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REPORT OF THE ASSISTANT MAYOR FOR SERVICES FOR CHILDREN AND YOUNG PEOPLE
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TO CABINET
ON 26TH November 2013
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TITLE:PROPOSAL FOR CHANGE OF USE IN THE PROVISION OF OVERNIGHT SHORT BREAKS FOR CHILDREN WITH DISABILITIES.
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CONCLUSIONS:
That Cabinet consider the recommendations following consultation with parents, young people and professionals and approve the proposal to change the use of The Grange short break residential unit. The issues raised by parents and professionals during the consultation have been responded to and parents invited to visit Granville Short Break Care Unit to reassure themselves that their concerns have been addressed. It is proposed that the implementation of the changes should start early 2014.
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RECOMMENDATION:
That the City Mayor approves the proposal that The Grange should provide medium to long term care for children withdisabilities. Young people with disabilities age 14+ who have previously had short breaks at The Grange will continue to access these at the Community Health and Social Care Provision at GranvilleShort Break Care Unit. Young people aged under 14 years old will have short breaks with Salford’s enhanced foster carers.
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EXECUTIVE SUMMARY:
The consultation to change the use of The Grange began on 10th May 2013 and concluded on 15th August 2013. The options within the consultation documents are:
a)That all young people aged 14+ currently receiving short breaks services at The Grange will in future receive that support instead through Community Health and Social Care Provision at the Granville Short Break Care Unit.
b)That all young people aged under 14 years old currently receiving short break services at The Grange will in future receive that support throughSalford’s enhanced foster carer services. In some cases, it may be in the Young Person’s best interest to continue to receive short breaks with the foster carers when they reach the age of 14.
c)To change the use of The Grange to provide medium to long term care for children with complex needs and disabilities with the following options:
- To retain The Grange as an in house provision.
- To procure an alternative provider to run the service, which would see the move under TUPE arrangements of existing staff to the new provider.
- To explore other market options such as the possibility of staff within the service running the unit as a cooperative mutual.
During the consultation period, responses were provided to questions raised by parents, staff and professionals and the Trade Union, Unison, in order to clarify and provide further detailson the proposals. A petition signed by 859people was submitted to Council on 17th July 2013. Whilst the proposal is not part of any savings plan for 2013-14 in Children’s Services, it is part of the savings planfor Community Health and Social Care in 2013-14. The new proposed date to start the implementation of the changes isearly 2014. Although there will be savings for Children’s Services from the proposal in future years, there are in addition very significant benefits because of the possibility of providing both respite and longer term care for children with disabilities in Salford by the City Council.
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BACKGROUND:
The Short Breaks Duty which came into force on 1st April 2011 requires Local Authorities to provide a range of short break services to carers of disabled children which includes;
“Overnight care in the homes of disabled children or elsewhere”
Salford has traditionally met this requirement in legislation through a combination of two services; our enhanced foster care service that specialises in providing short breaks for children with multiple and complex health needsand our in house residential provision, The Grange, which provides overnight care for children with disabilities aged 7-17 years old.
When a child or young person requires more than 75 nights of short break care a year, the local authority currently has to find a suitable placement for that child outside of the city as our in-house provision at present does not cater for long term care. By law any residential provision (such as The Grange) can only provide either short break care or long term care and not both in the same premises.
The Grange is a five bedded short break residential unit for children with disabilities aged between 7and 17 years old. The Unit is a large, modern two storey building, with a well equipped garden to the rear situated on the Brookhouse Estate in Salford.
The overall aim of the Grange is to provide high quality care in a safe, warm and welcoming environment where young people are supported to reach their potential. Staffs seek to promote well being and self esteem by building positive relationships based on respect and understanding. The Grange offers activities and opportunities to young people and enables them to broaden their social experiences.
The Grange promotes the development of independence and daily living skills. Short breaks provide carers with an opportunity to “re-charge” and enable families to have time for tasks and activities that would not otherwise be possible. Staffs promote the rights of young people, respect differences and diversityandchallenge discriminatory attitude.
There are currently 21 children and young people who use the facilities at The Grange who are aged between 8 and17. In addition, with OFSTED agreement,there are currently 2 young people who are Looked After using the facility on a medium term basis. The Grange was judged to be outstanding in 2011/12 and good in 2012/13 and 2013/14 under the new Ofsted inspection framework. The Grange is staffed with: 1 Head of home, 1 deputy manager, 6 residential workers, 3.5 nights staff and 1.5 support workers. The unit has been running under capacity for a number of years and occupancy levels over the past eight years have averaged 54%.
