Agenda item

For the Scrutiny Panel to consider and approve the scope and terms of reference for the scrutiny review of Transition of Young People from Children’s Services to Adult Services in Haringey.

9.1       The Panel considered the scoping report and terms of reference for the review.  With regards to the scoping report, the panel’s attention was drawn to the Council’s local response to government’s initiatives “Valuing People” (2001) and “Valuing People Now” (2007) which required services to be planned to enable people with learning disabilities to lead full and purposeful lives.  Other initiatives include:

 

·        Local commitments to developing services which are geared towards maintaining People’s independence stemming from Our Health Our Care Our Say (2006);

 

·        Children and Young People’s Service Plan 2009-12 priories the need for an integrated approach to transition for vulnerable young people and those with learning difficulties and disabilities including mental health;

 

·        The Haringey Youth Strategy identifies the need to support young people with disabilities in transition;

 

·        National Transition Support Programme (2008) has been established by the Government to raise the standards of transition in all local areas; and

 

·        Aiming High: Better Support for Disabled Children and their Families (May 2007) is the Government’s transformation programme for disabled children services. Transition support is one of the identified work streams in the programme and emphasises the importance of joined up working and services centred on children and their families.

 

9.2       There were some overlap with similar objectives, however the quality of outcomes was the most significant issue, some services were provided through adult services and others through children services; it was important to ensure that vulnerable children did not fall through the gaps.

 

9.3       In response to a question regarding pooled budgets, it was noted that currently there were no joint arrangements for children with physical disabilities and mental health issues.  There was joint procurement for the Primary Care Trust and the Mental Health Trust.  Clients were identified at age 16 to ensure early identification of transition issues, consider options for meeting the needs of the client and also to ensure value for money in service provision.

 

9.4       It was noted that the Audit Commission viewed Haringey as a high spending borough on commissioning and in response to a question on the strategies taken by the Children & Young People Service (the Service) to address this, the panel learned that the Service used a method called the Funding Calculator tool and were considering a Pan-London approach as a further possible tool to assist in proactively managing the Learning Disabilities market. Haringey have also been successfully working with a company called OLM to help review some of its expensive Learning Disability placements and reduce costs.

 

9.5       It was agreed that this issue would be discussed in more detail at a future meeting of the panel when budgets and value for money issues would be discussed. Further details of the Funding Calculator can be found at: www.southeastiep.gov.uk/

 

9.6       Due to increasing demand and budget constraints there was a need to plan services effectively to ensure value for money.

 

9.7       Definition of transition

 

9,8       “The [1] [transition] process must be individual to the needs and aspirations of each young person. It is a fluid process, spread out over a number of years, and often local options for young people are limited and support can be patchy and inconsistent. These challenges are compounded by young people’s moves from one service to another at different ages. For example a disabled young person may move from paediatric to adult health care services at 16, then at 18 moves from children’s to adult social care. This is alongside the transition stages in their education. Each of these transitions is likely to occur independently of each other, which means that young people and their families may repeatedly have to deal with new agencies and professionals, re-telling their story each time.” 

 

9.9       Young people who received children’s services may continue to need services when they are adults. This will involve transferring responsibility for assessing needs and providing services from children’s to adults’ services. The process of     transfer is referred to as 'transition'.

 

9.10    It was important that transition was viewed as a process and not just a single event. Implementing improved transition involves: recognition of the importance of the process; adequate consultation with professionals and users, flexibility in timing of transition; a period of preparation for the young person and family; information transfer; monitoring of attendance until the young person is established in the appropriate adult oriented service.

 

9.11    The Panel learned that nationally young people with complex disability present particular challenges because often there is no equivalent adult service able or willing to take on their long-term health care and medical supervision.   There is a need to develop and ensure that a holistic approach to the transition of young people.  However, there was recognition that sometimes they may fall through the      net.  The ADS Steering group were looking at developing a corporate model to address this.

 

9.12   Personalisation agenda 

 

9.13    Personalisation of services was defined as ‘the way in which services are tailored to the needs and preferences of citizens’ the overall vision is that the state should empower citizens to shape their own lives and the services they receive.  This transformation in the way that services are shaped and provided is being compared with the changes which occurred with the introduction of the NHS Community Care Act 1990. 

 

9.14    Personalisation varies from area to area but has the potential for services to solve problems together; this service could have a major impact on quality outcome for the individuals. 

 

9.15There has been a significant amount of national research carried out on Transition and this showed that the barriers to good transition outcomes included:

 

·        Delays because of transitional worker capacity and slow allocation to teams.

