SHORT BREAKS REVIEW

A REVIEW OF SHORT BREAKS FOR

DISABLED CHILDREN AND YOUNG PEOPLE

2013

For the purpose of this review, the term ‘children’ is used in respect of children and young people aged 0 to the child’s 18th birthday

For the purpose of this review, the term ‘parents’ is used in respect of parent and carers who have caring responsibility for the children and young people

CONTENTS

1. Introduction

2.Hollybank

3.Riverside

4.Mencap Childminding

5.Direct Payments

6.Home Based Foster Care and ‘Shared Lives’

7.Outreach

8. Personalised Support and Care

9.Provision for Low Incidence Disabilities: Deaf Children and Blind Children

10.Proposal for Sitting Service

11.Small Grants

12.Specialist Provision for 0 to 5 year olds

13.Proposal for ASD Specific Provision

14.Proposal for young people aged 15 +

15.Access to Universal Services

16.Use of Hawes Down

17Personal Budgets and Personalisation

18.Reference documents

EXECUTIVE SUMMARY

The number and complexity of needs of disabled children and young people is increasing both nationally and locally and is expected to continue to increase into the foreseeable future.

A review of the current Short Break offer within Bromley has been undertaken which recognises that resources must be targeted to those in greatest need whilst ensuring that there are sufficient services to prevent levels of need escalating.

Bromley is supporting the growth of Personal Budgets and Direct Payments but continues to be mindful of its Safeguarding responsibilities. Safeguarding checks, training needs and ‘right to work’ checks will be promoted and a ‘framework’ of agencies who have been highly vetted and monitored will also provide support staff who can be commissioned by LBB, CCG and directly by service users.

Block commissioning of contracts will restrict the pace of roll out Personal Budgets but the use of group provision does meet the needs of a high number of children & young people and offers good value for money. A number of contracts are due to be reviewed in 2013 which presents an opportunity to consider how group based provision may be considered in order to ensure that good outcomes for children are achieved whilst maintaining best value for money

Inclusion into universal services will need to be developed across all age ranges as this will create more opportunities for access to provisions within local communities, and if this can be linked into the development of independence skills such as travel training it will prepare many disabled children and young people for a smooth transition into their adulthood.

This report is intended to inform on current services, with comment on how and if these services may fit with a future Short Breaks strategy and the local authority is seeking views from parents/carers and disabled children and young people on the proposed direction of travel.

1.INTRODUCTION

1.1InJune 2012CYP Executive requested thata cost effective re-structuring of short breaks for disabled children be considered in order to meet the increasing demand for short breaks, including extended short breaks. This was in response to the acknowledged significant increase in numbers of children with complex needs, including those with ASD, coupled with the approved the expansion of GlebeSchool in 2014.

1.2The Executive paper specifically noted that a review take account of eligibility criteria for Short Breaks and should set out to reduce reliance on overnight options, with more provision of day time breaks. In addition, the Executive paper noted that as many of the young people currently accessing short breaks services will not be eligible for adult services, a review of short break provision for young people post 16 should be undertaken to ensure successful transition to adulthood.

1.3Bromley’s school population has increased by 13% between 2009 and 2012 and continues to grow. Department of Education statistics note that within the school population 20% of children will have SEN and 2% will have highly complex needs. There has also been an 25% increase in children surviving premature birth over the past 10 years, with 60% of those children having severe and complex enduring disabilities.

1.4The 2011 JSNA identified that the Borough is experiencing significant increases in both the number of young people requiring services and also identified an increasing complexity of their needs, including increasing volumes of children with complex needs and disabilities

1.5There are an estimated 4,700children and young people in the Borough

who have a disability and/or significant special needs The percentage of pupils in Bromley schools with Special Educational Needs has increased over the last 3 years from 17.1% in 2009 to 17.8% in 2010 to 18.3% in 2011, representing an increase of 628 additional pupils. Over the next 10 years, there are clear indications that the level of needs of the children and young people are increasing. National figures show that between 2004 and 2009 there was a 29% increase in children with profound and multiple learning difficulties, and in Bromley, as at September 2011, this has translated into a 15% increase in the most disabled children

1.6The Children Act 1989 requires Local Authorities to provide services designed to give breaks for carers of disabled children. Regulations relating to this duty came into force on 1April 2011, requiring each local authority to produce an annual Short Breaks Services Statement and a range of short breaks services. Short breaks services are currently available to children and young people who reach the eligibility threshold up to the age of 18.

1.7Short Breaks provide opportunities for disabled children and young people to have enjoyable social experiences as well as providing a valuable break for their parents or carers.They can enhance social development and reduce social isolation. Short breaks include day, evening, overnight or weekend activities which take place in the child's own home, the home of a carer, a residential setting or community setting. Short breaks should occur on a regular and planned basis and should be part of an integrated program of support which is regularly reviewed.

