LOOKED AFTER CHILDREN HEALTH EXCHANGE (LACHE) ROUNDTABLE WORKSHOP Tuesday 17th September at Children in Wales, Cardiff Looked after Children, Care Leavers and the Social Services and Well-being (Wales) Bill 1 SUMMARY REPORT This report provides a summary of the Roundtable Workshop convened by Children in Wales in partnership with the LOOKED AFTER CHILDREN HEALTH EXCHANGE (LACHE) on the 17th September 2013. Aims of the workshop To provide an opportunity for delegates to be informed of the latest developments in respect of the Social Services and Well-Being Bill in respect of the proposed impact on Looked after Children, Care Leavers and the services which support these groups To consider the conclusions and recommendations from the National Assembly for Wales Health and Social Care Committee and Children and Young People Committee in respect of Looked after Children and Care Leavers To hear from speakers some of the main issues and concerns both in respect of the Social Services and Well-Being Bill and in terms of the present issues around partnership working, implementation and delivery of existing legislation, and service provision for Looked after Children and Care Leavers To inform Stage 2 of the legislative process and begin to identify the key issues to help inform future Regulations and Codes of Practice to support the delivery of the Social Services and Well-Being Bill To provide an opportunity to reflect on, consider and discuss the broader issues beyond the current content of the Social Services and Well-Being Bill in respect of Looked after Children and Care Leavers Outcomes of the workshop Delegates will be more informed of the latest developments in respect of the Social Services and Well-Being Bill in respect of the proposed impact on Looked after Children, Care Leavers and the services which support these groups Delegates will be more informed of the relevant conclusions and recommendations from the National Assembly for Wales Health and Social Care Committee and 2 Children and Young People Committee in respect of Looked after Children and Care Leavers together with some of the issues raised through scrutiny in Committee Delegates will, through cross sector discussions, be more informed of the issues and challenges in respect of delivering services for Looked after Children and Care Leavers as well as the implementation of current policy and legislation Delegates will be more informed of the key proposals being advanced by the Third sector and the potential opportunities to influence the legislative process moving forward Outputs of the workshop A summary report will be compiled and circulated to all attendees and members of the LOOKED AFTER CHILDREN’S HEALTH EXCHANGE who were unable to attend the workshop Speaker presentations and links to the Social Services and Well Being Bill will be made available as above. 3 Looked after Children, Care Leavers and the Social Services and Well-being (Wales) Bill Welcome and Introductions Sean O’Neill (Policy Director at Children in Wales and co-ordinator of the LOOKED AFTER CHILDREN HEALTH EXCHANGE) introduced the format of the session, the aims and anticipated outcomes from the workshop. Delegates introduced themselves. Format of the Session This is outlined in Appendix 1 Participants and Apologies 20 professional members attended this workshop from the health sector, third sector and Government Speaker 1 – DAVID CLAYTON, SENIOR POLICY LEAD, CHILDREN’S SERVICES, WELSH GOVERMENT David provided the group with a brief overview of the development of the Social Services and Well-Being Bill, the scrutiny stages undertaken to date and the commitment of the Deputy Minister and Welsh Government to transforming the way in which services are delivered to children, young people and adults, together with the ways in which people are engaged with such services. The legislation will have a three tier structure. 4 Key points (in respect of Looked after Children) Statutory Guidance currently in place will be reviewed, remade and replaced. In the context of health, this will include A Stable Life and Brighter Future guidance (and accompanying regulations) The Code of Practice will bring together Statutory Guidance in one place to support implementation of the Bill It is to be determined whether there will be a single over-arching Code of Practice comprising a number of volumes (as supported implementation of the Children Act 1989) or a services (series) of Codes.( Part 6 of the Bill largely consolidates and restates existing legislation Some parts of the Children Act 1989 remain outside the powers of the Welsh Government e.g.in respect of court orders. However, the UK Government’s Children and Families Bill is also delivering reform reform in respect of court orders and other aspects of the family justice system. Part 6 will not lesson existing obligations and duties Existing legislation is comprehensive and well structured Regulations to support the Bill will consider entry into care, in care arrangements, transition from care and independent living. Regulations will also focus on placements, including foster care, residential care and family-friends care etc Definition of Well-Being for children has been embedded in legislation for 10 years. This has been revised and