Contact: Graham Wright, ext 7263, Gill Horrobin, ext 7091

1 Summary

1.1 That approval be given for the implementation of the first phase of the strategy as set out in the Action Plan in Section 6.

1.2 That further detailed costings and viability work be supported.

1.3 That a further report on the evaluation of the first phase be presented to the Executive Member in due course.

1.4 That a report on plans for the second phase be presented to the Executive Member in due course.

1.5 That further determination of the outstanding matter of capital funding regarding the refurbishment of Woodend, Andover, be referred to the Executive Member in due course.

2 Reason(s)

2.1 To begin implementation of the residential care strategy within existing resources, such that the county's in-house residential care is a high quality, cost-effective service of choice, and able to offer services more appropriate to the varying needs of children and young people.

3 Other options considered and rejected

3.1 Not considered feasible to pursue other options if the necessary objectives are to be met.

4 Conflicts of Interest declared by the decision-maker or a Member or Officer consulted

4.1 None

5 Dispensation granted by the Standards Committee

6 Reason(s) for the matter being dealt with if urgent

6.1 N/A

Approved by: Date of decision:

Councillor Felicity Hindson

1.

2. Introduction

2.1 This report proposes an action plan for the first phase of the implementation of the Children & Families in-house residential care strategy.

It forms the latest stage in the development of services for Hampshire's Looked After Children (LAC).

2.2 Children and Families services overall are in the process of comprehensive redevelopment in line with the Social Services Department's remodelling.

2.3 Significant influences for LAC services have included the key objectives in the government's `Quality Protects' programme, the new national care standards introduced by the National Care Standards Commission (NCSC), and the improvement plan of the recently completed Best Value Review of LAC Services.

2.4 The basic objectives in the strategy and the necessary characteristics of the associated services have been in place for some time, having been approved by Social Services Committee in April 2000.

2.5 A total of twenty residential places have been lost to the in-house sector brought about by the need to reduce the total number of places in each of the department's ten units, in order to meet with the new NCSC requirements. A further reduction has been caused by the temporary closure of two homes, it being anticipated that their premises and physical condition not being capable of meeting the new standards.

2.6 Currently, full implementation of the strategy in a single financial year is not affordable. Budgetary constraints not withstanding, it is necessary to start implementation on a phased basis, releasing funding from existing resources in an opportunistic but controlled manner.

The action plan in section six sets out the steps and their inter-relationships in more detail.

1.7 Successful implementation of the strategy depends upon a number of complementary developments in other service areas of the Children and Families sector, e.g. the effectiveness of the new family placement, family support and permanence teams, and the reviewing service, which form key elements of the remodelled Children and Families sector.

1.8 Managers and staff in the county's residential units have been thoroughly briefed on the strategy and are keen to pursue developments which will improve services for looked after children and young people in residential care, as well as opening up professional and career opportunities, through the accordant raising of the profile of residential care.

Developments have been enhanced by formally accredited training for residential staff and managers, via the National Vocational Qualification (NVQ) programme, part of the Department's commitment to the National Training Strategy (NTS).

A recruitment programme has been prepared, the success of which it is expected will be increased by the recent regrading of the Unit Manager posts.

1.9 The LAC Best Value Review highlighted amongst its findings the relative unit costs of its in-house and independent residential care, and the range of variables which influence cost-effectiveness.

The proposed implementation plan is designed to deliver better services at more competitive unit costs than those derived from the current configuration when based on residential units' actual expenditure, over the last two financial years.

1.10 The sector is now well placed to pursue these developments as part of the coordinated programme of change aimed at securing improved outcomes for children and young people.

2. Background

2.1 The outline structure for delivering the residential strategy from April 2002 was approved by Children's Services Sub-Committee in April 2000. Since that time additional work has been carried out to refine the strategy and identify more fully the resource requirements.

