Assessment, Psychosocial and Prescribing Support to the Adult Neurodevelopmental (ND) (Autism and ADHD) Service

Provision of Autism Spectrum Disorder clinics and ADHD clinics including assessment, diagnosis, titration and stabilisation for adults 18 years and above in Kent and Medway delivered over a 3-year period (01.04.22 to 31.03.25) The provider(s) will contribute to the bespoke face to face clinical MDTs for ASC diagnostics and post diagnostic interventions, and online ADHD diagnostics, prescribing and titration for service users It is anticipated that the provider(s) will only undertake face to face assessment for ADHD for those individuals who have high levels of complex needs or difficulties engaging with the process of virtual consultations. The provider(s) will deliver online / face to face assessments for ADHD, which will be led by a psychiatrist with specialist clinical knowledge and experience and will include a full clinical and psychosocial assessment of the person; including discussion about behaviour and symptoms in the different domains and settings of the person's everyday life. An assessment of the person's needs, coexisting conditions, social, familial and educational or occupational circumstances and physical health will also be undertaken through the use of pre-assessment questionnaires and taking a case history. Following a diagnosis of ADHD, a structured discussion will be held with the individual (and their families/carers as appropriate) about how ADHD could affect their life. This structured discussion will inform the shared treatment plan/report that will be provided following the assessment. Psychological treatments which include individual and group adapted cognitive behavioural therapy will be offered only when agreed through KCHFT and/or the governance groups have been consulted and agreed to the treatment. The provider will access existing resources in mental health and social care services for identified needs of service users'. Where existing services do not meet service users' needs, then the provider should make suggestions about alternate options on how these needs could be met and make recommendations about processes and staffing requirements in line with the NICE guidance on Autism Spectrum Conditions and ADHD. Where an individual is identified as having moderate to severe mental health co-morbid requirements, then referral to the Community Mental Health Teams may be made. Where presenting autistic behaviour is complex and or challenging and the individual is at risk of inpatient and or out of area treatment then the provider will follow the agreed protocols for assessment and treatment, which may include onward referral to other specialists within the Complex Autism Service. Where the individual exhibits behaviour which places them at risk of offending, then onward referral to the local forensic service for assessment may be required. Providing a comprehensive assessment of suspected autism will be:- • Undertaken by professionals who are trained and competent • Team-based and draw on a range of professions and skills • Where possible involve a family member, partner, carer or other informant or use documentary evidence. To aid diagnosis and assessment for adults, the provider should consider using a formal assessment tool, such as: • Adult Asperger Assessment (AAA; includes the Autism-Spectrum Quotient [AQ] and Empathy Quotient [EQ])[6] • Autism Diagnostic Interview - Revised (ADI-R)[7] • Autism Diagnostic Observation Schedule 2 - (ADOS-2)[8] • Asperger Syndrome (and high-functioning autism) Diagnostic Interview (ASDI)[9] • Ritvo Autism Asperger Diagnostic Scale - Revised (RAADS-R)[10] The recommended approach is via MDT and Multimodal: The process should be: i) Accessible information, guidance & advice available ii) Initial phone consultation iii) Screening tools iv) Assessment process v) Report vi) Feedback vii) Follow up if necessary Online Digital Provision Where appropriate to deliver safe, effective treatment and with the explicit patient consent or agreement that this is their preference, then digital access and use of virtual online provision may be used. NB Where diagnostic assessment processes are dependent on tools and complex interactions then face to face services may be more appropriate. Training to Professionals and Carers There may be occasions whereby the provider is requested to support the training of health and social care professionals as well as carers in order to increase their levels of awareness and understanding of autism and ADHD in order to support the needs of the person for whom they are caring. In addition, there may be a requirement to support primary care GPs with advice, guidance and training around any issues of on-going prescribing for ADHD medication. This may be by telephone, email or contribution to any formal training sessions, where these have been agreed by the governance partnership to provide Service Coverage - Hours The provider will deliver