Joint working across education, health and social care effective practice case study: Bedford Borough vision impairment (VI) Team
Bedford Borough VI Team
Background
The Bedford VI Team (education) is part of the Sensory and Communication Support Team. This team is an education team and comprises vision impairment (VI), hearing impairment (HI) and autistic spectrum conditions (ASC) advisory teams employed by and working across Bedford Borough, which is a unitary authority.
Prior to 2009 there was a single local authority – Bedfordshire County Council. Since then, all services have been split between Bedford Borough Council and Central Bedfordshire Council. Because many of the current employees had been used to working together, this meant that staff have remained in touch and continued to work collaboratively.
There are approximately 90 children and young people from 0-19 on the Bedford Borough VI caseload, supported by two qualified teachers of children and young people with vision impairment (QTVIs), one of whom is also the manager of the VI team. The team also has four centrally employed specialist teaching assistants and a resources officer / technician. The VI team is based at the Child Development Centre (CDC) in Kempston.The CDC is run jointly by Bedford Borough Council and Health Services. This enables very close liaison with colleagues from health.
Partner agencies
Health partners
There are several health partners, including those from across several geographical and service boundaries:
· ‘Moorfields at Bedford’ which runs the Paediatric Ophthalmology eye clinic, based at the Enhanced Service Centre (known locally as the Bedford Hospital North Wing) and provides the consultant paediatric ophthalmologist. There are ophthalmologists working in other ophthalmology specialisms on the other Bedford Hospital site, South Wing, who will also refer to the VI service.
· Bedford Hospital NHS Trust has a range of health professionals employed by the Trust. These include consultant paediatricians, , audiologists, physiotherapists, occupational therapists, and speech and language therapists
· South Essex Partnership University NHS Foundation Trust (SEPT) provides the Community Eye Service, which comprises orthoptists, community ophthalmologists and optometrists who are based in various locations across Bedfordshire. SEPT has different boundaries to Bedford Hospital NHS Trust. In Bedford, the main base is the Enhanced Service Centre and there is also a peripheral clinic in Flitwick, Biggleswade and Shefford (Central Bedfordshire). The orthoptists also provide services for children with multiple disabilities at the Child Development Centre in Bedford, the Edwin Lobo Centre in Luton and also to 5 special schools across Bedford Borough and Central Bedfordshire.
Social Services partners
The Social Services Sensory Team is a specialist team for children and adults, covering all ages including babies. The team works across the whole of Bedfordshire (with the exception of Luton) and is a shared service hosted by Bedford Borough Council. In addition to providing social care and rehabilitation services, the Social Services team maintains the CVI (Certificate of Visual Impairment) register of people in the county who are severely sight impaired or sight impaired.
There are five members of staff in the team comprising:
· One Advanced Practitioner (Social/Rehabilitation Worker)
· One Social Worker
· Four Rehabilitation Workers
· Three Community Support Workers
· One Administrator
· One Support Administrator
All mobility and some everyday living skills training for children and young people in Bedford are provided by this team. One of the four Rehabilitation Workers, who has a number of years of experience, leads on the work with children and young people and works most closely with the VI Education Team. All the Rehabilitation Workers also have school age children on their caseload.
The criterion for support from the Social Services Sensory Team is that the child has a significant (not correctable) VI that will impact on their independence. The child or young person does not have to be registered to have an assessment and support.
The Children with Disabilities Team is based in the same office as the VI Social Services team and the two services work closely together. The VI Social Services team advises parents that, in addition to a habilitation assessment, their child can also be assessed by the children with disabilities team.
Current working relationship with partner agencies
Referrals between agencies
There are formal procedures, including the certification and registration process, to refer children and young people. As everyone works closely together, each team tries to ensure that parents and children are seen as soon as possible following identification of a VI.
· Health to education: the referral system from health to the education VI team is made complicated by the large number of referral routes and which of the allied health or medical professionals makes the referral. Ophthalmologists usually refer by letter to the VI team – the letter will include a signed consent to the referral from the child’s parent/carer. Many referrals are from local Orthoptists who use the referral form.
· Health to social services: the main referral route is usually through the CVI process, and all the hospitals know the procedure. While there can be delays due to different administration processes in the various consultants’ clinics and clinic venues, and staff shortages at the hospital, good links and systems between the hospitals and Social Services are in place. Referrals can also be made for any child with a significant VI who is not certified/eligible for certification but may require mobility and rehabilitation training.
· Education to social services: this is a formal process, using a designated referral form for mobility input, for when the education VI team is aware of a child who isn’t registered but will require support from a Rehabilitation Worker. Due to the good working relationship between the teams, these referrals are usually picked up quickly.
· Social services to education: if the social services team receives a CVI for registration, they will check that the VI education team has also received a referral for that child.
· Schools to VI (education): There is an established referral form, which should be completed by the head teacher / SENDCo.
Education and Social Services joint working
The Social Services VI Team provides mobility and age appropriate independence training for children and young people. There is some crossover with education as the VI team may already be supporting a pupil in practical lessons at school (e.g. food technology), whilst the Rehabilitation Worker teaches some everyday living skills as appropriate and also encourages families to promote/encourage the child’s independence.
Following registration of a baby or child, the Social Services Rehabilitation Worker, who leads on work with children, will make a joint home visit with the Qualified Teacher for the Visual Impaired (QTVI) so that they can both explain their different roles and the ways in which each team will be able to support the child or young person (CYP) and their family. This is more helpful for parents than having different professionals visiting independently of each other.
