Making Changes Together for Disabled Children, Young People and Carers in County Durham.

Themes this local practice example relates to:

  • Disability
  • Youth
  • General resources

Basic details

Organisation submitting example

Durham County Council

Local authority/local area:

Durham County Council


Summary 

Durham County Council has redesigned and developed a new approach to increasing its range of short breaks for disabled children and their families. This has been done through closer working with providers and stakeholders, particularly disabled children and their parents and carers. This has resulted in improved outcomes for the children and families and costs savings to the county.

Background

Following on from Aiming High for Disabled Children, Durham County Council is committed to improving services for disabled children and young people, parents and carers. In order to do this, work with families and providers has continued to increase capacity, reduce overall costs and meet jointly agreed priorities.

Drivers

The key focus was to improve the local services that communities can access and reduce the need for disabled children and young people to access services away from where they live. The key driver for us was that disabled children and young people, parents and carers had welcomed the changes already delivered in partnership with them and there was a desire to continue to improve local provision. One key area of this was to deliver a comprehensive and varied short break menu.

Aims and Objectives for Effective Community Engagement in Commissioning

The aim was to build upon the success of Aiming High for Disabled Children in delivering innovative short breaks, to increase the range and availability of activities and to build on the participation process in County Durham for disabled children and young people and families. This would meet the needs of the local community, push the boundaries and change attitudes about what activities disabled children and young people could access. 

The model of participation involved disabled children and young people and parents/carers working in partnership with commissioners in all facets of the commissioning process. The short break commissioning is led by the needs of service users and is explained in Durham’s short break statement. 

Through the Making Changes Together Parents/Carers Group, Durham has successfully created a participation process that allows parents/carers from across the county to inform commissioning at all levels. This has enabled the wide range of needs that parents and carers of disabled children and young people have, to be met effectively. 

Mirroring that process, disabled children and young people from the eXtreme group are supported to input into the services commissioned (eXtreme is the name chosen for one of the children and young people’s groups, by its participants, of whom there are over 50). This process engages disabled children and young people of all ages and has led to specific commissioning activity.

Engagement with providers has been crucial to effective commissioning and working forums have been developed to work with, and support, providers. This has led to increased provision and reduced cost.

The practice

Durham’s participation process uses Investing in Children and involves holding ‘agenda days’, where disabled children from across the county have the opportunity to discuss the issues that matter to them without any steer or direction. They are supported independently through specially trained staff who can facilitate the agenda days. They are then able to influence commissioning to address the issues they have raised, and to follow up to see if their views have been acted upon. The process requires careful planning and logistics to ensure that the voice of all disabled children and young people is heard. As a result of this process, the groups have direct access to influence funding decisions and this has proved particularly beneficial in developing the menu of services.

Data profile information on the disabled children’s population was used in conjunction with the views of service users, as well as the services, buildings and resources available, to map and plan for short breaks post-Aiming High for Disabled Children. 

A short break statement was produced in June 2011 with all stakeholders which started the process of identifying how an effective short break menu could deliver other key priorities linked to the stated commissioning intentions. Previous performance information from providers was analysed and, with the support of parents/carers where appropriate, services were either commissioned or decommissioned. This led to the continuation of Disabled Children’s Access to Childcare. 

Short breaks have been transformed considerably and Durham now has over 40 providers delivering a range of activities that can be accessed through a self-referral. Through the participation process, a wide number of breaks and activities that cover a huge spectrum of art, culture, sport and clubs, have been commissioned. These include, for example:

• Brass band for autistic children and young people
• Specialist cinemas for hearing impaired children
• Joint work with the University of Durham for sports coaching and activities
• Steel drum clubs, Duke of Edinburgh success, abseiling, cookery, crafts, allotment projects, fly fishing, visually impaired cricket, swimming classes for children with hearing loss, performing arts

By widening the scope of short breaks, links with new partners have been made and the working relationship with the voluntary sector has improved. This has enabled funding to be sought and resources maximised. “Cross commissions” are now in place, where voluntary sector providers use public sector and private sector facilities; joint commissioning with Adult Services and other strategic partners to support transition, is also in place. 

Those involved

The number of stakeholders has increased. A process of matching short breaks with other key drivers, both for the local authority (LA) and for partners took place and this is reflected in the approach to commissioning. 

Information and data is shared with all stakeholders to enable them to be involved, in various formats including Twitter and a text service, in the design of commissioning strategies and reviewing the success of the process. The key to the success of the short break programme is the sense of ownership by everyone, which is clearly rooted in listening to families.

Those involved in the process include:

• Disabled children and young people, parents/carers
• Over 40 voluntary sector organisations
• The University of Durham
• Private organisations who both provide and donate resources 
• The LA and partners, including Children & Young People’s Service, Adult Services, Leisure Services, Cultural Services, schools, health, FE providers 
• Social enterprises 

The referral process to access the short break menu is very simple. For the vast majority of the menu, families can self-refer using information they receive through Twitter, text, email and a quarterly newsletter. Other short breaks can be accessed through special schools or specific services, such as the sensory support service.

Timescale

The short break programme is just part of Durham’s overarching Disability Joint Commissioning Plan that was produced with health colleagues and parents/carers. The plan covers a three year period and has 16 specific actions to improve the services available for families with disabled children and young people. 2011/12 is first year of that process.

