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ITEM EX8

EXECUTIVE – 2 APRIL 2003

CHILDREN’S DISABILITY SERVICES: RESPITE CARE PARTNERSHIP ARRANGEMENTS

Report by Director for Social & Health Care

1. In July 2002 the Executive agreed that proposals to develop an integrated residential respite scheme should be taken forward by an extended partnership between the County Council, Barnardo’s and the Oxfordshire Learning Disability NHS Trust.
2. In November and December 2002 the Executive and the Social & Health Care Scrutiny Committee considered further reports from the Director for Social & Health Care which provided detail on the responses to the consultation on the proposed changes, the financial implications of the changes and an analysis of the need for children’s disability services. In the light of the Scrutiny Committee’s recommendations the Executive agreed that the partnership should proceed with its plans for a redesigned service. The redesigned service would include the children’s residential respite provision and an expanded community play and leisure service.
3. The Service Redesign Project has been managed by a steering group consisting of senior managers with strategic and operational responsibilities from the three partnership agencies. The steering group has co-ordinated the work of a number of different subgroups which have provided expert advice on particular aspects of the project, notably estates, finances, service and human resources. The involvement of staff with day to day responsibility and experience of running every aspect of children’s disability services in the creation of the new service has been a key principle in the way the project has been developed. Since the beginning of January 2003 there has been a full time Project Manager seconded from Barnardo’s who has been co-ordinating the Service Redesign Project.
4. The Steering Group and this report recommend the creation of a Reference Group which would involve elected members/trustees as well as senior officers of the particular agencies. The Reference Group would ensure that the project developed in line with the guidelines established by these underlying principles, identified below.

Underlying Principles of the Partnership

5. The following principles have been developed by the three partnership organisations who plan to involve parents and other stakeholders in any necessary revision.

• A shared belief that disabled children can be helped to fulfil their potential through the valuable social, educational and cultural opportunities that accessible play and leisure and residential services can provide; and that such services also support families and help them continue in their caring role.

• That, in the light of the broad range of need the partnership serves, the interaction of children and their impact upon each other will be areas of particular focus when planning and delivering services.
• That a fully integrated service for disabled children is best delivered by a staff group drawn from different disciplines and professions working alongside each other.
• That productive dialogue between those providing and those commissioning services is essential to good equitable outcomes, including where appropriate, active involvement by service providers, parents and children in assessments of need and robust reviews of the services provided.
• That services commissioned with these principles in mind are likely to be more efficient and effective in meeting need, reducing duplication of effort and minimising unnecessary bureaucracy.

6. A disabled children’s participation strategy has been developed with the Children’s Rights Development Team of Save the Children. Front line staff from eleven different Children’s Disability Services from Social Care, Health and the voluntary sector are working with the Development Team in 4 x 1 day training sessions over 12 months in order to develop the capacity of practitioners to consult with children and ensure services are shaped by their expressed needs.
7. Alongside these training sessions, the Youth Consultation Worker from the Development Team has planned a programme of self-advocacy work with disabled young people. She will work with three groups of young people in their own settings. They have been identified as:

• The After School and Youth Groups of the Oxfordshire Community Project at its Bicester Base.
• St. Nicholas’ House.
• The "Buddies 1" Youth Group based at Chilterns Resource Centre.

8. These settings have been chosen to ensure that they cover children with a wide range of ages abilities and needs. Parents will be consulted to ensure that they are in agreement for their children to take part. The consultation sessions with the children and young people attending the Oxfordshire Community Project activities have already started, and parents have given permission for every child to take part.
9. Feedback from the children about their services and how they would like to see them developed will be shared with the different inter-agency strategy groups involved in planning children’s services and with elected members who are involved in the Proposed Children’s Panel.
10. A monthly newsletter compiled by the Project Manager giving details of the progress of the Service Redesign Project was launched in January 2003. It is sent to all parents whose children receive services from the partner agencies, all special schools and professionals and staff who work with disabled children. The newsletter aims to ensure that all stakeholders are updated on a regular basis about the way the project is developing.
11. A series of question and answer sessions for parents with key managers from the project group have been planned at various sites across the County. The first meeting was arranged for March 2003 and meetings will be taking place on a monthly basis. These meetings will also allow parents to review the architects’ plans for the three redesigned centres and will facilitate consultation about the changes.
12. Constructive meetings have been held with different groups of interested parents across the County. One meeting was organised by parents in the north of the county and was attended by the local MP and another was arranged by parents and governors at Bardwell School in Bicester. The Project Manager was invited to a recent meeting of FORCe to discuss the progress of the service redesign. Hernes House continues to have dialogue with parents through the Hernes House Association.
13. Managers from the three partner agencies have met and are in ongoing dialogue with the Chilterns Action Group which is hoping to buy the Chilterns Resource Centre and run it as an independent enterprise. The Group is seeking capital and revenue finding from a number of local Trusts and is being assisted in developing its business plan by managers from Barnardo’s, the National Care Standards Commission, the Early Years and Day Care Partnership Team and the Oxfordshire Community Project.

