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1 Ledbury Road consultation

Purpose of the consultation

Herefordshire Council, supported by the Herefordshire Clinical Commissioning Group (CCG), is seeking your views on proposed changes to the way that short break services are contracted and delivered at 1 Ledbury Road from April 2016 to March 2017. 

This consultation builds on the dialogue we have had with families during 2015 and previously and our frequently asked questions provide additional background information.

The council’s Cabinet will consider recommendations regarding service arrangements for 2016 to 2017 on 21 January 2016 and we welcome any initial feedback by 19 January 2016, although the consultation period will run until 19 February 2016.

The consultation findings will be considered alongside the above Cabinet report and recommendations at the end of February, when a final council decision will be taken. Subject to that decision, the findings will also help inform any future contract arrangements for services at 1 Ledbury Road. The consultation findings will be published on the council’s newsroom.

The CCG will consider these proposals at its governing body meeting on 23 February.

How to respond

You can provide initial feedback by 19 January by e-mailing shortbreaks@herefordshire.gov.uk

Alternatively, you can respond formally to the consultation by 19 February by completing the online SurveyMonkey questionnaire. If you require the consultation in an alternative format, please call 01432 261596 or e-mail shortbreaks@herefordshire.gov.uk.

You can also attend one of two public consultation events being held on Monday 25 January at:

The Kindle Centre, Belmont Road, Hereford, HR2 7JE   1pm – 2pm
Shirehall, St Peter’s Square, Hereford, HR1 2HX   6pm – 7pm

To book a place at one of the events, please call 01432 261596 or e-mail shortbreaks@herefordshire.gov.uk.

These events are now concluded, please view the consultation presentation to find out more.

Who we are consulting with

Families

We are particularly keen to hear from children and families that may be eligible for overnight short breaks funded by the council and CCG. This includes families that are currently, or have previously been, accessing 1 Ledbury Road. Eligibility for an overnight short breaks service funded by the council is determined by a professional assessment of the needs of a child and their carer/s.

We have therefore written to all families currently open to the council’s children with disabilities team to ensure they can also respond to the consultation. If you have specific questions about support for your child, please call 01432 260857 and speak to the children with disabilities team duty social worker.

We also welcome responses from families who are not currently being supported by the council’s children with disabilities team.

Interested parties

We are also interested to hear from individuals and organisations that support children with disabilities and their families in Herefordshire, including special interest groups, charities, service providers, schools and special schools.

Background information

Families of children with disabilities make many different arrangements to support their lives and this consultation relates to overnight short breaks provided by the council, with support from the CCG.

The primary duty to provide short breaks is set out by the Children Act 1989, which describes the council’s duties in relation to children in need, which can include a disabled child. By providing a range and level of services appropriate to those children's needs, local authorities are required to:

  • Safeguard and promote the welfare of children within their area who are in need
  • So far as is consistent with the duty to safeguard, promote the upbringing of such children by their families 

Within the statutory duties, local authorities should enable carers of disabled children to have breaks from caring by providing, as appropriate, a reliable range of services. This could involve:

  • Daytime or overnight care for disabled children in their own homes and elsewhere 
  • Services that enable disabled children to take part in educational and recreational activities
  • Emergency care, for example, due to illness in the family or safeguarding concerns

1 Ledbury Road has been providing respite services for a long time under a health service contract, most recently via the CCG. It’s registered as a 9 bed hospital ward and has been operating a ‘medical’ model reliant on professional nursing staff. For most of its operational life, children were signposted or referred to 1 Ledbury Road, but few were officially known to the council’s children with disabilities team or had undergone a comprehensive social care assessment of their needs.

In 2013 the council, in partnership with the CCG, invited local and national providers of services to deliver a range of daytime and overnight short break services. Informed by dialogue with families at the time, the new services would help Herefordshire move towards a more ‘social’ model of short breaks provision.

Families wanted their short break services to meet their needs by helping them to achieve particular outcomes, including:

Children with additional or complex needs have fair access to a range of short break services that meet their needs and are:

  • Able to achieve personal goals and learn new skills
  • Able to spend time with their friends and make new ones
  • Able to take part in exciting activities that interest them
  • Supported to maximise their independence and feel more confident

Parent carers are supported in their caring role to:

  • Feel less stressed and have some time for themselves when they can be ‘off duty’ and relax knowing their child is in safe hands
  • Spend time with their other children or together as a family
  • Get to know other families who share similar experiences
  • Be confident that their child is having fun with skilled carers who understand their needs

One of the options requested was for residential based short breaks, but a contract could not be awarded at that time. Under a CCG contract in the interim period, Wye Valley NHS Trust has continued to provide services at 1 Ledbury Road to those families that were already being supported whilst alternative solutions were sought.