1.8Provision of Short Breaks is based on an assessment of the whole family to determine both their personal and social needs. The Local Authority has a legal duty to provide breaks from caring to assist parents and others who provide care for disabled children and young people enabling them to continue to do so, or do so more effectively for those assessed as being eligible for such provision. Short Breaks should be provided to those for whom a break from their caring responsibilities will improve the quality of the care theyprovide, as well as for those who may be struggling to care for disabled children.

1.9The eligibility for Short Breaks is that the children and young person’s disability must have a substantial and long term adverse impact on their ability to carry out day to day activities.

1.10This duty extends to the Local Authority providing an appropriate and relevant range of choice of Short Break services as deemed necessary by way of consultation with stakeholders, including service users.

1.11There is no statutory level of Short Breaks that is legislated as being an appropriate level. For this purpose, a locally agreed eligibility criteria is applied and individual assessments of need undertaken prior to any Short Break service being agreed.

1.12The responsibility for this assessment in Bromley lies with the Disabled Children’s Social Work Team within Access & Inclusion Division, Education , Care and Health Directorate.

2.CATEGORIES OF SHORT BREAKS

2.1UNIVERSAL SERVICES

2.1.1Universal services are those services provided to all children, young people and their families, such as Children and Family Centres, youth clubs, extended school activities and child care. Universal services may either be part of inclusive mainstream services, or specialist services and are available to all children and young people and their families. Where universal services are provided in a dedicated way for disabled children and young people, this is usually because this is the most appropriate way of meeting the high support needs of that group, for example, a youth club provided for children with learning disabilities and/or on the autistic spectrum, who also have challenging behaviour.Parents and carers can apply directly to the relevant provider and there is no need for social work involvement or assessment to access these services.

2.1.2.Examples of universal services in Bromley

  • Leisure provision e.g. Bromley Mytime sports and leisure centres
  • London Borough of Bromley Youth Service
  • After school clubs, borough wide holiday schemes
  • Activities, e.g horse riding, swimming

2.1.3All universal services have a duty to respond to the Equality Act 2010 by ensuring that their services are accessible and comply with reasonable adjustments required for disabled children and young people.

2.2LOCAL OFFER

2.2.1The Local Offer is available to disabled children up to the age of 18 who do not require social work intervention. To be eligible, the child's disability must have a substantial and long-term adverse impact on their ability to carry out typical day-to-day activities.Short Breaks through the Local Offer can be assessed via a CAF (Common Assessment Framework) referral form which can be completed by any professional involved with a child.All requests for Local Offer Short Breaks are reviewed by managers in the Disabled Children's Social Work Team.

2.2.2The Local Offer enables parents/carers to currently choose one of the following short breaks annually

  • Direct payments - £1000 per year
  • Childminding (short breaks) - 100 hours
  • Outreach - 100 hours
  • Saturday club and or holiday scheme - 18 days

2.3COMPLEX AND ADDITIONAL NEEDS

2.3.1Short Breaks provided at this level are for disabled children where the family is in need of additional specialist support and advice to reduce the risk of family breakdown. A social work assessment is required which will determine the recommended Short Break package dependent on individual family needs.

2.3.2Short Breaks in this category are as follows

  • Direct payments
  • Childminding Network and Network Plus
  • Outreach
  • Saturday club and or holiday scheme
  • Family based overnight Short Breaks
  • Hollybank overnight Short Breaks

2.4SPECIALIST/ACUTE NEEDS

2.4.1Short Breaks provided at this level are for disabled children in need of safeguarding who may be subject to child protection plans, or disabled children who are at serious risk of becoming 'Looked After Children' by the Local Authority.

2.4.2A social work assessment is required to recommend and monitor the provision of this level of service. Support packages at this level are individually designed to ensure children and young people remain in their family home and the local community and may include any combination of the following services.

  • Direct payments
  • Childminding Network and Network Plus
  • Outreach
  • Saturday club and/or holiday scheme
  • Family based overnight Short Breaks
  • Hollybank overnight Short Breaks

3.ANALYSIS OF CURRENT USE

3.1There are currently 462children and young people aged 0 – 17 years known to the Children’s Disability Team, most of whom will be receiving Short Breaks.

3.2Children ‘s needs are categorised as ‘low’, ‘medium’ or ‘high’ .The number of children within the ‘High’ category represent 42% of the total number of children receiving Short Breaks and it is those children who are given priority within the Disabled Children’s Team in order to ensure their needs can continue to be met within the Short Breaks offer, whilst the team must also endeavour to ensure that the needs of those in lower categories continue to be met without further escalation.