  Site Development

14. Architects SDA have completed an initial feasibility study of a range of sites, in Banbury (bungalows in Neithrop Avenue and Sycamore in Oxford Road), Oxford (St Nicholas’ House in Littlemore and bungalows in Saxon Way) and Abingdon (Summerfield). Based upon this work, three sites have been selected: Sycamore, the bungalows in Saxon Way, Oxford and Summerfield. These sites have been chosen because the existing buildings can be most easily and economically converted within the shortest timescales to make them fit the purpose.
15. The buildings in Banbury and Oxford, which will provide short-term respite provision for children with a wide range of complex needs, have also been chosen because of their proximity to acute hospital services. It is proposed that the Summerfield building should be used for children who require full time or shared care because of their particular needs and family circumstances. The design of the current building at Summerfield cannot be efficiently developed to cater for the children with complex medical needs because there are no ceilings to accommodate ceiling tracking mechanisms for safe hoisting which are likely to be necessary under National Care Standards Commission (NCSC) guidelines shortly.
16. The following timescales have been provided by the architects:

Site	Start Date	Completion Date	No. of Beds
Sycamore – Banbury	9/2/04	5/9/04	5
Summerfield – Abingdon	20/9/04	16/2/ 05	5
Saxon Way – Oxford	March 04?	August 04?	5 (+ 2 Emergency)

These estimates are based upon detailed modelling, including 3 week buffers for all works, some allowance for delay over Christmas periods, a commissioning date of June 2003 and a likely twelve week response for planning applications.

17. Work on the different sites has been programmed to run consecutively to allow for ongoing services to be provided for children displaced by building work at their usual centre. The period before work can start on the centres will be used to consult with individual children and their families about how best to offer support during the closure period. The plan is to provide outreach support in the children’s local community but also to offer overnight respite at St. Nicholas’ House and Hernes House.
18. The Saxon Way bungalows are currently home to a number of profoundly disabled adults cared for by the Learning Disability Trust. Their personal living plans have all been completed and they wish to live elsewhere. A Project Manager has now been appointed by the Trust to begin the process of moving them to new accommodation of their choice. If the Saxon Way bungalows become available in the next few months then work could begin concurrently with building work at the other centres, with considerable impact upon the overall completion date. Although it is not possible to schedule this in at this stage, an attempt has been made to model best and worst care scenarios. The best case scenario, based upon re-provisioning of Saxon Way residents within one year, suggests an overall completion date of March 2005; the worst case pushes this back to October 2005.
19. The architects who undertook the initial feasibility study for the project have considerable experience of working on buildings designed for this client group and are recommended to oversee the redesign of the three buildings.
20. An initial modelling of the children who currently receive a service with the bednights available suggests a required capacity of over 85% in term time. Further work is needed with regard to holiday periods, and parents will be consulted about the best way to provide services out of the term time, especially in the summer holiday. There is no standard advice from the Department of Health or the National Care Standards Commission about occupancy levels, but the Social Services Inspectorate talks about 80/85% as a ‘reasonable’ occupancy level for residential care.

Finance

21. Financial work so far has concentrated on the operational cost of the units needed to provide the redesigned service and the capital cost of enhancing the property base to deliver it.

(i) Capital

22. The table below illustrates the provisional capital receipt values of the properties which will be disposed of through the redesign to fund the capital enhancement costs and project management and other related professional fees.

