Summary of Safeguarding Children With Disabilities and Complex Health Needs in Residential Settings:

Phase One Report Findings (October 2022):

1. Voice of the Child:

   - Wishes and feelings of children were not routinely sought.

   - Limited support for children to participate in review meetings or report abuse.


2. Leadership and Management:

   - "Closed culture" led to unreported abuse and neglect.

   - Lack of learning from incidents and insufficient preventive actions.


3. Staffing Levels and Support:

   - High vacancies and staff turnover affecting care quality.

   - Some staff received inadequate induction and outdated training.


4. Quality Assurance Procedures:

   - Complex and fragmented oversight arrangements.

   - Lack of professional curiosity and challenge.


5. Provision of Support:

   - Some children placed far from home due to a lack of local support.

   - Insufficient local community or residential support.


6. Information Sharing:

   - Information not effectively brought together.

   - Issues with the Local Authority Designated Officer (LADO) function.


7. Physical Restraints and Interventions:

   - Overuse of restraints and disproportionate temporary confinement.

   - Insufficient training for staff in restraint techniques.


Phase Two Report and Priority Areas for Improvement (April 2023):

1. Promoting Voices and Rights of Children:

   - Set expectations for hearing disabled children's voices.

   - Provide staff with communication support skills.

   - Facilitate regular contact with children's families.


2. Effective Strategic Commissioning:

   - Strengthen statutory guidance for commissioning services.

   - Evaluate and change commissioning practices for children's needs.


3. Improving the Quality of Provision:

   - Increase range and flexibility of provision in schools and the community.

   - Address leadership issues in residential settings.

   - Strengthen workforce sufficiency and development.


4. Strengthening Quality Assurance and Regulation:

   - Reduce over-reliance on provider reports.

   - Improve consistency in LADO approaches.

   - Enhance systems for information sharing, risk identification, and oversight.


National Recommendations:

1. Access to Advocacy:

   - Ensure access to independent advocacy for children with disabilities.


2. Support for Residential Placement Consideration:

   - Provide advice and support for children and families considering residential placement.


3. Joint Commissioning of Services:

   - Require joint commissioning for children with disabilities aligned with local plans.


4. Support Program for Commissioners:

   - Coordinate support program for local authorities and ICBs for better forecasting and procurement.


5. Government Pathfinder Programs:

   - Prioritise local initiatives in government pathfinder programs.

   - Develop an integrated strategy for the children's workforce in residential settings.


6. Leadership and Workforce Investment:

   - Address challenges in recruiting, retaining, and developing the workforce.


7. Enhanced Role for Local Authorities:

   - Give enhanced oversight role to host local authorities and ICBs.


8. Regulatory Framework and Joint Inspection:

   - Review and revise regulatory framework for residential settings.

   - Establish joint inspection by Ofsted and CQC for residential settings.


Recommendations for National Implementation or Local Partnerships:

1. All children with disabilities and complex health needs should have access to independently commissioned, non-instructed advocacy from advocates with specialist training to actively safeguard children and respond to their communication and other needs.

2. Where an admission to a residential placement for 38 weeks or more is being considered, children, young people and their parents should have access to advice and support through their local Special Educational Needs and Disability Information Advice and Support Service. Where necessary, a ‘navigator’ should be allocated to work with the family.

3. Local authorities and integrated care boards (ICBs) should be required in the Department for Education (DfE) and NHS England statutory guidance to jointly commission safe, sufficient and appropriate provisions for children with disabilities and complex health needs aligned with local inclusion plans and planning for care through Regional Care Cooperatives.

4. The DfE, Department for Health and Social Care (DHSC) and NHS England should co-ordinate a support programme for commissioners in local authorities and ICBs, focusing on improving forecasting, procurement and market shaping.

5. Local initiatives to improve the quality and range of provision for children with disabilities and complex health needs should be priorities for inclusion in the government’s pathfinder programmes in children’s social care and special educational needs and disabilities (SEND). 

6. The government should commission the development of an integrated strategy for the children’s workforce in residential settings, including leadership development, workforce standards and training.

7. National leadership and provider investment is needed to address challenges in recruiting, retaining and developing the workforce.

8. Host local authorities and ICBs should be given an enhanced role in the oversight of residential settings.

9. The DfE and DHSC should review and revise the regulatory framework for residential settings to reduce complexity and improve the impact of current arrangements; and take immediate steps to establish arrangements for joint inspection by Ofsted and CQC of residential settings for children with disabilities and complex health needs.


Government Response (December 2023):

   - Accepts or accepts in principle all nine national recommendations.

   - Outlines actions in response to key areas including safety, reforming safeguarding, community support, commissioning, and workforce development.

   - Urges providers and responsible bodies to review practices in light of the report.


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