The request sought business cases for children with complex needs and the number of paediatric learning disability nurses; the authority disclosed a revised business case document detailing cost reductions and strategic changes but did not explicitly confirm the nurse count in the provided text.
Key Facts
The Children and Young People with Complex Healthcare Needs (CYPCHN) Business Case was presented to Manx Care BCRG on 14 November 2024.
Due to financial challenges, the BCRG advised focusing on 'invest to save' opportunities to strengthen the case.
The Respite Business Case is independent of the CYPCHN Business Case but complementary in delivering improvements.
Revised costs for the CYPCHN initiative were reduced from £272,476 to £153,515 total.
The proposal to recruit a Band 5 nurse for an Assistant Care Coordinator role was eliminated in favor of using an existing secondment.
Data Disclosed
14th November 2024
2025-04-07
2025-02-20
£272,476
£153,515
£250,487
£132,707
£10,000
£59,958
£120,661
£71,417
£48,553
£11,315
£2,737
Band 5
Band 6
Band 4
Band 8a
FY 26-27
Original Request
Please provide copies of business cases (whether approved or not). For the following:
- Children with complex needs
- reasonable adjustments for children's with complex needs.
Please confirm how many paediatric learning disability nurses are employed by the department.
Data Tables (58)
Original Costs – Nov
Revised Costs - Jan
24
25
Initiative
One off
total
cost
Annual
One off
total
cost
Annual
costs (FY
26-27)
What's changed?
costs (FY
26-27
onwards
)
1.Develop a
standardised,
multidisciplinary
Complex
Healthcare
Needs Pathway
£0
£10,000
£0
£10,000
There is no change to this costing.
£10,000 is for the use of an
Independent Review Professional who
will play a vital role in assessing the
needs of the CYP. This is in line with
the National Framework for Children’s
Continuing Care where it states “The
panel should be independent from
those involved in assessment.1”
2. Establish an
Assistant Care
Coordinator role
£590
£59,958
£0
£0
Initially, the proposal was to recruit a
Band 5 nurse for the assistant care
coordinator role. The Service Team
believe that the secondment that is
currently in place could meet this
requirement, subject to confirmation
from
. This approach
would eliminate the projected costs
entirely.
3. Supporting
the health needs
of the child
when receiving
care in a non-
healthcare
environment
£14,181
£120,661
£13,590
£71,417
Costs for supporting the child's health
needs in non-healthcare environments
have been reduced. It has been agreed
to employ one Band 6 Nurse instead of
both a Band 6 and Band 4 Nurse.
Although not the preferred choice, this
role will still provide essential clinical
oversight, training, and guidance to
prevent unnecessary admissions.
4. Develop a
psychological
support offering
for families
£7,218
£48,553
£7,218
£48,553
There is no change to costings as
the Band 8a psychological support role
will provide essential support to
families, enhancing their capacity to
care for their children and preventing
crises.
6. Implement a
standard
approach to
transition of
children and
young people
with continuing
care needs to
adult services
N/A
£11,315
N/A
£2,737
The costs are for time spent by the
named GP who will ensure a consistent
contact for CYP transitioning into adult
services.
This has reduced based on a reduction
in the service team’s estimate of the
number of children who will be
transitioning.
The Annual health Review is not
currently part of the GMS contract and
the recommendation is that this is
added as business as usual to the
One off
total
cost
One off
total
cost
Annual
costs (FY
26-27)
2. Establish an
Assistant Care
Coordinator role
3. Supporting
the health needs
of the child
when receiving
care in a non-
healthcare
environment
6. Implement a
standard
approach to
transition of
children and
young people
with continuing
care needs to
adult services
contract. This will need time to make
this change so will be treated as
aspirational and not costed.
CYPCHN BC
Original Costs (Nov 24)
Revised Costs (Jan 25)
One off
£21,989
£20,808
Annual
£250,487
£132,707
Total
£272,476
£153,515
#
Initiative
One off total cost
Annual costs (FY 26-27)
1.
Develop a standardised,
multidisciplinary Complex
Healthcare Needs Pathway
No change
£0k
No change
£10k
Non-
Commentary
cashable
benefit
£1.1k to
4.4k
• A standardised pathway could reduce the number of assessments
and referrals that are undertaken because engaged agencies are
coordinated in the child’s care so do not need to make referrals or
repeat assessments.
• For example, in one case a child’s care included 11 referrals and 5
assessments over 6 years. This equates to 1.83 referrals and 0.83
assessments a year.
• The service team suggests that this initiative could reduce referrals
by 1 and assessments by 0.4 per year for each affected child. They
advise that this could impact up to 22 CYP.
• On average, costs for an assessment are £144 and a referral £133.
• If £144 referral costs (1 referral) and £53.2 assessment costs (0.4
assessments) are avoided for between 5 and 22 children, the
potential benefit is between £1.4k and £4.4k.
