Trafford sets agenda for integration of children's care and health services
Tuesday, April 26, 2016
Having outsourced day-to-day management of its children's services to an NHS trust, Trafford Council plans to become the first area to fully integrate social care and community health services for children and adults.
Given that it was the birthplace of the NHS in July 1948, it seems fitting that Trafford, in Greater Manchester, is now pioneering efforts to improve provision by integrating social care and community health services.
Earlier this month, a partnership deal between Trafford Council and Pennine Care NHS Foundation Trust saw the health organisation take on lead responsibility for the day-to-day provision of Trafford Council’s children’s services in what is believed to be the first arrangement of its type in England.
Over the next two years, the aim is to integrate social care and health services for both children and adults. Other councils are watching keenly, with some already expressing an interest in doing something similar in their area.
In fact, Trafford could be a test site for the other nine authorities in Greater Manchester. From the start of April, the Greater Manchester Combined Authority assumed powers and funding from Whitehall for overseeing integration of all health and care services.
Integration of health and social care services at Trafford Council has not happened overnight. Indeed, the local authority has been working with Pennine Care for a number of years.
Work to develop integrated multi-agency services for children and young people started in late 2000 and, by 2008, had progressed to the creation of Trafford Children and Young People Service. This service was governed and managed jointly by the council and Pennine Care.
The set-up, which is still currently in operation, sees provision delivered through four separate multi-agency services covering family support, children with complex and additional needs, children in care, and referral and assessment (see box).
Under the latest arrangements, developed through an agreement under Section 75 of the Health Act 2006, which was signed on 1 April, day-to-day responsibility for the provision of children and adult services in Trafford is the responsibility of Pennine Care.
However, the statutory responsibilities for these areas will remain with Trafford Council’s director of children’s services (DCS)and director of adult’s services respectively.
The budget of the integrated service is around £50m and boasts 1,300 staff.
The plan over the next year is to integrate existing children’s services with adult health and social care services to create an integrated “all-age” system.
“Things take time to change,” says Cathy Rooney, director for safeguarding and professional development at the newly integrated service. “What we are doing is managing services as they currently are and gravitating towards the final changes.”
The final structure is still to be finalised but will work on a locality model, with Trafford split into four geographical areas that will each have a core set of services.
These will be supported by centralised specialist services that cater for the entire local authority. There is also set to be a central “all- age front door” for assessing whether people – from young children to the elderly – require support.
“We have a multi-agency front door for children which, according to Ofsted, works very well,” Rooney says.
“Anyone in Trafford who requires support will get the same process to see how we can best support them.
“Services for children and adults with additional needs may stay centralised so we can get the transition right from children to adults.”
Richard Spearing, network director, is in charge of the entire operation, says there are some financial savings to be made through the arrangements, but not enough for local authorities to pursue this route for that reason alone.
“The biggest gain from this is around improvements to quality of care,” he says.
“If you go into this just to save money, you are starting in the wrong place. If you start based on quality and think it through there are financial efficiencies, management efficiencies, but not on the scale that people would imagine.
“We are learning as we go and we are going to make mistakes, but we will make sure we engage with staff and service users.”
Trafford Council’s children’s services were rated as “good” by Ofsted in May 2015 under the single inspection framework.
That report praised the “highly effective programme of change” that the council had embarked on.
“The success of the local authority is characterised by the highly effective partnership work, in particular the joint working arrangements between the local authority and the health service provider,” the report states.
It also goes into detail on the extent to which health professionals are fully embedded with children’s services, from early help for pre-school children to specialist interventions for looked-after young people and care leavers.
Four out of five of under-fives in Trafford are registered with children’s centres. An increase in health visitor capacity has helped improve specialist support for hard-to-reach families, such as those affected by domestic abuse, parental substance misuse and mental health problems.
The strong links between health and adult services – and the benefits this has for identifying children at risk – is also praised by Ofsted.
