1 Summary

1.1 In March 2004 Members of this Committee received a report which detailed the work of a sub-group of the Policy Review Committee which considered children's residential care provided by Hampshire County Council. This is the first area of service delivery regarding children looked after, to be scrutinised by Members as part of the new arrangements.

1.2 The March report detailed the membership of this group, the terms of reference and background information into the work undertaken at that stage.

1.3 Members agreed, in line with the recommendations, to extend the period of time that was dedicated to this work in order for the sub-group to examine in more depth the issues raised.

1.4 This report provides further details on the issues affecting the way in which residential services for children and young people are structured and most importantly, describes how key factors around service delivery are addressed, in order to ensure this part of the service provides good outcomes for children and young people.

1.5 Corporate Strategy

This item is relevant to three of the aims within the Corporate Strategy:

Aim 1 - Maximising Life Opportunities

Aim 5 - Improving Services

Aim 6 - Developing Councillors and Staff

1.6 Race Relations (Amendment) Act

The Government Regulations and Inspection arrangements specify requirement concerning racial (and other forms of) discrimination. Compliance with the Act in terms of carrying out an Impact Assessment is confirmed, forming part of the programme of work relating to the Department's Service Plans.

2 Background

2.1 Hampshire County Council has continued to invest in children's residential services in recognition that it is a crucial part of the overall continuum of services for children and families. It is accepted that there are always likely to be a minority group of children and young people who cannot cope with family life, either within their own or substitute family setting, because for example, of issues around severe abuse and neglect, multiple placement breakdown which result in attachment difficulties.

2.2 Members will recall from the March report that the structure for delivering residential services, as defined in the strategy, separates out short and long term care requirements.

2.2.1 Long term units (formerly known as Specialist Units) are defined as a County resource (supported by one line manager) and provide a period of settled residential care for those with longer term needs best met in a group care environment.

2.2.2 Short term units (formerly known as Core and Cluster units) are defined as providing a residential resource, as part of a community based package in order to prevent the child leaving his/her home except for planned periods of short term and ideally part time residential care. These units are an integral part of the family support service, line managed by district family support service managers.

2.3 The successful delivery of residential services depends upon a number of complementary developments in other areas of the Children and Families sector. Most young people who access residential services are those with whom the department is already involved. A whole systems approach focussing on joint planning is essential in order that as many children and young people return to live with their families as possible. The overarching aim of the residential service is to ensure those who receive services do so because it has been identified as the most appropriate resource to meet their needs.

2.4 The residential strategy has provided clarity about the primary function of the residential units in order that a sophisticated matching of needs and resources can take place. Adequate staffing levels and clarity about the services a home sets out to provide (published within every unit's Statement of Purpose) are fundamental factors identified within National Care Standards related to the provision of safe care. The development of the residential strategy, therefore, has enabled the department to meet these national standards. As part of the remodelling of children's services in 2002, there has been significant investment into the children's residential service, particularly in relation to staffing.

2.5 As stated in paragraph 2.3 it is imperative that residential services are closely aligned to other services, i.e. family placement, permanence and family support services in order to work jointly and ensure those in residential care are in the best placement to meet their needs. Children and young people may move into residential care from their home environment, from a foster care placement or from another residential service, so joint working with colleagues within Social Services and with colleagues from other agencies is crucial.

2.6 Developments in other parts of children and families service provision, e.g. the expansion of the family group conference service (FGCs) kinship care and family mentoring all impact on other parts of the service and Members of this sub-group have received briefings on each aspect of these developments in order to gain insight into the overall context for the delivery of services and how these impact upon residential services.

2.7 In March, Members highlighted specific aspects of service provision that were felt to be particularly conducive to good outcomes for children and young people and identified the need for thorough investigation within each aspect. The key areas identified were in relation to staffing, including training and development, outcomes in relation to health and education for those in residential care and appropriateness of placement for some young people.

3 Staffing

3.1 Members have been concerned to ensure the residential workforce comprises of appropriately skilled and experienced workers. Over the last six months, further exploration has taken place, whereby Members have looked in more depth at key staffing issues.

3.2 Recruitment

3.2.1 The residential sector has to respond to the needs of children and young people who present the greatest challenges and risks. Staff structures and ratios of staff to young people, therefore, have to be calculated carefully in order to ensure the service is delivered competently and safely. In order to meet National Care Standards, significant investment has been made into the residential sector in 2002/3 and 2003/4 to increase staffing levels and provide a structure for staffing that welcomes new recruits and supports the professional development of staff into more senior roles.