Site	Estimated Value
Hernes House	In the region of £1 million
St Nicholas’ House	£800,000
Chilterns	£450,000
Total	In the region of £2.25 million

23. Because of the technical differences between Health and the partners’ capital funding regimes, complicated ownership issues and the need for a VAT efficient solution, it has been decided to separate capital funding and spending streams. To that effect receipts from St Nicholas’ and Chilterns are to be used solely to fund capital costs associated with the enhancement of Sycamore and Summerfield, plus respective project fees.
24. The project architects in their initial feasibility report have valued the enhancement of the property base. The preferred property bases are tabled below, with their estimated cost of enhancement. They exclude the potential re-provisioning costs for the adults presently residing in Saxon Way, which will be resourced through OLDT. It also excludes project management fees, which presently are not substantial.
25. The costs below are draft but are considered reasonable by all the agencies property sections involved and are deemed within a 10% tolerance of the final estimates.

Property	Enhancement Cost
Sycamore Resource Centre	£549,300
Summerfield Resource Centre	£321,500
Saxon Way (2 Bungalows)	£476,300
Draft Estimated Enhancement Costs

26. From the estimates above it is reasonable to assume that funding is available to cover the capital costs of the project.
27. This level of capital improvement represents a considerable long-term investment in Children’s Disability Services. The investment is considered necessary to allow the building to be accessible to all disabled children including those with profound physical disabilities and complex health needs (for example, those who are oxygen dependent). National Care Standards Commission guidelines suggest that much of this work (e.g. in-built ceiling tracking for hoists in all corridors and rooms) would be necessary to meet registration requirements that buildings are fit for purpose: it is clearly more economical to adapt three buildings to meet this standard than five. Bedroom and bathroom sizes need to be increased so that they are accessible to wheelchairs, and corridors need to be widened for the same reason. Separate sitting areas and play areas have been created to ensure that the buildings can be used efficiently and to maximum capacity so that children with very different needs can be catered for safely at the same time. A pager call system, identified as necessary by Care Standards, is to be installed in each centre so that waking night staff can be immediately aware when a child opens its bedroom door: this is considered necessary to ensure the safety of very vulnerable children who will be cared for alongside wakeful children with challenging behaviour and complex mental health needs. Care has been taken to respond to the needs identified by the children in their consultation. Dining rooms in the centre are being redesigned, for example, to allow for greater privacy:
28. Many children with complex physical disabilities and who are on the autistic spectrum are clear they find meal times difficult and noise and disruption need to be kept to a minimum to allow for food to be enjoyed. Similarly, water and sensory therapy rooms are to be provided in the centres as children have clearly indicated that they enjoy and benefit from such activities.

(ii) Revenue

29. As identified above extensive work has been undertaken to establish the cost of the redesigned service, incorporating the demands already identified in this paper. The table below illustrates the draft estimated cost of running the centres in the preferred property base. It must be noted that they represent the estimated cost at a steady state, so once all centres are operational.

Property	Service Type	Estimated Annual Cost
Sycamore	Short Breaks	£691,700
Saxon Way	Short Breaks	£691,700
Summerfield	Full Time and shared care	£652,500
TOTAL

This funding allows for a staffing ratio of 4 staff to 5 children and this is the minimum standard required by the National Care Standards.

30. Since the report to the Executive in July 2002 and the budget allocations decided in February 2003, funding for the redesign project at a steady state is now complete. The table below illustrates the funding that each agency is providing. This funding allows for the savings agreed in the 2003/04 Budget to be achieved.

Agency	Funding at Steady State
Social & Health Care	£1,115,800
OLDT (Direct Cost funding only)	£566,500
Barnardo’s	£353,600
TOTAL

31. There is still work to do to ensure that all costs and funding streams are matched and relevant, OLDT’s funding, for example, reflects direct cost only.
32. The crux of this project is how we get from current position to a steady operational state under the new arrangements. It is a highly complex process which will not only involve halving the property base, but will also require maintaining the service whilst in parallel redesigning it and implementing the new arrangements.
33. To that effect we have made a bid to the Office of the Deputy Prime Minister to fund potential additional costs through the transitional phase in providing care locally for those families who choose to have their respite provided in their local community.

Staffing

34. Work has been undertaken to model a staffing structure for the new centres and to compare this with existing staff resources. Mapping the proposed staffing structure in this way has confirmed that the redesign service is manageable in human resource terms. It is planned to increase the number of full time posts in the staffing structure which will provide greater continuity of care for children.
35. County Council staff who are affected by the service redesign have been briefed regularly by their managers and have had access to summaries about the progress of the project. More regular meeting are planned in the near future involving union representatives now that the proposals more closely reflect the reality of the redesigned service. OLDT has held regular meetings with its staff and their union/representative bodies to ensure they are kept up to date with plans for how the redesigned service should be devised.

