Kent and Medway Vanguard Options Project

Task 

The NHS Long Term Plan (LTP: 2019) makes a commitment to invest in additional support for the most vulnerable children and young people who have ‘complex needs’ and can be described as presenting with high risk, high harm behaviours, and high vulnerability. The Framework for Integrated Care (FfIC) is NHS England and Improvement’s response to this commitment. The FfIC provides a set of guiding principles – based on trauma-informed theory and practice – that promote genuine collaboration and co-production between existing services. 

To date, 12 vanguard projects, each with its own unique model to deliver the FfIC (community), have been funded across the UK. Kent and Medway are keen to pilot their own integrated model under the FfIC (community) to focus on improving the offer for children, young people, and young adults at risk of entering justice pathways / secure estate. They want to ensure that the future model is evidence-based, trauma-informed, and needs-led.  

Kent and Medway Integrated Care Board (ICB) commissioned TONIC to support the development of a set of activities and documents leading to a robust business case and service specification outlining potential for the local implementation of a FfIC (community) vanguard. 

Our Approach 

Project Management: Throughout the duration of the project, TONIC attended fortnightly touchpoint meeting to provide updates on progress, risk management, and emerging findings. In addition, a project steering group was established with regional commissioners , who met with TONIC on a monthly basis. The project steering group consisted of representations from NHS England Health and Justice South East (Children and Young People Commissioning), Kent County Council (Youth Justice Commissioning and Children’s Commissioning – Mental Health and Emotional Wellbeing), Medway Council (Youth Offending Team), and Kent and Medway’s Violence Reduction Unit. 

Scoping: TONIC conducted a detailed review of the LTP, FfIC, Health and Justice Framework for Integration, Serious Violence Duty, and safeguarding children’s requirements, summarising key elements in a document that could support decision-making.  

Best Practice Review: TONIC utilised existing knowledge, access to FutureNHS and FfIC resources, and contacts with vanguard regional and national teams, to summarise existing vanguard models, activity, outcomes, and learning. 

Needs Analysis: TONIC completed a localised risk factor profiling exercise to identify risk factors impacting children and young people’s mental health and offending. This included consideration of substance misuse, divorce rates, school exclusions, poverty, family dysfunction, domestic abuse, etc. This assisted TONIC with predicting demand, identifying unmet need, analysing trends over time, and allowed TONIC to suggest groups and geographical hotspots to prioritise, all of which was used to inform the proposed model and business case development.  

Co-Production: TONIC facilitated a series of co-production workshops and consultation activities with professionals (n=10) and children and young people (n=98), to test findings and concepts formulated from the above activities. This helped to develop ideas for model options further, which TONIC then explored with commissioners in a co-design workshop.  

Outcome 

Using all of the findings, TONIC developed a business case, setting out:  

  • Assessment of national frameworks the model will contribute to 

  • Which groups of children and young people this will support 

  • Identified gaps and how these will be addressed 

  • Approach and priorities year-by-year 

  • Estimated costs involved in developing, implementing, and operating the model 

  • Planned activities and expectations for the vanguard  

  • Identified risks and how these could be mitigated. 

Finally, TONIC drafted a service specification, including:  

  • Clinical/professional models of care 

  • Required activities 

  • Quality standards 

  • Dataset submissions 

  • Key performance indicators 

  • Outcomes frameworks. 

The proposed model would operate as a ‘Hub and Spoke’ service with each of the two ‘Spokes’ providing support to four Pupil Referrals Units across Kent and Medway (thus supporting the eight PRUs across Kent and Medway). The PRUs would also be able to draw on one or more of six specialist posts, based on availability and levels of demand. These include an Educational Psychologist, Mental Health Therapist, Post-16 Transition Coach, Family Support Worker and a Speech and Language Therapist. 

TONIC consulted key stakeholders, including commissioners, on the business case and service specification, to ensure it reflects their views and achieves all requirements.