3.2.2 A number of national and local recruitment campaigns have taken place to increase staffing levels in line with new staffing profiles, with some success. In March a vacancy level of 9.5% was reported for the residential sector. Of this, approximately one third were senior vacancies (i.e. qualified social workers, including Registered Managers). As is the case in fieldwork, qualified social workers are very difficult to recruit and with the exception of two senior posts currently filled within the residential sector, all those in posts at a senior level have been promoted within the department.

3.2.3 Two recent campaigns have resulted in a number of successful appointments, including at a senior level. The current vacancy rate within the sector currently stands at 13%, with just over a quarter of the vacant posts being at a senior level. The management profile for each unit comprises of two senior posts (assistant and deputy managers), in addition to the Registered Manager. All units now have at least two of the three senior posts filled which is an overall improvement.

3.2.4 Recruitment continues to be a challenge, which reflects the national position. Recent analysis has demonstrated that most senior appointments have been filled internally, so the next campaign which is currently being prepared, is taking into account these findings. Whilst internal growth and professional development of staff is a strength of the department, strategies for attracting external candidates require further examination. Additional market supplements to those already in place for qualified social workers have been put in place and it is hoped this will have a positive impact for the next residential recruitment campaign.

3.2.5 It needs to be recognised that in some instances a young person's needs are so challenging and the risks presented so high, that staffing additional to establishment will need to be put in place. In most instances this requires short term employment of staff through an approved staffing agency in order to increase the support that may be required for a specific young person and maintain appropriate staffing levels for the remainder of the resident group.

3.2.6 In the financial year 2003/2004 expenditure on agency staff was in the order of £544k. There is a general pattern in Hampshire's residential units of spend on agency staffing to cover vacancies, sickness and exceptional needs. A specific example of one young person's needs around lack of personal safety, self-harming behaviour and ongoing assaults on staff required additional staffing in order to reduce risks. The agency costs for this care package alone accounted for over one-third of the total agency spend within the residential sector for the year. The remaining costs related to additional support packages for young people with high support needs and cover for staff vacancies and sickness across the residential sector.

3.2.7 Despite the fact that it is particularly difficult to recruit senior staff, there is no shortage of applications from people with limited experience for the more junior posts. Given the department's positive track record for staff development it would, therefore, be appropriate to determine the cost effectiveness of a pool of peripatetic staff managed by the residential sector. The aim would be to reduce agency spend and focus upon development of less experienced but motivated staff to work across units in a flexible pattern, where need is greatest.

3.3 Development and Training

3.3.1 One of Hampshire Social Services specific strengths is the support provided to residential staff to achieve vocational and professional qualifications. There is a structure in place for all staff to progress, ranging from new, inexperienced residential workers to more senior residential social workers whose needs are for management training.

3.3.2 National Standards require that the majority of unqualified, residential staff have an NVQ 3 in Caring for Children and Young People, and managers an NVQ 4 in Management. The Department is on target to achieve this standard and is exceeding the standard by now opening up places on the NVQ 4 in Management to deputies in children's residential units. At least five deputy managers are due to begin this training in January 2005.

4 Education

4.1 Education of children looked after, specifically those in residential care, was highlighted as an issue that members of this sub-group wanted to investigate further. Children and young people in residential units, in common with children looked after, generally are at risk of having their education disrupted and it is for this reason that one of the Government's objectives for children's social services is to ensure that children looked after gain maximum life chance benefits from educational opportunities. A high proportion of young people in Hampshire's residential units are not accessing a full time education.

4.2 Social Services and Corporate Team in the Education Department (responsible for promoting the education of children looked after) have been proactive in developing strategies to address this issue and there are a number of joint areas of work currently being carried out to ensure that young people are accessing appropriate education. The examples described below pave the way for opportunities that the Children Bill has signalled for improved joint work between Social Services, the Education Department and schools.

4.3 Examples of good practice include:

4.3.1 A protocol between the Education Welfare Officer (EWO) Service and children's residential units which provides an EWO link person to each unit who will specifically work alongside those young people at risk of exclusion or who are not accessing their school place.

4.3.2 A new process which will comprise of immediate notifications to the Corporate Team of new admissions to the residential units, by Registered Managers. This will ensure the Corporate Team always has an up to date register of all residents in the sector.

4.3.3 Links with the Youth Service to support those young people in residential care who are not accessing full-time education (see example identified in paragraph 6.3.2).

4.3.4 Preliminary links with school governors to raise awareness of the issues facing children looked after within governor training services.

4.4 Current statistics regarding education of those in residential units show that 70% have a mainstream/special school placement. The remaining 30% access education other than at school (EOTAS) or are awaiting a placement.

4.5 The Corporate Team and Social Services are working together to formulate strategies to address issues for those awaiting school placements. Current options that are being explored are an admissions protocol which protects school places for children looked after and joint work between EOTAS, the Corporate Team and Social Services representatives to provide first day provision. In addition, partnerships with key local stakeholders are being developed to clearly identify and gain commitment of partners with protocols to support young people.

