13th December 2010
Middlesbrough Town Hall
Child and Adolescent Mental Health Services (CAMHS)Learning Disability (LD) Short Break Services FOR Teesside
1.Introduction & PURPOSE
This paper sets out the proposal fortemporary relocation of short break accommodation on Teesside currently provided for children and young people at Piperknowle, Stockton and 179 Normanby Road, Middlesbrough.
It outlines the Trust’s current provision for Children and Young People with a Learning Disability and Complex Health Needs / Challenging Behaviours, and explains the reasons behind the proposal to temporarily relocate both services into single site accommodation.
The existing service is compromised by the current accommodation which is far from ideal to meet the needs of this complex client group. In order to mitigate this risk, the Trust proposes relocating the existing services into a temporary but purpose built unit. A business case for the longer term will then be developed in partnership with the Commissioners, NHS Tees.
2.BACKGROUND
The current short break provision for children and young people with learning disabilities in the Teesside area of the Trust is provided on two sites. Piperknowle House in Stockton serves children in the Hartlepool and Stockton-on-Tees (North Tees) areas, providing 4 beds, the second facility is 179 Normanby Road based in Middlesbrough, providing 5 beds for children in the Middlesbrough and Redcar and Cleveland (South Tees) catchment areas.
The client group for the service is children aged 0-18 years who have a learning disability and complex health need (Profound and Multiple Learning Disabilities). On Teesside this is currently 26 clients. The children may have severe epilepsy, requiring regular interventions / difficulty with nutrition and dietary intake requiring intervention (Gastrostomy feeding) / breathing problems / general deterioration of health due to degenerative conditions and have mobility needs and sensory problems. The pattern of care for children who use this establishment is usually 3–5 day stays depending on the needs of the family; longer stays do take place.
179 Normanby Road - The building is a two storey Victorian detached house on a main road. Space is at a premium when the building is at capacity. The rooms are regular sized living accommodation which may have to house at least 4 children who use a wheelchair and 1 child with mobility difficulties, as well as staff working with the children. The shared bedrooms are upstairs and although provision/training has been given in the event of a fire, evacuating the building via lift and stairs is not ideal. The kitchen is small and accessibility can be a problem.
The downstairs bathroom is small and very dark, the majority of children who use 179 Normanby Road can only shower, but there is limited space to provide a bath option as well. Whilst privacy and dignity is maintained with the use of screens whilst the children are in bed, the fact that they have to share can cause problems when children are unwell / restless for the other occupant during the night.
Last year (January -December2009), 1112 bed days were utilised. This was due to the complexity of needs of some of the children and the physical constraints within the unit. The average length of stay per year, per child, was 48 nights respite (ranging from 35 to 62 nights for individual children), with the exception of one child who stayed for 195 nights. The limitations due to double rooms also dictates the sex-mix of the children. Flexibility is also compromised due to the service currently only available 5 days per week.
Piperknowle House- The building is a two story detached house on a main road which has good access to the building from the outside and a large back garden. The fact that there is only one living area downstairs impacts on the needs of the children, as there is no other room for the children to use for recreation/leisure. Despite staff ensuring that the mix of children is compatible, the lack of separate provision for children to have individual time does impact on behaviour.
The bedrooms upstairs are well appointed, however, there are only 2 bedrooms downstairs that can be used for children with mobility problems. This limits the number of children who can be accommodated at any one time.
The downstairs bathroom is accessed via the living room and has a bath and a changing/shower trolley. However, using both at the same time is not possible. When the trolley is in use there is limited access to the exit.
Last year (January -December2009), 639 bed days were utilised. This was due to the complexity of needs of some of the children and the physical constraints within the unit resulting in 103 days closure. Average length of stay per year, per child, was 40 nights respite per child (ranging from 15 to 89 nights for individual children).
Due to the lack of flexibility of accommodation, the number of bed days available is greatly reduced. Flexibility is also compromised due to the monthly closures.
Commissioners Intentions - Negotiations regarding the longer term provision of this service will be undertaken over the coming months. However, the Trust feels that due to the current accommodation being unsuitable, it would like to propose a move to an interim position allowing planning to continue for the longer term. The Commissioners, NHS Tees,have indicated their support for this proposal.
