Foreword

Over the last three-years partners across Health, Education and Social Care have worked together to deliver the key priorities and actions as set out in the original Joint Health, Social Care and Education Transitions Strategy 2019 to 2022. The delivery of the Transitions strategy and action has improved the outcomes for our young people, especially those with special educational needs and disabilities and our children who are looked after, as they transition from childhood to adulthood. This includes providing more training for our staff to better support and prepare young people at an earlier stage for services appropriate to their needs as they reach adulthood. 

To see our full ‘you said, we did’ document reflecting on what we have achieved visit our Local Offer website.

However, we know that more needs to be done to ensure the transition for our young people and their families/carers is a smooth and supported time.  Therefore, we have decided to refresh our strategy and update our priorities and actions for a further two-years. We will continue to focus on our three key aims of integrated service, effective planning and informed choices whilst also working closely with our partners.

Our refreshed Joint Health, Social Care & Education Transitions Strategy 2022 to 2024 will also link to a wider transitions strategy across Leicester, Leicestershire and Rutland (LLR).  This is in development and will become the overarching plan, which will ensure that services across these areas meet the needs for our young people.

About the strategy

This Joint Health, Social Care and Education Transitions Strategy has been written to help ensure that the staff working to support young people as they transition into adulthood are clear about the work which needs to be done to make sure young people have a good experience as they leave children’s services and become adults.  The strategy also provides information for young people, their parents/carers and any other people supporting young people (e.g. school staff) to understand what is being done in Leicester City to support young people as they transition into adulthood.  Alongside the full strategy document, summaries targeted at a ‘non-professional audience’ are available.

The Joint Health, Social Care and Education Transitions Strategy outlines what our ambitions and aims are for making improvements to our support during the period of transition, details what we know about the young people who might need support when they transition and provides an overview of actions which need to be taken in order to improve the lives of young people and their families as they undergo transition to adulthood.  The strategy will help make sure that all the important teams which support young people work well together.  This is a working document and will adapt and change over its lifespan to reflect improvements and changes which have been made and any changes in the national and local picture.  The strategy will be reviewed and updated by the Transitions Delivery Group on an annual basis. 

If you do not feel we are getting it right, please use the Local Offer to get in touch with the relevant person to discuss the situation and seek help - Leicester City Local Offer.

In addition to the full strategy this document is also available in a range of different formats to ensure it is accessible to young people, parent carers and other non-professionals, as well as people with a learning disability. 

Follow the links below to view the alternative formats:

• Transitions easy-read plan 2022-2024 (PDF)

Introduction

Since this Strategy was created, focused training has been provided to the staff who support young people and we have begun to create clearer pathways as young people move into adulthood. A range of other Strategies across partnerships have also been developed to link in with this Strategy. These include:

• SEND Preparing for Adulthood (PfA) Strategy
• LLR SEND Joint Commissioning Strategy
• Placement Sufficiency Strategy

This Strategy has been refreshed to take into account what we have achieved and to continue to move forward, building on this good work.

For young people who receive support from children’s health and social care services these services often end when they turn 18 and they become ‘adults’ (though some services continue until age 25).  Some of these young people will then go on to receive support from adult health and social care services, but these are often different to the services young people had received before.  Some young people will not receive adult services at all.  This period of change as a young person enters adulthood is known as ‘transition’.

During the period of ‘transition’ a young person will begin to get ready for leaving children’s services and becoming an adult.  There are four key areas which a young person should prepare for, these are:

• Education and/or employment
• Independent living
• Friends, relationships and community
• Good health

Cohorts

Health and care professionals in Leicester agree that it is important to support young people with additional needs as they ‘transition’ into adulthood. 

Three cohorts of young people have been identified as particularly likely to need support.  These cohorts are:

• Young people who are looked after by the council;
• Young people with Special Educational Needs and/or Disabilities (SEND);
• Young people entering adult services.

Though three clear cohorts have been identified, it is recognised that there are overlaps between these groups (see diagram), for example a young person might be looked after and have a disability, and work will be mindful of this. 

Ambition and aims

We put children at the heart of everything we do. Using the Lundy model of participation, we listen to and act upon the views of young people and their families to inform service development, intervention and decision making. Our ambition and aims allow us to continue strengthening our processes and meet the needs of young people moving into adulthood.

To support the ambition that ‘young people with additional care and support needs are supported to be independent in adult life and achieve positive outcomes in terms of employment; independent living; friends, relationships & community; and good health’ three key aims have been identified:

Integrated service

Young people with additional needs are supported by key agencies working in partnership.  A robust framework for partnership working and information sharing ensures that relevant care and health partners understand their roles in the transition process and effectively use joint planning.

Effective planning

Young people with additional needs are at the centre of a transition planning process which starts at age 14 at the latest and allows for effective forward planning.  This allows for services and budgets to be planned for the projected support needs of young people moving into adulthood.