4.6 In addition to the areas of work highlighted, a pilot project, with involvement from the education department (led by EOTAS), local schools and Social Services, is underway in the north of the county to address how the educational needs of young people are met , the aim being to ensure they access a full-time place as soon as possible.

5 Health

5.1 In April 2002, amended Children Act Regulations revised arrangements for promoting the health of children looked after. The amendments contain additional requirements for local authorities, the Strategic Health Authority and Primary Care Trusts (PCTs) to put in place health assessments and health care plans (with defined reviewing arrangements) that focus broadly on holistic health needs, i.e. mental health, sexual health, diet, exercise, dentistry etc., rather than the previous medical model of delivery which responded to the detection of ill health.

5.2 As part of the Government's recent developments regarding the scrutiny role to be played by local authorities in terms of local health delivery, Hampshire County Council's Health Review Committee (HRC) have included the Health of children Looked After as one of its first reviews, alongside health of school age children.

5.3 Health promotion of children looked after is therefore high on the department's agenda as it is a key aspect of it's corporate obligations. Social Services and the PCTs across Hampshire have focussed on joint work to improve healthcare and services around health promotion for this group of children and young people, in response to the recommendations contained within the HRC report and the revised legislation.

5.4 Teenagers form the majority of those placed in Hampshire's residential homes and in common with this age group, generally tend to be more resistant to monitoring or `parental intervention' as far as ongoing health checks and health care planning is concerned. However, there are some examples of very good joint working practices whereby specific links have been made with residential units and key leads within the PCTs to raise awareness for the young people around their healthcare and lifestyles. In some cases, young people who have refused intervention for some time have had the opportunity to discuss their health needs within their unit, confidentially with a named or designated nurse

5.5 Developments to improve practice are ongoing and the department's performance in relation to the national indicator for healthcare is improving. The national indicator is as follows:-

`Of children looked after for at least 12 months, the average percentage with a) dental check in the year; b) annual health check in the year.'

The department's current performance has now reached just under 85% and has significantly improved over the past two years. This position is reflected equally in the residential sector. The remaining 15% of those young people in the residential sector relate mainly to those who are refusing dental and health intervention and as stated in paragraph 5.4, there are strategies in place to address how we meet the needs of this group.

6. Responding to Needs

6.1 Members have expressed some concern regarding a lack of assessment of some young people's needs prior to placement which has, on occasions, resulted in an inappropriate placement.

6.2 The long-term units have now been operating within this primary function for two and a half years and all those in placement are there appropriately. There is a referral process which supports planned admissions and ensures that residential care is the most appropriate resource to meet identified needs. The service has met the needs of a number of young people with complex needs who may otherwise have moved into a non-County resource.

6.3 The short-term units have been in operation for 18 months. The revised function has been a significant change and has provided the department with challenges regarding implementation. The provision of accommodation as a preventative measure is a culture change in itself. It also poses a risk of appearing to increase the population of children looked after because a unit with six beds could have a greater number of young people on their register at any one time. Service users have to be classed as looked after if any episode of accommodation exceeds 24 hours. An additional challenge is the transition from one primary function to another whilst continuing to operate, the result being a group of residents with a variety of long and short-terms needs during the transition period.

6.3.1 It is predicted over time, that the increase in the children looked after population will decrease as the department is able to support more families to remain together, at an earlier stage and, in turn, reduce the number of referrals from families experiencing breakdown.

6.3.2 An opportunity arose with one short-term unit in the County whereby it became possible to cease new admissions to the unit until all those currently resident had moved on. This provided a fixed period of time whereby the unit had no residents and was able to focus upon team training, team building, development of a communications strategy with fieldwork teams and joint identification of need for those young people with whom the department were involved and where there was a high risk of family breakdown. Most young people now receiving a service at this unit have a shared care programme, with parents retaining overall responsibility. The likelihood of full rehabilitation therefore is much higher than for those young people where contact is severed. There has been good integrated practice with a member of staff from the EOTAS service being posted out to the local youth service day centre to meet a specific young person's needs from the residential unit. The unit in question (a six bedded unit) currently has twelve families receiving a service which includes some accommodation.

6.3.3 The development of the short-term units continues. The example described in paragraph 6.3.2 shows the possibilities. In the interim, strategies to prevent inappropriate and sometimes unplanned placements into these units continue to be developed, which includes developing systems for referral and assessment similar to those in the long-term units.

