Name of Authority: CUMBRIA COUNTY COUNCIL

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Self-assessment

June 2006

Name of Authority: CUMBRIA COUNTY COUNCIL

Adult Learning Inspectorate

Audit Commission

Commission for Social Care Inspection (CSCI)

Healthcare Commission

HM Crown Prosecution Service Inspectorate

HM Inspectorate of Constabulary

HM Inspectorate of Court Administration

HM Inspectorate of Prisons

HM Inspectorate of Probation

Ofsted

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CONTENTSPage

PART A4

Background information

PART B5

Context and arrangements for partnership working

PART C 7

Analysis of needs, involvement and impact

PART D9

The management of services for children and young people,

including the use of resources and the capacity to improve.

When completing this form:

• please refer to Part 1: Guidance on self-assessment for joint area reviews and annual performance assessment;
• please do not use a font size smaller than 11 point; and
• please ensure that the overall number of pages is no more that 20 for APA purposes and no more than 26 for a JAR

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PART ABackground Information

• The Children and Young People’s Strategic Partnership Board, together with fifteen identified members of staff from Partner agencies attended a briefing event in April. The latter group then shared their written contributions at a writing day in May.
• Leading writers were identified for each Outcome, one CSA and one partner in each case
• A subsequent Challenge Day was held in June for 45 representatives from the wider partnership to challenge and interrogate the accuracy and robustness of the self-assessment
• Further contributions were submitted by the wider CYPSP Forum group through an interactive workshop
• The CYPSP Board has signed off the Self Assessment: see below. Individual signed letters are held on file.

PART BContext and arrangements for joint working

1.Contextual background

The key contextual background to Cumbria is shown through the following documents that summarise the context succinctly:

• Information for Applicants
• Cumbria in figures
• Children and Young People’s Plan

Detailed contextual information, together with priorities identified through APA 2005 and regulatory visits is included in this self assessment under each outcome area.

2.Arrangements for Joint Working

Since 2005 joint working arrangements have been rationalised and re-configured under the umbrella of the Children and Young people’s Strategic Partnership (CYPSP).

• CYPSP board: Comprising Chief Executives and Senior Officers of our Partner Organisations such as PLTs, Connexions Cumbria, Police, LSC, voluntary sector etc

The board meets each month as the key Governance Group and hold partners to account for their contribution to children’s and young people’s well being. Early discussions have taken place about moving to a Commissioning Trust. Board members chair the Project Group (below)

• CYPSP Forum. This is a larger group reflecting the breadth of partnership in Cumbria, it meets quarterly as a reference group.
• CYPSP Project groups. Currently 9 groups exist to drive the partnership agenda. These cover:
• Participation
• CAF/IS
• Workforce Development
• Local Planning and working
• Multi-agency performance
• Communication
• Commissioning
• Role of schools/GPs

3.Cross referencing

The documents cited in the guidance are available in the document submission list and/or on the Cumbria County Council website (www.cumbria.gov.uk).

2001 Census information Key Statistics, Focus on Children and Young Adults

4.Priorities for Children and Young people

• Children and Young Peoples Plan (page 11)

Please provide the following self-assessment grades

Only required for a joint area review:

Required for the joint area review and annual performance assessment.

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PART C Needs analysis, impact and involvement.

• The loss of dentists in 2004/05 is being addressed by PCTs. Contracts have been agreed and will restore capacity, fully by 2008. All CLA have access to dentistry either through practices or PCT Dental Services.
• Increased investment in CAMHS and the development of a countywide strategy and commissioning partnership has strengthened the development of “Comprehensive CAMHS” reducing waiting times and improving service access. Services for CLA have been improved by increasing capacity and by developing service pathways.
• The co-ordination of drugs services has improved through the strengthening of joint planning and commissioning arrangements. Clear priorities have been identified in the DAAT strategy and CYPP.