2.2 The residential strategy is the third component to be delivered of the overall Looked After Children Strategy, the adolescent support service and foster care strategy being implemented first. The reason for this was ultimately to focus on a family support strategy for those 12+, diverting them from being looked after (12+ taking up 70% of the LAC resources) and to increase the pool of foster carers by improved support and recruitment strategies. The aim of this is to ensure that those placed in residential care were there as first choice, not as a last resort because there were no foster placements within County resources. It is recognised that some young people are best placed in residential settings, due to complex needs, usually around multiple placement breakdowns. The longer term aim, however is to reduce the proportion of LAC in residential care.

2.3 A major piece of research which informed the residential strategy was the audit carried out by Mike Sym (seconded to the Department of Health) in 1997. The audit highlighted shortfalls of services to children looked after in residential homes at the time and in particular commented upon `over capacity', both in relation to the size of the units and occupancy levels, lack of choice, a 'volatile cocktail of needs' and excessive lengths of stay in placement.

2.4 Additional research carried out by officers in 1999 reported further concerns arising from very high average occupancy levels (97%) and reports from staff and unit managers that levels of challenging behaviour were rising, the safe management of violent incidents, often fuelled by drug and alcohol misuse, was becoming increasingly difficult. Some children were felt to be inappropriately placed for group living as their behaviour could not be sufficiently contained at a level which did not adversely impact upon other resident children and staff. Without exception managers and staff reported their concerns that eight children living together was excessive. This is fully supported by 'Research in Practice' where six is considered the optimum number (see Section 3 - National Care Standards).

3 National Care Standards

3.1 In April of this year the regulation and inspection of children's homes was removed from local authority control, to be carried out by the newly created National Care Standards Commission (NCSC), an independent body.

3.2 Revised Children's Homes Regulations and National Minimum Standards form the basis upon which local authority children's homes have been registered and will subsequently be inspected. Applications for registration were submitted to the NCSC by 31^st March.

3.3 The regulations and national standards have been developed so as to ensure that there are in place the types of safeguards in children's homes that were recommended by the Utting Report and the Waterhouse Report. The key beneficiaries will be the children and young people in residential care with associated benefits for our residential workforce. The regulations and standards will address the day-to-day care children and young people receive, covering staffing levels and training, health, safety, personal development, environment and support. The key benefits will be significantly to reduce the risks identified, to improve the quality of life, and to promote good outcomes for children and young people in residential care.

3.4 Messages from research into caring for children away from home have highlighted those factors which promote high quality provision in residential settings. Findings suggest that Social Services Departments should aim to keep their homes as small as possible and in various surveys carried out, six has been highlighted as the appropriate number of children or young people to be accommodated in any one Home.

Amended Children's Homes Regulations, related to the National Standards, have responded to this research by requiring that any home which provides accommodation for more than six children does so by exception and has to satisfy additional and demanding criteria. Early advice from the NCSC into staffing levels in Hampshire's children's homes indicate that the county has acted positively in anticipation of the new Standards and Guidance and thereby remedied previous concerns.

4 The Proposed Model for Hampshire

4.1 The strategy has been based on significant research into residential care, both nationally and locally. Sir William Utting's Safeguards Review highlighted a number of issues about residential care which have been taken into account which, because of preparatory work, have put the department in a good position to meet the National Minimum Standards once the strategy is implemented. The strategy focuses on children's needs by recognising the degree of support that is required to progress plans and move some of the most vulnerable children and young people in society back home or to permanent placements. The strategy aims to prevent some young people moving to high cost non-county residential resources on the basis that with adequate support, their needs can be met locally, in Hampshire.

4.2 There are ten 'mainstream' residential units in Hampshire. These are units that do not provide services for children with physical and learning disabilities. The strategy proposes to refine the Statement of Purpose for these ten units on the basis that it is possible to separate out principal needs and plan services accordingly.

4.3 The model proposes six `Core & Cluster' units. These will be locally based, as is presently the case, but with the capacity to offer residential care as part of a continuum of community based support services. It is designed to prevent the need for children to be looked after through the provision of family support services, but when unavoidable, to ensure the period of accommodation is as short as possible. The cluster of resources are drawn from a variety of sources, including residential workers, family support teams (in line with remodelling), foster carers, health services and professionals offering psychological help and education support services. Where residential care is offered as part of a package of services, it will be short-term and where possible, shared with parents or other primary carers. The Best Value Review of Looked After Children highlighted that parents who had been finding it difficult to cope reported that respite or shared care would have, and in some cases did, prevent their child being looked after continuously or long-term.