As the same team provides mobility and rehabilitation throughout childhood and into adulthood there is no formal transition from Children’s to Adult Services; mobility training continues to be offered and provided as and when it is needed. The Rehabilitation Worker becomes involved in transition planning for young people moving from school to further education.
For young people planning to go to university in a different local authority area, the Bedford Social Services Team can ensure that a referral is made to the relevant person/team in the host authority. They can also keep track of how support is progressing. When young people return to the Local Authority from out of authority settings they know that they can contact the team for further support if it is needed.
Education and health joint working
Joint working with the QTVI and orthoptists is arranged where both parties feel this would be beneficial. This includes working together in Developmental Vision Clinics and joint assessments in schools.
The VI Team also carries out joint working with other health professionals, for example, occupational therapists and physiotherapists. This includes assessments at the CDC, joint visits to home and educational settings and combined written reports.
The VI Team has had links with the low vision clinic when team members attended low vision assessments with individual children and their parents /carers if invited. Due to changes in LV personnel however, this link is sometimes difficult to sustain.
Multi-agency meetings
All professionals involved in providing services to CYP with VI in Bedford Borough and Central Bedfordshire meet 2-3 times a year. Attendees include: peripatetic VI teachers, consultant ophthalmologists, paediatric optometrists, orthoptists and Social Services VI Team staff. The meetings enable group members to share information in person in addition to emails and phone calls.
These meetings typically include:
· opportunities to discuss pertinent issues such as new government or local policies/procedures/guidelines
· individual members sharing their expertise in a particular area
· supporting professional development of the other members of the group
· case discussions of individual children.
Topics discussed in a single meeting in 2016 included CQC inspections, a NICE consultation on transitions, EHCPs for children with VI and ways to overcome challenges related to the assessment process, a presentation on various childhood eye conditions, and advice about ways to support an individual child.
The group has jointly produced an information booklet for parents: http://www.moorfields.nhs.uk/sites/default/files/uploads/documents/Bedford%20Children%20Booklet.pdf
What factors make the partnership working effective and enables it to be maintained?
· Historical factors: an embedded way of working together which has survived subsequent boundary and other changes. Meetings between the VI team, orthoptists and social service VI teams had already been established and when new paediatric consultant ophthalmologists came into the area, they built upon this existing arrangement.
· Personnel factors (individual and group): the paediatric consultant ophthalmologist (the current post holder and her predecessor) played a key part by bringing in other clinicians working with vision impaired children, in particular paediatric ophthalmologists and associate specialists who weren’t previously involved with the group. A key factor in effective partnership working is the personal integrity and dedication of the professionals involved. They all recognise that interlinking has been an ethos of all teams over many years. There have been few staff changes. Recognising this ethos and the benefits of joint working, the paediatric ophthalmologists have supported and enhanced its development.
· Mutual respect: all the individuals involved have a good relationship with each other and respect for each other’s professional role.
· Leadership/ having a key contact from each sector/group: These are the consultant paediatric ophthalmologist, the manager of the Bedford VI team, the team leader of the social services VI team, and the team leaders of the SEPT (orthoptists) team.
· Forward thinking and planning: also links to the previous and subsequent points – the meetings are booked around the eye clinics so a great deal of forward thinking and planning is needed. The meetings alternate between Bedford and Luton, to ensure that the time spent travelling to the venues is split equally for all.
· Sharing of responsibility: reminding each other that a meeting is due, making sure the meeting is taking place, sharing the organisational arrangements, making suggestions for the meeting content and offers to present a topic.
· Location factors: having so many staff from different disciplines based together in the CDC where relationships can be maintained via informal, face to face contact – this is most useful for the Bedford VI team
· Bringing these all together: the main reason for the current meetings between the VI teachers, social services staff and orthoptists is to foster the continuation of an established arrangement; individuals are motivated to maintain the system and the professional relationships between these individuals.
What are the challenges to partnership working?
Many of the challenges detailed below have put strains on partnership working as individuals come under increasing pressure and become more demoralised. Yet the continuation of this partnership approach becomes ever more important – not just for reasons of morale but also to ensure continuation during a period of constant change. This is something that is understood by managers, who have continued to be supportive.
· Pressures on individual services due to the external context: in the past few years the teams have been working under increasing pressures due to a combination of budget cuts and rising caseloads of children including an increase in the number of those with more complex needs. Competing demands on staff members’ time as a result of these pressures means that there is less time for joint meetings and other aspects of partnership working. Extra effort is needed to ensure that the partnership is maintained.
· Organisational changes: organisational changes that have occurred as a direct response to local authority budget cuts, and changes to NHS organisation at local level, can present a challenge to partnership working, particularly where this leads to changes in systems/structures or to personnel.
· LA and health boundary differences and the high number of health sites: one of the aims of partnership working is to ensure prompt referral and good communication between health, education and social care. This is made more difficult by the large number of different health sites and providers in the local area. Devising a referral system from health to education that can deal with the number of health sites and providers is proving to be an ongoing challenge which the partner agencies are continuing to work on.
Impact on EHCPs
While the EHCP process is led by a separate, central SEND team in Bedford Borough, for children with VI, the multi-disciplinary working relationship makes the process of working on EHC assessments and plans more straightforward. All relevant professionals meet together with the child or young person’s parents (and the child/young person where relevant) to discuss the EHCP and to go through the draft plan in detail. Following discussion, a final draft of the EHCP is issued and then reviewed.
Benefits for parents and children and young people
A holistic approach to support enables a rounded picture of the child or young person to be obtained. Whether support is led by health, education or social services depends on the identified needs of the child/young person. The lead team may change as needs change.