To ask the Minister of Health to outline the procedure for long-term placements for individuals with complex needs and learning difficulties, broken down by Health and Social Care Trust.

Individual Trust responses are set out below:

Western Health and Social Care Trust (WHSCT)

Children’s Services-

All the needs of a Looked After Child are reviewed via the statutory Looked After Child process where the need for placement is discussed and agreed. The multi-disciplinary team involved with the child meet to consider the needs of the child and develop a care plan which involves parents and carers. All Trust facilities are considered. Following further discussion, the most appropriate placement which best suits the needs of the child is agreed. In the instance where Trust facilities are unsuitable, then alternative placements are explored, which can include the UK or the Republic of Ireland.

Adults Services:

The support needs of Adults with a Learning Disability, including determination of the need for a long-term placement, is based on a holistic assessment of the Service User’s needs. The assessment which has input from the Service User, their family and multi-disciplinary team members has a particular focus on the social and health needs of the Service User which in turn informs the level of support, including the nature of placement that is required. Placements are provided in accordance with existing contracts, and appropriate processes such as procurement and commissioning processes to ensure the suitability of the placement in meeting identified Service User’s needs.

Belfast Health and Social Care Trust (BHSCT)

Children’s Services

The focus of intervention with children with disabilities centres on early intervention, support and prevention of family breakdown to enable children and young people to remain in the care of their parents/carers. For any child who is admitted to care, care planning considerations include the viability and reunification if this is possible to their family or whether they should continue to be cared for outside of parental care. Any child or young person admitted to care is reviewed via the Looked After Children’s Procedures, with LAC reviews convened as per policy to formally review the child/young person’s circumstances and to formulate their care plan.

Any change to a long-term care plan is considered and analysed at each Looked After Child Review and any change to a long-term placement is considered by all professionals involved with the family. The decision is based on the best interests of the child or young person. When a long-term plan is agreed, the Trust considers both in house options and private providers to determine the most suitable placement for a child or young person. This is undertaken in partnership with families.

Adult Services:

The BHSCT Adult Intellectual Disability/Learning Disability Service completes assessments and care management reviews in line with Care Management Standards to assess needs for long term placements. Placements are provided in accordance with existing contracts, and appropriate processes for example, procurement and commissioning processes to ensure the suitability of the placement in terms of meeting identified Service User needs.

Northern Health and Social Care Trust (NHSCT):

Children’s Services

The Trust places significant emphasis on family support and supporting children with complex needs and learning difficulties and their families within their own homes. Only when all support has been exhausted and parents are unable to safely meet the needs of their children would a child with complex needs and learning difficulties be placed outside of parental care. This would need to be collaboratively assessed and planned for with the consent of the parents, unless necessary for the Trust to initiate public law proceedings. Any child or young person admitted to care is reviewed under the Looked After Child policies and procedures. When a long-term care plan is agreed, in the first instance the Trust will explore any family options assessed as meeting the needs of the child/young person. In the absence of this being available, the Trust will consider in-house placement provisions. Often there will be court oversight and scrutiny in relation to Trust care planning and decision making (relevant to children/ young people where public law proceedings are active).

Adults Services:

Following a multi-disciplinary team assessment of need, a care plan is formulated which determines the level of support needed in a long-term placement. A Carer Assessment is offered. It is determined at this stage if an individual needs Supported living, Residential or Nursing care or a more bespoke individually procured/commissioned placement. This is dependent on the level and type of complex needs. Following the assessment, the Trust’s Learning Disability Weekly Resource Allocation Panel chaired by Head of Service, considers the assessed need. Each case is based on the individual’s circumstances and the needs of the carer to determine when the placement may be required. If a placement has already been identified in one of the Learning Disability facilities the Trust is contracted with, then this will be approved to proceed if the need for support is immediate. If the cost of a placement is above usual tariff the Trust follows business case planning processes to secure funding. On occasions if no placement is available to meet an individual’s bespoke needs, then Learning Disability Services request support from Trust Contracts Department to consider if a procurement process across providers can be undertaken to find a suitable placement. Once funding is agreed then the placement can proceed. Following commencement, periodic reviews are held to ensure the placement continues to meet the Service User’s assessed need.

