Hertfordshire Health & Wellbeing Board
Partnership Commissioning Strategy for
Children with Complex Care and Additional Needs
2012-15
Narrowing the Gap between Children with Complex Care and Additional Needs and all Children
DRAFT V1129Nov12
N.B. This document is still a working draft
Prepared by the Children with Complex Care and Additional Needs Strategic Commissioning Group

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Hertfordshire Health & Wellbeing Board
Partnership Commissioning Strategy for
Children with Complex Care and Additional Needs
2012-15
Narrowing the Gap between Children with Complex Care and Additional Needs and all Children
CONTENTS / PAGE
Foreword / 3
1. Our vision / 4
2. Introduction / 4
3. Context and key drivers / 6
4. The children with complex care and additional needs population / 8
5. Objectives of the strategy / 12
Objective 1: Enhance integration of commissioning, services and resources / 13
Objective 2: Improve support for children and young people with autism / 16
Objective 3: Increasing the number of children who are able to have their / 17
needs met locally
Objective 4: Implement new joint working arrangements through SEND / 19
Pathfinder
6. Themes of the Strategy / 20

Foreword from the Chair of the Children with Complex Care and Additional Needs Commissioning Group

I am pleased, on behalf of the Children with Complex Care and Additional Needs Commissioning Group, to introduce their first Commissioning Strategy. This strategy identifies how we aim to ensure that children with complex care and additional needs (CCCAN) are able to enjoy a happy, healthy and safe childhood that prepares them for adult life and enables them to reach their full potential.

Children with complex care and additional needs are some of the most vulnerable children in society with wide ranges of types of need. The Group has identified areas where services can be commissioned across Education, Children’s Social Care and Health to improve the outcomes of these children and young people. The commissioning strategy aims to support the development of a whole-life pathway for children into adulthood which also takes into account the individual circumstances of each child and young person.

The objectives identified are underpinned by three over-arching themes that are necessary to ensure their success. These are:

(i)Improving the transition experience for the CCCAN population

(ii)Listening to the views of children’s parents and carers

(iii)Ensuring equality and diversity needs are met.

The strategic objectives in this strategy have been identified by the multi-agency group as those that will be able to make a real difference to improving outcomes for children with complex care and additional needs, and I hope that next year’s progress report will show significant advances in improving these outcomes.

Dr Hilary Angwin

Chair of the Children with Complex Care and Additional Needs Commissioning Group

  1. Our Vision

A child or young person is defined as disabled if they have special needs in the area of health, education or physical, intellectual, emotional, social or behavioural development due to:

(i)Multiple and complex health needs

(ii)Sense impairment such as hearing loss, visual impairment or deaf-blind

(iii)A significant learning difficulty

(iv)A chronic physical illness

(v)Autism (autistic spectrum disorder) and communication disorder

(vi)A significant pre-school development delay

This strategy will support this population of children aged -9 months to 24 years.

Our vision for our children and young people with complex care and additional needs is the same as for all children in Hertfordshire, which is that they enjoy a happy, healthy and safe childhood that prepares them well for adult life and enables them to reach their full potential, by enabling them to be resourceful, reflective and resilient.

We want to establish a whole life pathway for children and young people that looks at long term goals and outcomes, takes in to account the individual circumstances of each child and young person and help set realistic goals, working closely with families, for different stages of their lives. To achieve this, we want to focus on integrated planning from the outset, enable better transition across agencies and improve links with adult services.

We will challenge existing historical arrangements and associated barriers, particularly to support parents dealing with different agencies that have different processes and systems. We want to develop long term arrangements for joined up working between health, education and children’s social care, and to ensure increased flexibility in how these agencies respond; changing organisational and working culture not just processes and systems.

  1. Introduction

Children with Complex Care and Additional Needs are some of the most vulnerable children in society with wide ranges of types of need. Alongside the establishedcategories of SEN, such as specific learning difficulties and profound and multi-sensory impairment, for example, there are physical or mental impairments that have substantial and long-term adverse effects on a child or young person’s ability to carry out normal day-to-day activities.

This strategy sets out the shared commissioning priorities of key agencies in Hertfordshire for children with complex care and additional needs. The commissioning strategy provides a framework for identifying children and young people’s needs and gaps in service provision; setting our commissioning priorities and evaluating options for meeting these, including developing the market; identifying the key outcomes we are seeking to achieve; detailing the collective resources available; and setting targets for reducing expenditure.

This partnership commissioning strategy is one in a series of cross cutting strategies which underpin Hertfordshire’s new Health & Wellbeing Partnership Commissioning Framework which has been introduced in response to Liberating the NHS: Legislative Framework and Next Steps. Its aims are also consistent with the Joint Service Plan for Education & Early Intervention and Safeguarding & Specialist Services.