#
Initiative
Revised One off
total cost
Revised Annual costs (FY 26-
27)
3.
Supporting the health needs
of the child when receiving
care in a non-healthcare
environment (respite and
non-respite environments)
£13,590
£71,417
Revised One off
total cost
Revised Annual costs (FY 26-
27)
Non-
Commentary
cashable
benefit
£15.2k to
£30.5k
• The nursing role will provide clinical oversight, training, and guidance
to prevent unnecessary hospital admissions. Introducing a nursing
role at the respite centre has already reduced admissions, e.g., one
child went from being admitted 16 times in 3 years to just once in 2
years.
• The Service Team suggest that the nursing role could result in 4
fewer admissions per year. A hospital admission on average costs
£1,140 (bed days plus additional nursing time). If there are 4 fewer
admissions for 3 children each year, this results in potential benefits
between £15.2k to £30.5k 5k (different assumption for no. of
admissions - max being 4 in a year per child).
#
Initiative
One off total cost
Annual costs (FY 26-27)
4.
Develop a psychological
support offering for families
No change
£7,218
No change
£48,553
Non-
Commentary
cashable
benefit
£8.4k to
£16.9k
• This initiative will provide psychological support to CYP and families,
which should reduce the requirement for emergency respite care.
• In one example, due to poor mental health, a child required
emergency respite care 5 times in3 years, totally 25 days.
• The service team advise that by introducing additional support the
requirement for respite days could reduce by 50% (e.g. 8.33 less 4.2
days per annum per child or less 2.1 with a reduction of 25%) and
reduce Social Worker time by same %. The service team advise this
may apply to on average 3 children and young people each year.
• If fewer emergency respite days are required each year (and
associated reduced social worker time), there could be potential
benefits of £8.4k (if days reduce by 50%), up to £16.9k.
£20,808
To be discussed and agreed at
Transformation Committee
£132,707
Estimated to be in the range of
£24,900 to £52,000 (dependent
on assumptions used)
Transformation Fund
Transformation Fund
Manx Care OR next Mandate
inclusion
Service Area
Children and Young Persons with Complex Healthcare Needs (CYPCHN)
Date
23rd January 2025
Author:
Owner:
Health and Care Transformation (HCT) Programme
Pathway
Children and Young Persons with Complex Healthcare
Needs
Problem Statements
A: There is no defined pathway for CYPCHN
B: Whilst there is a set pathway for assessing Social Care
needs, there is no framework or standardised approach to
assessing combined health, education and social care needs to
provide a holistic care package on the island.
C: Although complex health and care needs can have a life
changing impact on families, very little emotional or
psychological support is available.
D: There are currently delays and challenges around training
care staff with responsibility for CYPCHN at respite centres
and in non-respite facilities in the community. There is no
designated nurse to oversee the care of this cohort of children
and young people (C/YP) in non-hospital settings.
E: There is no urgent and emergency care pathway.
F: There is no pathway or coordinated approach to transition
to adult services, with no agreed age for this process to start.
There is no named GP or appointed adult physician to support
with transition which can result in a disjointed provision of
services whilst transitioning from child to adult services.
G: There is no formal process in place to opt for care at home.
H: There are challenges around Tertiary Care handover and
return, relating to lack of support for travelling and limited
communication between the on-island services and tertiary
centres.
Vision
To create an efficient, evidence based, sustainable and Island
specific pathway for CYPCHN and their families that
incorporates a standardised assessment process, a suitable
urgent and emergency care pathway, adequate support for
the children and their families and a standardised transition to
adult services, with the aim of creating the optimal quality of
life for these C/YP.
Proposed Change
1. Develop a standardised, multidisciplinary complex
healthcare needs pathway
2. Establish a new Assistant Care Coordinator role
Initiatives (pathway
transformation)
3. Support the health needs of the C/YP when receiving care
in a non-healthcare environment (both respite and non-
respite environments)
4. Develop a new psychological support offering for families
5. Create and implement an urgent and emergency care
pathway
6. Implement a standard approach to transition to adult
services
7. Co-location of staff administration and service delivery
(aspirational)
Quality Standards
The future pathway has been developed using national best
practice, including UK National Institute for Health and Care
Excellence (NICE) guidelines1 for children with severe complex
needs, The National Framework for Children and Young
People’s Continuing Care (CYPCC)2 and Children with
Exceptional Healthcare Needs3.
