Agenda item

On 1 October 2013 the Committee established a rapid scrutiny exercise to consider the proposals under a joint review between the Council and NHS Wiltshire Clinical Commissioning Group on overnight short breaks for disabled Children and Young People in Wiltshire. This included a proposal to close the Hillcote short breaks unit in Salisbury.

The exercise took place on 7 November and several members also attended a public meeting about the proposals held in Salisbury on 6 November.

The report of the rapid scrutiny group (copy attached) was referred to the Clinical Commissioning Group Governing Body, who will make the final decision on the proposals on 26 November. The group’s recommendations were referred to the Cabinet Member for Children’s Services who attends the CCG Governing Body but is not the decision maker.

The decision of the Clinical Commissioning Group Governing Body will be reported at the meeting.

The Chairman reminded Members that at its last meeting, the Select Committee established a rapid scrutiny exercise to consider the proposals under a joint review between the Council and NHS Wiltshire Clinical Commissioning Group on overnight short breaks for disabled children and young people in Wiltshire.  This included a proposal to close Hillcote short breaks unit in Salisbury.

The rapid scrutiny exercise took place on 7 November 2013 and several members also attended a public meeting about the proposals held in Salisbury the previous day.   The report of the rapid scrutiny was referred to the Clinical Commissioning Group Governing Body, the decision maker on this matter, and also to the Cabinet Member for Children’s Services. 

In the light of concerns expressed by many parties on the proposals, the CCG Governing Body decided to defer their decision on this matter until their next meeting on 28 January 2014, the same day as the Select Committee’s next meeting.

Cllr Laura Mayes, Cabinet Member for Children’s Services, made the following comments on recommendations contained in the rapid scrutiny report:

1          The proposals have not been properly costed

The figure of £40,000 per specialist carer had been arrived at through discussions with two neighbouring authorities who had specialist carers providing overnight short breaks for disabled children (Dorset and Gloucestershire).  Although the two schemes were slightly different, the cost was roughly the same.  The cost included adaptations and equipment.  A member of staff from Wiltshire Council had gone through the costs in detail with contacts in these two authorities.

The new specialist carer scheme was highly unlikely to have any impact on the future use and sustainability of Canon’s House.  It was known that some families preferred residential provision, whilst others were happier with their child being looked after in a family home.  There will always be a need for a residential unit in a county the size of Wiltshire.

The proposal was cost neutral in that the CCG had signed up to re-investing the funding currently used to run Hillcote in other overnight short breaks and earlier support for families with a disabled child.  This commitment was included in the minutes of the CCG Governing Body meeting.  There was no intention on the part of the CCG to make a saving from the proposed closure of Hillcote – this was what cost neutral meant.

2          Potential difficulties in recruiting specialist carers

The Council had held detailed discussions with the two adjacent local authorities who had no difficulty recruiting specialist carers.  In Dorset, these carers were recruited from their Family Link Scheme.  In Wiltshire, interest had already been expressed in being a specialist carer by a member of Hillcote staff.  It was right to point out that it would be difficult to recruit a number of Specialist Carers before April 2014, but this was not an option that any of the five families of the young people currently using Hillcote wanted to explore.

3          Quality assurance and safeguarding checks of specialist carers

It was right that specialist carers were subject to the same quality assurance and safeguarding checks as foster carers.  These were rigorous checks.  Children and young people who were looked after by foster carers were often vulnerable in a variety of ways and this was why safeguarding checks were so important.  The intention of a specialist carer scheme to provide overnight short breaks for disabled children was that the specialist carer and the family of the disabled child formed a good relationship and knew each other well.  It was not expected that any parent would leave their child with somebody that they did not feel comfortable with.

4          Continuity of provision for service users if a specialist carer decides to stop operating

Specialist carers were recruited, on a contract, to provide a specific amount of overnight short break support.  Carers would need to give notice if they decided to stop operating.  If this happened, then discussions would take place with families about alternative support.  It was right to note that long term support could not be guaranteed.

5          Not demonstrated that proposed specialist carer scheme will be able to provide care at short notice

Within the contracts agreed with a specialist carer, some flexibility could be built in so that they could support families at short notice.  However, the position was no different than with a residential unit.  Hillcote was only open for part of the week, so would not always be available at short notice.  When a parent could not care for a disabled child at short notice, Children’s Social Care would make arrangements for the child to be looked after if the family doid not have relatives/friends who could provide help.

6          Parents have not been made aware of or offered provision at Hillcote when it may have been appropriate

Access to overnight short breaks was only given following an assessment by a Social Worker within the Children’s Disability Teams.  All families with a significantly disabled child were in contact with a wide range of professionals.  In Southern Wiltshire, all these professionals would be aware of Hillcote, that it provided overnight short breaks and that access was via the Children’s Disability Teams.  These teams were not aware of any families being referred that met the criteria for overnight short breaks and who had not been offered support. Two of the families that used Hillcote actually lived closer to Canon’s House than to Hillcote.  The decline in the use of Hillcote was not related to a lack of information, but it was a specialist service and was therefore not ‘advertised’ as it was only offered to those families with the highest level of needs.  For other families with a disabled child, there were other options (including Wiltshire’s Short Break Scheme which was accessed by approximately 1,000 families).

7          What emergency plans will be put in place if Canon’s House was temporarily unable to operate

All service providers had business continuity plans.  If Canon’s House were temporarily unable to operate then other arrangements would need to be made for those children and young people who had planned overnight short breaks at the unit.  The closure of Hillcote would not make any difference to the position now.  There were no spare buildings for any service just in case there was a fire.

8          No information provided on early intervention services and how their effectiveness has been assessed

If Hillcote closed, then some funding would be re-invested in early intervention services (in line with the views of parents and carers of disabled children across the county who had been telling the Council for a number of years that they wanted help before things reached crisis point, for example help with challenging behaviour, sleep and continence).  The CCG already funded a Children’s Learning Disability Nursing Service that worked with families struggling with, for example, behaviour or sleep routines for a learning disabled child.  However, this only had the equivalent of 3 full-time members of staff for the whole county.  This service would be expanded so that help could be provided for a larger number of families at an earlier stage.  An expanded Children’s Learning Disability Nursing Service would work closely with both Canon’s House staff and specialist carers, alongside families with a learning disabled child.

After some discussion,

Resolved:

(1)       To endorse the report of the Overnight Short Breaks for Children and Young People with SEND Rapid Scrutiny Exercise and to note the Cabinet Member’s comments.

(2)     To note that the Wiltshire CCG Governing Body had elected to defer consideration of the proposals of the Council and NHS Wiltshire Clinical Commissioning Group until their meeting on 28 January 2014.