updated and this will also apply to adults Care plans will become Care and Support Plans. Regulations will set out the key elements of the Plans e.g. timing, content and review. Health and education outcomes, contact arrangements and Independent Visiting will also be considered. Presently, local authorities have a number of plans – health, education, mental health etc. The Bill includes provision to enable these plans to be integrated into a single plan. New provision requiring local authorities to secure sufficient accommodation to meet the needs of Looked after Children 5 David outlined the current timescales for the further development of the Bill. These were set out as follows The Bill is currently going through the National Assembly’s Legislative process with a final vote due to be taken by Assembly Members in early 2014. Policy intent for all major Regulations underpinning the new system will be developed whilst the Bill is progressing through the scrutiny process. Sign off the policy intent in late 2013. Royal Assent of the Bill is anticipated in March 2014. Consultation on subordinate legislation will begin in early 2014-15 The making of subordinate legislation, including Regulations, priority codes and guidance will commence in 2014-15. This will be followed by training in the new duties and transition to the new system in 2015/16. The Welsh Government intends for the bulk of the Bill to be implemented by April 2016. Key points Stage 2 scrutiny of the Bill will begin in early October following a debate in Plenary. The debate is planned for 8th October There will be a large number of Welsh Government amendments to the Bill The DM has already indicated through a Written Statement that there will be an amendment around Advocacy Stage 2 will provide an opportunity for non-government amendments to be put forward Stage 2 scrutiny will again be undertaken by the Health and Social Care Committee and conclude in December. Two half-day and a full day session has been set aside by the Committee to consider the amendments No decision has been made as yet as to how the amendments will be grouped – possibly thematic? The Deputy Minister was hopeful of publishing the Govt. amendments shortly to provide opportunity for AMs and stakeholders to consider. Some work has already started in respect of developing the Eligibility Framework Stage 3 will commence in the new year Though the Bill is scheduled to be implemented fully by April 2016, sections of the Bill will be put forward for implementation following Royal Assent in March 2014 The policy intent to underpin the Bill will need to be completed by December 2013. Consultation process will begin in early 2014 6 Speaker 2 – SEAN O’NEILL, POLICY DIRECTOR, CHILDREN IN WALES Sean’s presentation focused on the conclusions and recommendations from the reports of both the National Assembly for Wales Health and Social Care Committee (July) and the Children and Young People Committee (May) in relation to the elements pertaining to Looked after Children and Care Leavers. This was complemented by a number of the key issues provided to Committee through oral and/or written evidence during Stage 1 of scrutiny1. Timelines we set out as January – Bill was referred to the H&SC committee for consideration February – H&SC committee requested that the C&YP committee to scrutinise the Bill C&YP Committee did so – 2 sessions held in April – Report submitted to the H&SC Committee in early May H&SC Committee – took written and oral evidence up until June and published the report in July Final published report contained 61 Recommendations In considering the recommendations relevant to Looked after Children and Care Leavers, delegates were asked to consider the statement by the First Minister that the Social Services Bill would be the vehicle to strengthen the government’s approach to supporting looked after children (July 2012) One of the questions for today therefore was does the Bill deliver the Welsh Government stated aims in respect of looked after children and care leavers? General principles Does the Bill, in respect of LAC/CL, meet the 4 general principles – that of Consolidates existing legislation. Simplifies and clarifies duties to aid the effective delivery of social services Social Services & Well Being Bill & links to responses to the Bill to date via Committee http://www.senedd.assemblywales.org/mgIssueHistoryHome.aspx?IId=5664 NAfW Children and Young People Committee report (May) which fed in to the H&SC Committee report http://www.senedd.assemblywales.org/documents/s17060/CYP%20letter%20on%20SSW%20Bill.pdf NAfW Health and Social Care Committee report (July) http://www.assemblywales.org/bus-home/bus-business-fourth-assembly-laid-docs/cr-ld9418-e.pdf?langoption=3&ttl=CRLD9418%20%20Health%20and%20Social%20Care%20Committee%3A%20%20Stage%201%20Committee%20Report%2C%20Social%20 Services%20and%20Well-being%20%20%28Wales%29%20Bill 1 7 Promote partnerships and closer, more integrated working between local authorities, and between local authorities and other partners, including NHS providers Strengthens national direction and increased consistency of access to and provision of social services with an enhanced prevention and early intervention role for local authorities and their partners