Agenda item

Purpose of the item: To update the Select Committee on progress to deliver the aims and objectives set out in the strategy within the first year of the implementation phase and seek support for continuing the work. 

Witnesses:

Sinead Mooney – Cabinet Member for Adults and Health

Hayley Connor – Director for Commissioning (Children, Families and Lifelong Learning)

Steve Hook – Assistant Director for Learning Disabilities, Autism and Transition

Liz Williams – Joint Strategic Commissioning Convenor (Learning Disabilities and Autism)

Clare Burgess – Chief Executive of Surrey Coalition of Disabled People

Key points raised during the discussion:

1.     The Assistant Director explained that the strategy was signed off in September 2021 and the report provided an update of the progress to date. During the development of the strategy there had been consultation with the autistic community. Resources of £500,000 had been allocated from the Better Care Fund and additional funding had been secured from NHS England for specific projects. Some projects could be delivered in the first year, whereas others would take longer to deliver.

2.    The Chairman asked about co-operation with other partners involved in the strategy. The Assistant Director responded that the foundation of the strategy was based around co-production. The Council would continue to consult with the autistic community throughout the implementation of the strategy. A governance model that included partners was crucial, with senior level officer responsibility and input from those with lived experience. The implementation of the strategy was held across the system and the Implementation Board would monitor gaps. 

3.  A Member queried the accessibility of the information produced for autistic services. The Assistant Director explained that there were minimum standards that the Council had to reach, such as easy read benchmarks. The Council checked with groups like ATLAS to make sure that the information produced was relevant and easy to understand. The Learning Disabilities and Autism (LD&A) Partnership Board included communication officers with specific expertise.

4.    In response to a question on the amount and the timescale of funding from the Better Care Fund, the Assistant Director responded that the funding had been used to recruit to key posts and develop an information strategy and a training programme. Although there was an annual bidding process, officers were confident that they would attract ongoing funding due to the profile and impact of the project. Each partner involved had committed their own resources to deliver on aspects of the strategy that they were responsible for. Successful bids had been made to the NHS, such as funding to improve sensory environments for individuals with autism.

5.    A Member asked about the collaboration with other partners to increase awareness and understanding of autism in Surrey. The Director stated that the commissioning function had been integrated with Surrey Heartlands. Raising awareness and understanding of autism was a big element of the consultation and a focus of the first year of the strategy was autism friendly communities and schools. The national and regional autism strategies provided opportunities to learn from others and the autism community brought ideas, such as children and young people suggesting the change in the use of language. The Member highlighted the importance of ethnicity and autism. The Director agreed that equality, diversity and inclusion (EDI) needed to run through the strategy.

6.    A Member enquired about work to raise awareness of autism amongst members of the black, Asian, and minority ethnic (BAME) and Gypsy, Roma, Traveller (GRT) communities. There was a GRT strategic group which the Council would link up with. It was known that there were differences in terms of seeking help and identification of autism in these communities. One reason could be access, as navigating the services was raised as an issue in the consultation process. The Assistant Director added that there were challenges as an employer to ensure it had sufficient experience of working with the BAME community. The Adult Social Care Servicehad tried to recruit a representative workforce and 34% of the staff in the LD&A and transition team were from BAME backgrounds. The Cabinet Member informed the Members that they would take the strategy back to the EDI Lead Officer in the Council. The Chairman suggested that the Committee had an informal briefing on this topic.

7.    A Member asked about the impact of the coronavirus pandemic on the implementation of the strategy. The Director responded that the strategy was developed at the height of the pandemic, and they switched to using remote options and moved away from hosting large events based on feedback. Diagnoses of autism were delayed as a result of the pandemic but the Director expected this to change as circumstances changed. 

8.  Responding to a question on the decision process for school placements for autistic children, the Director explained that there was a clear decision-making phase, and the Education Health and Care Plans (EHCPs) planning process was clearly set out. The decisions had not changed throughout the development of the strategy. A child’s EHCP was reviewed, and decisions were made in consultation with schools and parents.