Mobilisation and
Implementation Plan
high level milestones
(post approval date)
• Month 0 – Treasury Approval of Business Case
• Month 4 – Adult physician for transition to adult services
appointed
• Month 4 – Sessions with Named GP Commence
• Month 5 – Contract and procurement process finalised for
independent review professional (including DPIA) with
independent review professional (assessment process)
assigned and in post
• Mid-month 9 – Band 6 Nurse, Band 4 Nurse, Assistant
Care Coordinator and Psychologist in post
• Mid-month 9 – End of mobilisation (implementation
commences)
• Mid-month 10 – End of implementation (service live date)
Mobilisation and
Implementation Plan
high level milestones
(post approval date)
• In-line with best practice (see Appendix G), a new Assistant Care Co-ordinator role will be
introduced to support the existing Care Coordinator.
• The Assistant Care Co-ordinator will act as a named point of contact for families to support
their health needs. This will involve responsibility for C/YPs with lower acuity needs, which
currently cannot always be met.
• Introducing this role for lower acuity needs will allow the Care Coordinator, who would oversee
this work, to focus on coordination of services and supporting more complex issues.
How?
• A job description would be developed in consultation with the existing Care Coordinator.
• The intention is to formalise the current secondment role who will work with the Care
Coordinator across the case load, advocating for and supporting the children and young people
with complex Healthcare needs.
• The role will report into the Care Coordinator, whilst working closely with the wider
multidisciplinary team (including health, social care and education).
• The role will help avoid a single point of failure; once the Assistant Care Co-ordinator is
embedded in the role, they will provide some level of cover when the Care Co-ordinator is
unavailable.
• The responsibilities and expectations of the role would be clearly defined and agreed during
implementation. Their responsibilities will include:
• A focus on lower acuity C/YP and families
• Being the named key point of contact for families, ensuring clear support pathways
• Liaison with all health providers and services, both on and off island
• Co-ordination with other agencies (social care, education, third sector, etc.) with
regards to health needs
• Care Planning
• Supporting hospital admissions
• Coordinating and supporting tertiary handover and return, including communication
• Following recruitment, training would need to be provided, which will include a period of
shadowing the existing Care Coordinator.
Rationale and best practice
• Feedback from the service user survey highlighted that additional support with Care
Coordination is required as this is a very valuable area of support, with the Care Coordinator
acting as a conduit between the families and the multiple services they access and taking strain
off the daily lives of the families.
• The CYPCC UK National Framework recommends a co-ordinator or administrator to act as a
single point of contact with whom professionals can liaise.
• The UK is piloting a Key Worker model developed through extensive consultation with young
people, parent carers and other stakeholders (see appendix G). The NHS Long Term
Plan includes a commitment that ‘by 2023/24 children and young people with a learning
disability with the most complex needs will have a designated keyworker’. From 2023/24, it is
expected that all ICSs will offer their key working services to young people up to the age of 25.
(Here, the term ke y worker reflects the roles and responsibilities that the Assistant Care
Coordinator will be taking on).
• A case study in South Yorkshire highlighted the positive effect a designated keyworker has had
in ensuring children, young people and their families get the right support at the right time.
Name
Role within Manx Care
Head of the Ambulance Service
Hear & Treat Team Leader
Associate Director of Nursing, Medicine, Urgent and
Emergency Care
Project Manager for Urgent and Emergency Integrated
Care
Lead Business Manager
General Manager for Women’s and Children’s services
General Manager for Mental Health Services
Hospital Youth Coordinator
Proposed Initiative
For every CYPCHN who is transitioning to adult services:
a) A timed CYPCHN Transition Pathway will be in place; this will commence at age 14.
b) A multi-agency Transition Plan will be in place, ensuring an active, timely & co-ordinated
transition to adult services.
c) There will be an appointed Adult Physician; this will be an overarching role which coordinates
the transition process and ensures that the right people are involved at the right time.
d) There will be a named GP who will participate in the transition process ensuring GP
engagement and involvement.
e) After transition the Adult Long Term Condition Coordinator will take over the Care Coordinator
role for the CYPCHN.
f) Best practice guidelines highlight that an annual health review is carried out. This can take
place using the Learning Disability Annual Health check Template (NICE) and/or condition
specific guidelines. As this is not currently part of the GMS contract the recommendation is
that this is added as business as usual to the contract. This will need time to make this change
so will be treated as aspirational and not costed.
How?
a1) The transition to adult services will start at the age of 14 for each CYPCHN, via an agreed and
implemented CYPCHN Transition Pathway.
a2) The Care Coordinators will lead the transition process for the C/YP on their caseload. They will
act as a single point of contact for a child (and family) approaching transition, as well as
briefing key professionals and coordinating transition.
b1) The Transition Plan will be developed (and implemented) to include a plan for unplanned and
planned hospital admissions and ongoing community care across all specialist areas. It should
be agreed by all services involved. An alert should be placed on the most relevant patient
record systems (there may be more than 1).
b2) The Transition Plan should describe how the C/YP’s health and care needs will be supported
within adult services taking into account: maintaining good health, independent living, and
participating in society. It will form part of the C/YP’s Complex Needs Care Plan and be agreed
with the Multidisciplinary Team.