3.3A number of children access more than one Short Break. This may be due to parents wishing to vary the provision to suit their needs or may be due to the high needs of children who may need to access as much Short Break provision as possible in order to prevent family breakdown :-

4.SPECIALSCHOOL DEVELOPMENT PLANS

4.1The Local Authority is progressing the development of increased ‘in borough’ day school provision in response to reducing ‘out of borough’ school expenditure.

4.2Officers have therefore been tasked with a review of Short Breaks which will address how resources can be best utilised which will (1) ensure that the Local Authority meets its statutory Short Break duty, (2) project any potential increase in demand as a result of more children & young people remaining in borough, whilst (3) ensuring a sufficiency of range and choice, (4) within available budget now and in the future.

5.SHORT BREAKS BUDGET

5.1The LBB Short Breaks budget for 2013/14 is £2,569,280 (including staff costs)

.HOLLYBANK

1.Service Description

1.1Hollybank is an overnight residential Short Break provision for disabled children and young people aged rising 5 to their 18th birthday. It is jointly funded by Bromley Clinical Commissioning Group and London Borough of Bromley

1.2The service is provided by Bromley Healthcare.

1.3There are 12beds available,including one emergency bed, and the premises are split into 2 distinct units.

1.4Hollybank is open 7 days per week, providing a 24 hour service .The provision is actually open for 350nights per year which enables closure for one training day per month and closure over Christmas Day, Boxing Day and New Years day.

1.5The service is registered with OFSTED and adheres to the National Minimum Standards for Children’s Homes (2011) as applied to Short Break settings.

1.6The current OFSTED rating is ‘good’ in every category (October 2012), (‘good’ meaning ‘a service of high quality that exceeds minimum requirements) and the inspector at the last unannounced visit commented that it is now working within the ‘outstanding’ category (‘outstanding’ meaning a service of exceptional quality that significantly exceeds minimum requirement’).

1.7The service purpose is to offer regular planned overnight Short Breaks with the highest standard of care for children and young people with multiple disabilities, including challenging behaviours associated with a disability, and complex health care needs, working in partnership with their families and other carers, helping to maintain the disabled child or young person within their family, thus minimising the need for out of borough placements, whilst the child enjoys the Short Break experience.

1.8Current OFSTED Registration conditions allow that the maximum number of nights that any one user may stay at Hollybank is 75 nights in any one year. In exceptional cases children may have more than 75 nights but this requires specific consent to be provided by OFSTED.

1.9All service users are subject to an annual review of their placement plan, with monitoring undertaken at least 6 monthly.

1.10Hollybank comprises a totally re-furbished residential home which provides an overnight Short Break service. The home itself is divided into two distinct units. The ‘Purple’ unit has 7 beds for children with complex health care needs and/or physical disabilities and/or learning disabilities. There is an ‘emergency bed’ within this unit The ‘Yellow’ unit has 5 beds specifically intended for children and young people with autism and challenging behaviour and/or learning disabilities. Both units have been designed and equipped accordingly. More recently the specific designation of the units has been re-considered due to the increase in number of children with autism. The decision on the appropriate unit for an individual child has shifted away from being diagnosis driven and moved towards being determined by the most appropriate environment and peer group for each child as well as the level of challenge presented.

1.11When planning and allocating provision, best efforts are made to ensure that service users are offered stays with an appropriate peer group.

1.12Whilst at Hollybank service users are given opportunities to experience a range of activities in the local community. Each service user is allocated a key worker who is a member of the care staff and the children are encouraged and supported to make decisions about their own lives and to influence the way Hollybank is run.

1.13Staffing includes registered nurses, registered social workers, senior support workers and care assistants.

1.14An emergency bed provision was set up in 2010in response to an increasing demand for emergency placements being required whilst Hollybank was operating at full capacity. The bed is physically located within the Purple unit and has the effect of reducing bed spaces which can be allocated on a planned basis to 6 within that unit.

1.15This bed and room is equipped to meet the needs of both ‘yellow’ and ‘purple’ service users. The bed may be allocated to children who are existing service users and any others, providing they meet the eligibility criteria for the Disabled Children’s Team.

1.16The maximum stay for any one child within the Emergency Bed is exceptionally up to 17 nights, providing the individual child’s total stays at Hollybank do not exceed 75 night in any one year.

2.Access to Service

2.1Referrals are accepted via the Specialist Support & Disability Panel (SS&DP) which is a multi disciplinary panel consisting of members of LBB Social Care, Education and Health. Referrals are completed following assessments completed by social care staff in the Disabled Children’s Team