Manchester City Council

Manchester Early Intervention and Prevention Services for Children with Learning Disabilities and/or Autism

Briefly describe the initiative/ project/service; please include your aims and objectives

Manchester Health and Care Commissioning (MHCC) – a partnership of Manchester City Council and Manchester Clinical Commissioning Group identified the need for an early intervention and prevention service to better meet the needs and aspirations of children with a learning disability (LD) and/or autism and their families. A small yet significant number of Children and Young People in Manchester have complex needs and packages of care that are jointly funded by health, social care and education. A number are placed out of the local authority boundary, away from potentially protective factors of home, family, carers, friends and their local community, not because they require specialist support ‘at distance’ but because local provision is presently not available or configured to meet their needs.

Our shared ambition with families was a desire for children with a learning disability (LD) and/or autism to be able to live in the family home and/or family-based care within their local community, where:
– Families/carers are equipped and supported for when a child or young person’s behaviours become challenging;
– Children and their families have choice in terms of care settings closer to home which can meet their needs
– Children who are currently in residential care or inpatient settings are able to be supported back into family-based care, consistent with the No Wrong Door approach.
– Foster placements are provided with strategies and support to create and maintain placements for children with LD and/or autism,

Children, Young People and their families have played a key role in developing the concept and vision. It is from their feedback on ‘what would make a difference’, that has enabled Manchester City Council and Manchester Health and Care Commission (MHCC) to have a real opportunity to draw down an NHS England capital funding to refurbish and re-specify an existing MCC property that was previously used as a Children’s home. This we are expecting to result in a service that better responds to the needs of children and their families whilst offering a more efficient use of current resources and value for money.

As part of the NHS England capital funding process, a cost benefit analysis (CBA) was developed to understand how this would benefit young people in Manchester. The proposed operating model has taken into account the findings from this cost benefit analysis and has 3 key aims:
– improve the outcomes for children and families
– support integrated working across the system, drawing on existing local healthcare and wider expertise
– reduce the number of children in high cost long-term residential or extended inpatient hospital settings.

What are the key achievements?

The provision models and implements strategies with the child and their family in their own home, and when required, provides short breaks care whilst intensive behaviour support strategies can be implemented to support both the child and wider family network. This local facility ensures children and young people experience ‘permanence’ through a stable home and/or family-based care with consistency of support networks which offers the opportunity to reduce the reliance on restrictive practices and ‘out of area’ placements (a key priority within the GM area).

The re-purposed facility is projected to lead to avoidance of four residential placements per annum, delivering an estimated net £460k reduction in costs per annum 2021/22 onwards. In the first 2 months of running alone, 2 young people have been diverted from care and families report that they are confident to support them to remain at home. This has already created a cost avoidance of an annual cost of £360k. By utilising a current local authority asset, which was under utilised, and NHS capital funding we were able to create a highly specialist service at an effective cost This was coupled with working closely with local stakeholders to utilise expertise and knowledge to ensure the provision links in and provides high quality added value to the existing offer.

It is anticipating the service will over time lead to further savings in terms of increased capacity within the in house foster carers to support children with complex needs, less children placed ‘at distance’ and a reduced reliance on independent short breaks respite facilities.

The main aim of the project is to support the following direct and wider system benefits:
– Reduction of emergency/crisis admissions including hospital admissions and A&E attendances.
– Reduction in out of area placements.
– Prevention entry to/stepping down children and young people from residential care
– Children experience ‘permanence’ through stable home and care placements and consistency of relationships, even in short- term placements.
– Reduction in family/placement breakdown.

Case Study: The service provider (Barnardo’s) has been commissioned by Manchester City Council to deliver a bespoke package of support in regard of a child that needs supporting within the family home. MCC requested a time flexible and outcomes-based approach responding to the identified co-produced needs both within the family home and in accessing the community. The service responded by providing support early morning, during the daytime and evening visits to observe and support all areas of family life and routine. Prior the provider’s involvement, MCC social workers were searching and had a residential placement found for the child. The placement offer came in at £3,750 per week. This placement is no longer needed as the child is now able to remain within the family home.

How Innovative is your initiative?

The innovation is in two parts.
1. The co-production of the services / innovative use of existing resource
2. The multi-agency commissioning /procurement of the service.

From the outset, we wanted to ensure that families co-led this work, from identifying the key issues that families face through to the design of the new service, the design of the building (including how it looks, the furnishings etc), the subsequent appointment of a partner through a procurement process (Barnado’s), and the oversight of the delivery of the new service (parents are a core part of the quality assurance model, for example).

The person-centred approach continues on the ground. All referrals have co-produced outcomes, developed between family and social care and these form the plan. The service does not deliver a set plan, i.e. 3 hours per week. It is based around the children’s and families’ needs and it is measured by the outcomes delivered. This model of commissioning represents a significant shift from more traditional residential care commissioning, which can often be highly transactional, with limited child and parent/care engagement (e.g. as highlighted by national reviews like Narey).

Commissioning a brand new, innovate service
This service showcases how an existing resource can be decommissioned and recommissioned to meet relevant need. This was based on an informed CBA and data sets. NHS England data highlighted that 4 CYP with either an LD or Autism (or both) were admitted to a Tier 4 bed in 2019/20 with the average LoS currently 149 days (approx. 5 months). All of these admissions were unplanned with 2 due to return to the family home following treatment suggesting that the possibility of providing intensive support previously may have prevented such an admission. This service offers the opportunity to support children & young people with LD/ASD in their own home, and when required, provide short term accommodation whist intensive therapy can be provided to support both the child and wider family network. This local facility ensures children and young people experience ‘permanence’ through stable home, care placements and consistency of support networks (school/relationships) and offers the opportunity to reduce the reliance on restrictive practices and ‘out of area’ placements.

The type of cohorts who were identified as difficult to place and have a range of behavioral difficulties and post adoption difficulties as outlined by Manchester’s Multi Agency Panel in 2018/19 are children and young people with disabilities, social emotional mental health (SEMH). In addition there was a gap in provision of a specific LD/ASD service, leading to an increased likelihood of this cohort being placed out of area, away from protective factors, and at significant cost to the Local Authority and NHS.

What are the key learning points?

Co-production does take time and an investment of resource. The end product though does pay dividends. Parents/families trust the service and access the support from it. Even during times of crisis. We went out to procurement twice as we did not identify the right provider first time. We invested in 1-1 market engagement which produced innovative models and energy into the process. These included additions to the service such as;
– 24/7 help line for families, carers and social workers, as the service was running as a residential unit anyway.
– Flexible funding, across the 5 year contract to enable realistic start up costs.
– Meeting the needs of more than the prescribed 80 families per year though innovation, use of volunteers and a range of engagement.

Ensuring not only the prevention element of not coming into care or hospital but also the early intervention to support families as soon as possible. This learning has been taken to inform your joint commissioning approach across adults, children’s and health services.