Archived decisions

Agenda Item 7

HAMPSHIRE COUNTY COUNCIL

Report

1. Purpose of Report

1.1 The attached scoping document sets out the context for a potential joint review of therapy service provision to children with special educational needs. The review will seek to draw on a previous review of therapy provision as well as an independent review undertaken in 2008. The work proposed will aim to clarify how progress can be made and equitable services provided for children across Hampshire.

2. Contextual Information

2.1 This issue has been of concern to Children's Services, Children and their families for considerable period of time. The attention and focus of the Children's and Young People's Select Committee joined with that of the Health Overview and Scrutiny Committee will be particularly welcome if progress on this issue results.

3. Conclusion

3.1 The Committee is requested to give approval to this work being taken forward jointly with the Health Overview and Scrutiny Committee.

IMPACT ASSESSMENTS:

Equalities Impact Assessment:

Impact on Crime and Disorder:

Climate Change:

How does what is being proposed impact on our carbon footprint / energy consumption?

_ How does what is being proposed consider the need to adapt to climate change, and be resilient to its longer term impacts?

Health Overview and Scrutiny Committee

with

Children and Young People's Select Committee

Provision of Therapy Services for Children with Disabilities and Complex Care Needs

Preliminary Scoping for Joint Review

1. Introduction

1.1 Two related areas of work concerning children are currently under consideration by scrutiny committees. One relates to a review originally undertaken by the Health Review Committee in 2005 which looked at `Access to Therapy Services for Children in School and Pre-school'. In this context the Chairman of the Health Overview and Scrutiny Committee (HOSC) agreed at a full council meeting in late 2008, that the Committee would consider reviewing the issue of nursery provision for SEN children.

1.2 The second area of work, is an ongoing `Scrutiny of Short Breaks, Palliative Care and Carer Services for Children with Severe Disabilities'. This was identified as a topic by the Children and Young People's Select Committee in 2007 for their 2008 work programme, and has been ongoing since early that year.

1.3 It has become apparent that the two reviews share some common features, that is to say, they both involve services provided to children with disabilities. It seems reasonable, therefore to consider the possibility that both pieces of work might be better progressed as a joint scrutiny comprising members of both committees. In further support of this is the fact that for both issues, the same Government guidance and policy would apply, and many of the same key stakeholders would be involved.

1.4 The Health Overview and Scrutiny Committee should therefore be requested to take the lead, working jointly with the Children and Young People's Select Committee to undertake a joint review, based on the recommendation at 3.1 This will ensure that the NHS responds fully to any issues raised in relation to this work.

2. Common legislation

2.1 The Government focus on children, their health, care and education is evident in a large number of publications relevant to either one, or both of the work areas above. Examples of the publications include:

· Choice for parents, the best start for children: a ten year strategy for childcare (HM Treasury et al, 2004)

· Disabled Children and Young People and those with Complex Health Needs ( DH & DES, NSF for CYP&MS, Oct 2004)

· The Childcare Act 2006

· Aiming High for Disabled Children, May 07 (Treasury, Dept Education and Skills)

· Better Care: Better Lives, February 08 (Dept of Health/CNO-D-CF&M)

· Healthy lives, brighter futures - The strategy for children and young people's health, February 09 (Department of Health, Department for Children, Schools and Families)

· Every ^disabled Child Matters (campaign by 4 leading organisations working with disabled children and their families) some local authorities have developed their own `charters' to recognise this concern.

Aiming High for Disabled Children

2.2 Of particular significance for both committees is Aiming High for Disabled Children. Firstly, it is directly relevant to the concern shared by both committees about disabled children, for instance it highlights the importance of specialist services, such as:

2.2.1 Short Breaks:

"4.2 Families with disabled children often face particularly high levels of stress which may result in family breakdown. For parents and siblings of disabled children, short breaks reduce stress, allow a rest from caring, provide time to carry out tasks and activities that other parents take for granted and allow more time with other children...

4.4 Furthermore, short breaks can also have a positive impact on disabled children, as they help to tackle social isolation, provide access to leisure activities, friendship networks, and promote development."

2.2.2 Therapy Services:

"...4.13 Therapy Services for disabled children are key to improving their outcomes. Speech and language therapists, occupational therapists, and physiotherapists help to enable and promote communication, improve and manage posture, and maximise mobility. The ability to communicate is fundamental to children's learning and progression..."

2.2.3 The Aiming High document also emphasises the need for `universal services' to be available for all disabled children, this encompasses things such as childcare and access to early years services. Whilst these services often do exist, it is not necessarily the case that local provision is supported by enough appropriate training or equipment to properly include disabled children.

2.2.4 Nursery provision for SEN children

Nursery provision comes within `universal services' ("...Universal services are those services (sometimes also referred to as mainstream services) that are provided to, or are routinely available to, all children and their families. Universal services are designed to meet the sorts of needs that all children have...", Every Child Matters, ) such as, childcare,

"4.8 ...As well as facilitating parental employment, childcare will benefit disabled children as it benefits non-disabled children, with the provision of high quality education and care at an early age...".