• There are good primary health care services in place throughout the county. Birth weights, perinatal mortality, and immunisation rates are in line with or above national averages resulting in healthy babies.
• There is a broad range of services in place providing information, advice and guidance to parents on keeping their children healthy.
• A significant majority of schools are involved in healthy schools initiatives and there are high rates of participation in school sports.
• Teenage pregnancy rates are declining in most areas with advice on sexual health issues being increasingly available in community settings. Access to acute hospital care in rural areas in the north of the county is improving through changes in working practices and better service integration.
• Children Looked After are able to access health assessments, screening services and primary and secondary health care services.

• Need to reduce health inequalities in areas of high deprivation.
• The range and coordination of services available to children with SEN/CwD and their carers needs to be significantly improved.
• Further progress is needed in the development of “Comprehensive CAMHS”.
• Teenage pregnancy rates are not reducing in Carlisle and Barrow.
• The range of information, advice and guidance services available to parents in the county would benefit from greater planning and coordination.

• There is a wide range of universal and targeted health care services available throughout the county providing advice and support to parents of pre school and school age children. These include advice and support in relation to maternal mental health, behaviour management for children with ADHD and ASD, drugs and alcohol and sexual health issues.
• Access to ante and postnatal maternity services including specialist services for young mums and drug taking parents is good. Breast-feeding is promoted through universal services supported by breast-feeding promoters although the rates of breast-feeding vary. West Cumberland Hospital Maternity Unit is accredited under the UNICEF Baby Friendly Initiative. Birth weights are above average and mortality rates and perinatal mortality in line with national benchmarks.
• Healthy eating is promoted in LSSP and children’s centres. Parents are involved in healthy school accreditation workshops to support the development of healthy life styles in the home environment.
• Parents of disabled children are supported in accessing a range of health services coordinated in Early Support Programmes piloted in East Cumbria. This is now being rolled out across Cumbria.

• There is a need to improve the consistency and co-ordination of parenting advice services. There are gaps in advice services for parents of older children and parents of children with SEN/CwD.
• Rates of smoking during pregnancy in Carlisle and some parts of South Cumbria are decreasing but are still higher than national and benchmark averages increasing the risk of childhood illness. Health promotion activity needs to be better targeted at this high-risk group.

• 83% of schools are engaged in healthy schools programmes with 50% of schools scheduled to obtain Healthy School award by December 2006. Out of 74 schools inspected 16% have been judged as outstanding and 71% as good in the extent to which children adopt healthy life styles. All KS1 and most KS2 children receive free fruit in school.
• 65% of schools provide quality assured Sex and Relationship Education (SRE) within the curriculum.
• All school nurses are in the process of being accredited in foundation family planning certificate; some administer emergency contraception and testing supported by a condom distribution scheme.
• Out of school clubs promote sport and fun activities and include hard to reach groups and excluded groups. Free transport is provided in school holidays to enable young people to access sport and leisure centres.
• Health promotion programmes are accessible in community settings such as the Drop Zone café in Barrow, Eden Rural Foyer and through the Youth Service and Connexions Cumbria service. These programmes provide confidential advice and guidance focusing on sexual health, substance misuse, and healthy living guidance.
• Young men’s Community Health Workers have demonstrated that since coming into post there has been a 42% increase in young people using GUM clinics, and 1654 young people have benefited from awareness raising and contraceptive services.[ Connexions Cumbria BIP (Page 29)]
• The Straightline multi-agency substance misuse service promotes early intervention, advice and education, mentoring, counselling and a tier 2 and 3 treatment service targeted on a needs basis at children and young people 11 to 19. This service is accessible through schools, Connexions Cumbria and other community settings around the county. Over 300 young people were referred to this service between January and October 2005.
• The YOS carry out specialist assessment to identify young people with substance misuse behaviours and co-ordinate responses through a specialist worker.

• There is a need to further improve the co-ordination of support services and interventions available to young people. In particular there is a need to reduce the incidence of childhood obesity and the rate of smoking and drinking amongst young women aged 13 and over.

