Direct Line: 0151 643 5334
NHS Wirral Clinical Commissioning Group
Old Market House
Date: 3rd August 2018
Name: Martin Butcher
Our Ref: ID1169
Tel: 0151 651 0011
Dear Mr Butcher, Re: Freedom of Information Request
Thank you for your request for information made under the Freedom of Information Act 2000
which was received into this office on 17th July 2018.
You Asked for:
Please provide copies of any policies your CGG has on the commissioning of services for
those with an FASD.
What services has your CCG commissioned to meet the ‘reasonable requirements’, as is
your duty under Section 3 NHS Act 2006, of those in your area who have or may have
Foetal Alcohol Spectrum Disorders as a result of antenatal exposure to alcohol, and what
is your CCG doing to secure improvement in the physical and mental health of persons
with Foetal Alcohol Spectrum Disorders and for the prevention, diagnosis and treatment
of FASD (as is in your power under Section 3A NHS Act 2006)? Please release any
information you hold concerning provision for:
prevention education following the Chief Medical Officers’ guidelines that the safest
course is not to drink while pregnant or attempting to become pregnant;
diagnosis for both children and adults;
post-diagnostic care in the years 2013- 2018 from professionals including, but not limited
to, paediatricians, GPs, nurses, psychologists, occupational therapists, speech and
language therapists, mental health services and other disability support services to
provide specialised intervention services for patients on the FASD spectrum across their
Please release any information concerning how is your CCG exercising its duty (as
specified under Section 14R NHS Act 2006) to securing “continuous improvement in the
quality of services provided” to individuals with Foetal Alcohol Spectrum Disorders “for or
in connection with the prevention, diagnosis or treatment” of FASD?
What is the budget for commissioned services for FASD in the current financial year?
What was the budget in financial years beginning in 2013, 2014, 2015, 2016 and 2017?
Please release any agreed plans for service expansion for future years.
Has your CCG conducted, commissioned or assisted the conduct of research into any
matters relating to the causation, prevention, diagnosis or treatment of Foetal Alcohol
Spectrum Disorders, as is in your powers according to Section 5 NHS Act 2006 Schedule
1 (paragraph 13).
Does your CCG commission services from the National FASD Clinic? If so, what is the
budget for this in the current financial year?
Please release any information concerning ways in which your CCG is fulfilling its duty
(specified under Section 14Z, NHS Act 2006) to promote education and training related
Do you have a lead person in your CCG on FASD? Please provide the name and role of
the person responsible.
Please release any information concerning the steps are you taking or have you taken
(according to your duty under section 14Z2 of the NHS Act, 2006), to involve individuals
with FASD or their caregivers in “planning commissioning arrangements; in the
development and consideration of proposals for change; in decisions affecting the
operation of commissioning arrangements where implementation would have an impact
on the manner in which services are delivered or the range of services available.”?
How many inquiries/requests/letters have you received from medical practitioners or
patients/families in your area related to FASD in the years 2013-2018?
NHS Wirral Clinical Commissioning Group (CCG) does not have a specific policy
covering the commissioning of services for those with FASD. However, the CCG is
partners in Wirral Council’s Wirral Alcohol Strategy which references FASD and is
available on the Council’s website at the following link: https://www.wirral.gov.uk/sites/default/files/all/About%20the%20council/Wirral%20Plan/Al
NHS Wirral CCG commissions a Specialist Midwife Team at Arrowe Park Hospital (Wirral
University Teaching Hospital NHS Foundation Trust) to deliver perinatal mental health
support to women. Wirral University Teaching Hospital finances a Substance Use
Midwife (0.8 WTE) ,this is a separate role to the Perinatal Mental Health Team but in
addition to. Alcohol Consumption is discussed at Booking with every pregnant woman
who books at Wirral University Teaching Hospital (WUTH) by the Community Midwife.
To note, for any pregnant women whose alcohol consumption is identified as a risk is
supported by a Substance Use Midwife. Pregnant women are screened at booking using
the Alcohol Use Disorders Identification Test (AUDIT-C) tool and if the results of the
screening warrant referred to the Substance Use Midwife who completes a Severity of
Alcohol Dependence Questionnaire (SADQ) and provides practical support and advice
around FAS and FASD.
NHS Wirral CCG, along with CCGs across Cheshire and Merseyside, commissions a
Specialist Perinatal Mental Health Team; in Cheshire and Wirral this is provided by the
Cheshire & Wirral Partnership NHS Foundation Trust. This team uses an alcohol audit
tool that each woman completes as part of the initial assessment. The team also liaises
with substance misuse teams if they have concerns about changing presentation in a
woman’s health during the perinatal period.
NHS Wirral CCG commissions the Child and Adolescent Mental Health Service
(CAMHS) provided by the Cheshire & Wirral Partnership NHS Foundation Trust.
Children affected by antenatal exposure to alcohol can be supported by CAMHS.
CAMHS also operates a telephone advice line (9:00-22:00 weekdays and 12:00-20:00
weekends and public holidays; the telephone number is 0151 – 488 – 8453): anyone
concerned about the mental health or emotional wellbeing of a child or young person in
Wirral can call this number.
Please see attached a copy of the Wirral Alcohol Strategy. The strategy makes a
‘Deliver clear information to local people and services about the risks of foetal alcohol
spectrum disorder’. This is currently work in progress. The specialist midwife team at
WUTH support and advise pregnant women and families as well as midwives, health
visitors and other professionals.
The Adult Substance Misuse Service for Wirral, Wirral Ways to Recovery (WWtR) run
brief psychosocial intervention sessions for women on their books who drink and who are
of child bearing age. The sessions cover a range of risks that alcohol misuse can cause
including the risk of a child being born with FASD.
If a pregnant woman was drinking in pregnancy/ suspected to have a child at risk of
FASD, the Substance Use Midwife would raise an alert with the Paediatrics Neo-natal
service and diagnosis would fall under the responsibility of Paediatrics at WUTH.
The Substance Use Midwife supports and advises pregnant women who are known to be
consuming alcohol in pregnancy or have scored 5 or more on the AUDIT-C
questionnaire. The Specialist Mental Health Team will refer to the Substance Misuse
Midwife if a woman in their care admits to using alcohol in pregnancy.
All Midwives and Health Visitors deliver brief intervention advice to women and families in
regards to alcohol consumption in pregnancy and beyond.
The CCG does not commission a specialised intervention service for FASD outside of the
services described in response to question 2.
The CCG does not have a specific budget for FASD.
There is no formal plan for expansion of service. However, in partnership with Wirral
Council, a review of the offer for children and young people around substance misuse is
underway. The specialist Midwife Team at WUTH has recently recruited a Trauma
Therapist who can address any underlying trauma issue that may be contributing to an
alcohol problem during pregnancy and in the first year after pregnancy.
No. In the development of the Alcohol Strategy and in support of the Joint Strategic
Needs Assessment (JSNA), the Public Health Team reviewed a number of reference
sources shown in the References section (on page 24 of the strategy).
Please see answer to question 1.
No. Alcohol Misuse commissioning more generally is led by Public Health in Wirral
Council. The lead for this is Dr Elspeth Anwar, Public Health Consultant, Health and
Wellbeing, Strategic Hub, Wirral Council.
Please see attached a copy of the Wirral Alcohol Strategy - Work is currently underway
to review the offer for children and young people around substance misuse to ensure that
an integrated programme is available, informed by consultation with children, young
people and key stakeholders.
We hope this information is useful, however if you require any further information please do not
hesitate to contact a member of the Corporate Affairs Team (contact details at the top of this
Director of Corporate Affairs
NHS Wirral Clinical Commissioning Group
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