to prevent or delay the need for care and support Promote the empowerment of service users – enhancing their voice and control The following key sections and issues were put forward for delegates to consider - PART 6 - Services for looked after children and accommodated children CYP Committee considered whether Part 6 of the Bill was an appropriate update to existing duties and appropriately consolidates existing legislation. The Explanatory Memorandum states that provisions in Part 6 of the Bill update and clarify obligations and duties towards LAC (during Committee) it was put forward that Part 6 of the Bill does very little to alter existing legislation and does not address some of the current shortcomings (There is) partial consolidation of existing legislation and replication of some sections of the Children Act and Adoption and Children Act, BUT could this cause confusion and complication amongst social workers and practitioners? Does an attempt to simplify legislation lead to alter interpretation? Section 88-94 - Categories of care leavers. (during Committee) issue were raised around the terminology –– H&SCC called for more appropriate terminology to be considered and Welsh Government are receptive to hearing alternatives being put forward Overarching issues we need to consider Access to services Power to charge 16-17 year olds - this should be removed and will undermine the intentions of the Bill and restrict access to advice, information and services Power to charge families for information, advice and assistance as well as for preventative services (could deter people from accessing services) – H&SC Committee called for greater clarity on the circumstances in which charges could be imposed for services Here it was noted that a Local authority in England are consulting on plans to charge parents up to £900 per month if a child is taken into care on a voluntary basis or non-crisis situation. It will also considering charging for certain services designed to keep children within their own family – child over 16 may also be asked to contribute to the cost of their care – there are some exemptions BUT....) 8 Partnership working – should the responsibilities of other partners to work together to deliver social care services to children be more explicit on the Bill? Danger that only social services will remain accountable in the absence of duties on other partners in the Bill? E.g. to other local authority services and local health boards. Without clarity, is there potential for disputes between agencies as to who is responsible arise? Will the Bill deliver the multi agency response needed? H&SC Committee called for governance and partnership arrangements to be prescribed through regulation to prevent disputes AND was persuaded by the evidence in favour of fully integrated health and social care, calling for a separate bill to be brought forward as is currently being considered in Scotland. This could also include provisions around pooling budgets and greater sharing of resources between local authorities and local health boards. User voice and control Advocacy services on the face of the Bill? Weakness in the Bill no references to independent advocacy other than in relation to complaints. The Children’s Commissioner for Wales, through his Missing Voices review called for the need for children and young people to have better access advocacy support and raised concerns around awareness of advocacy amongst children and young people. H&SC Committee welcomed the Welsh Governments commitment to bring forward an amendment around advocacy and called for these details to be made available before the start of Stage 2. Fostering to adoption provision Discussion around the need for securing earlier permanence for children– but does the Bill provide for this? Concerns raised around the timescales on fostering to adoption in the Bill. Written in its present form this will not be in the best interests of children who may have to move twice before being placed with their permanent family .This concern is also stated within the context of C14 of Children and Families Bill which brings care proceedings into the 26 week timescale .There will not be sufficient time to make fostering to adopt placement . Fostering to Adopt could also face challenge by birth family members under Article 6 and 8 of Human Rights Act in respect of making pre emptive decisions on placement for adoption prior to court direction. Concerns that fostering to adoption is being confused with concurrency placements. Calls for the Bill to include provision for local authority to have a duty to consider as part of a permanency plan for children, placements with carers who could become the child’s permanent carers where this is in the child’s best interest And what about the following..... 