·        Limited monitoring and tracking

·        Insufficient strategic planning

·        Parents/carers feeling they have little information

·        The need for transition reviews and plans to be person centred.

·        Out of area placements

·        Lack of supported employment service and

·        Difficulties accessing activities.

·        Difficulties around funding.

 

9.16    Consultation with young people nationally shows that they want:

 

·        A job

·        To go to college

·        More independent living including housing, shopping, cooking

·        Managing money

·        Making friends through normal channels

·        A boyfriend/girlfriend

·        To be safe

·        To be in control

·        Emotional support

·        To be able to go out locally

·        To have some choices and

·        To know early what they need to do to achieve their goals.

 

9.17    Local Context – Summary of Transition Planning:

 

9.18    The panel was informed that children with Statements of Special Educational Needs (SEN), on School Action Plus and School Action, have their statements reviewed annually.  The first annual review meeting focussing on transition planning occurred when the young person was in year 9 (14 years old). There were approximately 1,200 young people with statements.  There was a good group of Special Educational Needs Co-ordinators (SENCOs) in the borough.  372 young people have a Transition Plan.

 

9.19          There are currently 92 young people with statements in the 14 – 19 yrs age range who have been identified as requiring adult services.   The table below shows how clients are categorised.

 

Total who may need adult services: 92
	Numbers likely to require Adult Services	Numbers likely to require Mental Health Services/CAMHS	Joint Referrals (children who may require Mental Health and/or Adult Services)
Year 10
Year 11	13
Year 12	31		1
Year 13	32
Year 14	8	3	4
Total	84	3	5

 

9.20    Members commented on the relatively small numbers of young people likely to require mental Health Services and were informed that whilst the numbers of young people diagnosed with mental health and likely to require mental health services are very small their needs are complex in addition, this group were likely to be diagnosed at a later stage.

 

9.21    Connexions monitor the destination routes of all young people leaving school. Data on those Not In Employment, Education and Training (NEET) is also produced annually and reducing this number is a priority for the Council. Data shows that the position of young people with Learning Difficulties and Disabilities (LDD) is improving.

 

                                         

 

 

 

	Recent records show the improving situation in Haringey for young people       with Learning Difficulties and Disabilities [LLD]

 

 

     9.22   Progress to date:

 

With regards to progress made to date, the panel heard that Special Educational Needs handbook are in all schools this includes guidance on transition and sample transition plans including use of symbols to capture young people’s views;

 

·        Annual transition meeting for parents/carers to provide opportunities to hear about the process and meet key staff and providers;   Opportunities fairs centrally and in schools increasingly offer more choices;

·        All young people with statements of SEN have Transition plans which identify key actions, responsibilities and timescales;

·        All Special Schools and Haringey Sixth Form Centre use Person Centre Plans;

·        Monitoring of young people’s involvement in reviews shows that the majority of young people attend their annual review. For many this requires significant support leading up to the review to ensure they are able to express their views about the hopes and wishes for the future. Communication aids and video evidence are available for young people with the most complex needs;

·        The annual Powerful Voices conferences, Youth Council and targeted consultations with young people all provide opportunities for young people to comment on current processes and policy as it affects them and to influence future planning;

·        There is a meaningful work experience programmes in place in mainstream and special schools for young people with LDD, including MENCAP Pathways , City Farm, A music  club in Hackney, Marks and Spencer,  The Roundhouse Cafe, a campaign group office for disabled people’s rights and many others. Special Schools have used enterprise schemes to provide work experience for young people with complex needs and proceeds in one school are sent to their link schools in Africa.

·        There is good up to date data on all young people with LDD from 14 yrs + including needs, education, health and social care provision and this is shared with adults to inform planning.

·        The well established monthly multi agency 14+ transition panel which monitors and tracks young people in transition also fulfils a strategic role in terms of policy and procedures

·        Joint protocol in place between Children with Disabilities (CwD) team and Adults  Learning Disability Partnership (LDP)

·        The restructuring of staff between CwD team and LDP created a transition team in LDP

·        Haringey Sixth Form Centre offer wider range of courses to young people who transfer from special schools and there are currently 20 young people accessing mainstream courses

·        There are good working relationship between services

·        Personalisation pilot underway in LDP

·        The use if Individual Budgets is planned for young people in transition from 2010

·        Person Centred Planning in place for all young adults in LDP

·        A Review of Partnership Board has been completed

·        A new transition resource was provided for Adults through Area 51 in 2009

·        An Autistic Spectrum Disorder (ASD) Steering Group  has been established to consider ASD specific provision for young adults

·        Training has been provided for GPs to support the monitoring of  health checks

·        There is improved liaison between Adults and acute hospitals.