South Eastern Health and Social Care Trust (SEHSCT):

Children’s Services:

In respect of Children’s Services, there is no singular procedure for long- term placements for individuals with complex needs and learning difficulties. Instead this situation is governed by multiple pieces of Policy, Legislation and Regulations and Guidance depending upon the given set of circumstances. A number of the primary drivers the Trust must adhere to includes, ‘The Arrangements for Placement of Children (General) Regulations (Northern Ireland) 1996’ ‘The Foster Placement (Children) Regulations (Northern Ireland) 1996’ and ‘The Children (Northern Ireland) Order 1995’. There are multiple procedures for the reception of young people requiring a long-term placement as well as governing the review of placement and the transition from placement. A core piece of legislation is, ‘The Review of Children’s Cases Regulations (Northern Ireland) 1996’ which guide the Looked After Review arrangements.

Adult Services

Adult Learning Disability Teams work with those who meet the criteria for the service, i.e. a confirmed learning disability as formally assessed. Where it is identified that a long-term placement is required, staff will update current systems to reflect this need. A scoping of current vacancies in the system is completed by the multi-disciplinary team to identify any possible placement options. There are occasions where the need can be met within existing contracts and families will be updated and conjoined in the transition planning alongside the multi-disciplinary team. However, for more complex service users where there is no identified placement option currently in existence, the SEHSCT will link with contracted providers to discuss the development of a more bespoke service to meet this more complex need. Where necessary this may require the service to consider out of area placements. All stakeholders are involved as appropriate in this journey including family and advocacy as appropriate, through this process.

Southern Health and Social Care Trust (SHSCT):

Children’s Services

Any recommendation that a child with a disability requires a long-term placement will be based on a Social Work assessment under the Understanding the Needs of Children in Northern Ireland (UNOCINI) Framework. This assessment is completed in partnership with the child’s family and will take into account the child’s wishes and feelings along with input from other professionals involved. A referral will then be made to the appropriate Trust Panel which will determine if the request is appropriate and give a view on what type of placement would best meet the child’s needs. Planning will then take place to introduce the child to their identified placement and once the transition has taken place the child will then be considered a Looked After Child (LAC) and be subject to the LAC Review process. Depending on each child’s particular circumstances the Trust may seek to share parental responsibility with the child’s parents and apply for a Care Order under the Children (NI) Order 1995. Transition planning for Children in long term placements commences at their fourteenth birthday and Adult services become actively involved in planning after their sixteen birthday. Procedures for transition from Children to Adult services is guided by the Trust Transition Policy.

Adult Services:

The individual’s key worker completes an assessment of need using the Northern Ireland Single Assessment Tool (NISAT) and collates multidisciplinary team assessments which informs the individuals Care & Support Plan. The wishes of the individual and their family (if appropriate) are considered, through the support of Independent Disability Advocates. An open and transparent dialogue with relevant internal / external stakeholders is maintained throughout this process. Multidisciplinary assessments will be reviewed and level of need matched with potential placement providers or enhanced care packages applied while progressing towards a placement. Available living placements/properties will be examined to determine suitability to meet the assessed need of the prospective tenant. If no suitable placement is available there may be discussions with contracts to procure a service model to meet the assessed need. The Accommodation Panel has a key function to identify the most suitable placement for service users known to the Community Learning Disability Services who require an out of home placement. Engagement of the Specialist Placement pathway is available for individuals who require a bespoke placement following recommendations from the Disability Services Accommodation Panel. Individuals who require this pathway will be assessed as having high care and support needs and unlikely to be suitable for communal living and thus require single occupancy tenure/placement. Once the placement has been identified and agreed with individual/family, supported by Independent Advocacy as appropriate, support is provided to settle the Service User into the placement, with regular monitoring and review facilitated to ensure the placement continues to effectively meet Service User assessed need.