The Children and Young People's ADHD Service for the Isle of Wight

The Children and young people's ADHD (Attention Deficit Hyperactivity Disorder) Service for the Isle of Wight is currently delivered by the Paediatric team within the Isle of Wight (IOW) NHS Trust. The service provides an ADHD diagnostic assessment service including titration to optimal dosage of medication for children and young people. The service undertakes prescribing and medication reviews, assessment and treatment for ADHD and the provision specifically sits within the IOW NHS Trust Paediatrics service.

The CCG and the Trust had been working together to stabilise the service due as increasing demand was placing a significant pressure on available capacity. However, at the end of July 2021, IOW NHS Trust advised that they could not continue to deliver a safe Children and Young People's ADHD service and requested urgent action from Hampshire, Southampton and Isle of Wight CCG. The service capacity had been severely impacted by the following:

• Out of the 2 nurses (both agency) 1 had resigned on 30 July 2021 giving 14 days' notice and there were concerns that the second nurse might also resign
• 1 of the 2 consultants (interim) had resigned giving 3 months' notice, losing 2 sessions per week
• As a consequence, the only permanent capacity within the service was the IOW NHS Trust lead consultant at 3.5 sessions per week.
• Previous recruitment exercise for practitioners within the service had taken over 5 months and the Trust's market research on the possibility of recruiting further agency staff had not been positive.

This was unexpected and unforeseen for both the Trust and the CCG as we were working together to improve the service capacity. Following the above communications, senior management dialogue between Hampshire, Southampton and Isle of Wight CCG and IOW NHS Trust confirmed that there were no other options to support the service to continue in the Trust and an agreed end date of 16 September 2021 was set.

In order to avoid cessation of services, a new service is required from the 17 September 2021. The cessation of service would place at considerable risk a large number of children and young people. The current caseload managed by IOW NHS Trust is 938 children and young people, and of this cohort 261 patients needing monthly ADHD prescriptions and 432 patients require prescriptions every 60 days for melatonin. Furthermore 15% of the caseload is currently being titrated.

The service provision required is a medically led assessment and prescribing service, offering assessment, initiation and titration of ADHD medication and follow up monitoring by appropriately qualified and experienced doctors registered with the General Medical Council with a current licence to practice. From the point at which medication is considered stable in controlling a patient's ADHD, subsequent monitoring is typically managed by GPs in Primary Care. Shared care arrangements, while in development and working very well in places, are not yet fully established on the Isle of Wight.

The emergency contracting of Psicon for 9 months will not only address the urgent need but will also allow for the opportunity to undertake a full ADHD service review across HSI CCG with a view to an all age pathway being established by June 2022. This review will include service user engagement and model development to build a longer-term sustainable service offer.

The total maximum cost for 9 month's service provision (excluding medication costs) is £699,000. Costs will depend on activity required and completed but will be capped at £699,000 for 9 months. Based on previous costs the medicines cost will be no more than £300,000 for the 9-month contract. Activity is based on data supplied by Isle of Wight NHS Trust.

This is for new referrals and those on the waiting list. Assumptions are: 90% diagnosis rate; 100% of positive diagnoses require medication; and 10 new referrals per month. The initial focus will be on transfer of the existing caseload. New referrals will be seen after the first three to four months. As this is an emergency contract to maintain the current position the capped contract value may not allow for all existing and new activity and therefore there may still be a waiting list. The detailed service review is required to understand the full picture and build a model that includes demand management and share care arrangements so that the future service can meet the full population need.