4.4 This strategy aims to promote maximum involvement from those with parental responsibility. The research carried out by officers in 1999 identified a lack of parental involvement in relation to a significant number of young people looked after. This was highlighted as a major factor in terms of rehabilitation home and has therefore been prevalent in the design of Core & Cluster services and the number of young people who are likely to require such a service. The service will offer thirty-six residential care places at any given time. Despite each unit looking after no more than six residents at a time, additional young people may be linked to a home `register' who can be looked after when others are with parents. The service requires a cultural change in social care practice, the emphasis being on engaging and maintaining commitment from parents and wider family from the onset with the aim of the plan being rehabilitation home as soon as is possible. This is in line with remodelling and the development of family support teams. Core and Cluster units will be managed within the family support service by District.

4.5 The remaining four units will be classed as longer term 'specialist' units with a focus on therapy for the most vulnerable young people. These young people are likely to be those who have suffered significant harm from a number of causes, including neglect and multiple placement breakdown. They will be young people who have little trust in adults and who would find a small family unit too threatening. The aim of these units would be to prepare young people to move on to foster care or, where possible, back home, within a family or friends setting.

4.6 Discussions are currently underway with Health (Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs)) in order to plan joint working practices and ensure that young people in these units have access to psychological help and where necessary, fast access to psychiatric services.

4.7 With the correct support mechanisms, young people who are currently in non-county residential resources (those with emotional and behavioural needs) could remain in Hampshire resources and have their needs met locally, an option far more conducive with good child care practice and potentially more cost-effective.

4.8 The four specialist units will offer six places each: a total of twenty four places. They will serve as a countywide resource and will be line managed by the one Service Manager in order to ensure services are consistent and entry to the service based on the achievement of a balance of the best option for the individual and on a workable mix of residents. It is difficult to determine the number of long-term beds required as at present a high proportion of young people would have been more appropriately placed in foster care, had placements been available. However, with further development of family support services it is envisaged that twenty-four long-term residential placements for the County should be sufficient. It will also allow for the placement of some young people who would have otherwise moved into a non-county resource.

4.9 All homes will operate on a planned admission basis in recognition that the comings and goings of emergency admissions, particularly those out-of-hours, are very disruptive to all concerned and make the service a dangerous one to work in and manage. Developments in the family placement service aim to address resources for emergency placements.

5 Staffing Profile

5.1 There is considerable variation in the staffing profiles across the ten units at present. Staff teams range from 8 to 11 full time equivalents. The staffing profile does not allow for staff to carry out direct work with young people or to provide additional cover when intensive packages of support are required. It also means that staff cannot cover for colleagues when they are off sick or absent from the workplace. This results in a heavy reliance on agency staff, causing very heavy budget pressures and almost always, is not good quality childcare. A high proportion of agency staff do not have adequate training which presents difficulties, particularly in physical handling strategies, control and restraint. Without this training, departmental staff and young people are vulnerable and risk factors are high.

5.2 Sickness rates in children's residential care are the highest in the County Council. The recent Best Value Review for looked after children concluded that sickness rates in this service averaged at 20 days per person per year compared to 8.4 in Social Services overall and 12 days in the children and families sector generally.

5.3 Staffing levels across the County residential service have been subject to change over the last two years or so in response to differing pressures as perceived by local manager. Statutory inspections have highlighted concerns about staffing levels for a number of years, especially in relation to those units with the lower ratios of staff establishments. For the first time, this strategy has looked at what staffing levels are required in order to provide a safe service, alleviate the need to buy services of agency staff on an unplanned basis (unless in the most exceptional circumstances). It will allow for direct work to be carried out with young people and meet national standards regarding adequate staffing ratios and cover for staff on training courses. Training requirements will increase in line with National Standards and units will have to ensure there is sufficient staffing cover to allow for this.

