I was asked by the Department of Health to review the system of care and treatment of disabled children with a complex mix of needs involving challenging behaviour, learning disabilities and often autism.
I was motivated by a concern I share with many others that these children are disappearing into the system with little hope of enjoying life in their home community again.
While These are Our Children has primarily been a review of the health system, all these children are in need of a multi-agency response to meet their needs. They will be known to education teams, because they should all be in school, and will be known to social care staff because of the high-level of family support they require. Some of them will be looked after children, so the local authority’s duties as a corporate parent will also apply.
I was asked by the Department of Health to look at the action that could be taken at a national level, by Government and other bodies, but local authorities have a vital part to play if the lives of these children are to be improved. The first thing that local authorities must do is get an accurate understanding of how many of these children come from the local area, how many are being treated outside their home authority and how many are at risk of being treated elsewhere.
Only with a good understanding of this can local authorities decide on what services they need. When talking to commissioners and managers I often heard that it was impossible to create local services because of the small number of children involved. I think local authorities can do better.
Whether it be as part of SEND reforms, or joint commissioning processes, I would like to see more local authorities forging sub-regional partnerships to pool budgets for services and asking the question: ‘If we aggregate our populations of these children, what can we achieve?’ In that way we can prevent these children and young people taking the well-worn path to settings so far from their home that regular family contact becomes impossible.
Time and time again I heard evidence that the most common reason that these young people end up in inpatient settings is school exclusion – because the mainstream or special school they are attending couldn’t support their needs. And the second is family breakdown. So each local area should look at the work being done in schools and ask how this supports the family. For example, are there adequate facilities for these children during school holidays - a time when parents can particularly feel the strain? If these holiday schemes fall foul of budget cuts then there will be an inevitable knock on effect on admissions.
In These are Our Children I call on each child in an inpatient setting, or at risk of entering one, to have a key worker from either health or social care, but in touch with both, to act as a single point of contact with the family. If the family is getting support from social services it makes sense that this person is a social worker but whichever arrangement suits a local area best, families with a child making their way through what can be a complicated and confusing system must always have someone they can turn to. Someone they know, and who knows them and their child.
Above all I’d like local authorities to read the report and take a step back and ask ‘What are we doing about autism?’ Autism is not the key to understanding all of these children, but it is a dominant factor in many of their lives. If local authorities have a good strategy for supporting children with autism at every level of care, adding on support services for other disabled children with complex mental health needs, their responses will be that much more robust.
If we get this right, we can shift the focus of responsibility so that ‘these children’ become ‘our children’ with exactly the same rights to health, education, community life and hope, as their peers. If we don’t act, then our care services for the most vulnerable disabled children will add up to little more than warehousing, acting as the long stay hospitals that I thought we’d left behind.
These are Our Children is available from the Department of Health website.
And the work doesn’t stop here! The Council for Disabled Children is conducting another review into the quality of care in residential special schools, due to be published later this year. Find out how you can give evidence to the review here.
This article was originally published online in Children and Young People Now. You can read the original article here>
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