c1) An Adult Physician will be identified to lead on transition for C/YP with complex needs:
• Participation in transition planning including attending joint clinics
• Helping to co-ordinate planned hospital admissions after their 16th birthday
• Providing continuity for C/YP during unplanned hospital admissions
• Being the named adult physician for families or professionals to contact for concerns
around hospital care (on island) for CYP with complex needs
d1) A GP (at the practice the C/YP is registered with) will be identified as the named Transition GP:
• Participation in transition planning (via email, Teams and attending meetings)
• Undertaking an earlier health review as required (where clinically appropriate). This is
undertaken following clinical guidelines for the health condition / professional
judgement.
d2) The delivery mechanism for the named Transition GP (i.e. whether it must be 1 identified GP for
each child transitioning, or a cohort of GP’s) is to be identified during implementation.
d3) The named Transition GP could be commissioned by Manx Care from the PCN. Business Case
costings are based on a pan island annual time commitment of circa 30 hours per annum (7.5
GP sessions). Manx Care have indicated that if the Business Case is approved, this role can be
added to the PCN DES for direct enhanced service contract in year and added to the Locality
Hub service list for the salaried model and the contract.
Rationale and best practice
• The key components described above are in line with NICE guidelines ‘1.8 - Transition from
children's to adult’s services.
• The service user questionnaire highlighted that:
o Only 7% of 40 users stated they were satisfied with their transition to adult services, with
37% responding that they were not happy.
o 31% of 40 users stated they had not discussed transitioning to adult services with a Key
Worker/relevant professional.
Proposed Initiative
• Co-location of staff into one office, to increase multidisciplinary team (MDT) effectiveness.
•
Co-location of service delivery, to increase efficiency of access to services for the CYPCHN
cohort and improve the patient and family experience, potentially delivering care closer to home
if geographically delivered.
#
Initiative
1
Develop a standardised, multidisciplinary complex healthcare needs pathway
2
Establish a new Assistant Care Coordinator role (secondment role)
3
Support the health needs of the C/YP when receiving care in a non-healthcare
environment (both respite and non-respite environments)
4
Develop a new psychological support offering for families
5
Create and implement an urgent and emergency care pathway for CYPCHN
6
Implement a standard approach to transition of CYPCHN to adult services
7
Co-location of staff administration and service delivery (aspirational)
CHALLENGING
High impact
Low ease
7 1 4
3
IMPLEMENT
High impact
High ease
6
2
5
Low impact
Low ease
RECONSIDER
Low impact
High ease
POSSIBLE
Finance Case Summary
Option 1 (Do
Option 2 (adopt changes)
nothing)
One-off costs (2024-2025)
£0
£20,808
Ongoing revenue costs
(2025/26 onwards)
£0
£132,707
Non-Cash Releasing Benefits
(2024/25)
£0
£0
Non-Cash Releasing Benefits
(2025/26 onwards)
£0
Estimated to be in the range of £24,762 to £51,707
(dependent on assumptions used)
Pathway
stage
Option and associated initiatives
One-off Total
Cost (£)17
Ongoing costs
(£) 18
Non-
cashable
benefit
Assessment
of needs and
outcome
1. Develop a standardised,
multidisciplinary Complex Healthcare
Needs Pathway
£0
£10,000
£1.1k to 4.4k
2. Establish Assistant Care Co-ordinator
Role
£0
£0
n/a
Support
provided
3. Support the health needs of the C/YP
when receiving care in a non-healthcare
environment
£13,590
£71,417
£15.2k to
£30.5k
4. Develop a new psychological support
offering for families
£7,218
£48,553
£8.6k to
£17.2k
5. Create and implement an urgent and
emergency care pathway for CYPCHN
No additional
cost
No additional cost
n/a
Transition
6. Implement a standard approach to
transition of CYPCHN to adult services
n/a
£2,737
n/a
Aspirational
7. Improve effectiveness of
multidisciplinary team (MDT) and access to
services for CYPCHN cohort by co-locating
services
Not costed
Not costed
Not costed
PMO support (0.2 WTE HEO Band 19
Project Manager for 9 months)
No cost
associated
No cost
associated
No cost
associated
Total for Option 2
£20,808
£132,707
£25k to £52k
Pathway
stage
One-off Total
Cost (£)17
Ongoing costs
(£) 18
Non-
cashable
benefit
#
Cost Elements &
Measures
Source &
Benchmarks
Cost (FY 24/25 for
one-time costs and
FY 26/27 for
ongoing)
Annual costs (2026-2027)
A
Independent Review
Professional
Quote from NHS
Midlands and
Lancashire
Commissioning
Support Unit (ML)
Children and Young
People’s Service
(CYP).
