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Closer to home

Having spent an enjoyable and thoughtful few days at the NCASC conference in Bournemouth last week, I have been reflecting on the workshop session on implementing learning from the National Panel’s reports on supporting children and young people with disabilities and complex health needs that I had the pleasure of chairing. As we eagerly await the government’s response to the phase 1 and phase 2 reports, it’s a good time to take stock of what this vulnerable group of children and young people want and what we, as a system, need to do to ensure both that we listen to them and that their needs are met.

I agree with the National Panel’s recommendations that the system needs to be thoroughly reset for these children and young people; high quality care must be brought closer to home. Ideally, these children and young people should be able to remain living at home, despite their significant needs. However, their families will need help to do this. Wraparound support in the home should be routinely available from care and health professionals, as it is in adult social care, to make this possible. We also need long-term and sustainable funding for regular short breaks, which would also allow these families the opportunity to recharge.

For children and young people whose needs cannot be met with a bespoke wraparound support package in their home, we need local provision - where they can remain connected to their communities and the people who care about them the most. While closed institutions always carry risk, physical proximity to families and connected persons, as well as responsible professionals, will significantly reduce the inherent risks identified in the Panel’s two reports.

These services and provision can only be developed effectively together with health and education partners and through joined up national policy and funding. While I don’t necessarily agree that Regional Care Cooperatives will solve the problem, there are huge opportunities for LAs, health partners and voluntary organisations to work together to develop therapeutic children’s homes to better meet the needs of this cohort. At a recent meeting of the ADCS Health, Care and Additional Needs Policy Committee, we heard how Wakefield and Hertfordshire Councils are opening innovative, jointly commissioned homes for children and young people with complex needs in a similar vein. There is much learning which can be drawn across, including the management of complex contrasting governance structures and decision-making processes. If we keep children at the heart of this, surely we can find a way through the inevitable bureaucracy and governance challenges?

Services like this can only work if there is a clear understanding of roles and accountability across social care, health, and education partners. We must move away from the age-long argument of who should have to pay, and instead turn the conversation to what can we put in place to best support children and young people’s needs?

For this, we need a thorough system wide step-change in approach. While recognising the financial challenges for ICBs, the NHS needs to start prioritising children and young people whose needs often play second fiddle to those of older people and to urgent priorities such as hospital discharge. We need a new system of placed-based leadership, with the DCS as system leader and champion for children, with the levers and influence necessary to deliver on the ambitions we hold for children, young people, and their families.

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