Hertfordshire is an “early implementer” for Health and Wellbeing arrangements set out in the Partnership Commissioning Framework and is part of Hertfordshire’s emerging Health and Wellbeing Board arrangements. The Children and Young People’s Strategic Commissioning Group (CYPSCG) will be responsible for developing the children’s element of the joint health and wellbeing strategy, developing and interpreting the Joint Strategic Needs Analysis to shape commissioning and spending plans and developing an overarching commissioning strategy for children and young people.

The CYPSCG will be the key commissioning group for the prioritisation and co-ordination of services commissioned for children and young people, and will provide the strategic join up across the three strategic commissioning groups, which are;

(i)Early Intervention and Prevention (EI&P)

(ii)Children with Complex Care and Additional Needs (CCCAN)

(iii)Children and Young People Living Away from Home (CYPLAH)

The Children with Complex Care and Additional Needs (CCCAN) group will be responsible for overseeing the implementation of the Children with Complex Care and Additional Needs Commissioning Strategy. It will ensure effective links are maintained with the Child and Adolescent Mental Health services (CAMHS) strategic commissioning group to address the mental health needs of this cohort of children and young people.

The strategy provides a holistic commissioning approach for addressing the health, education, and children’s social care needs of Children with Complex Care and Additional Needs in Hertfordshire. The benefits of a joined up approach will ensure that we;

(i)Share intelligence about needs;

(ii)Target our services to give the greatest impact on outcomes;

(iii)Avoid duplication of services;

(iv)Achieve efficiencies and ensure value for money;

(v)Improve our ability to implement personalised commissioning;

(vi)Develop co-ordinated services;

(vii)Share best practice and expertise.

  1. Context and Key Drivers

Estimates of the proportion of children with a disability vary, with research suggesting that around 6 to 7 per cent of children are disabled. There is a significant overlap between disabled children and those with SEN, with research suggesting that around three-quarters of disabled children also have SEN (SEND Green Paper, Support and aspiration: A new approach to special educational needs and disability)

This strategy will seek to address some of the vision and aspiration of the SEND Green Paper, Support and aspiration: A new approach to special educational needs and disability, namely;

(i)Early identification of needs in order for parents and professionals to put in place the right care pathway in place quickly. Although some impairments are normally identified at birth or soon after, other types of need emerge as children grow up. Graham Allen, MP and Lead for The Early Intervention Review Team,reportedonthe importance of intervening as soonas possible, not just for children and their families, but also for wider society

(ii)Supporting parents and carers in exercising more control over support for their child and family, by ensuring:

  • a clear local offer of services and support is available
  • parents have the option of personalised funding
  • parents have access to transparent information about the funding which supports their child’s needs

(iii)ProvidingChildren with Complex Care and Additional Needs the best opportunities and support so that as far as possible they can succeed in both education and their careers, live as independently and healthily as they are able to and be active members of their communities

(iv)Provide families with confidence in, and greater control over, the services that they use and receive

This strategy will achieve this by;

(i)Developing long term arrangements for joined up working between health, education and children’s social care, and to ensure increased flexibility in how these agencies respond; changing organisational and working culture, not just processes and systems

(ii)Planning and commissioning services across Hertfordshire County Council’s Children’s Services (Education and Social Care) and NHS Hertfordshire, to ensure that they are

  • Informed by needs rather than service driven, with a focus on agreed priorities
  • Planned and developed at all stagesthrough active participation fromparents, carers, children and youngpeople
  • Linking to and influencing all developing operational strategies
  • Supported by CCCAN and the CYPSCG, linking with Hertfordshire’s Health and Wellbeing Board

(iii)Working to breakdown the barriers and challenges families and young people face during the transition from education and children’s services into fulfilling adulthood with employment, good health and independence. Many young people who are disabled or who have SEN can face additional challenges during their teenage years. In March 2007, the government launched a Green Paper called Raising Expectations, which proposed that, from 2015, all young people should be required to participate in some form of education or training until they reach 18. As part of the Spending Review and the White Paper, The Importance of Teaching, the Government re-confirmed its commitmentto raising the participation age to 18 by 2015

(iv)Developing stronger local strategic planning and commissioning arrangements that:

  • Take into consideration the Joint Strategic Needs Assessment, guidelines and standards from the National Institute for Health and Clinical Excellence (NICE), and health service outcomes frameworks
  • Work with the Shadow Clinical Commissioning Groups to explore the best ways of providing support for the commissioning of healthcare services, including mental health, for children and young people with SEN or who are disabled and their families
  • Reduce bureaucratic burdens by simplifying and improving the statutory guidance for all professionals working with children and young people with SEN or who are disabled from birth to 25 so that it is clear, accessible and helpful
  1. The Children with Complex Care and Additional Needs Population