• All children in the county receive health surveillance and screening; there are high rates of immunisations and vaccinations at age 2 and 5.
• Child safety programmes run across the county with some LSSP and children’s centres and HV services providing safety equipment and advice in the home aimed at reducing childhood accidents.
• New dental contracts prioritise children and young people ensuring good service access.
• There is 24 hour seven day a week access to A and E in all parts of the county with good access times.
• There is close working between community and acute child health services particularly in rural areas.
• There are high levels of satisfaction expressed by young people on access to and waiting times in the Acute Hospital Trusts . (Healthcare Commission young patient questionnaire completed in 2004). (More comprehensive information is available at
• Activity based programmes are delivered in different parts of the county through LSSP, children’s centres and Connexions Cumbria promoting physical exercise and self esteem.

• There is a need to develop better systems to review the reasons for admissions to A and E and to improve the environment in A and E and to ensure there is an appropriate child focus.

• Significant progress has been made in the last twelve months to bring together CAMHS planning and commissioning arrangements across the county. A strong mechanism is now in place to deliver “Comprehensive CAMHS” supported by a countywide strategy and significant investment in new service areas. (See CAMHS strategy). .
• All mothers are routinely screened for Post Natal Depression allowing the early identification of maternal mental ill heath and early access to appropriate services.
• Health Visitors are trained to deliver the Solihull programme, which supports parents in identifying psychological, emotional and behavioural issues in early years.
• Primary Mental Health Care Workers provide a countywide service giving advice and guidance on emotional resilience and the signposting of children to appropriate services.
• There is a range of initiatives in place in schools promoting emotional resilience. These include nurture groups, pyramid programmes and SEALS programmes. In 2005/06 104 Primary Schools were supported with this programme and a further 60 schools will receive this support during 2006/07.
• Webster Stratton Parenting Programmes are provided in Carlisle via the tier 3 CAMHS team working with over fifty families with primary school children with conduct disorders.
• There is a range of support services targeted at troubled young people including young offenders and CLA supported by specialist posts. Special assessment and treatment services are provided in the YOS.
• There are 3 well-established tier 3 CAMHS teams with countywide coverage. These specialist services are in community settings with outreach into schools and family and community centres.
• Joint training including skills escalator training is provided on a multi-agency basis supporting the development of a common approaches and service pathways.
• In South Cumbria a single point of referral is assisting waiting list management.
• Pathways for children with ADHD is in place in South Cumbria.
• In Morecambe Bay PCT a single point of referral has reduced waiting times for CAMHS and EP services.

• There is a need to further develop service pathways within and between services in “Comprehensive CAMHS”. Priorities include pathways for children with ADHD (North Cumbria), ASD and Autism, and to improve links into drug and alcohol services. There are plans to recruit a specialist CAMHS consultant to work with children with drug and alcohol problems.
• Waiting lists have been significantly reduced in the south of the county but remain too long.

• Current staff vacancies in the YOS have reduced the availability of assessments, treatment and support for young offenders. Further work is needed to ensure that this group of young people are better served within mainstream services.
• There are no Tier 4 beds in the county, and low numbers in the North of England generally. Difficulties can be experienced in accessing in-patient care. This issue is being addressed regionally.

• 82% of CLA have up to date health assessments, immunisations and dental checks. Priority has been given to CLA in accessing dental services through practices and community settings.
• Designated nurses are in place across the county and a designated doctor is in place in the south. Specialist nurses ensure CLA have their health needs met and HVs/SNs carry out review health assessments. There is a specialist doctor for CLA in East Cumbria.
• All children’s homes provide healthy diets and encourage young people to participate in the planning of menus and food preparation.
• Access to specialist CAMHS is managed through a clear pathway. A specialist CLA CAMHS team provides additional support targeted at children who have experienced placement disruptions and children who have been placed for adoption or who have been adopted.

• A minority (18%) of CLA choose not to access health assessment and screening services. More work is needed to engage this group who are predominantly adolescents, to improve pathways between social care teams and the CLA health teams and to meet the needs of care leavers.