Related Sector: Health & Social Care

Most social workers, team managers, group managers and financial controllers express concerns that social care is picking up the lion’s share of the costs to meet the continuing care required for children with complex needs. Most social workers feel frustrated that the health assessor continually turn down their applications for Health to take over a more substantial role in a child or young person’s continuing case.

Consequences? Social care is paying out millions of pounds each week that should instead be funded from Health.

It is apparent that CCG’s are reluctant to take over a bigger share of responsibility – both financial and practically - which ultimately leaves social care meeting most, if not all, of the child’s complex needs as a child or young person.

In addition, this could potentially disqualify that young person from qualifying for NHS Continuing Healthcare as they transition to an adult. This may leave an individual in an extremely vulnerable position as all social care provisions are withdrawn, by virtue of their age, and they fail to qualify for CHC as an adult.

So why is Social Care failing in these applications?

  • Applications need to be much evidence based – social workers need to be more ready to identify and collect all relevant, current, factual evidence to support their case with appropriate forward planning, case management and front loading
  • Front loading requires first hand reports and assessments to be obtained from all professionals and agencies involved with the child’s care to be placed before the assessor
  • There needs to be a greater distinction identified between the child’s health care needs v their social care needs
  • Once the child’s health care needs have been identified the evidence in support needs to then demonstrate that the child’s complex needs are over and above what can be met from universal health, social care and educational provision
  • There needs to be a better understanding and reference to the principles established in the leading case of R (on the application of D & another) v Haringey London BC [2005] All ER (D) 256. The Judge in that case provided clear guidance on the scope of the local authority’s duties to provide health care provision pursuant to section 17 of the Children Act 1989
  • Professional need to be armed more readily to identify evidentially the restrictions of the Local Authorities' duties and provision of services pursuant to section 17 CA 1989 and section 20 CA 1989 as against the continuing health care of a child with complex needs
  • Social workers need to be more robust in correctly scoring the domains within the decision support toolkit to enable the health assessor to arrive at a correct scores /determination of holistic assessment of the child’s complex needs
  • Social workers need to identify which health need or needs this child requires and should not distinguish between physical, neurological or psychological needs
  • Identifying to the CCG at a much earlier age in the child or young person life (i.e. 14 years old) that they will need to be assessed for CHC
  • Ensuring that the continuing care process is timely
  • Being more aware and familiar with dispute resolution and the appeals process

Over and above all of these points – the biggest error that seems to be made by social care when advancing these applications to a CCG health assessor is that they are failing to establish evidentially the continuing care needs of the child MINUS the existing package of care they are already providing via Child in Need, Voluntary Accommodation or by Care Order. The starting position is not ‘what does this child require over and above what is already being provided by ourselves and other agencies’ but rather ‘if we stripped this child of all of the services they are currently receiving from social care would they qualify for continuing health needs?’.

By advancing your applications, listing at the outset all of the services and funding that is already being provided by social care and others, it is far too easy for the health assessor to arrive at a conclusion that the child’s complex needs are already being met adequately by social care via universal services.

Bond Solon delivers a one day interactive skills-based course on Continuing Care for Children and Young People to ensure social workers are able to carry out Continuing Care applications to best practice standards.

Francesca Burfield
Bond Solon Subject Matter Expert and Children’s Social Care Trainer

This article was first published on 14th November 2017.

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