9 Placement of children and out of country arrangements When I’m ready scheme – transition to adulthood - remain with former foster carers in a familiar supported setting as an alternative to supported lodgings Sibling contact (sec 79-80) when placed separately - section needs strengthening Portability of care plans Management and review of cases Suitability of accommodation Choice and availability of independent visitors Views of children and young people in review meetings Foster care Unannounced inspection of care homes Role of residential care homes for children – not seen as a last resort Finally, other areas of significance raised during scrutiny Repeal of Section 17 and Part 3 of the Children Act 1989 (impact on Disabled Children) and loss of Child in Need Preventative services – shift of focus and resources over time to rebalance the system with more towards early intervention and preventative services from acute services. Need to strengthen the preventative duty on health services to match that on local authorities ‘People’ agenda – common set of processes for people or separate arrangements for children and adults? – Potential impact of any loss of focus on children and children’s services. Possibly leading to the interests of children being overshadowed by those of adults National eligibility criteria – key to whether the Bill delivers its stated intentions – await further details around this Safeguarding Boards (issues around merging regional adult and children’s boards – H&SC Committee say this should be removed and national boards should be separate) Removal of the ‘reasonable punishment’ defence –the majority of the Committee didn’t believe that this Bill is the right vehicle to pursue this issue Alignment for the assessment process to avoid duplication. ROUNDTABLE DISCUSSION GROUPS Four tables were established and a set of questions were provided to assist delegates to focus their discussion. 10 Speaker 3 – KATE CARR, NSPCC CYMRU/THIRD SECTOR POLICY OFFICERS GROUP Kate’s input focused on the discussions which have taken place within the NSPCC Cymru, and their engagement with other children’s third sector organisations as part of the NGO Policy Officers Group, and with both children and adult organisations through the Social Services Advisory Group. The key concerns shared included The need for a clear and robust set of principles on the face of the Bill Concerns around the lack of definition of ‘Person in Need’ The implications of the loss of Child In Need from legislature without the above definition Section 6 of the Bill in relation Prevention and the need to strengthen links with Health to ensure a multi sector response is delivered. Safeguarding Boards – concerns around the potential merger of children and adult boards at a local level, the relationship between the National Board and the local boards and the structures of accountability The absence of housing and independent living within the definition of well being. The need to ensure all elements of the relevant sections of the Children Act are sufficiently translated into this Bill in respect of engagement with and services for children and young people User voice and control section and outcomes needs to be strengthened for LAC and should specifically ensure that the views, wishes and feelings of Looked after Children and the outcomes they wish to achieve are heard. Some of the sections of the Bill are insufficiently direct – many of the ‘may’ do should be amended to ‘must do’ Advocacy services and arrangements must be included in the Bill, these are essential to safeguarding, even more so for LAC ‘When I’m ready’ scheme – the clear intent and the principles which underpin this scheme should be included to enable roll out of the scheme. Speaker 4 – DR. CAROLYN SAMPEYS, BAAF MEDICAL ADVISORYS GROUP AND CARDIFF & VALE HEALTH BOARD Carolyn delivered an informative presentation from a health perspective, and the key role the health sector performs in relation to delivering services for looked after children. The Social Services and Well Being bill, we are informed, will ‘transform the landscape in Wales’. In this context, the following broad questions were put forward What’s helpful? What’s missing? Is there enough concentration on LAC? 11 What’s on our wish list? Start from scratch The presentation then set out the following Where are the problems? × Out Of Area placements (Issues around consistency, variability in services and the need for continuity) × Variable resources (Inconsistent budgets, different funding streams) × Variable services (No uniformity - there is no one prescribed service to meet the health needs of looked after children) × Funding issues / commissioning issues (Who funds? Who is responsible? Inconsistent and variable, Different interpretations of guidance and regulations) × Notification (There is no consistent and agreed pathway that all partners are adhering to. Stable Life attempts to achieve this but is not sufficiently prescriptive, only ideals) × Performance Indicators (These need to be revised as they are no longer measuring the effectiveness of the services that the health sector is providing) What’s working? Specialist LAC nurses (A real achievement has been made since Stable Life. However, capacity remains an issue in some areas and there is variability across LHB areas) Multidisciplinary teams Interagency working Lead professionals (Yes, but there is variability between Health Boards e.g. no lead paediatrician for looked after children in some LHB) Networks 12 Areas to consider Services to meet needs (Services should be sufficiently responsible and have the capacity, resources and ability to meet the needs of looked after children in their health board area) Provider