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Children and Young People Scrutiny Committee

Date: 22nd January 2008 Agenda No: 3 Report’s Title: Children and Young people with Disabilities – Update on Developments

Purpose of Report: To update the Committee and to seek views on next steps Relevant Policy or Strategy: Commissioning strategy for children and young people with disabilities approved by Cabinet April 2007 When last seen by Scrutiny and outcome(s) November 2006 BVPI/Local Performance Indicator/PSA Indicators/ Other Indicators/CPA Rating (to include direction of travel and comparative figures where available) ISPP Level 1 Objectives/Targets To increase the percentage of children and young people with a transition plan to over 90% by 2009/10 Key Risks

That outcomes for children and young people with disabilities continues to be very poor in comparison with their non-disabled peers. Partnership Working The Commissioning Strategy was prepared in close consultation with partners, particularly the Gloucestershire Primary Care Trust. Main Service Issues identified in MTFS process An additional £250,000 has been included in the budget proposals for 2008.09 currently out for consultation Staffing Issues No decisions have yet been taken on tendering for services. Staff and unions will be fully consulted. Officer Contact: Stewart King, Head of Specialist Services, Tel: 01452 425441 e-mail: stewart.king@gloucestershire.gov.uk

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Introduction The original aim of this report was to seek Scrutiny’s views on commissioning support services for children and young people with disabilities prior to Cabinet consideration on 6th February. That report has now been deferred to the Cabinet meeting on 23rd April; this allows more time to work through the practicalities of what is a particularly complex tendering exercise in an uncertain market. We also now know that we have been successful in our application for Pathfinder status under the Government’s Aiming High initiative; this will bring in a further £534,000 of grant funding in 2008/09. Although the tendering process for services has been deferred, there is still a very wide range of developments on services for children and young people with disabilities and their families. This report summaries those developments and seeks Scrutiny’s views on priorities for developments over the medium term. Background – The Commissioning Strategy Evidence at national level suggests that the numbers of children and young people with disabilities is growing and will continue to do so. The Department for Children, Schools and Families estimates that 7% of children under 16 in the UK have a disability or long-term condition. On this basis there are nearly 10,000 children with a disability in Gloucestershire. Local evidence suggests that the numbers of children and young people with complex needs will continue to grow in Gloucestershire over the next ten years. The Commissioning Strategy agreed by Cabinet on 20th April 2007 set out a vision to be achieved within 10 years: • In terms of the achievement of Every Child Matters outcomes, there are no differences

between disabled and non-disabled children and young people. • All disabled children and young people are able to access the same opportunities,

activities and mainstream services as their non-disabled brothers, sisters and friends, with additional support if necessary, and receive specialist services where this is the most effective way of meeting identified needs.

• All staff in mainstream services are confident and able to work with all disabled children

and young people apart from those with the most complex needs. • Children and young people and families are in the driving seat in the development of

services and the removal of barriers for children and young people with disabilities. • Statutory services build on the strengths and abilities of children and families rather than

focusing on what they cannot do and where they are failing to cope. • Young people move smoothly into adulthood with changes in support services planned

and know in advance. Improving outcomes for children and young people was agreed as a priority in the first Children and Young People’s Plan 2006-2009 in recognition of the growing evidence that their needs were not being well met. For example, children and young people with disabilities are: • More likely to grow up in poverty • Thirteen times more likely to be excluded from school • Four to six times more likely have mental health problems • More likely to be socially isolated • Much less likely to live independently when they grow up

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The commissioning strategy suggests a three-strand approach to providing support for children and young people with disabilities and their families: 1. meeting more of the needs of disabled children in universal and mainstream services

with appropriate support, and supporting inclusion in their own communities, in line with the requirements of the Disability Discrimination Act and Disability Equality requirements.

2. Improving the level and impact of participation of children and young people and parents in planning and commissioning services, and the promotion of services that given parents and young people more control.

3. Improving access to timely and appropriately targeted and specialist support through investment in key areas and more effective use of existing resources, with an emphasis on preventative services and services that promote independence and a smoother transition to adult life.