Band 8a on MPTC pay
scale (Apr 23 onwards
+ inflation) (highest
scale point)
£38,230.33
D
On costs
27% of employee
costs to cover ER NI
and ER Pensions
£10,322.19
Summary
One-time costs
£7,217.62
Annual cost
£48,552.52
Potential non-cashable financial benefit £8.4k to £16.9k
Assumptions for benefit figure
This initiative will provide psychological support to C/YP and families, which should
reduce the requirement for emergency respite care.
In one example, due to poor mental health, a child required emergency respite care 5
times in 3 years, totalling 25 days (8.33 days per year).
The service team advise that by introducing additional support, the requirement for
respite days could reduce to between 4 and 6 days per year (reduction of between 25
and 50%), with Social Worker time reducing in line. The service team advise this may
apply to on average 3 children and young people each year.
If fewer emergency respite days are required each year (and associated reduced social
worker time), there could be potential benefits in the range of £8.4k to £16.9k.
Cost Elements &
Measures
Source &
Benchmarks
#
Cost Elements &
Measures
Source &
Benchmarks
Cost
Annual costs
C
C/YP Named GP for
Transition Process
7.5 GP Sessions x
£365 (*75%)
£2,737.50
Summary
Annual cost
£2,737.50
Cost Elements &
Measures
Source &
Benchmarks
Theme/issue identified in patient/family
How initiatives respond to theme/issue
feedback
During the initial diagnosis, 62% of service
users were not satisfied with the level of care,
information and support that they received.
Improved communication about the
process and next steps was the leading
element that service users felt were missing.
The introduction of a defined assessment
process, with transparent and standardised
decision-making on access to services will
respond to this feedback.
71% of service users were not satisfied with
the level of care, information and support that
they receive now. A lack of general
support, care not being tailored to their
needs and unclear direction of care were
stated as the leading components missing.
The introduction of an Assistant Care
Coordinator as a single point of contact and a
Complex Needs Plan should ensure that C/YP
and families receive a more coherent,
coordinated service and feel more fully involved
and informed.
Service users noted a lack of specialist staff
at respite centres and in other care
environments, impacting on the ability of the
service to operate at full capacity.
Interventions to improve access to and
consistency of training for care providers will
respond to these challenges.
Mental health/ psychological support to
families was identified as missing and needed.
Psychological support initiatives including the
recruitment of a psychologist and the
introduction of a new Assistant Care Coordinator
will respond to this issue.
Service users were not satisfied with their
experiences in ED and with the facilities
available for this cohort (such as changing
facilities).
The introduction of defined urgent and
emergency care pathways, including clear
signposting, should encourage a smoother and
clearer pathway through urgent and emergency
care for this cohort.
Aspirational initiatives to implement more
appropriate facilities and equipment (through
future ED design plans and paediatric ward
design plans) should respond to issues around
the provision of appropriate facilities.
Poor transition to adult services was
identified as a key theme with only seven
percent of service users being satisfied with
their transition to adult services.
A set process for transition to adult services and
the implementation of the named GP for
transitioning C/YP will respond to this issue.
Appraisal criteria
Option 1 (Do nothing)
Option 2 (Pathway
transformation)
Case for Change
Low – does not resolve the clinical
case for change
High – designed to tackle the clinical
case for change
Financial case
Low – offers no benefit, at no
additional cost
Low - investment anticipated to
achieve improved experience, but
not savings
Strategic alignment
Low – does not align with key
strategies
High – aligns with key strategies
Patient feedback
Low – has no impact on patient
experience
High – is anticipated to improve
patient experience
Travel and
environmental impact
Low – has no travel or environmental
impact
Low – has no travel or
environmental impact
Data Protection
(details in appendix L)
Low – has no impact on data
protection
Medium – The need for a DPIA
should be considered if patient
information is captured
Equality Act
(details in appendix L)
Low – has limited impact on groups
with protected characteristics
Medium – benefits some people with
disabilities
Risk
Likelihood
Impact
Mitigation
Not the resource in
place to deliver the
changes within
implementation
Medium
• This may impact on
the speed of
implementation and
effectiveness of the
future pathway
• Ensure appropriate PMO resource in
place to deliver the change
initiatives and ensure engagement
with relevant stakeholders
Some of the
practicalities of the
design and benefits
are not sufficiently
understood
High
• May impact on ability
to implement the
change within
appropriate
cost/benefit
parameters
• Steering Group have developed the
change initiatives together and have
the insight and knowledge required;
they need to be engaged fully in the
implementation process
• Implementation PM to work with the
Steering Group to resolve any
emerging design questions
Challenging to
recruit the new
staff members
(specifically the
Psychologist and
Nurse roles)
High
• This may impact on
the speed of
implementation,
ability to implement
these initiatives, and
effectiveness of the
future pathway
• For the psychologist role to engage
with Mental Health SMEs to support
with the correct strategy to recruit
• Consider international channels (if
needed) to recruit nurses.