3.THE CASE FOR CHANGE
Young people with the most severe autism and challenging behaviour are amongst the most stressful for families and professionals to work with. Access to short breaks,however,is particularly difficult for a number of reasons including:
- This client group being deemed unsuitable to access respite care at the same time as the more vulnerable client group of young people with Learning Disabilities and Complex Health / Medical needs;
- The environment or staff group are in some cases not sufficiently “autism specific” to meet the needs of these young people;
- Difficulties in identifying sufficiently experienced workers who can provide overnight respite infamilies’ homes on a regular basis, with no residential short break alternative.
A quiet, uncluttered and predictable environment is particularly important for these young people. This includes having continuity of staff, trained and experienced in meeting their specific needs.
As described, the current facilities are no longer suitable. They can no longer accommodate the severity of challenging behaviour presented by the children or the necessary occupancy levels. For example, individual children may have to be cared for alone in the facility due to the nature of their problems and the risks they would present to other children. There is a need to re-provide the service in more suitable and flexible purpose-built single-storey accommodation, more able to meet the needs of the client groups.
4.ACTION
The Trust proposes to utilise the currently empty Baysdale Unit on the RoseberryPark site. The Baysdale unit was designed specifically to ensurea child and family-centred environment. The location is fairly central to the catchment area, located at the front of the Roseberry Park site in Middlesbrough. This building will, with some minor works, provide 6 beds for a mix of Challenging Behaviour and Technologically Dependent children until the longer term future of this service becomes clear.
The location of thisunit has a number of advantages, particularly the state of the art, accessible and high standard accommodation. The unit is some way out of the main RoseberryPark site, with its own discrete entrance and secluded garden.
Based on the number of children known to services, current activity, and the available budget, the Trust anticipates that 6 beds (2 units of 3 beds),would suffice to meet current demand. Although bed numbers are lower than currently provided (9), given the greater flexibility, no anticipated closures and the purpose built nature of the proposed unit not being compromised by client mix, this would allow for an increase to 2190 bed days. Discussions with the commissioners indicate this model would be supported.
The Baysdale Unit is available for a limited period of time (18 months) but will ensure that the Trust can continue to provide a safe and high quality service and provides suitable mitigation of the potential risks associated with the existing accommodation. This temporary relocationwill allow time for NHS Tees to carry out a full review regarding the longer term provision of CAMHS LD Short Break Services across Teesside.
In the interim, it is acknowledged that the Trust and Commissioners will need to consider the implications for additional travel and associated costs for those young people who would previously have accessed the Piperknowle and Normanby Road Units.
5.ENGAGEMENT PROCESS
A Communication and Engagement Plan for the temporary transfer of services to the Baysdale Unit has been developed, focusing on parents / carers / guardians of children and young people using the service and also including local stakeholders, and thisis currently being implemented. A copy of this Plan is enclosed. The aim of this activity is to:
- Effectively communicate the reasons for the change and the details of future service provision;
- Provide an opportunity for questions, concerns and suggestions to be raised and answered;
- Ensure that issues raised are appropriately responded to and where possible, taken on board.
As part of this engagement activity, a range of mechanisms for seeking and recording the views of parents / carers / guardians of children and young people using the service and local stakeholders will be used, including:
- A public meetingat the Baysdale Unit on 27 October
- Meetings with organisations / groups as requested
- One-to-one meetings with parents, carers and guardians
- Survey included in letters to Parents
The involvement activity will be recorded, and a report produced detailing actions taken to capture views, opinions expressed and how these have been taken on board.
During the period of the temporary location of the service in the Baysdale Unit, NHS Tees will undertake a review of the future provision of the service in the longer term. Depending on the outcome and implications of this review, formal consultationunder section 244 of the NHS Act 2006 will be planned for if deemed appropriate.
6.TIMETABLE
The timetable for the developmentis dependent on the outcome of the engagement process and completion of the works required to make the unit ready. Should this proposal be supported, it is proposed to relocate the existing service to this new single site very early in the new year.
7.CONCLUSION
The proposed new location will provide far superior accommodation to the existing buildings, allowing the Trust to continue to provide a safe, accessible and high quality service.
The proposed development is consistent with national strategy, local commissioner intentions and with the Trust Site Development Control Plan for the Roseberry Park site. The project will enable implementation of other Trust initiatives (including improved environment, Safety, Privacy and Dignity, single sex accommodation, and ensuite bedroom inpatient facilities) within this service area.