2005/06 / 2006/07 / 2007/08 / 2008/09 / 2009/10 / 2010/11 / 2011/12 / 2012/13 / 2013/1)462% / 54% / 45% / 50% / 48% / 54% / 71.5% / 70.5% / 70%
(October 2013)
The reasons for the increase in rates of occupancy from 2011/2012 to date is due to two Looked After Children who have been placed at The Grangefor several months before moving to outside long term placements. The current occupancy without the Looked after Children is 46%.
There have been a number of factors that have influenced thereduction in demand for overnight short break care services:
- The Disability Resources Panelthat examinesall requests for specialist short break care services also looks at alternative options to overnight short breaks where appropriate.
- The development of increased domiciliary careservices for disabled children, which can be an alternative to short break residential care.
- Increased community based services, which gives disabled children the opportunity for fun and leisure activities, and gives parents a break from caring at weekends and school holidays.
- Better awareness of direct payments, enabling parents to employ a personal assistant for their child.
The unit cost of a place at The Grange is high despite the considerable work undertaken in the past two years to reduce these through updated risk assessments and a reduction in the use of agency staff. The facilities, along with staff are highly thought of by the majority of parents, butthe work of officers suggests thatboththe service and the building are under used and do not provide value for money.
The other significant aspect of the proposed changes is the Children and Families Bill. The Government is changing the system for children and young people with Special Educational Needs (SEN), including those who are disabled. The Bill’s aim is to extend the SEN system from birth to 25,ensuring needs are met through offering families personal budgets,supporting continuity of planned provision and intending to improve cooperation between all services that support children and their families.
Granville Short Break unit offers specialist care to support people who have complex physical, health and learning disabilities needs. The unit provide short breaks care for up to 12 people. They offer persons centred support which treats people with dignity and respect and promote independence and choices.
The proposals present the opportunity to provide overnight short break care in a different way through Community Health and Social Care’s facility at the Granville Short Break Care Unit.
Those young people who would normally leave The Grange aged 17 and go on to receive adult support through ‘Granville’ would, as part of these recommendation, go through that transition process earlier at age 14 and those young people under 14 will receive overnight care through our enhanced foster carer scheme. The Grange will,therefore, beused to provide medium to long term care service for children with complex needs and disabilities. This would reduce the need to place children outside of the city, improve their life experiences and will save on the cost of more expensive out of borough residential placements.
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KEY DECISION:Yes
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DETAILS:
The Grange is a five bedded Short Break Residential Unit. The current cohort of children and young people accessing overnight services through The Grange is 21.
The breakdown of age groups is:
Age / Number8 / 1
10 / 1
11 / 1
12 / 2
13 / 2
14 / 5
15 / 5
16 / 2
17 / 2
In addition, there are two young people age 11 and 16who are Looked After. Special permission was requested from Ofsted for this arrangement until long term placements are identified for the young people.
Granville Short Break Care Unit
Granville is a 12 bedded fully adapted short break unit and has a safe space for young people who require additionalequipment in their rooms. Staffs at Granville have undergone significant internal training which includes tracheotomy care (breathing through a hole in the throat) and PEG feeding for people who have a PEG tube inserted in their stomach. The staff have also been ‘skilled up’ on specialised but basic tasks with skills sets similar to those of an auxiliary nurse which enables them to support people with complex physical health needs as well as those with learning difficulties. In addition, they have been trained in the areas of person centred planning, Total Communication and AutismSpectrum Conditions.
At Granville there is a Manager and 3 Assistant Managers, the unit is covered by a manager at all times. There is a minimum of 4/5 support workers on duty at key times, and if required this can be raised and wrap around teams are also used if required for individuals with complex needs. Staffing ratios are in line with individual care plans and assessments, any additional support needs are discussed and commissioned where appropriate
Transition to Adult Services is well embedded for Looked after Children but less sofor children who received short break care. If young people were able to receive short breaks from Granville, the transition process would start earlier and make the move from Children’s to Adults Services more seamless. This fits closely with the aspirations of the Children and Families Bill. Between the ages of 18 and 21, a young person will experience a whole range of changes in their life by using Granville from age 14, this would ensure that short break care support would remain constant and be one less change to have to deal with during that time. Through the use of’ Granville, support would be in line with adult provision,whereby it is outcome focused and based on promoting independence and enablement.