Difficult to get
involvement of all
panel members
within the
Assessment
process
Medium
• Could result in
unsuitable decisions
being made at
assessment
• Use of a validated decision-making
tool (Decision Support Tool)
• Potential to engage an expert that
sits outside the panel for advice via
email
CEN
• Children with Exceptional Healthcare Needs
CYP
• Child/young person
• Children/young people
CYPCHN
• Children and Young People with Complex Healthcare Needs
DHSC
• Department for Health and Social Care
ED
• Emergency Department
MDT
• Multidisciplinary Team
MIU
• Minor Injuries Unit
PCN
• Primary Care Network
SPC
• Specialist Provision Centres
WTE
• Whole time equivalent
Name
Role
Organisation
Care Coordinator for Children and Young Persons with Complex Care Needs
Manx Care
Business support for Women, Children and Families
Manx Care
Care Group Manager
Manx Care
Children’s Occupational Therapist / Interim Children’s Therapy Team Lead
Manx Care
Children’s Specialty Doctor
Manx Care
Community Paediatrician / Designated Doctor for Child Protection/LAC
Manx Care
Public Health Lead, Project Lead for the Women’s Health Strategy and CONI
Coordinator
Manx Care
Service Lead Children’s Community Nursing
Manx Care
Team Manager for Children with Disabilities and oversight over Social Care
Respite Centres
Manx Care
Adult Social Care (Assistant Director/Children and Families)
Manx Care
Clinical director for medicine
Manx Care
Consultant Paediatrician
Manx Care
Senior Nurse for Women’s and Children’s
Manx Care
Name
Role
Organisation
Care Coordinator for Children and Young Persons with
Complex Care Needs
Manx Care
Business support for Women, Children and Families
Manx Care
Community Paediatrician
Manx Care
Children’s Physiotherapy
Manx Care
Lead Social Care Manager and Social Worker for Children
and Young Persons with Complex Care Needs
Manx Care
Senior Special Educational Needs Advisor
Department for Education,
Sport and Culture
Senior Nurse for Women’s and Children’s
Manx Care
Rebecca House Hospice Manager
Rebecca House Hospice (3rd
sector)
Service Lead Children’s Community Nursing
Manx Care
Team Manager for Children with Disabilities and oversight
over Social Care Respite Centres
Manx Care
Representative for Adult Social Care leadership (Assistant
Director of Children and Families)
Manx Care
Clinical director for medicine
Manx Care
Full Response Text
Page | 1
Health and Care Transformation Programme
Care Pathway Addendum Paper
Children and Young People with Complex Care Needs
On 14th November 2024, the Children and Young People with Complex Healthcare Needs
(CYPCHN) Business Case was presented to Manx Care BCRG. Due to the current financial
challenges across the health and care system, BCRG advised a focus on "invest to save"
opportunities for those change initiatives with a recurrent cost, to strengthen the case. The
BCRG also asked for confirmation whether the Respite Business Case submitted by Social
Care was linked to the CYPCHN Business Case.
Respite Business Case
We have been advised that the Respite Business Case relates to residential provision rather
than this business case, which has a series of interventions that ensures there is a
standardised assessment process, a suitable urgent and emergency care pathway,
adequate support for the C/YP and their families with a standardised transition to adult
services and initiatives that address inappropriate hospital admission. The two business
cases are independent of each other (so could be implemented separately) but are
complementary, as both deliver improvements to this cohort of patients and their families.
Invest to save
The project team completed this work with the service leads and in addition added
information around safety and compliance benefits. In terms of compliance and safety, all
initiatives will support a higher quality and safer service for children and young people, more
closely aligned to NICE guidance.
Whilst undertaking this exercise, the service team were able to identify cost reductions for
certain initiatives.
This addendum paper provides an overview of the original costings, the reduction in the
funding request (Table 1) and specific non-cash releasing benefits (Table 2).
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Table 1- Original versus revised costs
;
Original Costs – Nov
24
Revised Costs - Jan
25
Initiative
One off
total
cost
Annual
costs (FY
26-27
onwards
)
One off
total
cost
Annual
costs (FY
26-27)
What's changed?
1.Develop a
standardised,
multidisciplinary
Complex
Healthcare
Needs Pathway
£0
£10,000
£0
£10,000
There is no change to this costing.
£10,000 is for the use of an
Independent Review Professional who
will play a vital role in assessing the
needs of the CYP. This is in line with
the National Framework for Children’s
Continuing Care where it states “The
panel should be independent from
those involved in assessment.1”
2. Establish an
Assistant Care
Coordinator role
£590
£59,958
£0
£0
Initially, the proposal was to recruit a
Band 5 nurse for the assistant care
coordinator role. The Service Team
believe that the secondment that is
currently in place could meet this
requirement, subject to confirmation
from
. This approach
would eliminate the projected costs
entirely.
