Agendas, Meetings and Minutes - Agenda item

Agenda item

Future Provision of Overnight Unit-Based Short Breaks for Children with Disabilities

Minutes:

The Cabinet Member with Responsibility for Children and Families, and the Assistant Director for Early Help and Commissioning had been invited to the meeting to update the Panel on the future provision of overnight unit-based short breaks for children with disabilities ahead of the discussion at Cabinet on 6 June 2019.

 

The Director of Strategy and Partnerships and the Service Delivery Unit Lead for Children Young People & Families (both representing Worcestershire Health and Care NHS Trust) also attended.

 

The Assistant Director for Early Help and Commissioning introduced the report by way of a presentation.  The following main points were made:

 

·       Members were reminded that there had been a previous consultation in January 2018 which had led to a report to Cabinet in July 2018.  Cabinet had agreed that further work should be done on the design of the short breaks service across the County.

·       In September 2018 two co-design events had been held with parents/ carers, providers and other professionals.

·       The Overnight Short Breaks Units did not operate geographical catchment areas but instead children accessed the units on the basis of assessed need.

·       The service had worked with colleagues in adult services on the new design in order to maintain continuity and aid transition from Children’s Services to Adult Services.

·       Feedback from the co-design work had suggested that, although there was a growing demand for short breaks, this demand was not necessarily for overnight respite.

·       One main theme that had emerged from the co-design events was the importance of providing help at an early stage to avoid families reaching crisis point.  Overnight short breaks should be part of a planned package of support and not accessed in response to a crisis.

·       It was confirmed that, as part of the proposals, the Ludlow Road unit would close.  Members were reminded that the unit was going through the process of Ofsted registration.  It was a requirement of Ofsted that all bedrooms were single occupancy, something that was currently not the case at Ludlow Road.  The Health and Care Trust (WHCT) had committed that by the end of August 2019, there would no longer be shared accommodation at Ludlow Road, meaning bed capacity would reduce from 6 to 4.

·       Provision at Osborne Court included a hydrotherapy pool and separate units for children and adults on a single site.  The unit offered provision to families countywide. The proposals would increase bed capacity for children on the site by 4.  Two of these additional beds would be for children in Worcestershire and two could be used to accommodate children from neighbouring counties.

·       The initial proposal was that the additional provision for children would be for weekdays only.  However, this could be reviewed in the future in the light of responses to the consultation.

·       The improved quality of the offer was emphasised.  Osborne Court had better facilities, refurbished units and significantly more flexibility than Ludlow Road.  A further benefit was the familiarity for young people as they transitioned to adult services, something that parents were often concerned about.

·       An added benefit of the Osborne Court site was access to Thorn Lodge which provided support for young people with particularly complex needs.

·       The Health and Care Trust had worked with the Local Authority to assess current and future needs in order to create a sustainable service.  There had been questions about the future of the short breaks service for several years now and these proposals were designed to create stability.

·       It was acknowledged that change was a concern for families.  It would be important to talk to all families using Ludlow Road and other provision and to look carefully at individual care plans.  A meeting of parents and carers had taken place the previous day and a number of concerns had emerged, including the logistics of travel and transport, and the importance of maintaining the meaningfulness of respite.

·       A positive aspect of the service was that all respite was provided within the county and was available in different areas.

·       A timeline for future activity was shared.  Feedback from the meeting with parents and carers had made it clear that transitional arrangements should not be fixed by this timetable but should respond to the children’s needs.  The timing of future activity needed to be mindful of the children’s care needs and any issues with the building work, retaining the flexibility to ensure continuity of care.

 

The Panel was given the opportunity to ask questions and the following main points were raised:

 

·       It was confirmed that 6 parents and carers had attended the 3 June parents meeting.  Further information was requested on the issues they had raised.  Members were reminded that the purpose of the meeting had been to summarise the Cabinet report and present them with the information included.  Any questions raised would be added to the frequently asked questions section on the service website.

·       Officers were able to reassure parents that respite would not be cut as a result of the proposals.  In fact, sufficiency would be increased.

·       It was important to acknowledge the level of ongoing uncertainty for parents and some wanted to be sure that what was proposed would actually happen this time.  Parents also wanted to be involved in the re-design of the Osborne Court site and to be reassured about what would happen to the staff at Ludlow Road.  Some had expressed the hope that as many members of staff as possible could transfer to Osborne Court.

·       A further parental concern had been about what would happen if the Ludlow Road unit was to close before the refurbishment at Osborne Close was complete.  The Panel was reassured that this would not be allowed to happen.

·       Parents had real anxiety about the process and it would be important to look at individual circumstances.

·       The Cabinet Member with Responsibility for Children and Families acknowledged the importance of taking into account the views of the parents and the interests of the child.  He hoped that any Member criticism of the proposals would be real and challenging, based on the facts and supported by evidence.  It was important to remember the vulnerability of the families and remain objective.  He thanked the officers from WCC and WHCT for working together to produce these proposals.