The Joint Strategic Needs Assessment (JSNA)defines a child as disabled if he or she has special needs in the area of health, education or physical, intellectual, emotional, social or behavioural development due to:

(i)Multiple and complex health needs

(ii)Sense impairment such as hearing loss, visual impairment or deaf-blind

(iii)A significant learning difficulty

(iv)A chronic physical illness

(v)Autism (autistic spectrum disorder) and communication disorder

(vi)A significant pre-school development delay

There are 343,600 0-24 year olds in Hertfordshire (Census Population Estimates 2011), 74,700 are 0-4 year olds and 269,5005-24 year olds. There are 13,128 children with a named Special Educational Need, using the School Census. Behavioural Educational and Social Difficulties (BESD) is the predominant type of LDD using the methodology as described on the JSNA. As such, this figure does not include those who are:

(i)Privately educated

(ii)Less than 5 years of age

(iii)Not continuing their education beyond the age of 16 within a LocalAuthorityMaintainedSchool

The JSNA tells us that, in Hertfordshire, males make up 70% of all named SEND, with this being most pronounced with regards to Autism (males make up 86% of need) and BESD (males make up 76% of need). Overall, the LDD rate is about 7% of the children and young people population using the School Census data. However rates can vary greatly between ethnic backgrounds.

More detail about the LDD profile and information for forecast modelling LDD prevalence for Hertfordshire is available on the JSNA.

In addition to the JSNA, further work carried out by CCCAN, uptoNovember 2011, has shown:

(i)4,375 children and young people in Hertfordshire have a Statement of Education Need

(ii)For those children and young people with a Statement of Education Need where there is data, 59% are male and 41% are female

(iii)Figure 1: Age of children and young people with a Statement of Education Need

(iv)Figure 2: Primary Special Need of children and young people, where listed

(v)Figure 3: Percentage of 0 - 5 year olds receiving health therapy

(vi)Figure 4: Estimated number of children aged 0 - 5 years with a Learning Difficulty or Disability (LDD)

This is a predictive estimate of the number of children aged <5 years with LDD based on the proportion of school age population (5 - 18 yrs) with LDD applied to the 2007 Mid Year Estimates. District numbers may differ to the sum of children's centres in that district due to the effects of rounding.

  1. Objectives of the Strategy

The overall aim of this Strategy is to Narrow the Gap betweenchildren and young people with complex care and additional needsand all children. We will support the identification, simplification and removal of unnecessary complex and difficult transition arrangements, which will influence all future iterations of this strategy and other functional strategies. We will look to jointly design and commission services across education, children’s social care and health, to support the development of whole life pathway for children and young people that looks at long term goals and outcomes, takes in to account the individual circumstances of each child and young person. We will look at pooling and aligning resources and services and to start to embed a change of culture in the way we work.

Hertfordshire’s Children with Complex Care and Additional NeedsCommissioning Strategy has the following strategic objectives:

Objective 1: Enhance integration of commissioning, services and resources

Developing long term arrangements for joined up working between health, education and children’s social care, for both the commissioning and provision of services, will reduce potential barriers for parents dealing with different agencies and help ensure equity and the development of a wider range of joined up cost effective services.

Children’s Occupational Therapy

The role of Occupational Therapy (OT) is tofocus on those aspects of daily life that present a challenge for the child or young person. Thechild, family or others involved in the daily life of the child or young person identify the activity that they either want or need to do, which may include activities or tasks from three main areas:

(i)Self-care/self maintenance, such as eating and drinking

(ii)Play and leisure, such as playing with others

(iii)Productivity, such as practical school tasks

OT is currently provided by both health service and Children’s Services which can lead to confusion and duplication; parents are not always aware of the different responsibilities of local authorities and health. Where occupational therapy is cited in part three of a child’s statement of educational needs it is the statutory responsibility of Children’s Services to provide this; a contract with the health service provider is in place to support this delivery as well as the services of some private occupational therapists.

The strategy aims to improve the provision of OT services to children and young people by creating an integrated multi-skilled team able to provide an improved experience of the service delivered more holistically for the child, and by reducing duplication the service will increase its capacity to respond to the increasing population of children needing OT support.

Our priorityis to deliver an integrated Occupational Therapy service that;
(i)Meets the needs and expectations of disabled children and their families
(ii)Has the same access and level of service countywide
(iii)Is financially sustainable for Hertfordshire County Council and NHS Hertfordshire
(iv)Delivers on the nationally set standards for children’s services

Speech, Language and Communication Needs