7 Comparison with Other Local Authorities

7.1 Contact has been made with a number of other local authorities, both within Hampshire's `family group' of authorities and some which border Hampshire. The structure for delivery of services nationally appears to be very similar to that in Hampshire, with primary functions separating out specific age ranges and short and long-term care. The focus for all local authorities contacted was to move towards planned admissions for all children and young people who enter residential care. Some operated a system with a number of units having one emergency bed, in recognition that occasionally a young person can `appear from nowhere' and there is no information available to determine an appropriate response. Others focussed the service specifically on a planned admission process. All authorities recognised the importance of planned admissions, but felt there was still some way to go to fully achieve this.

7.2 One authority did have a Crisis Intervention Unit in order to respond to emergencies and assess needs before moving anyone into another resource. This particular model has been discussed at some length within the sub-group but a crucial factor which mitigates against such a structure is that a unit such as this can very easily become blocked if young people cannot be moved on very quickly. Hampshire has operated a system like this in the past and moved away from the structure for this very reason. Feedback from the other authority concerned stated that this was a real issue that they were struggling to tackle. Most authorities contacted struggled to move children and young people on, particularly those who required a foster placement.

7.3 Another authority had put in place a written referral process for all their residential units to avoid unplanned admissions. Referrals were examined by the line manager responsible for the residential units to identify appropriateness of the referral, liaise with other managers accordingly and promote planned moves into the residential sector. Feedback was very positive.

7.4 A factor which applies to all authorities except Hampshire was that residential services were all centrally line managed and this was cited as a crucial factor in the achievement of appropriate and planned placements. In Hampshire currently, the long-term units are line managed centrally.

8 Other Developments

8.1 Through liaison with other authorities, Hampshire has recently been working closely with another shire county to examine their approach to reduce offending rates of children looked after. Offending rates are closely scrutinised by central government and performance of councils is monitored as part of the performance assessment system. The national indicator is as follows:

`The percentage of children looked after aged 10+ receiving a final warning/caution or conviction in the year'

8.2 In respect of the population of children looked after who offend in Hampshire, we know that those in residential care are over-represented. This is not a unique feature, but in the county referred to, offending rates of children looked after have reduced by half due to the implementation of a Restorative Justice model of practice in all their residential units. The model promotes a way of working whereby parties with a stake in a specific offence resolve collectively how to deal with the aftermath of the offence and its implications for the future.

8.3 Hampshire Social Services, in partnership with the Wessex Youth Offending Team, is currently formulating a strategy to reduce offending of children looked after. Within this, a range of methods are being considered to implement a restorative justice model of practice. This includes examining whether the Local Public Service Agreement (LPSA2) may provide an opportunity for implementation, the main priority being `Helping People Feel Safe'. The overarching aims for the residential sector are to reduce police involvement and subsequently reduce offending rates.

9 Conclusions

9.1 Members of this sub-group welcome the developments that have taken place regarding the structure for delivering residential services.

9.2 There are challenges to be addressed to ensure all short-term units are operating in line with their primary function, but members welcome earlier involvement with families in need, from the residential sector. The progress of one unit described in 6.3.2 demonstrates the model can be effective and a further opportunity to develop these services further will present when another residential unit, which has been temporarily closed, re-opens in the new year.

9.3 It is likely that the population of children looked after, as measured according to Government requirements, may increase over the forthcoming year as the department supports more families from the short term residential units. As described in paragraph 6.3, due to the shared care nature of some care plans, more young people will be receiving accommodation as part of the support offered and this, in turn, will increase the population of children looked after for a period of time. The longer term benefits however, will be fewer family breakdowns and a reduced population of young people looked after, aged 12 years and over.

9.4 Following the research gained from other authorities, it would be worth reviewing the line management structure and consider centralising the line management of the short-term units in line with other local authority structures.

9.5 There are numerous examples of joint working both within the department and with external agencies. Members of this sub-group welcome this approach and anticipate continued developments, particularly in the area of education of children looked after, of overall health needs and access to services through the County Council's Recreation and Heritage Department . The Children Bill, when enacted, will serve to further encourage this approach.

9.6 Members of the sub-group welcome research into the possible use of peripatetic staff.

Recommendations

1. That Members of the Policy Review Committee welcome the development work undertaken thus far.

2. That the model of shared care building on family strength illustrated in paragraph 6.3.2 be further developed to include other children's residential units.

3. That the following proposals are made to the Executive Member for Social Care;

a. Development work continues regarding the assessment and referral process for children and young people who require a residential service;

b. Family group conferences become the normal method of decision making when a child is to be looked after in the residential setting;

c. Further work is carried out to determine whether line management structures for the short-term residential units should be centralised, as part of any developments and opportunities that the Children Bill presents.

Section 100D - 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.

N.B. the list excludes:

1. Published works

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

None

8.4