with : placing the child and their family, their needs and what matters to them, at the centre of support planning.
A local authority in England and its partner commissioning bodies must make arrangements (“joint commissioning arrangements”) about the education, health and care provision to be secured for —
a) children and young people for whom the authority is responsible who have special educational needs, and
b) children and young people in the authority’s area who have a disability.
These arrangements must include in particular the assessment and planning process, delivery of provision specified by an plan, and arrangements for personal budgets.
It is important that partners seeking to jointly commission services are first united around a shared understanding of the needs of the population. This is the basis on which local areas agree strategy and a set of holistic outcomes that they want to achieve for children, young people and their families. Knowsley has a joint JSNA.
3. Key programmes within health and the NHS
3.1 Knowsley and CCG have a co-produced joint strategy for 0-25 and a joint implementation plan based on long term ambitions for the residents of Knowsley in the context of our statutory responsibilities.
3.2 These reflect the aims of the Children and Families Act – to improve and develop more integrated, personalised services with a focus on outcomes and they align with a number of key NHS initiatives. These include: -
3.2.1 The Personalised Care Programme, which includes Integrated Personal Commissioning - developing mechanisms to pool resources across health and social care;
3.2.2 The changes introduced under the Transforming Care Programme (2014-2018) – improving community based provision and reducing residential placements for people with Challenging Behaviour, Autism and Learning Disability (Building the Right Support plan - Transforming Care delivery Plan) – and key commitments made in the long-term plan to improve services and outcomes for children and young people with autism and/or a learning disability, including the introduction of a key worker role;
3.2.3 The transformation of Children and Adolescent Mental Health Services in accordance with the commitments made in the NHS Long Term Plan and following on from the Future in Mind report, including development of:
- 24/7 crisis care
- complex trauma services for children ‘in selected areas’
- a comprehensive offer for 0-25 year olds integrating health, social care, education, VCS (e.g. iThrive)
3.3 Health strategic and operational work will be affected by the move towards integrated, place-based commissioning.
The aim is that all Sustainability and Transformation Partnerships (STPs) will evolve into Integrated Care Systems (ICSs), whereby partners ‘take collective responsibility for managing resources, working in partnership to deliver NHS standards, and improving the health of the population they serve’ (NHS England, 2018).
3.4 The NHS Long Term Plan includes a commitment to continue to support the development of ICSs. The DCO role will be reviewed at this point.
4 The DCO Role - national picture
4.1 In 2019, the CDC published the results of a survey of DMO/DCO models around the country: -
Professional background of survey respondents
- The level of resource provided for the role also varied
DCO contracted hours ranged from 0.5 days to 5 days [30% were 5 day role]
DMOs range – ranged from less than 0.5days – 2 days p/w [47.4% one day ]
4.2 Key functions of the DCO role in Knowsley
4.2.1. The DCO has overall responsibility for and leads on designated work streams. Other, specific work streams, are allocated to the DDCO and Lead under the supervision of the DCO. The DCO ensures that is integrated across the organisation and that the CCG fully meets the associated statutory responsibilities for 0-25. The DCO is allocated four days per week in order to fulfil the role. This includes working closely with the deputy DCO [DDCO] and the Lead, providing monthly supervision meetings.
The DCO role includes the following components:
4.2.2 Oversight and assurance across all health services 0-25 delivering healthcare to children and young people with
4.2.3 Coordination and assurance of strategic health’s input into the process and reporting of health’s position and audits to quality committees
4.2.4 Strategic assurance re accountability of commissioners’ contribution to development of the joint commissioning and local area strategies
4.2.5 Championing Co-Production as a way of working within and across Health
4.2.6 Joint statutory responsibilities – i.e. in collaboration with partners
The Children and Families Act requires us to fulfil a number of statutory responsibilities: - identify, assess, and meet
, preparation for adulthood, and thereby improve outcomes for this cohort. This encompasses providers across universal, targeted and specialist services, from early years’ services through to adult services and requires them to work in partnership. The DCO is responsible for the health aspect.
4.2.7 In relation to health these arrangements should include, but not be limited to:
- Health visitors and school nursing teams
- Therapy services
- Specialist services
- Palliative care services
- Children and young people’s mental health services
- Looked-after children health services including designated doctors and nurses
- Adult mental health, learning disability and therapy services
- GPs
4.2.8 Note: The Code of Practice 2015 introduces the DMO role under the Section 3.45, recommending Partners ensure that “there is a Designated Medical Officer (DMO) to support the CCG in meeting its statutory responsibilities for children and young people with 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, or a disability, and when seeking advice on or disabilities.
In Knowsley, this sits within the DCO responsibilities and is fulfilled by the DDCO
4.2.9 The CCG and use the notifications of to ensure that sufficient services are available and to secure early intervention.
4.2.10 Notifications will inform single agency and joint commissioning.
Date this review approved: 20/09/2021
Date of next review: 20/09/2022