·       It was confirmed that the meeting with parents and carers had been attended by representatives of 4 families currently using Ludlow Road.  However, all Ludlow Road parents had been contacted by letter and had access to information via the county council’s website.  Briefings had also been held with all staff and managers to ensure consistency of message.  It was confirmed that 20 families currently used Ludlow Road.

·       Although officers had no feedback on why only 4 families had attended the parent/carers meeting, the Panel was reassured that when the consultation was launched there was an absolute need to ensure that every family had an opportunity to share their views.  Information would also be disseminated via the website and through Families in Partnership (Worcestershire’s Parent Carer Forum).  Headteachers of special schools would also be briefed and would be supporting this work.

·       The Chairman of the Panel expressed concern that the re-design should not become part of a politically motivated campaign locally in Wyre Forest.  She undertook to help with dissemination of information locally.  Members agreed that it was important to avoid scaremongering as this was upsetting for parents and children.

·       It was confirmed that 3 families would have additional travel as a result of the move to Osborne Court.  Families were concerned about logistics as well as distance from home or school.

·       The importance of engaging meaningfully and carefully with all families was emphasised.  Schools would also be important in this.

·       It was suggested that a further meeting of the Panel would be needed before the final proposals were agreed at Cabinet in September.  It may also be necessary to reconvene the scrutiny task group.  Panel Members may wish to observe any meetings with parents as part of the consultation.

·       A Panel Member commented that the proposals looked sensible and sustainable offering good flexibility.  It would be helpful to see data for occupancy rates and levels of demand.  If the number of families requiring support increased, there may be an issue for those living in the north of the county.  In response, Members were informed that work to date had improved understanding of how overnight respite was used.  Children tended to stay for one or two nights, although there were exceptions to this, for example to accommodate a family wedding or holiday.  The upper limit was 15 nights in a row and 75 nights over the year.  Overnight respite was there to support those with parental responsibility rather than to provide alternative long-term care arrangements.

·       The number of nights provided was based on social work assessed need.  The starting point was between two and seven nights per month based on an individual needs assessment.  This meant that it was possible to know current sufficiency needs across the county and forecast these accurately for the next quarter.  Forecasts could also be done for the longer term from 6 to 12 months.  Forecasts were done in collaboration with the Health and Care Trust and the in-house Research and Intelligence Team.

·       Occupancy rates would be published as part of the consultation.  In general, they were between 80 and 90%, with 100% occupancy being very difficult to achieve.  It was confirmed that figures for the number of families accessing the service, occupancy rates and cancellation rates would be provided in writing to the Panel.

·       Occasionally, overnight short breaks were ‘spot purchased’ from Acorns Hospice and families may also be able to access family-based provision with specialist foster carers.

·       In relation to Direct Payments, a question was asked about whether there was a functioning market for respite care and whether parents had a choice in this.  It was confirmed that, for 1-to-1 support workers, parents could contact a range of providers through a dynamic purchasing system, meaning the needs of the individual child could be met.  Direct payments were often used with people already known to the family.

·       It was confirmed that provision within the home was an option for some younger children or those with complex needs, sometimes via the Orchard Service (run by WHCT).  The Orchard Service was a team of nurses and carers which supported children with particularly complex or high-risk needs.  However, if the purpose of respite was to support the rest of the family, provision within the home was not always the best option.  It was confirmed that figures for the number of children accessing the Orchard Service would be provided following the meeting.

·        Further information was requested on

o   where children currently accessing Ludlow Road were based and the impact on travel arrangements of moving to either Providence Road or Osborne Court;

  • how many children had accessed Ludlow Road as new users in the last year and at what point would the introduction of new children cease.

·       It was confirmed that the decision to close the Ludlow Road unit was not solely financial.  It was not possible to provide the same standard of facilities at the Ludlow Road site as it was physically very limited.

·       It was confirmed that there was no proposal to reduce the level of weekend provision.

·       Specialist nursing provision would continue to be available according to children’s assessed medical needs.

·       Members were reminded that the different units catered for children with different needs, with the aim of bringing similar children together.  This also allowed for a suitable skills mix of staff to be put together.  All sites had facilities to support children with physical disabilities.  The Short Breaks Panel would try to match children to suitable provision but sometimes the need for care would override this.

·       A question was asked about the challenges of using the same site for children and adults.  It was confirmed that this would be risk assessed as part of the process of Ofsted registration.  The units would be completely separate and the children and adults would not mix.

·       An application had been made to amend the Ofsted registration for the unit at Providence Road.  Although no response had yet been received, it would need to be completed before any service changes could be implemented.

·       Eighteen young people were currently supported by family-based provision.  Although the Council was working with Barnardo’s to recruit additional hosts to expand this provision, this would take time to achieve.

·       A question was asked about whether families might cancel one night at Council-run provision at late notice if they were offered more nights with Acorns Hospice.  It was confirmed that, although this may have happened on one occasion, it was not a general issue.

·       Members were informed about the Short Breaks Panel which brought together Managers of all provision, giving a better oversight of care provision and better communication between units and social workers.