9.    The Chairman asked about the Personalised Resilience and Engagement Programme (PREP) and employment for those with LD&A. The Director explained that culture change was vital and the commitment to co-design had already illustrated a change in culture. PREP was an example of a scheme of evidence based relational models that had been established. The scheme helped children and young people to understand their settings and helped the Council to understand what provision needed to be made available. The Joint Strategic Commissioning Convenor (Convenor) added that the strategy had an employment workstream which linked into other initiatives, such as the No One Left Behind Schools and Employment Network. Naturally Talented Me was an online CV platform which added pictures and other formats to a traditional CV, which members of the autistic community preferred using. It was also important to understand the skills that were needed in the labour market. The Assistant Director added that people in receipt of Adult Social Care (ASC) in employment in Surrey was around 19.5%, which was in the top quartile nationally. The Council’s broader workforce strategy included work with the Surrey Care Association and Surrey Heartlands. They had secured a workforce innovation fund of £6 million which would help to increase the care workforce. The aim was to increase employment of those in marginal groups. The CEO of Catalyst who headed the Voluntary Community and Social Enterprise as part of the strategy.

10.The Chairman queried how the Council was working with Chambers of Commerce to support autistic people get into employment and how this was monitored. The Assistant Director explained that Chambers of Commerce were engaged with the strategy and the Council was also working closely with the Department of Work and Pensions (DWP) and Jobcentre Plus.

Three specially trained staff had been employed by Jobcentre Plus to support people with autism getting into work. The Council had made a bid with Surrey Choices to the DWP, which funded a project called Employment Works for Everyone, and helped 16 autistic people gain employment. The Chairman questioned whether Surrey Choices’ employment scheme could be widened to the cohort who were not receive statutorily recognised but required support. The Assistant Director responded that there were plans for Surrey Choices projects for those who were not eligible for care and support and a supported internship and apprenticeship programme for young people with an EHCP. 

11.A Member asked about support for transition into adulthood, specifically management of relationship changes. The Assistant Director agreed this was complicated for young people with additional needs. A Preparing for Adulthood Transformation Board, which the Cabinet Member sat on, had been developed to address some of the issues that developed during this period. The number of young people with EHCPs that would qualify for ASC was about 10%. It was important to provide additional support for those who would not qualify.

12.A Member questioned the flexibility of the system to support changes as individuals grew and transitioned. The Assistant Director explained that this was recognised by the Council and that they were trying to make the system more flexible. As part of the strategy, a series of support mechanisms would be developed to support people with autism in their homes when experiencing crisis. The Convenor added that there was a support register lead by clinicians that monitored individuals’ risk factors, in relation to admission, and this would soon be a digital register. Additionally, a piece of work was starting shortly in which a doctor would undertake scoping work with people with lived experience to understand their experience of crises to support the development of a crisis element of a pathway. 

13.In response to a question on current diagnosis waiting times, the Convenor explained that there were around 2,200 adults waiting for an assessment, three times as many referrals compared to 2019. Those currently being seen for a diagnosis were referred in 2018 and 2019. A workshop was held to understand the capacity and capability required to help reduce waiting times and meet the rising demand. The capacity in the team was for 36 diagnostics a month and they were receiving over 100 referrals a month. The Council had received funding from NHS England to test ways to support people prior to a diagnosis, as 60% of those waiting for an autism diagnosis would receive one. The funding would separate individuals into three groups: those who would definitely receive a diagnosis, those who may or may not receive a diagnosis, and those who would definitely not receive a diagnosis. This would allow the Council to signpost those who would not receive a diagnosis to other support. The Director stated that people were waiting too long and the backlog in Children’s Services had been known for some time. Surrey and Borders Partnership NHS Trust (SABP) commissioned external diagnosis support to help with the backlog which stood at approximately 1,500 children waiting for a neurodevelopmental assessment. Assessments took more than 6 months and the waiting list time had been reduced at certain points in time. The Mindworks neurodevelopmental pathway had not been transformed at the rate that the Council would have liked. However, children coming onto the pathway were linked up to a third sector provider who would offer both group and individual work, as well as working in schools. 

