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FAMILY-SUPPORT-SERVICES-FOR-CHILDREN-WITH-DISABILITIES

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FAMILY-SUPPORT-SERVICES-FOR-CHILDREN-WITH-DISABILITIES

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									FAMILY SUPPORT SERVICES FOR CHILDREN WITH DISABILITIES This report has been prepared taking information from the report prepared for Executive Committee for 10 November 2004. It also reflects some of the verbal information shared. 1.0 1.1 BACKGROUND In April 1999 Social Services established the Children’s Disability Team to provide an assessment and care management service and direct packages of support for disabled children and their families. This team was set up with a significant underestimate of the volume of referrals it would receive and had only a small budget to provide support costs. It was anticipated the Re:d Centre would be able to meet most support needs. Since April 1999 until the present time there has been a year-on-year increase in the number of referrals to the team and the numbers of families who receive support packages has grown considerably. Referrals to the Team are subject to clear criteria. As a result of assessment a scoring criteria is used to determine eligibility and the appropriate level of service. In June 2000 the Re:d Centre officially opened. This purpose-built centre was developed in partnership by Social Services, West Pennine Housing Association, NCH and Hurdles, a local parent led group supporting disabled young people and their families. The costs of the Re:d Centre are wholly met from the Children Social Services budget, who contract with NCH to deliver a number of services to disabled children and their families including short breaks, holiday playschemes, social opportunity groups etc. The centre also provides a base for Informe (Bury Children’s Disability Register) and Hurdles who also operate the Bury Parent Partnership on behalf of the Local Education Authority. The Re:d Centre provides a high quality and highly valued service for children and families. Whilst the service was renegotiated last year to ensure the extension of services for the most vulnerable, the Centre also provides support for some families who do not meet the threshold for services from the Children’s Disability Social Work Team. Whilst some of these services are delivered from the resources provided by Children’s Social Services, additional resources are also provided by Connexions and the Children’s Fund. The Hurdles group also provides valuable support. In July 2002 the Council agreed to integrate its services for disabled children under one line manager. Education and Social Services for children with complex needs, hearing impairments, visual impairment, learning difficulty, autism, speech and language impairment, physical difficulties and medical needs , home teaching for children with medical needs and Portage home teaching now form the Children’s Disability Service. Services in Bury have been traditionally run by different agencies with very little coordination of provision across the borough, no comprehensive listing of services and little involvement of families in service design. The Multi Agency Disability Resource Panel was set up in 2002 to co-ordinate service allocation across Bury and to ensure fair distribution of services by the use of common criteria. The Disability Register co-ordinator has produced the first directory of services for families and a multi agency group meets to ensure fair access to play scheme provision. A short break opportunity strategy has been

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developed and designed to coordinate services and ensure that families with lower levels of need access the range of preventative services available thereby reducing the need for intervention from the Children’s Disability Social Work Service. 1.6 Although the Children’s Disability Service started from a low base in 1999, the range and level of provision has expanded to the position where we compare favourably with the level of support provided by other Greater Manchester Authorities.

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ISSUES In recent years there have been advances in the prevention of disabilities in children and improvements in the healthcare services that support the survival of severely disabled children. Consequently there has been an increase in the proportion of children whose disabilities are severe and multiple and a corresponding decrease in the proportion of children with mild or moderate disabilities. The total number of children with disabilities is not necessarily growing but there are more children with complex needs. This puts acute pressure on all aspects of service provision. The spend on out of borough placements increases annually despite a reduction in the number of disabled children placed out of Bury. The costs of placements are increasing significantly beyond the 2% uplift available. Uplifts of 20% have been requested for children with the most complex needs. Where requests for high uplifts have been challenged the service has been told they must remove the child placed. Clearly this is detrimental to the welfare of the child when, in many cases, no other provision is available. The demand for services for children with disabilities has grown steadily since 1999. However, when the service was established there were limited resources and most of those resources were invested in the development of the Re:d Centre. The increased demand for family support and the fact that year-on-year costs of support packages have exceeded the uplift that the service has received has resulted in an increasing overspend. Despite remedial action taken last year, the projected overspend for this financial year necessitates radical action is taken to bring this service back to a point where it can either be managed within existing resources or that additional resources are made available. IMPLICATIONS In this financial year, the gap between the budget provision for the Children’s Disability Service and the assessed need has widened. The service is currently projecting a significant overspend. In 2003/04 the budget situation was addressed and a range of measures adopted:  The Re:d Centre contract was renegotiated ensuring evening and weekend provision targeted at those children in greatest need thus hoping to reduce the need for individually commissioned packages.    The Quality Protects initiative provided cost of two support worker posts whose work is targeted on those in greatest need. The threshold for entry into service provision was raised to reduce the number of families who receive a service. The short break opportunity strategy was developed in order to develop a range of preventative services.

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The impact of these developments has been insufficient to reduce the budget overspend in this service therefore more radical measures need to be put in place if this is to be addressed. Currently, all support packages for children with disabilities are being reviewed. Parents and carers have been given only a short-term commitment to existing levels of service. In order to reduce the projected overspend in this financial year and make existing budget provision viable next year. The options considered are:  Overall cost of packages be reduced by 25%. In order to allow for individual circumstances, individual packages would be reduced between 15-30% albeit ensuring the overall target for the service is met.  Cost of OOB placements are fixed but where support packages to families are in existence, as well as residential placements, the support packages will also be subject to a 25% reduction. All new packages will have a ceiling set for both the level of provision and the cost of the provision. The contract with NCH for the delivery of services at Re:d Centre to be renegotiated so that the key support services are delivered i.e. tea time and weekend breaks which would translate into some support in school holidays. The Re:d Centre would clearly not be able to meet the range of need that is currently met. Should this renegotiation not be possible, Children’s Social Services would set up a tea time and weekend short break service costing no more than the amount agreed. Children’s Social Services are committed to ensuring the delivery of family support services from the Re:d Centre.

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RISK CONSIDERATION Undoubtedly, a reduction of family support packages whether by direct support provision or by a reduction in the range of provision that can be provided via the Re:d Centre will seriously impact on families. The reality would be that, if a family receives 20 hours of support in caring for a profoundly disabled child, they could receive only 15 hours in future. The reduction in service will need a significant adjustment and some families will feel unable to cope. This may result in increased requests for placement OOB; if this is the case, this would have an impact for both Education and Children’s Social Services as well as a detrimental effect on children and their families. It must be noted the cost of children being placed in residential or foster care are greater than the cost of supporting them at home. CONCLUSION Given the rise in numbers of children and families who request support, there is no easy solution to the overspend in this area of service. The only way for the service to operate within budget is to find a way of both rationing a scarce resource and putting a ceiling on the amount of support that any family can receive. The options suggested provide extremely difficult choices, but allow the Council to continue to offer services to those most in need. This kind of “whole service” consideration will enable us to deal equitably with families in need within the resources available

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DECISION The Executive considered all issues and decided that:    Children’s Social Services should renegotiate the contract with NCH for the delivery of services at Re:d Centre. This service should cost no more than a set agreed amount but should include tea time and weekend breaks for the most vulnerable children. The decision about individual packages of support should be referred to Scrutiny for detailed examination prior to a final decision being taken.

Judith Longhill Assistant Director Children's Services

Joyce Berry Acting Head of Access and Inclusion

11 November 2004


								
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