3. Supporting
the health needs
of the child
when receiving
care in a non-
healthcare
environment
£14,181 £120,661
£13,590
£71,417
Costs for supporting the child's health
needs in non-healthcare environments
have been reduced. It has been agreed
to employ one Band 6 Nurse instead of
both a Band 6 and Band 4 Nurse.
Although not the preferred choice, this
role will still provide essential clinical
oversight, training, and guidance to
prevent unnecessary admissions.
4. Develop a
psychological
support offering
for families
£7,218
£48,553
£7,218
£48,553
There is no change to costings as
the Band 8a psychological support role
will provide essential support to
families, enhancing their capacity to
care for their children and preventing
crises.
6. Implement a
standard
approach to
transition of
children and
young people
with continuing
care needs to
adult services
N/A
£11,315
N/A
£2,737
The costs are for time spent by the
named GP who will ensure a consistent
contact for CYP transitioning into adult
services.
This has reduced based on a reduction
in the service team’s estimate of the
number of children who will be
transitioning.
The Annual health Review is not
currently part of the GMS contract and
the recommendation is that this is
added as business as usual to the
11 National Framework for Children and Young People's Continuing Care (publishing.service.gov.uk)
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contract. This will need time to make
this change so will be treated as
aspirational and not costed.
Summary of business case cost changes
CYPCHN BC
Original Costs (Nov 24)
Revised Costs (Jan 25)
One off
£21,989
£20,808
Annual
£250,487
£132,707
Total
£272,476
£153,515
Non-Cash Releasing Benefits
The Service Team have shared details about specific case studies and this information has
been used to calculate the potential benefits if the initiative is implemented. The potential
benefits are driven by the assumptions detailed, and any change to these assumptions will
affect the potential benefits. A range has been provided to reflect the variability of benefit
realisation that is anticipated.
Initiative
One off total cost
Annual costs (FY 26-27)
1. Develop a standardised,
multidisciplinary Complex
Healthcare Needs Pathway
No change
£0k
No change
£10k
Non-
cashable
benefit
Commentary
£1.1k to
4.4k
•
A standardised pathway could reduce the number of assessments
and referrals that are undertaken because engaged agencies are
coordinated in the child’s care so do not need to make referrals or
repeat assessments.
•
For example, in one case a child’s care included 11 referrals and 5
assessments over 6 years. This equates to 1.83 referrals and 0.83
assessments a year.
•
The service team suggests that this initiative could reduce referrals
by 1 and assessments by 0.4 per year for each affected child. They
advise that this could impact up to 22 CYP.
•
On average, costs for an assessment are £144 and a referral £133.
•
If £144 referral costs (1 referral) and £53.2 assessment costs (0.4
assessments) are avoided for between 5 and 22 children, the
potential benefit is between £1.4k and £4.4k.
Initiative
Revised One off
total cost
Revised Annual costs (FY 26-
27)
3. Supporting the health needs
of the child when receiving
care in a non-healthcare
environment (respite and
non-respite environments)
£13,590
£71,417
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Non-
cashable
benefit
Commentary
£15.2k to
£30.5k
•
The nursing role will provide clinical oversight, training, and guidance
to prevent unnecessary hospital admissions. Introducing a nursing
role at the respite centre has already reduced admissions, e.g., one
child went from being admitted 16 times in 3 years to just once in 2
years.
•
The Service Team suggest that the nursing role could result in 4
fewer admissions per year. A hospital admission on average costs
£1,140 (bed days plus additional nursing time). If there are 4 fewer
admissions for 3 children each year, this results in potential benefits
between £15.2k to £30.5k 5k (different assumption for no. of
admissions - max being 4 in a year per child).
Initiative
One off total cost
Annual costs (FY 26-27)
Develop a psychological
support offering for families
No change
£7,218
No change
£48,553
Non-
cashable
benefit
Commentary
£8.4k to
£16.9k
•
This initiative will provide psychological support to CYP and families,
which should reduce the requirement for emergency respite care.
•
In one example, due to poor mental health, a child required
emergency respite care 5 times in3 years, totally 25 days.
•
The service team advise that by introducing additional support the
requirement for respite days could reduce by 50% (e.g. 8.33 less 4.2
days per annum per child or less 2.1 with a reduction of 25%) and
reduce Social Worker time by same %. The service team advise this
may apply to on average 3 children and young people each year.
•
If fewer emergency respite days are required each year (and
associated reduced social worker time), there could be potential
benefits of £8.4k (if days reduce by 50%), up to £16.9k.
Summary of non-cash releasing benefits
CYPCHN BC
Minimum
Maximum
Initiative 1
1.1k
4.4k
Initiative 3
15.2k
30.5k
Initiative 4
8.4k
16.9k
Conclusion
In summary, the Service Team has been able to reduce the costs of the business case by
119k and calculate the potential benefits of implementing these initiatives, noting an overall
non-cashable benefit of £25k to £52k. These savings are based on specific assumptions as
per information we have received and collated from Manx Care.