"3.16 To allow Local Authorities and PCTs to plan and provide for their population, Government will look to all Local Authorities and PCTs to collect data on:

· The number of disabled children in their area, where possible classified by type of disability; and

· The percentage of this disabled children population accessing both universal and specialist services, such as short breaks or therapy services"

Healthy lives, brighter futures - The strategy for children and young people's health

2.3 Healthy Lives, Bright Futures is described as a "strategy for children and young people's health" (Department of Health, Department for Children, Schools and Families, February 2009). This recent document builds on, and assumes the previous publications, including Reaching High. It is hard to find a case for separating the issues identified by each of the committees, when legislation, guidance and the Strategy would treat them all as important concerns of interest for disabled children and their families.

Issues related to `specialist services'

2.3.1 Short Breaks

Every disabled Child Matters: Short breaks tracking Interim Report, April 2009:

· Non-pathfinder areas reported lack of real choice over services received,

· lack of information,

· lack of clarity about direct payments,

· lack of support for parents from LAs in managing direct payments

2.3.2 Therapy Services

(see A Review of Therapy Services for Children across Hampshire incorporating Occupational Therapy, Physiotherapy & Speech and Language Therapy, College of Occupational Therapists, August 2008):

· There are strong and positive relationships between professionals across agencies; and proposals have been made for improved and focused services.

· There is a great variation across the county in the types of therapy provision that children receive

· A greater consistency and equity across the region is required.

· The provider services, although numerous, are stretched in attempting to meet local needs, with varying degrees of success.

· Users, although largely complimentary about the services received, felt they had to "fight" for services.

· There are some noticeable gaps in service:

· Services to special schools are inadequate.

· Little/no therapy input into services for children and young people with autism.

· Little/no service to secondary age children or transition services to adult life.

2.3.3 Palliative care

Palliative Care Services for Children and Young People in England, Department of Health, 2007:

· Enormous overlap between children with disabilities and complex care needs and those requiring palliative care. Services for these groups should be planned together.

· Lack of understanding of what children's palliative care involved, most assuming it was just about end of life care.

· Lack of clarity about who was responsible for leading planning and development of services...requires health, education and social services to work together.

· Committed workforce spent too much time battling the system

· Poor information base with no nationally agreed figures on prevalence and little evidence of good needs assessments

· Little evidence of trend data being used in the planning of services

· Lack of transition services to manage the transfer to adult services

· Huge variation in the availability of services across England

· Children and young people often subject to multiple assessments and then often received no resulting service

· Families wanted more community services able to offer help and advice 24/7

Issues that have been identified in relation to `universal services'

2.3.4 Recurrent themes, as for example, identified in the Parliamentary Hearings on Services for Disabled Children, October 2006, and Aiming High for Disabled Children, May 2007, include:

· Staff Training - to increase their knowledge of disabled conditions and potential of disabled children to achieve success

· The availability of appropriate equipment to help make universal services more accessible to disabled children

· `Diagnostic overshadowing' where a health diagnosis fails to identify physical health needs because they are assumed to be part of another condition

2.3.5 In addition not infrequent reference is made to the strongly supporting role of `key workers' who ensure that children and their families receive a coherent package of services. This is a vital resource in a multi-agency, multi-disciplinary partnership context where such complexity needs effective management.

3. Proposed way forward

Scope:

3.1 Taking account of the current evidence available it is recommended that the scope of this joint review be, in the first instance, targeted at following up on the recommendations and conclusions of the independent "...Review of Therapy Services for Children across Hampshire incorporating Occupational Therapy, Physiotherapy and Speech and Language Therapy" undertaken in 2008. In addition it is recommended that the focus should be confined to the most vulnerable children, that is, those with Special Educational Needs. This will enable the work of the joint review to focus specifically on gaps identified in the provision of the key services, and where improvement can be achieved.

Opportunities to add value:

· Potential to make general recommendations, eg. to NHS/HCC commissioners concerning equitable access to services

· Potential to make recommendations to NHS/HCC providers regarding readiness to meet the core standards criteria (above)

· Possibly to make specific recommendations relating to specific services, eg: `short breaks'; `palliative care'; `carer services'; or `nursery provision/therapy services'. Alternatively to frame the work at a higher level of generalisation in terms of `universal' and `specialist' services.

· Possibly to make recommendations about structuring services in order to achieve desired and agreed outcomes and equitable service provision.

· Perhaps a critical question ought to be what has prevented improvements being made to an equitable provision of services across the county following the reviews in 2005 and 2008? Hence potential to possibly make a contribution to improving the effectiveness of scrutiny.

3.2 Note: what the committee does not want to do is to repeat the exercises undertaken in 2005, or more recently in 2008, but to determine how progress might be made and identify where the obstacles are.

Indicative timeframe:

3.3 See attached timeline sheet

Indicative Stakeholders:

· HCC

o Children's Services - Education

o Children's Services - SEN

o Children's Services - Therapy, commissioning leads

o Schools / Special schools

· Children / parents

· NHS

o Commissioning leads

o Therapy services

· 3^rd Sector

o Independent providers

o National orgs / charities

· Experts

4. Definitions

4.1 Universal Services: are provided to, or are routinely available to, all children, young people and their families.

4.2 Specialist Services: are provided specifically for children and young people with specialist, acute, complex or very high level need who would otherwise be at great risk of poor outcomes.