Tees Valley Joint Health Scrutiny Committee

TEES VALLEY JOINT HEALTH SCRUTINY COMMITTEE

23 APRIL 2012

MIDDLESBROUGH TOWN HALL

CHILD AND ADOLESCENT MENTAL HEALTH SERVICE (CAMHS)

LEARNING DISABILITIES (LD)

SHORT BREAK SERVICES FOR TEESSIDE

Introduction

Members of the Tees Valley Joint Health Scrutiny Committee were presented with a paper by Tees, Esk and Wear Valley (TEWV) NHS Foundation Trust on 13 December 2010.

The paper set out proposals for the temporary relocation of short break accommodation on Teesside currently provided for children and young people in the Stockton and Redcar & Cleveland Local Authority area.

The reason for the temporary relocation was that the accommodation in Stockton (PiperKnowle House) and Redcar & Cleveland (179 Normanby Road) was no longer suitable for the children who had significant complex needs.

TEWV proposed that the service was relocated to the Baysdale Unit on the Roseberry Park site as an interim solution. This unit is in Middlesbrough.

At the meeting of Tees Valley Scrutiny in December, it was acknowledged that TEWV Trust and the Commissioners (PCT) would need to consider the implications for additional travel and associated costs for those young people who had previously accessed the PiperKnowle and Normanby Road units.

At a further Tees Valley Health Scrutiny meeting on 14 March 2011, members were made aware that Stockton Council had indicated some concerns which were the subject of negotiation with the PCT – these concerns were in essence the funding of the transport arrangements to enable the young people to access the service.

Since the interim service was established in March 2011, ongoing discussion has taken place with the PCT and legal advice has also been sought from both Stockton Borough Council and the PCT regarding the funding of the travel arrangements.

Whilst these discussions have been ongoing the PCT/Stockton Borough Council and Redcar& Cleveland have continued to ensure transport is provided (via Local Authority service) to the young people, and the costs have been covered on a joint funded basis.

Historically where the children accessed the respite services in their home Local Authority, the School Transport Service would collect the young people from school (and transport them to the respite service) and the following morning collect them from the unit and take to school.

This has been “custom and practice” for many years and did not incur any additional costs, as these children were eligible for school transport and were being transported within the Borough on agreed school transport routes.

During school holiday periods parents make their own arrangements for transporting children to the unit.

Since the children now access service outside the Borough, there is now a cost, which is currently £23,000 a year in relation to children from Stockton and up to £36,100 per year, see below, in relation to children from Redcar& Cleveland. There are currently 23 young people attending Baysdale from Stockton and seven from Redcar& Cleveland.

In Redcar and Cleveland the Council now commissions a contractor to provide this service at £150.00 per day. In addition, an escort is provided at £40.00 per day to support the small number of children travelling each day (average three). This is then billed to the PCT at 50%.

If this transport service were to continue beyond September 2012 for Stockton children, then the cost would increase to £36,000 as we would need to hire a new vehicle (the current vehicle cannot be used long term).

The legal advice Stockton Local Authority has received is as follows:

“It is my view that the Council is not under a statutory duty to provide the transport from respite care. The Council has a statutory duty to provide home to school transport for eligible pupils – s.508 Education Act 1996 (as amended). DfE guidance confirms that “home” is the place where the pupil is “habitually and normally resident” (part2, page 12 footnote to the DfE guidance). Consequently the duty to provide transport is from the young person’s usual place of residence and not the temporary respite accommodation.

The Council does have a discretionary power to provide transport where it is necessary to facilitate attendance at school (s.508C Education Act 1996). The Council’s Home to School Policy, para 18 details when the Council may exercise this discretion being:

“consideration can be given to providing assistance with transport under exceptional circumstances or Crisis Support at the discretion of the Corporate Director of CESC”.

Consequently the Council should consider providing transport as a discretionary service and must follow an appropriate decision-making process when doing so. In particular when exercising its discretion we need to consider:

§ the need to treat each case on its merits e.g. how frequent is the respite care; for how long; can education be provided otherwise than at school; impact on the young person;

§ have regard to the legislation and guidance, including the duty to promote equality;

§ have regard to resources and other sources of assistance.

The outcome of this may be that there will be no transport provision or limited transport.

NHS Tees sought legal advice attached at Appendix 1, (the Local Authority would point out however that the Local Authority is not under a statutory duty to provide the transport from respite care) subsequent advice was also then sought regarding the PCT responsibility for arranging for children to go to a health respite provision (out with the school).

The advice was as follows:

“Our legal opinion is based upon “Eligibility for Patient Transport Services”, DoH, August 2007, Gateway Ref 8705).

Essentially, the general position of the NHS is that patients have to arrange and pay for their own (non-urgent) transport to and from premises providing NHS healthcare. However, transport can be provided by the NHS if there is a medical need due to:

(a) a need to access the skills of PTS staff; or

(b) their medical condition impacts on their mobility to such an extent that they would be unable to access healthcare without transport being provided; and/or

Transport can also be provided for a parent or guardian of children and/or to an escort or carer if their particular skills are needed. This type of “medically needed” transport is paid for by the PCT and provided free of charge. Factors such as distance and frequency of the journey can be taken into account and the patient should be able to reach healthcare in a reasonable time and reasonable comfort. In addition, financial assistance can be provided under the Hospital Travel Cost Scheme if there is no medical need for transport but the patient is eligible for assistance because of low income (there are various qualifying benefits, etc.). In the particular cases we are discussing if the children can travel in an ordinary vehicle (or they have an adapted vehicle of their own perhaps purchased through benefits) without a need for special care or attention then they/their parents should cover the costs (subject to eligibility for HTCS). If there is a need for specialist transport and/or care during the journey, for example if difficulties have been created by journeys now being longer due to relocation of services, then they may qualify for free transport if it is required for one of the reasons given above. In practical terms the situation of each child would need to be assessed and an appropriate clinical opinion given.”

In light of the legal advice from both (all) organisations, NHS Tees/Stockton and Redcar& Cleveland Local Authorities are seeking agreement to consult with parents on proposals to cease providing transport to the health respite unit with effect from September 2012.