High Functioning Autism and Asperger's Diagnosis and Support Service and Adult Attention Deficit Hyperactivity Disorder (ADHD) Diagnostic Assessment and Support Service

Autism:

The service will focus on diagnosing and supporting adults with suspected autism where there is not a coexisting learning disability. Learning Disability services are already commissioned to provide diagnosis and treatment of autism for patients with a learning disability. In most cases individuals with an IQ of below 70 are able to access Learning Disability services. Those with average or above average IQ (Asperger Syndrome or high functioning autism) often find it difficult to access support and diagnosis services. For the purpose of this service specification this group of patients will be referred to as having Asperger Syndrome (AS) although this will include high functioning autism. Diagnosis should be in-line with Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (or later editions as published).

ADHD:

To identify Attention Deficit Hyperactivity Disorder (ADHD) in adults, offer treatment and increase and improve the support and services available to people with ADHD and their families.

The service will provide diagnostic screening; diagnostic assessment; and provide treatment and initial titration where medication is used, monitoring and support to people with ADHD under a shared care protocol with GP's. GP's will be supported in their role by rapid access to information and support from the service.

The service will respond within 14 days of receiving a referral, complete an initial assessment with the service user within 30 days of the referral and a diagnosis will be completed within 90 days (days to be calculated as calendar days).

The service will provide support via person-centred planning, structured psychological and social education programmes, in single and group setting as appropriate, working towards drug cessation for those that require or request it and help and support to develop coping mechanisms.

The summary of recommendations in NICE guidance CCG72 will provide the key aspirations for the service, recognising full implementation may not be practicable immediately.

The service should provide:

a) A full clinical and psychosocial assessment, including discussion about the behaviours and symptoms in different settings;

b) A clear diagnostic assessment pathway, including referral and screening options for GP's, AMH teams and referrals from CAMHS. (The pathway should include a description of any specific tools and the types of assessments in the diagnostic assessment pathway);

c) Support to develop a person centred plan to help newly diagnosed adults to deal with the impact of ADHD;

d) Structured educational and development programmes to learn coping mechanisms and implement plans;

e) Support to cease the use of medication where required or requested;

f) Appropriate clinical information to GP's where ADHD is not diagnosed;

g) A response to GP's requests for guidance about supporting an individual where there has been an exacerbation of symptoms associated with their disorder;

h) An awareness and knowledge-raising programme for GPs and other health and social care professionals of the pathway for diagnosis;

i) In partnership with the patients GP, complete referrals to other appropriate professionals where comorbidities are suspected or diagnosed;

High Functioning Autism and Asperger's Diagnosis and Support Service and Adult Attention Deficit Hyperactivity Disorder (ADHD) Diagnostic Assessment and Support Service

Award of Contract for High Functioning Autism and Asperger's Diagnosis and Support Service and Adult Attention Deficit Hyperactivity Disorder (ADHD) Diagnostic Assessment and Support to Surrey and Borders Partnership NHS Foundation Trust, for a 3 year plus optional 24 month extension. Total contract value is for the full 5 year period.

Autism:

The service will focus on diagnosing and supporting adults with suspected autism where there is not a coexisting learning disability. Learning Disability services are already commissioned to provide diagnosis and treatment of autism for patients with a learning disability. In most cases individuals with an IQ of below 70 are able to access Learning Disability services. Those with average or above average IQ (Asperger Syndrome or high functioning autism) often find it difficult to access support and diagnosis services. For the purpose of this service specification this group of patients will be referred to as having Asperger Syndrome (AS) although this will include high functioning autism. Diagnosis should be in-line with Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (or later editions as published).

ADHD:

To identify Attention Deficit Hyperactivity Disorder (ADHD) in adults, offer treatment and increase and improve the support and services available to people with ADHD and their families.

The service will provide diagnostic screening; diagnostic assessment; and provide treatment and initial titration where medication is used, monitoring and support to people with ADHD under a shared care protocol with GP's. GP's will be supported in their role by rapid access to information and support from the service.

The service will respond within 14 days of receiving a referral, complete an initial assessment with the service user within 30 days of the referral and a diagnosis will be completed within 90 days (days to be calculated as calendar days).

The service will provide support via person-centred planning, structured psychological and social education programmes, in single and group setting as appropriate, working towards drug cessation for those that require or request it and help and support to develop coping mechanisms.

The summary of recommendations in NICE guidance CCG72 will provide the key aspirations for the service, recognising full implementation may not be practicable immediately.