a core service over 52 weeks per annum, which is available throughout accepted business working times of 09.00hrs to 17.00hrs, Monday to Friday. There may also be a requirement for the provider to offer additional access to their service in order to support the whole Adult ND pathway, which will be available on at least 2 evenings per week (between 5-8pm) and alternate Saturday sessions of no less than 4 hours per session. Where required, KCHFT will discuss and agree with the provider the scope of any additional hours, prior to them taking place. Reports / Information to service users There will be a maximum of 4 weeks from completion of assessment to the provision of a written report with recommendations which incorporates: • Patient details • Report author, date and those present during assessment • Documents seen before and during assessment • Diagnostic tools used, purpose and respective contributors • Referee history (e.g. developmental, family, educational) • Referee presentation (e.g. appearance, communication, empathy) • Diagnosis (e.g. meeting criteria, traits contributing to diagnosis, severity, further information required) • Recommendations (e.g. Psychological and Pharmacological Interventions, further assessments, signposting). • Treatment planning and expected timeframes. • Sign off and assessor declaration The Supplier will ensure that the content of the reports are clinically appropriate to the assessment carried out and details the assessment findings and recommendations made by their staff during the assessment A full audit of the service will be provided at the end of the contract to include statistics on diagnosis rates, satisfaction scores and feedback from service users and their families / carers. An identified staff member from the Supplier to be available five days per week as project manager for KCHFT staff to liaise with as required. Location Where delivering face to face clinics the provider(s) will ensure that staff are able to travel in order to deliver services across the designated KCHFT sites in Kent & Medway, in order to ensure that service users are able to access services in their local areas. Current sites, which may be subject to change, include:- • Tonbridge Cottage Hospital, Vauxhall Lane, Tonbridge, Kent TN11 0NE • Dartford West Health Centre (Redwood Practice), Tower Road, Dartford, Kent DA1 2HA • Sittingbourne Memorial Hospital, Bell Road, Sittingbourne, Kent ME10 4DT • Lordswood Healthy Living Centre, Sultan Road, Lordswood, Chatham Gillingham ME5 8TJ • Heathside Centre, Heath Road, Coxheath, Maidstone ME17 4AH The provider will ensure equitable access to their services and may include the use of technologies / digital provision, where agreed with KCHFT and appropriate to do so. Delivery period 1 April 2022 - 31 March 2025 Section IV. Procedure IV.1) Description IV.1.1) Type of procedure Award of a contract without prior publication of a call for competition in the cases listed below The procurement falls outside the scope of application of the regulations Explanation: Kent & Medway CCG have agreed to direct award the contract for delivery of the new adult neurodevelopmental (autism and ADHD) health service to KCHFT. The contract will be awarded to KCHFT from 1 April 2022. Full service delivery will commence on 1 April 2022. KCHFT will subcontract with all providers currently delivering adult autism and/or ADHD diagnostic and support health services within Kent and Medway. These providers are Psicon Ltd, Psychiatry UK and Sinclair Strong Consultants Ltd. They are the only providers locally able to provide the additional specialist clinical diagnostic and post diagnostic support not provided by KCHFT within the service model. All three are registered with CQC and can evidence they are meeting NICE guidance and relevant clinical standards. As not one of these three providers is in a position to undertake all of the subcontracted work required and due diligence has indicated that the availability of other suitable providers in the market place is extremely limited/not available KCHFT proposes to not undertake a procurement exercise via competitive tendering and to directly award contracts to the three companies named above. KCHFT as the lead provider is aware of the potential risk of a challenge from currently unknown providers within the marketplace associated with this approach and accepts this risk. This potential risk will be managed through the issuing of a Voluntary Ex-Ante Transparency Notice (VEAT) notice if the contract is awarded by CCG commissioners to KCHFT. Should another suitable provider(s) challenge the decision then KCHFT would look to work with the provider(s) as part of the partnership arrangements. Additional information: These are the only known suppliers and this is an urgent need for the Trust's patients. The Trust is scoping a complaint procurement process for a contract to come into force after the term specified in this advert. This Contract has been awarded.