14.A Member sought assurance that the waiting times would reduce, and the Chairman asked about the barriers with the neurodevelopmental pathway. The Director responded that it was hoped that they would have developed multi-disciplinary hubs that would provide holistic support at an earlier stage. Mindworks had invested more in family support for those pre-diagnosis, but due to demand and workforce issues there were issues with the development of the pathway. This was a national issue. The Assistant Director assured the Members that the Council was committed to working with colleagues at SABP. Currently, a diagnosis was perceived as a gateway into services. The Council were working with schools to support young people with autism prior to a diagnosis. 

15.A Member asked whether the referral rates for children and young people were similar to the rates for adults. The Director shared that there was rising demand. For example, last year there was capacity to complete ten assessments a week, but there was demand for 18 a week, which is why additional support had been commissioned but challenges to recruitment and transforming the Service remained. 

16.The CEO of Surrey Coalition of Disabled People sought assurance that those already on the waiting list, who were unlikely to receive a diagnosis, would not be removed. The Director confirmed that there were no intentions to remove anyone from the waiting list. The CEO raised the issue of the NHS not recognising diagnoses (such as, Attention Deficit Hyperactivity Disorder) from the private sector. The Convenor explained that if an individual received a diagnosis from the private sector, they would have to get any prescribed medication at a continual basis from the private sector and fund it themselves. There was no short cut to get into the NHS and receive your medication through the NHS. The Convenor would double check that this information was completely accurate. The Director would provide an answer from a children and young people’s perspective following the meeting. 

17.In response to questions on further independent living accommodation and autism training for housing officers, the Assistant Director explained that they were continuing to look at accommodation options for those with autism. There were a number of independent living schemes in development across three sites across Surrey to support those with learning disabilities and autism. As part of the autism friendly community in Redhill, work had been undertaken with housing officers at the borough council to improve access. A training programme for housing departments in district and borough councils. A Member asked about the timeframe for this work. The Assistant Director explained that the work was underway through the pathway around independent living. Concepts were being trialled on a small scale and then plans to roll them would be explored. 

18.The Chairman asked whether the training was mandatory and who received it. The Assistant Director confirmed that the training was mandatory for specialist services across Adults and Children’s. If partners signed up to the strategy, they had to complete the training too. 

20.A Member questioned the support provided for those who experienced a death of a family member who supported them with accommodation. The Assistant Director recognised that many autistic people who did not qualify for ASC support, relied on their carers and families. There was an ageing population of family carers and thus, there was a Carers Strategy in place to identify that cohort of people and prioritising that cohort to move into independent living. 

Actions/requests for further information:

1.    The Director of Commissioning (CFLL) to provide additional information on annual reviews of EHC Plans.

2.    The Director of Commissioning (CFLL) to provide an answer regarding private diagnoses not being recognised by the NHS from a Children’s Services perspective.

Recommendations:

The Adults and Health Select Committee makes the following recommendations:

1.    For Learning Disabilities and Autism Leads at Surrey County Council and other partners involved in the strategy to raise further awareness of Autism amongst elements of the BAME/GRT community. To have an informal meeting on progress toward this in a future informal Adults and Health Select Committee meeting.

2.    For Learning Disabilities and Autism Leads at Surrey County Council to closely work with Surrey Heartlands and Frimley ICSs to ensure that knowledge and consideration of autism is emphasised in EDI training and as well as in EDI principles surrounding staff recruitment and work practices.

3.    For Learning Disabilities and Autism Leads at Surrey County Council and other partners involved in the strategy to adopt a meaningful co-production approach, a shared vision, resourcing and prompt timelines to implement the strategy, given that the success of the strategy will largely rest on being able to collaborate effectively with other partners.

Bring this item back to the Adults and Health Select Committee in an informal session, with specific updates on thework with Employability as well as the preparations for the Adulthood Board Activities.