Review of care, treatment and support for children and young people with special needs:
This article outlines the Review, ‘These are our children’, and certain recommendations of Dame Christine Lenehan, Director of the Council for Disabled Children
This article outlines the Review, ‘These are our children’, and certain recommendations of Dame Christine Lenehan, Director of the Council for Disabled Children (January 2017), to improve care, support and treatment for children and young people with special needs (learning disabilities, mental health, autism and behaviour challenges). To help do so and to understand her recommendations the article looks at some current issues or problems faced by children with special needs.
There is concern that if professionals find the system a challenge, then it is almost impossible for families to navigate. Lack of communication and support for patients was a key issue raised in the individual case reviews of the young people that prompted the review this article is based on. Lenehan recommends that, in order to ensure every child gets the level of support that the best parents give their own children, that Local Authorities establish how the right level of commitment and support can be given to children and young people from their area that are placed in inpatient settings outside their area. There would need to be agreement between the LA in which the setting is located and the home LA on their roles and responsibilities. This would ensure that there is clear accountability for these children and young people and that they are adequately safeguarded and supported. It is also important that Local Authorities work in partnership with families where the child is still in contact with them, including where they retain parenting responsibilities.
Lenehan also makes recommendations regarding each child or young person in an inpatient setting, or at risk of going into an inpatient setting. Those who do not already have an individual performing this role, should have a keyworker/named worker either from health or local authority services, and be in touch with them. This person, based in the child’s home area, should have sufficient authority and expertise to support the young person and their family to navigate the system. They should also act as a liaison point for them.
Within the system, there is money, activity and intent, which impacts on children with special needs. However, it is problematic that it fails to come together in a single, coherent strategy. Transforming Care ‘should provide the vehicle for this’ and has this year, included a children-specific focus for delivery. However, it has struggled to gain cross-system engagement. The programme has a children and young people’s work stream - but it is in its early days. There needs to be good links between areas of work, and a strong message about their shared outcomes. Otherwise, there is the risk of them being seen as competing priorities, rather than working together. There are a lot of good resources for children and young people with special needs, including the recent pathway commissioned by NHS England. Yet it is difficult to understand the status of these resources, how they are communicated to Clinical Commissioning Groups, and then how they are implemented. Lenehan recommends that different bodies work together to bring coherence/alignment at a national and local level, by the end of the 2016/17 financial year, to the initiatives, such as Transforming Care, which impact on services for children and young people with special needs.
Lenehan recommends, in regard to local implementation, that NHS England, the Association of Directors of Children’s Services, and the Local Government Association, support Transforming Care Partnerships in the implementation of the Service Model, as it applies to children and young people. They would do this by drawing on supplementary guidance issued by NHS England, and the pathway tools developed in partnership with The National Development Team for Inclusion (NDTi), and the Challenging Behaviour Foundation.
There have been issues around commissioning and provision for children and young people with the most complex needs, such as severe autism, severe learning disability, and mental health needs. There is a ‘broad issue with a lack of out of hours provision for children and young people with challenging behaviour, across services’. The current geographical spread of inpatient provision does not represent the population needs, both in geography, and in capacity. In relation to provision for the most complex, there are particular challenges. Lenehan states that there are few inpatient beds available. A number of children with special needs end up in residential schools as a last resort, and there are ‘real concerns’ about the level of professional health support available from psychiatrists, psychologists etc., in that setting. Lenehan heard concerns about Residential Special Schools, despite there being some very good ones.
In regards to the workforce, a multi-agency approach is key, and currently lacking. Where there is money available for recruitment, it is difficult to recruit appropriate staff, with the right skills. Lenehan recommends that those organisations with responsibility for workforce and training, should identify the staff skill gaps in respect of caring for children and young people with mental health conditions, autism, challenging behaviour and/or a learning disability, and take action to address them. This work needs to feed into the workforce strategy that Health Education England are currently working on.
special needs and disability
Lenehan states that ‘there is something fundamentally wrong with a financial system that appears to reward crisis but disincentives early intervention’. She notes that one interviewee said that “there are ‘perverse financial incentives’ in the system.” Regarding the issue of financial incentives, she recommends that services (short breaks, intensive support services such as those in Ealing and Bradford), for children and young people with a mental health condition, autism and/or a learning disability, be put forward by the Department of Health to be trialled using Social Impact Bonds (SIBs). There is reason to do this, as there is the potential to transform services for this group of children and young people, and to get the most effective use of the available funding.