 

9.23   The panel noted that the Service has identified the need to improve transition  for young people with Additional Needs, Learning Difficulties and Disabilities, including young people with special educational needs but without a statement, young people with mental health difficulties and young people leaving care.  There is also a need to ensure all planning reflected the National Transitional Programme to raise standards and to learn from best practice identified through this process and also the Personalisation Agenda. Greater emphasis also needs to be placed on the key roles young people and their families, separately and jointly have on this agenda.

 

9.24   My Service at 18

 

9.25    My Service at 18 has been established as a joint strategic transition planning group between C&YPS and Adults LP, in the past each Directorate had its own strategic group with representation from the Directorates on each, the new strategic group comprises representatives from Statutory and voluntary services, parents and providers.  The group had its first away day and agreed a joint action and delivery programme comprising of short, medium and long term goals and will report to The Disabilities Forum, the Children’s Trust and to the Learning Disability Partnership Board also the Well Being Stream Board, linking to the Haringey Strategic Partnership.

 

9.26    The Group also identified the need to review the multi agency pathways.  The revised pathways include short, medium and long term goals within a two year timeframe.  An example is to reframe the fourteen plus panel to the Transition Support Panel and to map out how all the Pathways are linked.  Clarification of all eligibility criteria and identification of key people in all agencies and clear roles and responsibilities would be required.

 

9.27    The Panel were informed that Children and adult services have recognised the

need to further review and develop these services and this work had begun. The first step was the joining together of two transition steering groups separately located in the CYPS and ACCS. (Adult, Culture and Community Services). The newly established steering group “my service at 18” quickly identified four work streams; following this an away day was organised to agree a             strategic plan and delivery programme. The delivery programme includes   short medium and long term goals and four work streams namely:

 

            1.         Needs analysis of specific complex needs/mapping of services                  in Children’s and Adults.

            2          Protocol, procedures and pathways.

            3.         Social Inclusion and Personalisation

            4.         Information, partnership ad consultation.

 

9.28    The very successful day was attended by over forty stakeholders (see appendix 1 for list of attendees). The day was characterised by a commitment to be forward looking.

 

9.29   Terms of Reference

 

9.30    The Terms of reference were agreed as follows:

 

“To assess the current transition services available to young people moving between children’s and adult services specifically to provide an objective view of these services and whether they provide value for money.”  This will include reviewing:

 

·        How children with special needs, disabilities and mental health issues are transferred from services delivered by children's services to adult services. This will cover planning, consultation and the handover of responsibility.

 

·         What is done for those children who do not meet the eligibility for adult services but who need some kind of lower-level support?

 

·         To consider how the implementation of the National Guidance on transition support programme is ensured in Haringey.

 

9.31   Timescale

 

9.32    The review aims to report to the Overview and Scrutiny Committee by March 2010.  The recommendations will then go to Cabinet and other bodies, for example NHS Haringey, following this.

 

	Nov	Dec		Jan 10		Feb	Mar.	Apr.
Scoping
Meetings
Consultation with service users
Reporting
OSC
Cabinet

 

9.33   Engagement:

 

9.34    The Panel learned that young people and their families have been consulted about         their expectations for their future and what are the barriers and what would help the transition process. Families have been consulted through the Aiming High programme in addition to the on going work initiated by the AEN/SEN Parent /carers Forum.

 

9.35    The ASD steering Group is looking at the development of autism specific provision for young adults post transition was informed by parents carrying out small group     and individual discussions on their experiences to date, good practice and gaps in the provision.

 

9.36    The Learning Disability Partnership Board has parent representatives of young people in transition. On 21^st October 2009 Haringey Learning disability Partnership hosted an Away Day to enable the Service to look at the work they wished the Partnership board to undertake. Scott Watkins, co- National Director of the Valuing People Team and Debbie Robinson, London Regional lead attended the morning session. Discussion on the day included how to improve service for young people and their families. Representatives of services such as housing and leisure also attended. In addition parents who are also members of the Partnership Board and other carer forums now lead on service developments and their work with Autistic Spectrum Disorder provision is an example of this outcome.

 

9.37    A parent has agreed to keep a transition diary for her 14 year old daughter with Down Syndrome. The aim is to recruit other parent and their young people to so other diaries.