and Commissioner responsibilities (The commissioning guidance which supports the objectives set out in Stable Life should be reviewed to ensure that payment is effectively following the child and that receiving health boards have the services in place for all vulnerable children as well as in response to an individual child’s need including carrying out health assessments when requested) Partnership working (Is this working consistently and robustly as intended?) National Adoption Service Change in Regulations? – LAC – Adoption Issues regarding health services for LAC LAC health provision across Wales – Age groups – Care leavers LAC Teams – Ideal service? – Lead Paediatrician within Health Boards – LAC Specialist nurses – Accountability? What COULD we do? Out of Area pathway across Wales – Placement Panel? (There is variability in the operation of Placement Panels – not working as designed in Stable Life) – Notification (In some areas there is a voluntary arrangement for notifying the local authority and health board of a young person’s placement and any changes to this) – OOA requests 13 Responsibility of Health Boards – Clarity over who should provide a service – Clarity over who pays for the service – Tariff – Quality Standard National Adoption Service National – National Board – Health representation Regional collaboration – Medical Advisory role – Adoption Panel – approvals – Logistics/ workload Local – Medical Advisory role – Adoption Panel - linkings Speaker 5 – FREDA LEWIS, DIRECTOR, FOSTERING NETWORK WALES Freda opened the discussion with a direct plea – implementation! Implementation It was recognised that there is a significant amount of legislation, policy and guidance already in place as it impacts on looked after children and care leavers yet there remains significant concerns as to how existing duties are being implemented and actions effectively monitored. The Social Services and Well Being Bill is generally welcomed but it must deliver real improvements for looked after children and not be an exercise simply in policy making. National Outcomes Framework The successful development and implementation of a national outcomes framework for social services is key if real change is to be achieved. A framework which all services have a duty to work towards will help eliminate variability and inconsistencies and allow us to effectively measure the outcomes for looked after children and care leavers. Foster Care Placements Given that the majority of looked after children are placed in foster care, why is there so little in the Bill in respect of this. This is a considerable omission and we will be looking to inform 14 the codes of practice to ensure that foster care receives sufficient recognition as is required and takes into account the strong evidence base which seeks reform in a number of areas. ‘Like Everyone Else’ Evidence continues to highlight the significant barriers looked after children face when seeking to engage in an activity or experience which requires permission. Many children placed in foster care miss out because foster carers are not allowed to make many decisions. There is an urgent need for reform and for this be to addressed. Calls will be made for foster carers who have a child in their care for 6 months of more to have ‘assumed delegated authority’ which will automatically give foster carer’s permission to make all decisions which they legally can apart from those identified. ‘When I’m Ready’ Scheme Whilst welcoming the ‘When I’m ready ‘scheme , it is not mandatory and this must be addressed. The principle of supporting children during the transition phase from care towards adulthood and for there to be an option for them to remain with their foster carer should be widely supported. Mandatory guidance is needed yet there remain significant barriers still in place preventing this being achieved. The complexity of the benefit system, moves towards Universal Credit and that Welsh Government do not have power over these issues are some of the identifiable barriers currently frustrating progression. ROUNDTABLE DISCUSSION GROUPS Three tables gave consideration to the final set of questions provided for delegates to help focus their discussion. Roundtable Discussion Key priorities and issues captured by flipchart Placement stability – not always achieved 78% of LAC are in foster care placements – should be recognised Shortage of foster carers Welsh Government need to implement the Recommendations of the NAfW Report into the enquiry into the placement of looked after children Independent statutory advocacy – should be prominent in the Bill CSSR – this local authority database can only be a tool to aid the placement process but how well is it working? Will the WLGA maintain this resource? It is only as good 15 as the information made available and will always require dialogue to supplement the decision making process. Should this be addressed on an all-Wales basis? National outcomes framework – need to get this right and consistently implemented Section of legislation and policy are not being implemented as planned. There needs to be a greater robustness in the monitoring arrangements to ensure legislation is delivered as intended. Too many ‘may’ or ‘can’ in guidance leads to