Aiming High for disabled children misses funding targets

Primary care trusts are failing to commit their Aiming High for Disabled Children funding to its intended purpose. Amy Taylor reports

When the government launched its Aiming High for Disabled Children’s programme in May 2007 it hoped to bring about a transformation of services across health and social care. But lack of engagement from some primary care trusts is threatening this vision.

The child health strategy, published in February, confirmed that £340m of funding had been added to PCTs’ budgets to provide short breaks, community equipment, wheelchairs and palliative care for disabled children as part of the Aiming High initiative from 2008-11. Local authorities were given the same amount over the same period.

Disabled children’s charities saw the joint funding as an unprecedented opportunity for health and social care to collaborate. But progress on the ground has been limited.

Council professionals are reporting difficulties in persuading some PCTs to commit to developing services or providing the level of funding expected. This is causing frustration, and means new services are on a small scale and are solely council run.

Not ring-fenced

The main problem is that PCTs’ Aiming High allocation, unlike local authorities’, is not ring-fenced so the Department of Health has no effective control over PCTs’ spending.

According to Laura Courtney, manager of the Every Disabled Child Matters campaign, the £340m allocated through Healthy lives, Brighter Futures – the child health strategy – works out as 1.23 per cent of each PCTs’ baseline budget.

“But as the money isn’t ring-fenced, all the Department of Health can say is this is our expectation,” she says.

A recent poll carried out by the EDCM campaign revealed that many PCTs found it difficult to identify where the Aiming High money was in their budgets, and there was no consistent understanding of what was expected of them.

“There remains a disparity between central government policy and local delivery,” says Courtney.

“For example, many PCTs have told EDCM that they don’t disaggregate spend on wheelchairs or equipment for disabled children from spend on adults, while others have said they ‘do not expect to match’ local authority investment on service improvement.”

Block contracts

Some PCTs complain that the purchase of services on a block contract basis means it is not always possible to identify what has been spent on disabled children within this.

If funding were ring-fenced, it would also allow money to be kept aside for staff development. Courtney says this is lacking in the NHS, and reveals itself in the attitudes sometimes held by GPs and dentists when disabled children use universal health services. Some specialist services are also not up to scratch, she adds.

“Many disabled children need targeted and specialist health services to enable them to have as ordinary a life as possible,” says Courtney. “One parent told EDCM ‘it took me three attempts and two years to get the right wheelchair for my son. It took six months for each wheelchair to arrive so he had already grown out of the first two’.”

Despite the government’s expectation that health and social care will develop services in partnership, Action for Children’s children’s services director and disabled children lead Stephen Roe says there are few examples of PCTs and local authorities jointly commissioning.

“Developments are fairly piecemeal,” Roe says, warning that the opportunity to provide integrated services could be wasted. “They don’t seem to be part of an overall review with all the partners, and most of the commissioning is being done by councils.

“A couple of senior managers in councils I’ve spoken to have said it’s been quite difficult to get commitment to development from their PCT.”

Mixed engagement

Jo Webber, deputy policy director at the NHS Confederation, acknowledges that PCTs’ engagement with Aiming High is mixed but says it is unfair to view them all in a negative light. She adds that it is still early days for the programme.

“In some PCTs you can find some examples of really, really good practice, and innovative ways of making sure the Aiming High objectives are met. In others, it’s not so good. In some areas it has been slow but it’s important not to tar everyone with the same brush.”

The EDCM is calling for accountability and transparency in the way PCTs spend their Aiming High money.

The government is also unhappy. In April, in light of evidence filtering through from the frontline, children’s minister Ed Balls and health secretary Alan Johnson – along with the director general of NHS finance, performance and operations David Flory and the chief nursing officer Christine Beasley – wrote to PCT chief executives and chairs saying the DH would require a “local statement” from every trust in September detailing what they had spent on Aiming High this financial year.

The campaign welcomes the move and states that the DH must challenge PCTs that do not meet expectations. It also wants tougher and regular inspections of PCTs’ services for disabled children. At the moment, inspections of these services are optional for PCTs.

Webber says separating spending on disabled children is genuinely difficult for PCTs but it is “absolutely right” that they should be able to tell the government how much they are spending.

“They need to be able to show how much they are developing services for disabled children,” she says. “The statements may be very helpful in terms of allowing people to see this.”

Case study: Plymouth looks to ease conflicting priorities

Helen McLindon is the children’s and maternity commissioner for NHS Plymouth. Shortly after the Aiming High money was identified in the child health strategy, McLindon sought advice from her colleagues in the finance team to identify the amount of funding NHS Plymouth would expect to allocate in its budget for this work.

McLindon says that there are genuine issues for PCTs around breaking down their spend on disabled children. She explains how NHS Plymouth has faced this in the past but is working to improve and broken down the spend for adults’ and children’s wheelchairs despite running a joint service.

“There’s a variation across the country on how much commissioners are spending,” McLindon says. “There’s a will in PCTs to meet the objectives of Aiming High. But it’s the practicality of whether some PCTs are able to use their allocated spend against other conflicting priorities.

“Here in Plymouth we have identified the funding from existing budgets for Aiming High. The proposals for its spend are yet to go through the prioritisation process but our expectation is that this money, once allocated, will enhance services for children with disabilities.”

Web links

The child health strategy

EDCM’s Disabled Children and Health briefing

Previous coverage from Community Care explaining the background to Aiming High for Disabled Children

This article is published in the 13 August issue of Community Care magazine under the heading Not aiming high enough