Granville is on the same estate as Chatsworth High School and Eccles College; this may mean for example, a member of staff could walk young people to their schools and colleges. Those more able young people could be travel trained instead, again promoting independence and enablement. Some of the advantages of providing short breaks at Granville include the consistency it will bring around the number of nights allocated across Children’s Services and Community Health and Social Care and the subsequent allocation through eligibility criteria which can be higher for adult service users. It also ensures that young people with very complex needs will be known to Community Health and Social Care earlier, thus enabling them to be able to develop detailed plans of how best to support these young people further on through the transition process and into adult life.
Community Health and Social Care are offering an allocation of 695 nights a year to Children’s Services. This would meet the current need and allow for growth of up to 20%.
For those children aged under 14,one additional foster carer has been assessed and was presented to fostering panel in September. A third carer is going through assessment. This increase in provision will support those young people within that age range. For those young people whose short break needs cannot be met by foster carers, we will look into providing short breaks by using spot purchase with private providers through the North West Framework.
Future use of The Grange
Salford City Council like many others across AGMA continually relied on outside placements for those children requiring long term care who are unable to be accommodated in Salford due to lack of long term provision. The proposal to change the use of The Grange to provide medium/long term care for children and young people with complex needs is, therefore, very viable. It allows the possibility of bringing back some of those young people placed out of Salford.
There are currently two Salford children with disabilities who meet The Grange criteria who could be brought back from Outside Placements. There are also currently two young people who require medium-long term placement who are placed at The Grange. By keeping The Grange in-house and bringing the two young people back to Salford, the Councilcould make savings.
The second option considered would be to transfer The Grange over to an alternative provider to run it as a medium to long term unit. With this option, the Council would negate most, if not all financial risk whilst still developing a medium-long term provision within the city. If the decision is taken to explore how an alternative provider could take over the running of the building and its staff, there will be HR implications and TUPE arrangements. The third option is to explore models of operating a staff mutual.
Outcome of consultation
The consultation process has taken the form of facetoface meetings with parents/carers, young people, residential staff and professionals both within and outside the council. There were consultation questionnaires and other information on the website, sent out via emails to professionals, parents, carers and also hard copies to parents/carers. Details of the meetings arranged and attendance are:
Dates / Attended By10.5.13
15.5.13
23.5.13
28.5.13
30.5.13
5.6.13
11.6.13
25.6 13
27.6.13
2.7.13
4.7.13
8.7.13
22.7.13 / Unison
Residential Staffs
1 Parent
3 Parents
0 Parent
Children with Disability Team
Reviewing Officers
0 Parent
0 Parent
10 Parents
0 Parent
Met with one young person (specific request)
6 Parents, 6 Professionals from Health and Education
In addition 16 young people were consulted on a 1:1 basis. The youngest aged 8 and the eldest 17. All the young people said they enjoy going to The Grange. They stated that feeling secure, the quality of thefood and having the same bedroom, andstaying with their peer group are important to them. They enjoy the variety of activities offered at The Grange, such as the pool table, computer, the garden, and they liked the staff.
14 parents/carers returned the questionnaire. The issues and questions they raised are in the attached Appendix1.Ten professionals including residential care workers, and health professional returned the questionnaires. There was also a separate response from Unison. All the questions and issues raised are in the attached ‘issues and responses’ document. Parents were given information about ‘Granville’and offered the opportunity to visit Granville to see the provision themselves.In addition formal written response was sent to those parents who sent emails with questions.
The main areas of concern for the parents and professionals are:
- Mixing children and adults in the same building.
Response: Our plan is to support the young people together, in a separate part of the building and the building has room to enable this to happen. It also means that parents with more than one child of different ages can have respite together. The people supported at Granville have very complex needs and are vulnerable adults with functional agenormally associated with that of children.
- Provision of age appropriate activities.
Response: Changes will be made to Granville to ensure provision of age appropriate activities for young people. Granville was closed during September when staffs are undergoing training and various changes are being made to the provision which include work to improve and refurbish the garden to make it more suitable for young people.