5.3.1 The nature of residential care requires that all staff are trained in positive handling techniques. In children's residential care, the policy requires that there are in-unit instructors who have significant responsibilities to the staff team in terms of refresher training and re-accreditation. Risks must be minimised by regular updates but this requires large commitment in terms of staff time, all of which requires backfill to cover the staffing of the unit. The proposed staffing establishments takes this into account and should provide sufficient staffing to cover the unit. With present staffing to resident ratios it is becoming increasingly difficult to release staff which has lead to high risk situations rendering the department vulnerable.

5.4 Given all the factors identified, it is necessary that the staffing establishment for Core & Cluster units is uplifted to 13 fte plus a manager, and for Specialist units, 14 fte plus a manager (on the basis of the more challenging behaviours of the residents in these units) - see Appendix 2.

5.5 The proposed staffing budget takes into account a structure which provides for two staff to deputise in the manager's absence and, a range of lower grade staff ranging from very new, inexperienced staff to those more experienced but without a professional qualification. The principle is that there will always be a senior staff member on duty to lead a shift.

5.5.1 The revised staffing budget also includes funding for a 0.5 FTE health Child and Adolescent Mental Health Service (CAMHS) professional in each of the specialist units. It is intended that matched funding from the Health sector be secured in order to offer support to residential staff, and to secure timely and appropriate access for Hampshire's looked after children for psychological assessment and treatment services. Negotiations are underway with PCTs and the SHA as part of the CAMHS strategy.

5.6 The role of the unit Manager as always is crucial and accountability increases with the implementation of the National Standards. There has to be sufficient staffing to allow the manager to take the lead on development, ensuring that standards are met without having to cover shifts routinely, which is currently the case.

5.7 There are also variances in relation to ancillary staff across the ten units. Cooks hours, cleaners and clerical support hours vary considerably. Again, as part of the strategy, the needs of the service have determined the number of hours required in relation to each role. Clerical support is crucial in order to prevent inaccuracies in management information which, for example, has historically misinformed occupancy levels.

5.8 For the first time, there will be a standardised staffing profile for each service, based on what is required to deliver that service. The profile will be consistent for each Core & Cluster unit, and consistent for each Specialist units.

6. Action Plan

(See flow chart at Appendix One)

6.1 The action plan has implications for both revenue and capital resources.

6.2 It is dependent for its successful realisation upon complementary action in foster care, adoption, `family and friends' care, and community based support services.

Needed also is the ability to target redeployment of opportunistic savings arising from the temporary disclosure of the two homes - Cambridge Road, Aldershot and Woodend, Andover which have had to be closed during 2001/02.

6.3 Priority needs to be given to the newly designated county specialist units, both in terms of responding to the most needy children and young people, and in order to reduce the spend on any new out of county (NCP) placements.

6.4 Residential care capacity provided by the two `mothballed' units is still needed; consequently it would not be possible to recycle funds on a permanent basis from the closure of either unit. In terms of location and need, both units are appropriately situated having regard to such factors as deprivation indicators and historical demand. Of additional significance is the fact that increasing pressure on non-county placement expenditure will be difficult to resist.

6.5 Revenue

6.5.1 Savings to fund implementation are identified from two sources: temporary closure and NCPs

6.5.2 In terms of the funds which can be recycled in order to support the first phase, some £333,000 is realisable during the current financial year, from a combination of staff establishments and general running costs savings. This estimate is based on the most recent information about the periods that Cambridge Road and Woodend will remain out of commission during the current financial year pending refurbishment, which stand at six months and twelve months respectively. The savings identified are net of costs, and have taken account of those things which have to continue to be set against the units' budgets, e.g. for some staff (i.e. DIPSW training) and for security arrangements. It has been possible to relocate permanent staff into other units or teams, and in most instances therefore the costs have been defrayed.

