Agenda item

This report updates on a review of in-house day and respite services for people with profound and complex learning and physical disabilities across the three boroughs, highlighting the key themes and proposals for the future. The report focuses on Hammersmith and Fulham services at Options and Rivercourt and refers to the developing offer for young people with complex disabilities aged 18-25yrs.

Kevin Williamson introduced the report in respect of in-house day and respite services for people with profound and complex learning and physical disabilities across the three boroughs, highlighting the proposals for the future.

The report focused on Hammersmith & Fulham services at Options and Rivercourt,  and referred to the developing offer for young people with complex disabilities, aged 18-25 years.

The key proposal was to move from a day service/centre model to one of Complex Community Opportunity Services. There would be three elements to the service: buildings, activities and opportunities and support.

There had been initial discussions between Options and Queensmill School to investigate the feasibility of developing an offer to people aged 19-25 with Autism during the day, which would help to improve the transition from Children’s to Adult Social Care.

The report set out the developing partnership work between Options and Mencap to share day facilities. The main driver for people with more complex needs with learning disabilities was to support them to remain or move back into the local borough area. 

Mr Williamson noted that there were issues with agency staff and that a review of staffing arrangements was underway.

Ms Jude Ragan, Head Teacher of Queensmill School, stated that the new school on Askham Road was for children suffering from complex autism and there were 145 children, aged from 2 to 19. The school was currently in the process of applying to get a small proportion of the school registered with the Care Quality Commission to provide respite care to under 19s and also young adults aged 19-25 with Autism on the school site. The proposal was for the school to partner with an external specialist support/care agency to deliver an after school, overnight and weekend offer, which would help to keep children in the borough. The new building would have four overnight beds.

Ms Ragan noted the change in the Special Educational Needs policy to cover those up to 25 years.

Mr McVeigh was concerned that the report, in describing service users, appeared to propose a one size fits all. In addition, journey times could be significant. Mr McVeigh stated that he had personal experience of the respite services at Riverside House and of an out of borough placement which had had a good outcome. However, he knew of one family who did not receive any respite care and queried the alternative.  

Mr Williamson assured members that it was not proposed that one size fits all. The pilots highlighted the need to look at care and support allocated to people on an individual basis, depending on the complexity of their needs.

Councillor Barlow commented on recruitment of the right people to this specialist role, with the right contract, wages and training, and queried what was offered by the agencies. Mr Williamson responded that recruitment was an issue across the three boroughs. Whilst there were some better agencies, there remained a need for more training and the development of core specialties. It was intended to partner with one or two specialist agencies and have regular specialist agency staff.

Councillor Barlow considered that the Council would have to provide the additional training for agency staff. Mr Williamson responded that managers were being trained as trainers, working with specialist groups to develop expertise. Ms Douglas added that the Council was trying to build a relationship with the specialist agencies to provide development of the workforce and to work in partnership with providers to ensure the right skill mix.

Mr Naylor spoke from personal experience of parents having to fight to get anything done and queried how staff could be persuaded to stay in what must be a very stressful job. Mr McVeigh raised the issue of staff also doing other jobs.

Mr Williamson responded that a culture was being embedded where everyone understood what the service was trying to do and the outcomes to be achieved. Ms Ragan added that there were 170 staff at Queensmill School, and it was important that they stayed as long as possible. Staff were motivated by training and also from self-esteem from doing the job well.

A member of the public queried progress in respect of the full engagement of Mencap, how services would be different and the assessment of outcomes and benefits.

Mr Williamson responded that the service was moving towards more partnership work, with more care based services to ensure that people were best served. Employment would be considered as part of an assessment and the service focus was being changed to outcomes. It was difficult to provide a general response. There would be future discussions in respect of the type of assessment, how outcomes would be agreed and how achieved, and families and carers would be involved. Ms Ragan added that outcomes, including employment and social care, were now being reported in Education, Health and Care Plans.

The Learning Disabilities Partnership Board took a high level overview of how services were meeting needs and supporting families. Ms Douglas suggested that there was a need to look at rebranding to an Opportunities Service. The buildings would be used to develop the service and provide support, but if it was not possible to deliver the range of services, a personal budget might be more appropriate.

The member of the public stated that, whilst Rivercourt provided respite care for people with complex needs, there was no provision for people with moderate needs. She had been provided with an assessment and a personal budget had been allocated, but there was nowhere to go, where the person could feel safe and supported. Ms Douglas responded that the options needed to be considered and that it might be possible to commission a service to meet the person’s needs.

Ms Douglas responded to queries in respect of carers being overworked because they had a number of jobs, and whether the Council looked at agencies’ policies and procedures. The Council asked agencies for information in respect of staff usage and undertook workforce development training. It contracted services through reputable agencies and, where there was high turnover, would question this.

Councillor Barlow recommended Unison’s Ethical Care Charter as a useful tool for benchmarking against other councils.

The Chair stated that there was clearly a need for opportunistic and flexible services for different levels of need and summarised the key points from the discussion:

1.    Service developments needed to be planned in a robust and consistent way for all people accessing the service, to ensure that the good intentions of assessments and outcomes were being met.

2.    There needed to be a more solid understanding of the staffing issues.

3.    There needed to be greater engagement with Mencap.

4.    There was a need for respite care for those with moderate needs.