The agreed recommendations from the strategy come under five headings: • Give children, young people and parents/carers a voice • Increase the impact of universal, targeted and specialist services • Improve and simplify access to services • Develop a coherent pattern of better support for children and young people • Maximise the use of resources Funding The County Council currently spends around £40.5m on special educational needs and a further £2.7m on social care services for children and young people with disabilities. It is not yet possible to disaggregate Health Service spending on children and young people with disabilities Additional funding for children and young people with disabilities services was approved in the Council’s budget for 2007/08 with £242,000 targeted at reducing waiting times for occupational therapy and social care services and improving transition planning. The proposals for the 2008/09 budget currently up for consultation include a further £250,000 to develop services including participation of children and young people in mainstream activities. Reshaping Services in Gloucestershire Current contracts with external providers for short breaks all expire between March and September 2008. This presents an opportunity to improve access to timely and appropriate targeted and specialist support through more effective use of existing resources. The Government has recognised the need to significantly expand the availability of short breaks for children and young people with disabilities. Aiming High grants will require local authorities to deliver on this aspiration. Successful pathfinder local authorities (including Gloucestershire) will need to expand their short break provision from April 2008 for short breaks, all local areas will receive the grant from April 2009. As a Pathfinder authority Gloucestershire will focus on four Learning Themes: • Ensuring that parents, children and young people are fully involved in the planning,

commissioning and delivery of short break services – in keeping with the local core offer. • Developing the use of direct payments for short breaks • The use and development of joint commissioning arrangements with local healthcare

partners in securing short break provision • Securing significant, cost effective short break provision by working effectively with

universal services.

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Current provision in Gloucestershire poses three main issues: • Equity – services are based on children’s homes that are not equally accessible to

families in all part of the County • Choice – Children and families have limited options in terms of the type of break they

receive, when they receive it, and the extent to which it can be fitted around the changing circumstances of their lives.

• There is a shortage of provision. Developing the Proposals Work has continued with parents to determine what services will be most useful to families. A small group of parents have been involved in developing a specification that will secure a more flexible and wider range of short breaks and promote inclusion in the community. Parents want support that is flexible, easy to access, quick to respond to emergencies and gives them as much control as possible, including:

- Activity breaks – community activity support - Out of school hours breaks – including holiday play schemes - Daytime breaks – community activities, Children’s Homes, contract carers,

Family Link - Evening breaks – including home sitting service - Caring at home – domiciliary care - Overnight breaks – Children’s Homes, contract carers, Family Link - Nursing care short breaks - Emergency/crisis daytime and overnight breaks

Consultation with parents and young people in Gloucestershire has also identified strong support for self-directed support through individual budgets, enabling families to have a greater say in what services will help them by making their own decisions. This is achieved by allocating resources to individual children and families, based on an assessment of level of needs. Parents, or young people, decide (with the support of a broker if they prefer) how to use those resources to achieve agreed outcomes. Individual budgets are drawn on as cash under the same terms as Direct Payments, and/or as services or other support. Individual budgets are appropriate for children and young people with very complex needs as well as those with more easily met needs. Individual budgets have significant long-term implications especially for current service providers and budget management. Any contractual arrangement will need to ensure providers can deliver sufficient flexibility to respond to individual needs and robust budget monitoring arrangements will need to be in place. A pilot involving 10 families will run from February to enable us to assess how to manage these risks. Since April 2007 the Budget Holding Lead Professional pilot, using the Common Assessment Framework, has led the way in successfully promoting the including of disabled children and young people in mainstream and universal services and activities. A partnership with CACD promoting inclusion in sports and the arts is further developing this approach. Participation of parents and young people has been developed through the involvement of parents and young people in commissioning short breaks, and in exploring the potential of individual budgets. The intention had been to seek Cabinet approval to run a very open tender process for all short term services including overnight breaks, a home sitting service, nursing care breaks and holiday play schemes. The contract value would have been around £6.5m including health funded services. We are now reviewing this on the basis that ‘parceling up’ service and taking different approaches to procurement on individual elements may give us better

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outcomes with a wider group of independent and voluntary organisations being able to put forward proposals. Other Developments A lack of available data on Children & Young People with Disabilities has made planning improvements difficult. The Local Area Assessment for 2007/8 include developing baseline data and mechanisms for collecting information on:

• Access to social and leisure opportunities • Satisfaction with Transition Plans • 16-18 year olds with a limiting long-term illness who are in education, employment or

training • parents/carers returning to work with access to wrap around service.

A consultant has been engaged to complete this work by the end of March. Transition planning has been a key issue. Consultants have been working with us and in close conjunction with Community and Adult Care to develop a Transition Pathway which is nearing completion.