Why change is necessary

The health commissioners have historically managed the contract arrangements for 1 Ledbury Road, although the prime duty for such service sits with the council. Wye Valley NHS Trust has struggled to maintain a consistent level of staffing and has had to reduce services during 2015. Renewed contract arrangements, based on assessed need of individual children, should enable the trust to stabilise staffing and ensure that families can access the level of support recommended by their assessment in a safe and potentially more flexible way.

1 Ledbury Road consisted of three 3 bed units, which in spring 2015 was supporting 40 children who had a variety of day and night time support. Since then, the number of service users has reduced as some young people have moved to adult services or had their needs met in other ways.

There are currently 25 children and young people making use of the provision and over recent months, the council has been working with families to review and update their assessments. A number of alternative services have been identified that can meet the needs of some families in a more appropriate manner. This may involve transferring to direct payment arrangements, daytime short breaks, family-based short breaks or specialist residential based short breaks. In partnership with those families concerned, the council is managing plans to transfer each child to their new service.

It is expected that the number of children requiring support at 1 Ledbury Road from April 2016 will reduce to around 15, requiring up to a total of 950 nights in 2016 - 2017. This will reduce further during the year as a result of natural transition of some young people to adult services. Furthermore, the assessed needs of fewer than 10 children can only be met in a residential setting such as 1 Ledbury Road, so the number of service users could reduce even further during the year as more appropriate alternative services become available.

Given Herefordshire’s population, it is anticipated that the number of children with disabilities needing overnight short breaks in a residential setting will remain low in the long term. The council, as lead commissioner, will continue the dialogue with charities and other providers to enhance the choice of services for families in Herefordshire. The council will also work with families so that more can take up direct payments rather than relying on the council holding contracts for short break services.

The proposal

We propose the following:

1) The council enters into a 12 month contract with Wye Valley NHS Trust for overnight short breaks at 1 Ledbury Road in 2016 - 2017.

a) The service would be based on the assessed need of individual children and would move to a social focused model reflecting the outcomes described by families, whilst also providing for health needs and operating safely.

b) A contract would support up to 15 children and young people by offering up to 1,092 nights of service for the 12 months. As a number of children will have transferred to alternative services by April 2016, these proposed contract arrangements would ensure that those children continuing at 1 Ledbury Road are able to access the number of nights recommended by their individual assessments and with greater flexibility than has been possible during 2015.

c) The arrangements are intended to be flexible so that families can discuss their individual requirements with the council’s children with disabilities team and 1 Ledbury Road should have the potential to offer blocks of time rather than the traditional one night a week, if that would be appropriate

2) In order to comply with legislation, Wye Valley NHS Trust would be required to register 1 Ledbury Road with Ofsted, the national regulator of children’s care services, which includes overnight short breaks and respite services in residential settings. The change in registration would also allow the service to adapt its staffing model to more socially focussed and cost effective arrangements, whilst still addressing health needs and operating safely.

3) In order to secure sufficient provision while the wider short breaks offer is further developed in Herefordshire, the council should become the contractual lead for overnight short break services at 1 Ledbury Road in 2016 - 2017. The provision at 1 Ledbury Road will be subject to financial contributions from both the council and the Herefordshire Clinical Commissioning Group. The council's Cabinet will be taking a decision regarding its contribution in January. The CCG will be taking a decision in February on the recommendation to continue to use the Better Care Fund resource for carers support to support the overall provision of short breaks.

4) This approach is intended to provide sustainable short breaks provision and a period of stability for families and the staff of 1 Ledbury Road, while alternative provision is developed and established. New services are expected to become established in 2016 - 2017, including alternative family-based and residential based overnight short break opportunities alongside enabling more families to take up direct payments, so that they can exercise choice. The council will also be preparing to re-commission its wider short breaks offer in advance of March 2017 and will be seeking to enter into new contract arrangements with a range of providers beyond that date. This will include any future residential respite provision and parents, carers, children and providers will be formally consulted as part of this.

To have your say, please complete the SurveyMonkey questionnaire by Friday 19 February 2016.