It is likely that families will have some concerns about the facility being on a major hospital site, however, the Trust will work closely with the Commissioners in order to reassure them and emphasise the benefits of being close to other specialist services with the skills and expertise of staff to care for the most challenging children and young people.
8.ACTION FOR OVERVIEW AND SCRUTINY
Overview and Scrutiny are asked to consider the content of this briefing and highlight any additional issues that they feel may need addressing and how they wish to be involved.
David Kerr
Project Lead/Senior Operational Support Manager
Tees, Esk & WearValleys NHS Foundation Trust
CAMHS LD Tees Short Breaks/DKerr116/10/2018
Communication and Engagement Action Plan – October 2010
Child and Adolescent Mental Health Services (CAMHS) and Learning Disability Short Break Residential Services for Teesside
1.Informing & Involving
Date / Purpose / Audience / Activity / Location / Action / Progress/Completion
Oct
2010 / Informing &
Involving / Parents of children and young people currently using the service / Letters sent to all parents / carers / guardians outlining service change, inviting participation in involvement & pointing to future plans / N/A / DK / Complete
Oct
2010 / Informing &
Involving / Tees Valley Joint Health Scrutiny Panel & copy to four local OSCs / Briefing Paper sent enclosing C&E Plan, plus letter inviting participation in involvement, offer to attend a meeting & pointing to future plans / N/A / DK / Paper
Sent
27/10/10
Oct/Nov
2010 / Informing &
Involving / Hartlepool LINk, Middlesbrough LINk, Redcar & Cleveland LINk, Stockton-on-Tees LINk / Briefing Paper sent enclosing C&E Plan, plus letter inviting participation in involvement, offer to attend a meeting & pointing to future plans / N/A / DK
Date / Purpose / Audience / Activity / Location / Action / Progress/
Completion
Oct/Nov
2010 / Informing &
Involving / Key local stakeholders:
- MPs
- CLDC/CLMC/CLPC/CLOC
- PBC Groups
- Board / Professional Executive Committee
- VDAs
- NESHA
Oct
2010 / Informing &
Involving / Voluntary and community sector stakeholders: / Letter sent outlining service change, inviting participation in involvement & pointing to future plans / N/A / DK
Oct
2010 / Informing &
Involving / Parents of children and young people using the service, the public and local stakeholders / Information outlining service change, inviting participation in involvement & pointing to future plans available at / N/A / SM / DK
Oct/Nov
2010 / Informing &
Involving / Parents of children and young people using the service, the public and local stakeholders / Press release to local media / N/A / DK/SM
Date / Purpose / Audience / Activity / Location / Action / Progress/
Completion
Oct
2010 / Informing &
Involving / NHS Tees and Provider Staff / Articles in staff newsletters Up2SpeedInsight outlining service / change, inviting participation in involvement & pointing to future plans / N/A / DK / SM
Oct
2010 / Informing &
Involving / Independent Contractors and Staff (Dentists, GPs, Opticians, Pharmacists) / Articles in newsletter Contractors’ Chronicle outlining service change, inviting participation in involvement & pointing to future plans / N/A / SM
Oct
2010 / Informing &
Involving / Local Authorities including Education / Meetings / TBC / CW
27 Oct
2010 / Informing &
Involving / Parents of children and young people using the service and local stakeholders / Open Meeting, 6.30pm / RoseberryPark, Baysdale Unit / DK / Confirmed
13 Dec
2010 / Informing &
Involving / TeesValley Joint Health Scrutiny Panel / Meeting / MiddlesbroughTown Hall / DK / Papers sent
27/10/10
Dec
2010 / Informing
Involving / Parents of children and young people using the service and local stakeholders / Collation of comments received during involvement, production & distribution of report / N/A / DK
Key
DKDavid KerrProject Lead / Senior Operational Support Manager, Tees, Esk and WearValleys NHS Foundation Trust
SMSarah MarsayCommunication and Engagement Manager, NHS Tees
CWClaire WalkerChildren's Commissioning Manager, NHS Middlesbrough and NHS Redcar and Cleveland
CAMHS LD Tees Short Breaks/DKerr116/10/2018