The plan not only looks at the commissioning of provision, but also addresses some of the deeper attitudinal changes that need to occur, including training for universal staff and providing equipment for settings.

Achievements so far

The evidence used is quantitative and qualitative and comes from various sources. Progress is benchmarked by looking at previous years’ performance, costs and complaints and the number of crises and family breakdowns. There has been a significant reduction in complaints and crises, linked to the menu of increased short breaks. Placements of children as a result of family breakdowns have reduced by over 70 per cent. Feedback from parents through an independent participation process, and through an independent agency is used to promote engagement and elicit views from a wide range of disabled children. Feedback is also received from providers and family evaluation forms. Through the Children’s Network, Twitter and text service, feedback is immediate and has been universally positive. 

Evidence of progress:

• A recently achieved “outstanding” Ofsted for safeguarding; no complaints received for over 12 months; a significant drop in the number of children accessing 52-week out-of-county placements since the targeted short break menu started in 2008/9. This has reduced from an average of 9 new placements per year to an average of 2. It has saved the LA and partners well over £1.5 million in initial costs alone. The net saving will be significant when considering the long term nature of these placements 
• Over 140,000 hours of short breaks provided – a year-on-year increase has occurred every year since 2008/9
• Supported local groups and initiatives that families valued
• Met the needs of families, as they were integral to the design and scrutiny of the project
• a workforce able to deliver the new approach
• Support to local business
• Delivered services across a large rural county – for example, mobile cinema 
• Developed Twitter and a text service in response to requests from families
• Universally positive feedback from over 1,000 families 
• Disabled children and young people had fun and felt great
• Pressures on parents of caring for disabled children were reduced
• Members of the eXtreme group of children and young people were invited to go to the European Commission to present what they do as an example of excellent practice.

As the short break programme evolves, Durham is increasing both the range and availability of provision. Services are commissioned based on direct feedback from all stakeholders and crucially, universal services are improving. 

The Council and its partners are committed to making County Durham the best place to live for EVERYONE. This work has challenged all agencies to be more inclusive in their approaches to all residents. By promoting healthy activities that are aimed at the whole family, a commitment to improving the health and wellbeing of the community, while supporting our local economy, has been demonstrated. The changes have been greatly helped by the involvement of the local community in the commissioning process and have not only protected investment, but have also helped develop and expand the market of providers.

Feedback from the children and young people themselves:

• ‘It's good because you get to meet new people and work together.’
• ‘We all understand each other so you feel more comfortable to say what you think.’
• ‘We get to say things about what should be changed and how.’
• ‘We can make things better for us and for everyone.’
• ‘We can challenge things we don't feel happy with and make people more aware of disabilities.’

Replication

Barriers and Challenges

Prior to starting this work, Durham mapped out the potential barriers and the people who needed to be on board in order to achieve their overall aims. This preparatory work has proved to be hugely significant. The key to good community participation and commissioning is transparency and honesty. Durham tackled the barriers it faced in a number of ways, e.g, good joint planning, participation of service users, looking at a range of new partners to work with and ensuring existing partners were included in new developments. This approach to tackling barriers ensured that finding solutions was everyone’s business, which has in turn further developed activity and attracted additional resources.

Cost 

Value for money has been achieved on various levels. Firstly, by enabling organisations to deliver short breaks in LA buildings, for example, costs have been kept to a minimum and secondly, by creating a mixed economy of providers led by the third sector. Thirdly, there has been a substantial decrease (over 70 per cent) in the number of new out-of-county placements linked to increased provision. This represents around £2 million per year. There has been a significant reduction in complaints, making savings on the time and cost of investigation. Through investment in the service, families report they are able to return to work/education and, in some cases, have ceased the use of medication. 

Potential Savings

The changes introduced are sustainable and have resulted in financial savings. The Children’s Trust recognises that protecting resources to deliver these preventative services will continue to bring significant cost savings. Parents were empowered to heavily influence commissioning and are more confident as a result. This mix enables growth and strategic support. Durham is working with all partners to look at securing additional resources and funding through FE; in addition, the Arts Council is supporting the programme of short breaks.

Learning from Experience 

It is vital to start from a sound basis and not rush into the commissioning process. It is imperative to have an understanding, not only of what stakeholders can bring to the table, but also of what they need to take away from it. It is important to drive change and respect the time and commitment disabled children and young people, parents and carers invest into the participation process. By listening to what families said they wanted, the nature and complexity of short breaks has changed. 

Key leadership behaviour characteristics
The following core behaviours have been identified as part of successful elements of leadership (see National College for Leadership of Schools and Children’s Services/C4EO (2011). Resourceful leadership: how directors of children’s services improve outcomes for children. Full report. Nottingham: NCSL see http://www.nationalcollege.org.uk/docinfo?id=144732&filename=resourceful-leadership-dcs.pdf). 

Durham County Council identified the following behaviours as key to the transformation of their service:

Openness to possibilities

The ability to collaborate

Demonstrating a belief in team and people

Personal resilience and tenacity

The ability to create and sustain commitment across a system

Focusing on results

The ability to simplify

The ability to learn continuously.

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