6.5.3 The implementation of the strategy in respect of the four county specialist residential units will cost £401,100 in a full year. Assuming an implementation launch in September 2002 additional costs for the new service will be £231,000 (Appendix 3).

6.5.4 The new specialist county homes can thus be set up and best use of the additional funds released of approximately £100,000 in the current financial year, determined (i.e. £333,000 savings less £231,000 set-up costs). Opportunities for use of savings will include start-up funding of the six new care and cluster units and pump priming and social services components of the CAMHS (Child and Adolescent Mental Health Services) support needed for the four specialist units.

6.5.5 A task force drawn from the key new services of the restructured children and families sector will follow up the earlier assessments of those residents in the four specialist units in order to identify and progress alternative more appropriate care placements, This will help to prepare the ground in terms of releasing capacity, which in part can be used for appropriate new placements, particularly for those in non-county placements, which will also be the responsibility of the task force.

6.5.6 A target of a minimum of five placements to be taken out of the current non-county placement commitment is achievable and would yield reductions in expenditure of between £200,000 and £400,000 in a full year. The actual sum would depend partly upon the type of current placement and the level of shared funding between social services, education and health. This reduction in expenditure would form part of the sector's commitment to its target reduction in NCP expenditure in 2002/03 budget settlement.

6.5.7 For some of the children and young people in Hampshire's own residential units (and even some NCPs) family placement will be the preferred choice. Typically savings on HCC residential care unit costs achieved by the use of independent sector foster care will be in the order of fifty per cent. Savings will be fed into the strategy.

6.5.8 Agency and other additional staff costs will be significantly reduced by the revised unit budgets which provide for permanent levels of staffing in excess of those previously. The historical agency staffing overspend (in the region of £600k pa) will be much reduced and to that extent will reduce pressure on the children and families budget overall, which in turn will aid achievement of the strategy. Necessary arrangements to cover unavoidable and unpredictable absences will build upon the recommendations of the work on peripatetic staff cover regarding sickness, absence and vacancies by the County Professional Services Consultancy tabled at Department Management Team (DMT) on 30^th May. DMT has recommended a pilot scheme, which will include residential child care staff and for which pump priming from the Corporate Pay & Benefit Group will be sought.

6.6 Capital

6.6.1 Negotiations about timescales and costs of re-commissioning the two closed residential units have been undertaken with Property, Business and Regulatory Services.

Cambridge Road, Aldershot - Agreement has been reached whereby the necessary building works and refurbishment can proceed to be funded by PBR at an estimated cost of £20,000. A projected date of 1 October 2002 has been set for reopening, during which period the recruitment and induction of a new Unit Manager will be carried out.

Woodend, Andover - The position regarding this unit is more problematic in that neither Social Services nor PBR are currently able to identify the necessary funding from within their respective capital budgets. The scale, and therefore costs of the works required to bring back into commission Woodend are of a markedly higher order than Cambridge Road, being estimated at approximately £150,000. It is therefore projected that this unit will remain out of commission in practical terms for the rest of this financial year.

It is proposed that PBR be commissioned to carry out a site and property search in the Andover area, to include Health and District Council options, as well as County Council estate, in order to establish whether there is a more cost effective option than the refurbishment of the Woodend property; also to establish whether there might be alternative uses for Woodend.

6.6 Whilst this action plan will achieve initial implementation it will be necessary to continue work in order to establish secure funding in subsequent financial years.

6.7 The degree of success of this first phase of implementation of the residential strategy will need to be evaluated, in order to inform subsequent phases.

7. Recommendations

It is recommended that the Executive Member:

7.1 Authorises implementation of the first phase of the strategy as set out in the Action Plan in Section 6.

7.2 Supports further detailed costings and viability work.

7.3 Receives a further report on the evaluation of the first phase.

7.4 Receives a report on plans for the second phase.

7.5 Refers for further determination the outstanding matter of capital funding regarding the refurbishment of Woodend, Andover.

Section 100 D - Local Government Act 1972 - Background Documents

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

NB the list excludes:

1. Published works

2. Documents which disclose exempt or confidential information as defined in the Act