·       It was important to understand the impact of respite care on the child’s lived experience.

·       A question was asked about Regulation 44 visits.  The Panel was informed that these were of a very high standard in Worcestershire.  They were not unannounced but were often at very short notice.  The inspections aimed to be a critical friend but were not the same as Ofsted inspections.  It was important that the Manager’s focus was not diverted by the Regulation 44 visit.  The visits generally lasted between 2 and 6 hours and would vary in what they looked at.  The aim was to ensure that on a regular basis someone independent could see the care provided.

·       Figures were requested on the number of parents and carers who attended the co-design events in September 2018.  It was agreed that these would be provided following the meeting.

·       Figures in the agenda report showed that the number of children accessing short breaks via support workers had increased from 29 in March 2018 to 128 in March 2019.  This appeared to be a large increase.  It was explained that this was the result of the move to the dynamic purchasing system for 1-to-1 support workers which allowed families to access different types of provision based on assessed need.  The way the service was commissioned had changed and there was clearly an unmet need.  It was confirmed that, although this did have a cost impact, some cost was transferred elsewhere meaning the service was still within budget.

·       It was important to note that the short breaks service was part of the wider system of support for Special Educational Needs and Disability (SEND) which could be accessed via the Local Offer website.  Access to this information was very important and the Local Offer needed to be understandable to all, including those who did not know much about SEND.

·       The Assistant Director for Early Help and Commissioning informed the Panel that she had been working with Wychavon District Council on website provision to improve access to available activities. It was agreed that this work should involve all District Councils to ensure equal access across the county.

·       A question was asked about why it was not possible to forecast future demand.  The Cabinet Member with Responsibility for Children and Families explained that, although it was the case that more children were being born earlier in pregnancy and this might lead to a greater demand, given the relatively small population of Worcestershire, it was not possible to make accurate predictions.  The Research and Intelligence Team had worked on identifying drivers for demand and could provide 3, 6 and 12-month forecasts.  However, the important thing to note was that the proposals in the Cabinet report provided flexibility for the future with the potential for additional provision if needed.

·       The report acknowledged that there was forecast to be an increase in the number of children with SEND.  This was as a result of an increase in diagnosis but also an increase in population.  However, it was difficult to then assess how this would correlate to a need for additional overnight respite provision.  Putting support in place at an earlier stage may reduce the need for support later on.  It was not possible to use population growth figures to predict the number of beds that would be required in the future.

·       The proposals would increase the number of beds at the Providence Road unit by two.  Given that this would mean more staff and a greater transport requirement, concern was expressed about car parking and vehicular access to an already tight site.  It was confirmed that this would be looked at as part of the management of provision at the site.  It had not been flagged that access to the site would be an issue, but it would be something that the Manger of the unit would take into account.

·       It was confirmed that the unit for adults in Bromsgrove was located on the site of the Princess of Wales Hospital, approximately ½ mile from Providence Road.  Visits to the unit would be arranged at time of transition.

·       It was confirmed that the service (including the in-house provision and the commissioning of services) would be transferred to Worcestershire Children First in due course and this would have no impact on working relationships with the WHCT.

·       It was suggested that the fact that the proposals were not primarily driven by cost but by service improvement was not emphasised enough in the report.  The benefits to parents of the proposed changes should be emphasised as part of the consultation.

·       It was suggested that a video of the provision at Osborne Court would be helpful to show potential parents what was available.  Officers confirmed that a video already existed for Providence Road and they would look into this suggestion.

·       The Trust’s capital investment and the County Council’s ongoing commitment was welcomed.  The proposals offered a great opportunity to move the service to a better place.

·       It was confirmed that there was no proposal to make any staff redundant as a result of the changes.  Following the consultation, staff would be asked whether they wished to re-locate to Osborne Court.  Those who did not wish to move would be retained within the Trust in different posts.

·       It was confirmed that the public consultation would be run jointly by WCC and WHCT.

 

The Chairman confirmed that she would attend the Cabinet meeting on 6 June to present the Panel’s views summarised as follows:

 

The Panel supported the recommendations as set out in the 6 June Cabinet report and were pleased to note the engagement with parents and would wish to see this continued throughout the process.  The following additional points were made:

 

·       The Panel would wish to hold an additional meeting to discuss the outcomes of the consultation before the September Cabinet meeting.

·       It may be necessary to reconvene the Scrutiny Task Group to feed into the consultation process.

·       Panel Members would welcome the opportunity to observe consultation meetings with parents/carers.

·       The Panel wished to see further information on:

o   Occupancy rates and current levels of demand for each unit, including how many children access each unit and cancellation rates.

o   The number of children supported by the Orchard Service.

o   The number of parents/carers attending the co-design events in September 2018.

·       It would be helpful to produce a video for parents/carers showing the facilities and accommodation available at Osborne Court, Malvern.

 

The Cabinet Member with Responsibility for Children and Families thanked the Panel for their involvement.

 

The Chairman thanked all those who had attended for this item.

Supporting documents: