Archived decisions

HAMPSHIRE COUNTY COUNCIL

1) Purpose of Report

1.1. In late 2007 the Select Committee identified short breaks for children with a disability as an priority for scrutiny and a workshop to explore the issues was held on the 10^th March 2008. The key messages from the workshop were summarised in a report to members on the 2^nd July 2008.

1.2. At the time of the workshop the Aiming High for Disabled Children development programme was commencing and subsequently a number of reports have been made to the Executive Member for Children and Families identifying the results of consultation, a commissioning strategy, authority to tender for some services and most recently (on the 12^th March 2009) proposals to commence consultation on revised eligibility criteria for access to specialist services.

1.3. This report updates Members of the Select Committee on progress in addressing issues raised in the workshop held on the 10^th March 2008. A further workshop is planned to be held on the 12^th May 2009.

2) Context

2.1. The key lines of enquiry for the select Committee's work were identified in three areas as follows.

· Developing the role of the Key Worker

· Strengthening early intervention opportunities

· Improving access to services

2.2. The workshop in March 208 was timely, in supporting the launch of the County Council's consultation process to explore the best way to approach the service development programme set out in Government guidance on Aiming High for Disabled Children. A number of consultation events were held through out 2008 and the key messages were very similar to the views expressed at the Select Committee workshop.

2.3. Consultation on the Aiming High and Transition programme has included the following opportunities.

· countywide consultation events and meetings between March and September 2008 with parent/carers groups, young people and other agencies

· parents meeting with Christine Lenehan (Council for Disabled Children) to consider the consultation outcomes

· participation event in Nov 2008 to consider developing a Parent forum in Hampshire- supported by Calderdale Parents Forum.

· training event for parents on setting up a Hampshire forum

· Transition consultation undertaken by disabled young researchers late 2008 and into 2009

2.4. As a result of consultation a commissioning strategy has been adopted summarised as follows:-

· Support to parents and carers by providing information and participation networks, including better information to assist families in accessing universal services.

· A targeted short break `offer' for children and young people attending special schools, including evening, week end and holiday short break care schemes accessed without further needs assessment

· An offer to fund the additional care supports those claiming higher rate care and or mobility DLA may need in accessing a short break in a universal service, also accessed without a further needs assessment and to include evening, week end and holiday short break care schemes

· Improvements in specialist services for those with the most complex or severe needs to provide better opportunities for short breaks. These services include care supports within the home, in overnight short break services, access to family link carers and include the use of Direct Payments in appropriate circumstances

2.5. Tendering has now commenced in relation to the information and participation service and for services to those attending special schools. Discussions are also under way with sports partnerships, community colleges, extended services coordinators, early years services and youth services in relation to the service offer for those claiming higher rate care and or mobility DLA. It is intended that some new services will begin to be available from July 2009, with full capacity developed during 2010/11.

2.6. The `offer' of access to short break services for those attending special school and claiming higher rate DLA can be taken up without a needs assessment and it is proposed that access to specialist services for those with complex and severe needs will continue to be via a needs assessment, often jointly conducted with health professionals and in the context of special educational needs assessments.

2.7. The Executive Member for Children and Families will consider on the 12^th March 2009 proposals to commence consultation on revised eligibility criteria which seek to clarify the definitions of severe and complex needs and the factors managers will take into account in determining the nature and level of service that will meet assessed need, within available resources.

2.8. Consultation will also include proposals to include a broader range of services which can be supported by a direct payment.

3) Developing the role of the key worker and the lead professional

3.1. Following the earlier Select Committee workshop a number of pilots have been established to develop best practice in interagency working, in particular to develop the role of the lead professional. This work relates to children and young people with severe disabilities supported in specialist services and also to those with more moderate disabilities, often supported in universal services.

3.2. The pilots in 2 special schools, a specialist social work team and in a services to youth team (former Connexions service) are developing well and best practice guidance will be developed to support further implementation and to guide future training. Future pilots are intended in health care settings.

3.3. The development of a large network of Children's Centres and Locality Teams using the Common Assessment Framework has also provided an opportunity to enhance the role of lead professional and key workers.

3.4. Of the 1130 completed CAFs in the last year, over 10% (130)have been in relation to children with a disability.

3.5. Additionally work underway, supported by the Transitions Board, to improve the experience of transition to adult services is also focussing on the role of the lead professional and interagency planning to ensure continuity of service, and in particular to ensure schools and colleges are supported in their work with young people in transition.

4) Strengthening early intervention opportunities

4.1. The issue of definition of disability and equity of access to services was highlighted in the earlier workshop and confirmed in consultation related to Aiming High.

4.2. A joint needs assessment has been undertaken with the PCT and there is now a far better appreciation of the number of children with a disability within Hampshire. This analysis has supported the development of the commissioning strategy which will offer a short break service to an additional 3600 children and young people, many of whom will not be accessing specialist services. Over and above this additional number of children and young people around 1000 children with severe disabilities who will continue to access specialist services following a needs assessment.

4.3. The pattern of needs is shown below.

· 308,000 children and young people in Hampshire

· 36,000 with a special educational need or disability

· 4,150 have a special educational need statement - 2400 attend a special school

· 5,700 receiving DLA

· 900 known to disability teams, of which 300 are using an overnight short break service

· Of the 900 users of specialist services 170 receive a Direct Payment to make their own arrangements for care.

4.4. The following chart shows the current pattern of access to services

5) Improving access to services

5.1. The commissioning strategy now adopted to develop services within the Aiming High programme directly addresses some of the concerns expressed to members of the Select Committee in relation to access to services.

5.2. These concerns included equity of access, lack of clarity of eligibility criteria and a threshold for access to services that excluded many with significant but not severe or complex disabilities.

5.3. The targeted offer for those attending a special school will enable access to a range of short break services after school, at week ends and in school holidays. In some special schools these opportunities have been developing within the extended services programme and the availability of Aiming High funds will ensure quicker developments with more consistent funding to meet the additional care needs of this group of children and young people. 2400 children and young people attend 26 special schools in Hampshire and a small number may be within the group of 900 young people accessing specialist short break services, however many children attending special schools do not currently access any form of short break.

5.4. Similarly the offer to fund the additional care support needs of those claiming higher rate (care and mobility) Disabled Living Allowances (DLA) in order that they can access universal services will reach around 1300 children and young people. It is unlikely many of these would meet the eligibility criteria for access to specialist services and whilst there is some very good provision available to disabled children in some universal services, such as youth clubs and sports provision, the availability of aiming High funds will allow for faster service developments with greater consistency of access in a broader range of settings.

5.5. Currently in the order of 900 children and young people with severe and complex disabilities access specialist service following a needs assessment. Government guidance confirms a requirement to ensure that the criteria used to assess eligibility for a service are clear and support a focus of service to those with the most complex disabilities.

5.6. The revised criteria to be considered by the Executive Member on the 12^th March have been developed with the following principles in mind.

· That the criteria for defining those complex or severe needs that could be met by access to specialist services are easy to understand and support an element of self assessment to allow parents to consider whether to seek a full needs assessment

· The criteria include consideration of the needs of carers

· That the factors managers take into account when considering the level of service necessary to meet assessed needs, within available resources, are clear and support accountability

· That the definitions of need are compatible with the emerging revised Continuing Care guidance, which guide how the County Council and the PCT consider sharing the cost of health and social care services in some circumstances

· That arrangements are available to appeal and review the application of the criteria in individual situations

5.7. The priority for funding new service developments in the first year (2009/10) is geared towards those attending special schools and claiming higher rate DLA, in effect largely those not currently accessing short break services currently.

5.8. Consultation on the revised eligibility criteria will commence in March and be concluded in June 2009 with a further report to the Executive Member in July 2009. It is envisaged that revised eligibility criteria could be in place from October 2009 and that any agreed changes to the Direct Payment arrangements could be in place from April 2010.

5.9. In the second year of the Aiming High Grant funds have been set a side to support an expansion of specialist services and of Direct Payments.

6) Conclusions

6.1. The earlier work of the Select Committee in drawing together stakeholders to explore key issues has been supported by later consultation as to the best way to develop services with the Aiming High programme.

6.2. Parallel work on transition, the role of the lead professional and the CAF has also addressed many of the issues raised in the earlier workshop and a number of interagency work programmes are in place

6.3. The intention within the Aiming High programme to develop a better supported network of information and participation opportunities for parents and carers will also ensure consistent opportunities for engagement in the future.

6.4. The Government has announced that a new national performance Indicator - NI54 - will be developed for application in 2009/10. It is known this will include a broad survey of the perception of parents and carers about services. The indicator is likely to include measures to demonstrate that additional short break services have been put in place.

6.5. The workshop in March 2008 identified that access to community play facilities was of concern to parents and capital from the Aiming High grant has been made available alongside existing Play Builder grants to ensure that there is a better network of open play spaces suitable to children with a broad range of disabilities.

6.6. The March 2008 workshop also raised concerns for the joint engagement with the PCT and the relationship between health and social care services. At that time no announcement about future funding to the PCT had been made available.

6.7. More recently the Government has confirmed that Nationally £340 m has been included with the base funding for PCTs in the two years from 2009/10 in the broader context of developing Child Health Strategies. The Government announcement specifically refers to anticipated improvements in short break services and confirms that the additional funds are not ring fenced.

6.8. A report has been made to the PCT Board identifying the County Council's approach to aiming high and a number of priorities have been identified for NHS led developments as the operating framework for the PCT in future years is developed. These include:-

· Review of a number of existing joint overnight short break services to explore the potential for service developments

· Support to the joint aids and equipment store

· Continuing Care and Palliative Care services

· Review of paediatric therapies (initial review undertaken)

6.9 The further workshop intended by the Select Committee on the 12^th May will provide an opportunity to share the progress so far in addressing issues raised in March 2008 and also will be a further opportunity to seek views on revised service eligibility criteria.