Agenda item

This report highlights the challenges and opportunities for vulnerable young people in this borough regarding transition from Children’s Services to Adult Social Care and provides a number of options moving forward.

 

Councillor Vaughan commented that the report on transition from Children’s Services to Adult Services was an important item in the Administration’s manifesto. Transition should be a seamless process, led by professionals. The offer going forward should include health, education and adult social care. There should be person centred seamless provision of care for the young person and their families.

 

Liz Bruce introduced the report, which highlighted the challenges and opportunities for vulnerable young people in the borough regarding transition from Children’s Services to Adult Services. The new ‘Transition Service’ would provide choice and control for the young person and their family, not available in the current provision.

 

Should a child have a Statement of special educational needs (SEN) or an Education, Health and Care Plan (EHC), it was good practice for the planning process to begin at age 14.

 

Mrs Bruce stated that there was limited provision within Hammersmith & Fulham. There was a narrow interpretation of who should be supported, largely young people with learning disabilities. The report set out the scope of the service and the current transition offer. Feedback from families was not very good.

 

The Children and Families Act, which was enacted in September 2014, had extended the age range of eligibility for a formal assessment and support plan for Education, Health and Care needs from 0-16 to 0-25 years.

 

In respect of Health, young people with complex needs would transfer from specific paediatric support to their local GP at age 18.

 

The report set out the key imperatives to improve and develop the transition experience for young people and their families and friends.

 

Ian Heggs stated that the replacement of a SEN with an EHC was a big change and the joint assessment needed to be co-ordinated in a more efficient way. Young people and their families had the right of referral to a tribunal.

 

There was now a requirement on local authorities to provide a high quality offer of specific courses and support for young people up to the age of 25 years. There was a need to develop and expand provision for young people 16-25 years. However, the budget remained the same.

 

Mr Heggs noted the development of provision at Queensmill Special School specifically for young people with autism.

 

Mr Heggs emphasised the importance of local services and supported housing. The Council was focused on taking on board the views of young people and their families and a person centred approach. The EHC assessment would take longer, in the region of 42 hours.

 

Mrs Bruce stated that there remained challenges in respect of the different services not working in silos and ensuring that the planning process with young people and their families was not an administrative process.

 

Nandini Ganesh stated in reference to the creation of a consultative forum, that Parentsactive existed. They had not been included in any of the surveys. Mr Heggs agreed that Parentsactive should be included and this would be addressed.

 

Alison Farmer stated that the work of Parentsactive would have been covered in the feedback from Healthwatch. There had not been a joined up consultation with Adult Social Care. There had been feedback from schools, but not specific surveys. The PAC was part of the consultation process, which was at an early stage.

 

Ms Ganesh queried which young people had been invited to the workshops in respect of the design of future commissioned services. Ms Farmer responded that a few workshops had been held in special schools and advice was still being sought.

 

Members considered the report to be misleading, and asked for clarification of the process and the stage it had reached.

 

Action: Alison Farmer

 

 

Patrick McVeigh noted that the number of young people given in the  report was small (75 young people with a learning disability and approximately 100 young people aged 16-25 with complex needs across the three boroughs) and  requested that a set of metrics be developed to enable the committee to better understand how transition was working in LBHF. These metrics should include at least:

 

(i)            Number of people awaiting EHC aged 14

(ii)           Number with EHC by age group

(iii)          Number with SEN by age group

(iv)         Number of people awaiting assessments that are outside statutory timescales of 20 weeks

(v)          Number of EHC reports underway

(vi)         Number of transitions backed up for people aged 18+

(vii)        Number of cases raised to the tribunal

(viii)       Number of cases upheld at tribunal

(ix)         Number of cases rejected at tribunal

(x)          Number of further appeal escalations and legal cases in process

(xi)         An analysis of content of SEN and EHC in terms of outcomes requiring psychology input, speEHC and language and occupational therapy for LBHF and NHS resource planning

(xii)        Independent living – how many and when

Mr McVeigh referred to the client database, and queried how long it would take to populate manually and the number of people working on the project. Mr Heggs responded that this data was available and would be provided.

 

Action: Ian Heggs.

 

 

Mr McVeigh referred to the late involvement of the Transition Team leading to anxiety and anger for carers and parents, and quoted from the Care Act:

 

‘Provision will continue throughout the assessment process until adult care and support is in place or until assessment indicates that adult care and support does not need to be provided.’

‘These changes mean that there is no “cliff edge” when someone reaching the age of 18 who is already receiving support will suddenly find themselves without the care and support they need at the point of becoming an adult.’

 

Mr McVeigh understood that Andrew Christie allegedly told parents that ‘however, we cannot change the fact that, once young people turn 18, they must transition to Adult Services.’

 

Mrs Bruce assured Members that there would be compliance with the Care Act and agreed to seek clarification from Mr Christie in respect of his alleged comment.