All initiatives will support a higher quality and safer service for children and young people,
more closely aligned to NICE guidance.
22/01/2025
END
Page 1 of 34
BCRG DRAFT VERSION – DECEMBER 2024
Health and Care Transformation Programme
Care Pathway Business Case (BC)
Children and Young Persons with Complex
Healthcare Needs
Monies Requested
One-Off Costs
Transformation Costs
Ongoing Revenue Costs (per annum)
Potential non-cashable savings (per
annum)
£20,808
To be discussed and agreed at
Transformation Committee
£132,707
Estimated to be in the range of
£24,900 to £52,000 (dependent
on assumptions used)
Source of Funding
Table of Contents
1
This document ....................................................................................................... 2
2
Introduction ........................................................................................................... 2
3
The Current Situation – how the service is delivered now ........................................... 5
4
The Case for Change – challenges & opportunities .................................................... 7
5
The Vision – how the process could be improved ...................................................... 9
6
Financial Case ....................................................................................................... 21
7
Impact Assessment (& feasibility) ........................................................................... 27
8
Mobilisation and Implementation – plan, metrics, dependencies and risks .................. 29
9
Review process undertaken .................................................................................... 31
10 Recommendations, decision required and next steps ................................................ 32
11 Appendix .............................................................................................................. 32
1 This document
DEPARTMENT: Department of Health and Social Care (DHSC)
BUSINESS CASE FOR: The implementation of an integrated pathway for Children and
Young Persons with Complex Healthcare Needs
Service Area
Children and Young Persons with Complex Healthcare Needs (CYPCHN)
Date
23rd January 2025
Author:
Owner:
Health and Care Transformation (HCT) Programme
This document describes the evidence-based Care Pathway Business Case for the
transformation of the Isle of Man Children and Young Persons with Complex
Healthcare Needs (CYPCHN) pathway. It describes the current position, the case for
change, the future vision for best practice care on the Island, the steps needed to achieve
that vision and the associated costs.
2 Introduction
2.1 Strategic context
In May 2019 Sir Jonathan Michael’s “Independent Review of the Isle of Man Health and
Social Care System” was unanimously approved by Tynwald. One of the key
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BCRG DRAFT VERSION – DECEMBER 2024
recommendations (12) was that “service by service integrated care pathways should be
designed, agreed, and delivered”.
On behalf of the DHSC and working in close partnership with Manx Care and key partners,
the Transformation Programme has progressed work to redesign a series of care pathways,
including Children and Young People with Complex Healthcare Needs (CYPCHN).
The previous CYPCHN Business Case was completed in April 2022 (but not progressed for
approval due to the 12-month project pause) so this current work has been an update or
“refresh” of the 2022 business case. The refresh looks at the clinical, operational, activity
and financial aspects of the pathway to ensure the business case remains up to date and
relevant for the service, service users and their families.
2.2 Executive Summary
Pathway
Children and Young Persons with Complex Healthcare
Needs
Problem Statements
A: There is no defined pathway for CYPCHN
B: Whilst there is a set pathway for assessing Social Care
needs, there is no framework or standardised approach to
assessing combined health, education and social care needs to
provide a holistic care package on the island.
C: Although complex health and care needs can have a life
changing impact on families, very little emotional or
psychological support is available.
D: There are currently delays and challenges around training
care staff with responsibility for CYPCHN at respite centres
and in non-respite facilities in the community. There is no
designated nurse to oversee the care of this cohort of children
and young people (C/YP) in non-hospital settings.
E: There is no urgent and emergency care pathway.
F: There is no pathway or coordinated approach to transition
to adult services, with no agreed age for this process to start.
There is no named GP or appointed adult physician to support
with transition which can result in a disjointed provision of
services whilst transitioning from child to adult services.
G: There is no formal process in place to opt for care at home.
H: There are challenges around Tertiary Care handover and
return, relating to lack of support for travelling and limited
communication between the on-island services and tertiary
centres.
Vision
To create an efficient, evidence based, sustainable and Island
specific pathway for CYPCHN and their families that
incorporates a standardised assessment process, a suitable
urgent and emergency care pathway, adequate support for
the children and their families and a standardised transition to
adult services, with the aim of creating the optimal quality of
life for these C/YP.
Proposed Change
Initiatives (pathway
transformation)
1. Develop a standardised, multidisciplinary complex
healthcare needs pathway
2. Establish a new Assistant Care Coordinator role
Page 4 of 34
BCRG DRAFT VERSION – DECEMBER 2024
3. Support the health needs of the C/YP when receiving care
in a non-healthcare environment (both respite and non-
respite environments)
4. Develop a new psychologic
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