Play and Leisure

36. It is recommended that transfer to Barnardo’s of Oxfordshire County Council’s Play and Leisure Services should take place by the Autumn of 2003. This will help to support the overall co-ordination of these services across the county. In addition, Barnardo’s is currently in negotiation with the Early Years and Day Care Partnership (EYDCP), to manage a post which will assist with the integration of the service. Barnardo’s have also made a bid to create a Volunteer Co-ordinator, who will establish a small team which can work to develop community play and leisure services across the county, particularly in areas where there are few resources at present.
37. The different statutory and voluntary agencies who provide community play and leisure services across the county are working together in an inclusive Play Partnership to develop a strategic planning framework and to co-ordinate bids to relevant funding sources like the New Opportunity Fund, Better Play and the Children’s Fund.
38. New play and leisure services are starting to bear fruit. The After School Club at John Watson School has 50 children on its books, all of whom receive regular play sessions; the Children’s After School and Holiday Scheme at the Blake School in Witney which will provide 5 places for disabled children will open as soon as the recruitment of a co-ordinator is completed. The new Banbury Let’s Play project will cater for 40 children over the summer holiday. The Co-ordinator has been appointed and will be in post after Easter. Links have also been made between this Project and Cherwell District Council with the aim of setting up sports groups for disabled children in the area. It is hoped that this will provide new opportunities for the children and also allow access to new sources of funding e.g. the Sports Council.
39. Work is being taken forward with Bishopswood School in Sonning Common to develop after school activities for children in the area who will be particularly affected by the service redesign because of the closure of Chilterns, from October 2003. After Easter one after school session a week will be run for a small group of children who attend the school. It is anticipated this can include some children who currently attend Chilterns. This service could expand further if recruitment difficulties could be resolved. The manager of the Community Project has made considerable efforts to recruit staff via a poster campaign, door to door leafleting and liaising with other agencies like the Chinnor Unit, the Children’s Information Service and EYDCP; however, full employment levels and the cost of living in the region combined with the number of different projects all trying to recruit play staff has made progress slow. Efforts to improve recruitment will continue over the coming months.
40. The provision of day care continues to receive careful consideration. Children receiving overnight care will continue to access day care during their period of residence at the centre. Where possible, children with particular needs or circumstances, those who may have a long gap between respite and those beginning to receive overnight respite care will be provided with day care. Previous reports to the Executive and Scrutiny Committee have highlighted that it will be difficult to achieve a mixture of children receiving respite care and day care at the same time. Whilst no final decision has been made about the provision of day care, this will continue to be the subject of consultation.

Project Management

41. The development of this project is complex; because it involves three partner agencies, a major estates programme, capital and revenue funding issues, and the maintenance and development of a new service for children and their families. To ensure smooth and speedy progress of the project and partnership it is proposed that the existing Steering Group, which comprises officers of the three partner agencies, should be maintained and established as a Disability Service Project Board, to progress the project as described in this report. The Project Sponsor for the Project Board will be the Director for Social & Health Care.
42. It is also proposed that a Reference Group should be established to oversee the development of the project, and ensure that its management conforms with the objectives of the partner authorities. The Group would need to include county councillors, trustees of OLDT and senior officers of the three partner agencies.

RECOMMENDATIONS:

43. The Executive is RECOMMENDED to:-

1. note the progress towards the development of a new respite care service and associated play and leisure services, through the partnership between the County Council, the Oxfordshire Learning Disability NHS Trust and Barnardo’s;
2. endorse the plans to develop the three centres at Sycamore, Oxford, Saxon Way and Summerfield, on the basis outlined in the report, including the estimated finance and staffing implications and project management arrangements;
3. agree the establishment of an informal Respite Care Development Reference Group, made up of representatives from the three partner agencies, to oversee the service redesign and implementation, on the basis that the County Council representation should be the Executive Members for Children & Young People and Community Care & Health together with the Director for Social & Health Care or their respective nominees.

CHARLES WADDICOR
Director of Social and Health Care

Background Papers: Nil

Contact Officer: Phil Hodgson, Head of Social Care for Children, Tel 01865 815833
Sarah Ainsworth, Service Manager, Tel 01865 815892

March 2003

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