inconsistent and variable practice. Great availability of quality accommodation for care leavers required What is working well? Good suite of legislation – this needs to be protected – through there are gaps Some good practice and partnership working but not on a consistent basis Development of a Charter for LAC and Care Leavers There is the ‘will’ to move forward in Wales and make the necessary changes. Wales is small enough to make a difference What are the key issues and areas for improvement? When I’m ready scheme – must make sure this is not lost and the principles behind the scheme are taken forward Too much emphasis on flexibility e.g. foster carers supporting young people in the community Legislation and guidance promises so much but under delivers Social services are presently operating in a crisis. Social workers do not have time to always support Looked After Children in either foster or residential placements and as such carers can be left to get on with it....... Assessments are not always consistent and timely as intended Services to support LAC are not always or consistently available Improvements are needed in the work undertaken with families and their on-going involvement in care planning Insufficient resources available Variable services across Wales Corporate parenting – greater ownership needed by all including Housing, Police, Education, Health CAMHS services and provision – barriers to access Advocacy commissioning arrangements are not consistent Are services determined by cost or their effectiveness in achieving noticeable and sustainable improvements and measurable outcomes 16 Transition to adulthood for disabled children who are LAC – lack of clarification. Concern that ‘when I’m ready’ arrangements will delay transition to specialist adult services. Residency issues. Should be a greater duty placed on local authorities and their partners – if an intervention is known to achieve positive results, why does it remain and option? Performance indicators – need to include some qualitative measurements and will need to link to the developing outcomes framework Should be designated roles in children’s health services and a greater consistency of shaping teams which are determined by better outcomes for LAC and care leavers Portability of assessments across services There was also a strong message that in order to achieve implementation there needs to be a greater emphasis on ‘duty to...........’. Should be a duty to consult with education, health and young people prior to an out of area placement Voice of the young person is often missing. Need to incorporate National Participation Standards Charging of services in relation to looked after children should not be considered. Not cost effective and negatively impact on levels of child poverty Need to consult young people around the categorisation of care levers – do not support the term ‘category’ and do not support current terms of ‘former’ and ‘relevant’. Charging for services is not clear in the bill Better partnership working between local authorities and health on a consistent basis Health is not one body. Need to be more specific in terms of which parts of health should be responsive Should health for LAC be a primary health need Multi agency teams – the most appropriate person should undertake the assessment Child benefit – what happens when a child is in care? Child benefit should follow the child and not be absorbed back into the Treasury How does the Bill support Directors to bring in other agencies The bill needs to reflect the statutory duties in the CA1989 and also the WG draft guidance on a model of advocacy for Wales that was published in 2009. In this WG established the terminology of ‘Independent professional advocacy’, distinguishing it from formal advocacy. Since that definition is now used, the bill needs to reflect this in outlining statutory duties by using the terminology of Independent professional advocacy- not simply advocacy. 17 Is there a need for a national strategy for Looked after Children (as there has been in Scotland)? Overall it feels that in light of what we know to have gone wrong for LAC there should be a higher level of commitment in Wales to do better! Sean O’Neill Children in Wales September 2013 18 APPENDIX 1 Format for the session Tea/coffee from 12.45pm Welcome and Introductions Speakers Round Table Discussion & Feedback Speakers Round Table Discussion & Feedback Next Steps & Close Speakers Welsh Government perspective – David Clayton – Social Services Directorate DHSS NAfW H&SC Committee report and recommendations – Sean O’Neill – Children in Wales Fostering perspective – Freda Lewis – Fostering Network Wales Health / Partnership Working perspective – Dr. Carolyn Sampeys – BAAF Medical Advisors Group and CDF & Vale Health Board Third Sector perspective – Kate Carr – NSPCC Cymru Local authority perspective - TBC Round Table Discussion Between two sets of short speaker presentations, there will be an opportunity for round table discussions to take place amongst attendees. Each table will be guided by a set of broad questions to help aid and stimulate discussion. Feedback will be taken from each table in turn. This will be a key part of the workshop 19
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