On 25th September, IMPOWER hosted a shared learning event attended by over 15 local authorities, and chaired by Kate Dexter (Assistant Director, Norfolk County Council). The focus was on how system leaders, practitioners and commissioners can collaborate to better meet the needs of children and families requiring support from Children’s Services.
The specific driver for the focus of this conversation was the challenges many local authorities face around finding appropriate and affordable care for an emerging cohort of children with very high levels of need and complexity. In many areas, this poses questions and challenges around the respective roles of local authorities (LAs) and health agencies, respective funding contributions, and how practitioners and collaborations work together on shared challenges.
The session involved a presentation from Charlotte Gray (Head of Children’s Strategic Commissioning, Lincolnshire County Council) on the excellent work Lincolnshire County Council have done to integrate commissioning and service delivery with health partners – both strategically and operationally. IMPOWER’s Louise Cullen also shared some insights from research into how different local areas have approached these challenges.
These are my four key takeaways from the session:
Investment in relationships and the right governance are key. Lincolnshire have put significant focus and investment into establishing integrated governance and relationships at a senior and operational level. This now means the local authority and health partners have representation and a voice at all relevant discussions around children and health – whether NHS or LA led. This has provided the foundation for some excellent collaboration across a shared agenda, and also helped to deliver resilience across the health and care interface during the COVID pandemic. Other discussions have highlighted the importance of ensuring the right links to Integrated Care Partnerships, and the right nominated lead at the Integrated Care System table for the voice and outcomes of children and young people.
There is an opportunity for local authorities to offer more leadership in this space. Through the strong relationships developed, Lincolnshire has worked with health partners to provide leadership of joint projects, services and commissioning where needed. For example, Lincolnshire CC directly commissions the Children and Adolescent Mental Health Service (CAMHs). They have used this role to support local strategic objectives including direct focus and investment into early intervention and prevention around mental health, and utilising the opportunity for digital – with impressive results.
Establishing the right care and funding across local authorities and health partners for children with high and complex needs is a universal challenge. Research across multiple local authorities has highlighted challenges around securing the right level of funding from health agencies for children where ‘continuing care’ and ‘S114’ are at play (from a local authority perspective). Common challenges are different interpretations or confusion around thresholds and lack of time/space for multi-agency work and collaboration.
There are examples of strong and effective collaboration around this specific challenge. From conversations and research across multiple local authorities, there were some good examples captured of effective partnership work around the specific issue of supporting children with very high levels of need across health and social care, including:
- Bespoke shared care arrangements enabling children to remain in their local area and maintain family links,
- Jointly commissioned overnight respite for children with complex health needs,
- Joint packages of care aiming to prevent care entry,
- Use of the Valuing Care approach to identify children with high levels of needs around health, and provide a framework and evidence for multi-agency discussions and collaboration.
Our report with the County Councils Network on integrated care systems (November 2022) identified links with children’s services as a rising issue for integrated care boards with increasing focus from the NHS.
We see this as the start of a conversation and we are planning to host another shared learning event with a focus on this area in the New Year. It will be bringing in the perspective of a range of health partner and LA representatives, and more examples of good practice.
If you’d like to get involved, please contact me via a direct message on LinkedIn or by email – firstname.lastname@example.org.