The service should provide:

a) A full clinical and psychosocial assessment, including discussion about the behaviours and symptoms in different settings;

b) A clear diagnostic assessment pathway, including referral and screening options for GP's, AMH teams and referrals from CAMHS. (The pathway should include a description of any specific tools and the types of assessments in the diagnostic assessment pathway);

c) Support to develop a person centred plan to help newly diagnosed adults to deal with the impact of ADHD;

d) Structured educational and development programmes to learn coping mechanisms and implement plans;

e) Support to cease the use of medication where required or requested;

f) Appropriate clinical information to GP's where ADHD is not diagnosed;

g) A response to GP's requests for guidance about supporting an individual where there has been an exacerbation of symptoms associated with their disorder;

h) An awareness and knowledge-raising programme for GPs and other health and social care professionals of the pathway for diagnosis;

i) In partnership with the patients GP, complete referrals to other appropriate professionals where comorbidities are suspected or diagnosed;

j) Access to information and signposting to appropriate services for patients and carers (e.g. Well-being Centres);

k) Information to help evaluate this model to inform future commissioning intentions;

l) Development of ADHD screening tool to support primary care / and or other refers

The COVID-19 outbreak along with other key issues including demand exceeding capacity, has led for the need for review across the ICS footprint to address gaps in provision and ending of the current contract on 31st December 2021, this has given rise to an urgent need for the continuation of the provision for The Adults Autism/ADHD service for Hampshire, Southampton and Isle of Wight CCG ( not covering the Southampton population)

The Covid pandemic has delayed the process of consulting on and agreeing a service pathway for re-procurement of the Adults Autism/ADHD diagnostic and support contract. Demand for both aspects of the service significantly exceeds capacity resulting in unacceptable waits and some service users using the choice agenda to request referral to independent providers. There is agreement that there are gaps in service provision for those with complex presentations and co-morbid mental health issues with a commitment to review and develop a more comprehensive neuro-developmental pathway. The merger of CCGs in the developing ICS needs to be reflected in the Commissioning Strategy forward plan for this service.

The Contracting Authority considers the above issues to be a state of urgency that has been brought about by circumstances which a diligent Contracting Authority could not have foreseen.

Accordingly, under Reg 72(1)(c) Public Contract Regulation 2015 the Hampshire, Southampton and IOW CCG has decided to extend their existing contract with Surrey and Borders Partnership NHS Foundation Trust for a short-term Direct Award for a 18 month contract , brought about by the COVID-19 outbreak, for the following reasons:

Examples:

• To maintain service delivery following the Covid-19 response.

• Change of provider would disrupt continuity in care and would be a detriment to patient care.

• Resources in the contracting authority were redirected to support frontline activities including direct care for patients and efforts to support supply chain activities. As a result, scheduled service review and subsequent re-tendering activity has been delayed.

Surrey and Borders Partnership NHS Foundation Trust is the leading provider of health and social care services for people of all ages with mental ill-health and learning disabilities in Surrey & North East Hampshire. The Trust was awarded the contract following the completion of a competitive tender in 2016.The Autism/ADHD diagnostic service has an excellent track record and has met all contractual and quality standards

Awarding for an interim period will give Hampshire, Southampton, and IOW CCG sufficient time to undertake a undertake a comprehensive service review in order to determine how future services should be configured and procured.

Therefore, this PCR Regulation 72 Modification Notice is being published to notify the extension of the contract for 18 months,. The modification does not alter the overall nature of the contract and any increase in price does not exceed 50% of the value of the original contract. The total Contract award value for 5 years was £1.9mil. the extension value is £809,835 for 18 months .

This time is considered necessary and proportional to alleviate the risk stated in this notice and will give the above-named Contracting Authority sufficient time to review the service to form the commissioning model.

The Covid pandemic has resulted in emergency measures which have delayed the process of consulting on and agreeing a service pathway and subsequent delay for re-procurement of the Adults Autism/ADHD diagnostic and support contract. Accordingly, under Reg 72(1)(c) Public Contract Regulation 2015 the Hampshire, Southampton and IOW CCG has decided to extend their existing contract with Surrey and Borders Partnership NHS Foundation Trust for a short-term Direct Award for a 18 month contract , brought about by the COVID-19 outbreak, for the following reasons:• To maintain service delivery following the Covid-19 response.• Change of provider would disrupt continuity in care and would be a detriment to patient care.• Resources in the contracting authority were redirected to support frontline activities including direct care for patients and efforts to support supply chain activities. As a result, scheduled service review and subsequent re-tendering activity has been delayed.