“Adult services for parents with mental ill-health, substance misuse and those who experience domestic abuse, ensure that issues of concern focus on solutions to safely reduce risk posed to children,” it states.
“They routinely check whether service users are parents, have caring responsibilities or contact with children.
“There is evidence in children’s case files that professionals share information, seek guidance and make referrals appropriately to children’s social care. They contribute to child protection conferences and core groups.”
The integrated health and social care service ensures looked-after children receive “good access to high-quality services”, particularly for those with complex needs.
Co-location of health, mental health and social work staff has been instrumental in health outcomes improving for children in care, the report says.
“Performance measured by national indicators shows 100 per cent of initial health assessments are completed within 28 days when children first become looked after, and 98 per cent of children in care for 12 months have a health assessment completed,” it states.
“Health service provision is sharply focused on meeting
looked-after children’s needs.
This is characterised by the good level of attention given to promoting healthy lifestyles for children through information and advice.
“This is helping to raise awareness with children under 10 to the risks posed by smoking cigarettes and misusing alcohol. With older children this awareness raising includes aspects of their sexual health.”
Co-location of social workers with health staff, including physiotherapists, psychologists and speech and language therapists ensures that children’s health and disability needs are comprehensively assessed and fully integrated into their care plans.
It also praises the support offered by the looked-after children nurse to older teenagers and care leavers who need advice about health issues or referral to more specialist help.
“Young people receive a health care booklet at the age of 18 that contains all the necessary and relevant information available to the looked-after children health team to enable young people to take charge of their future health care arrangements,” it adds.
At a strategic level, the report highlights the strong focus that the area’s health and wellbeing board has on the needs of children and young people, as well as the fact that the DCS takes an “active role” in the work of the board and clinical commissioning group.
Trafford’s integrated services
Integrated children’s social care and health is currently delivered through four services in Trafford:
- The multi-agency referral and assessment service (MARAS) acts as the ‘front door’ for Trafford’s children and young people’s service. It accepts referrals for children and young people that are deemed to be in need of a certain level of support and undertakes child protection enquiries where appropriate. It features a police officer, health professional, teacher, as well as social workers.
- Area family support teams, of which there are three across Trafford, provide ongoing support to children and families. They consist of health visitors, school nurses, the Connexions service, educational welfare staff and children’s social care, all based together, working in the same area and backed up by services delivered through children’s centres.
- The complex and additional needs service brings together children’s social care to support a child with complex additional needs and health-based services that work with the same children, such as speech and language therapists and community paediatricians.
- Children-in-care services incorporate a looked-after children nurse alongside child and adolescent mental health staff, who are fully “embedded” within care services in an attempt to support the emotional health and wellbeing needs of children in care and care leavers.
Inside view: Trafford’s integrated model can help families become stronger
By Cathy Rooney, director for safeguarding and professional development of the integrated service
Trafford has a long history on delivering integrated services in children’s services, health and social care. We now have it fully integrated across all of our children’s services. I believe that was a key component of why we did so well with Ofsted – our ability to demonstrate very close partnership working and understand each others’ roles quickly and work with a child very fast. Staff are so embedded with each other and coming up with holistic packages.
We have had the beginnings of that here for some time – what this [new] model does is scale that up significantly so that it also includes all adult services. We want to try and take it to the next stage and do it on a whole family basis.
It has enormous potential benefits for working with children and young people. In so many of the cases with children that we have open, they are open because of parental difficulties – because they are living with challenges and difficulties of their own that are impacting on their ability to support or protect their children.
The more we can work with adult services who understand those adult-based issues, the better the response will be. It has got enormous potential to help families become stronger and move on and not feel they are getting a fragmented approach.
People are obviously always centred on trying to find different models. There is a lot of interest in Greater Manchester, and other organisations are trying to get a sense of where we are going.
They are going to see how it progresses and see if there is anything transferable to their particular circumstances.
We built up our own solution. It is a model of something that we believe is working well, but it is not necessarily a solution that would work everywhere.