Children let down by departmental rivalry

Children with the most complex needs are being let down while
social services, education authorities and the NHS argue about
money, a conference on integrating services for this group was told
last week.

Delegates to the conference at London’s Barbican Centre,
organised by Harrogate Management Centre, heard that when health,
social care and education directors sat down together their lists
of the most “challenging” children coincided name for name.

For Tricia Cresswell, public health consultant with the Northern
and Yorkshire Public Health Observatory, the watershed came with
Gillian, a 16-year-old severely autistic girl who had broken the
bones of three care workers. A residential home had to be cleared
and double-staffed, and the girl sedated, before the right care
package was agreed.

“After Gillian, we agreed never to have a meeting like this
again,” said Cresswell. “You have to trust each other if you are
going to spend each other’s money.”

She urged pragmatism. “Make your parameters clear. Social
services, education and health will never agree about words on a
page, so you need a basket of definitions.”

The changes she made in Newcastle were initially resisted. “I
forbade any consultant to undertake a health needs assessment
unless it was connected with a service to be delivered.”

A group of managers from the different services now decide which
resources will go to which child and who pays. And the children
with disabilities team has a jointly funded manager.

Cresswell warned: “Forward planning is essential because it’s
going to get worse. The prevalence of autistic spectrum disorder is
increasing, particularly at the severe end. But we don’t have the
money to build shared local facilities to place kids in

Funding was a problem as new money coming into the NHS was
“badged” for priorities such as cancer or heart disease.
“Increasingly that’s happening in social services too,” she

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