 

Mr McVeigh sought confirmation that speech and language and other provisions would continue beyond school age until the desired outcomes had been achieved. Mr Steve Buckerfield, Head of Children’s Joint Commissioning for the three boroughs

stated that subject to clinician recommendation, speech and language would be provided free of charge at the point of delivery to individuals deemed to require support. Ms Farmer warned that this requirement was potentially unfunded.

 

Members considered that the overarching issue for Health was not the need to increase the provision of specialist services currently on offer for young people once they became adults, but the consistency of services offered by GPs. There were considerable differences in the quality, capability and skills of GPs in respect of young people with complex needs. Whilst paediatric services were very involved in the early stages, this support fell away. The issue was how to improve access to the services currently available.

 

Mr Buckerfield responded that there were a number of concerns in respect of access to health services post age 18+, which it was planned to address.

 

Councillor Brown commented that the quality and experience of GPs could make a significant difference and that people needed to be signposted to the right services.

 

Mr Buckerfield responded that one of the key outcomes of the Connected Care project in Hammersmith and Fulham was the development of Community Champions, local volunteers who provided signposting for other residents across a range of health, housing and social care services.

 

Eleanor Allen queried the role of key workers. Ms Farmer responded that key workers would manage the transition process and support young people and their families to make choices. Providers would be expected to do this.

 

Councillor Carlebach stated that consideration of GP services should not be restricted to Hammersmith and Fulham, as the borough was also served by GPs from Kensington and Chelsea and other neighbouring boroughs.

 

A member of the public described his family’s experience. His child had not been treated as an individual and they had lost the case to keep him at home, as a one year extension had been refused. They had lost all respite care when their child reached age 18 and speech and language therapy was no longer provided. There had been not been regular transition meetings.

 

Councillor Vaughan stated that clarification was required in respect of: whether speech and language therapy funding stopped at age 18 or whether it could go forward as part of the EHC; and responsibility for co-ordinating the input to transition meetings from young people and their families across a range of services. 

 

Mr Heggs responded that whilst SENs needed to be transferred to EHCs, it was not possible to do this for everyone. The focus of the EHC was on outcomes by the end of the next key stage and greater independence. Education would fund the continuance of speech and language therapy, if it helped to deliver the agreed outcome. Ms Farmer added that there was no additional funding to provide services to age 25. As an interim measure, some of the New Burdens Fund could be used. An additional full time speech and language therapist had been provided in schools. The Council was working towards the provision of a clear statement of the services young people and their families could expect.

 

Mrs Bruce responded that work was underway to bring about a culture change, including a review of the transition team model. The different services needed to work in partnership; there were currently too many interfaces and limited provision.

 

A member of the public who had a 19 year  old daughter with complex disabilities spoke of her positive experience at Chelsea and Westminster Hospital and also of the situation where she had been told that the SEN she had in place was to be transferred to an EHC and she would need to apply for an EHC assessment. The requirement for an EHC assessment was subsequently rejected. In addition, the panel’s decision had not been conveyed in an appropriate manner.

 

The member of the public emphasised the importance of a co-ordinated approach to transition and the involvement of health professionals. In addition, better training was required, and specifically in respect of placements. There was a lack of provision. There needed to be a holistic approach to residential accommodation.

 

Councillor Fennimore commented that the member of the public had had to fight every step of the way to ensure that she got the services she needed for her daughter with high level complex needs.

 

Mr McVeigh was concerned that SEND Code of Practice (9.4)  was being ignored:

‘During the transition period local authorities will transfer children and young people with statements onto the new system…. No-one should lose their Statement and not have it replaced with an EHC plan simply because the system is changing.’

Mr Heggs accepted the need to improve communications and agreed to investigate this case.

 

Action: Ian Heggs

 

Councillor Perez Shepherd commented on the effectiveness of personal stories and   endorsed the proposals for a more person centred approach and to consider transition models from other boroughs.

 

Councillor Needham commented on the importance of professional careers advice and the involvement of the young people in decisions, and the need for support for young people who moved away from home to attend university.

 

Mrs Bruce responded that there would be a review of the services in which the Council was investing, with a focus on learning disabilities. There were a range of groups who needed support.

 

Councillor Vaughan summarised the key points of the discussion:

 

1.      Issues had been identified in respect of communications and how providers communicated and worked with young people and their families, and the need for sign posting to the right services.

 

2.      There needed to be clarity in respect of the provision of speech and language therapy.

 

3.      It was key for professionals in Adult Social Care, Children’s Services and Education to engage in an appropriate way and for there to be joined up working. The process needed to work properly whilst retaining the focus on outcomes.

 

RESOLVED THAT:

 

It was recommended that a joint task force be established with the Children and Education PAC to take forward in more detail the transition from Children’s to Adult Services, in conjunction with expert witnesses.

 

Councillor Vaughan thanked the members of the Children & Education PAC and the parents for attending and contributing to the meeting.