Informed choices

Young people with additional needs are given the support, encouragement and tools to make choices and take control of their lives.  Their families and support networks have access to information and advice to ensure that all decision making is informed.

Note that in this context ‘young people’ can refer to people up to age 25 (who consider themselves to be and are considered to be adults).

Governance

To support the delivery of actions outlined in the Joint Health, Social Care and Education Transitions Strategy and the underpinning delivery plan, three working groups will bring together relevant partners to address aspects of the transitions pathway relevant to each of the three identified cohorts.  These work streams will be overseen by the Transitions Delivery Group, which brings together representatives from social care, education and health, and has responsibility for ensuring that work between the working groups is joined up and for monitoring risks and issues. 

The Transitions Delivery Group is accountable to the SEND Strategic Partnership board, the role of which is to provide scrutiny and challenge to the Transitions Delivery Group and offer assurance, while also ensuring that service user experience is the driver for improvements. The Transitions Delivery Group will continue to monitor new legislation and guidance and ensure this is reflected in our work and actions. The Transitions Delivery Group will also have oversight of the participation plan and ensuring that there is meaningful engagement with children and young people.  Additionally, the Transitions Delivery Group will provide an annual progress update to all Partners and members and will report into boards as appropriate.

Key primary strategic partners

• Children’s Trust Board
• Joint Integrated Commissioning Board
• CCG Children and Young People Design Group

Key secondary strategic partnership boards

• Leicester, Leicestershire and Rutland Autism Board
• Corporate Parenting Board
• SEND Strategic Partnership Board
• Learning Disability Partnership Board
• Leicester Educational Strategic Partnership
• Leicester Safeguarding Children Board
• Leicester Safeguarding Adults Board
• Mental Health Partnership Board

Partners

The governance and oversight of Leicester’s Joint Health, Social Care and Education Transitions Strategy recognises that the delivery of our offer is not the responsibility of a single agency but is owned by all partners that work with children, young people and families.

To support the ambitions and aims laid out in this strategy a number of partners will work in partnership to:

• Contribute towards achieving the aims,
• Accept challenges to their own service delivery practice by taking into consideration wider partnership needs,
• Work with mutual trust and combine expertise,
• Instil culture and practice of joint working.

While it is imperative that focus is given to the development of an effective relationship between the Social Care and Education department at Leicester City Council and Leicester City Clinical Commissioning Group, there are a number of other partners who will need to engage with the work in order to enable success.

Additionally, it is particularly key that the voices of young people and parent carers are heard and that they are key partners in delivering this work. The Participation and Engagement Plan underpins meaningful engagement using the principles of the Lundy model and identifies multiple and varied opportunities for young people and parent carers to be involved.

Partners identified include:

• Adult Social Care and Commissioning
• Learning Services
• Children’s Social Care and Early Help
• NHS Leicester City Clinical Commissioning Group
• Schools and colleges
• Children and Young Peoples Justice Service
• Police
• Voluntary and community sector
• Care Leaver Forum
• Housing
• Department for Work and Pensions
• NHS Leicestershire Partnership Trust
• Big Mouth Forum
• NHS Continuing Health Care
• Young People’s Council
• Leicester City Council Parent Carer Forum
• Children in Care Council
• Connexions

Cohort 1: Children looked after

Statutory responsibilities

Every 16 or 17-year-old who has been looked after by a local authority for a period of 13 weeks or more since the age of 14 becomes entitled to leaving care provision and the local authority must make this support available until a care leaver turns 25.  The support provided should focus on preparing the young person for life, ensuring they have the skills to support themselves and ultimately thrive.  From age 16 looked after children should have a ‘Pathway Plan’ which outlines the services and support to be provided to help them reach their goals and achieve independence. The Pathway Plan should also ensure that arrangements are in place to enable children leaving care to continue to obtain the healthcare they need.  To support this, the planning process should include a health perspective; The Looked after Children (LAC) Nursing Service should attend the pathway planning meetings and provide a summary of the child’s health information which is obtained during regular review health assessments.

The local authority must also ensure that care leavers can access a personal advisor until they turn 25.  The personal advisor is responsible for ensuring the young person is provided with the correct level of support.  The personal advisor should provide advice, coordinate the provision of services and keep in touch with the young person.

Local picture

In Leicester there is an upward trend in the number of looked after children and this is rising more rapidly than comparable authorities.  At the end of March 2022 there were 624 looked after children. The most prevalent reason for children being taken into care is neglect and abuse.  Ofsted have recognised the complexity of the looked after children cohort, citing complexities such as mental health needs, risk of sexual exploitation, being in custody and recently becoming parents. 

The LAC Nursing Service (NHS Leicestershire Partnership Trust) provides support to looked after children in Leicester until age 18.  The service has identified a number of specific vulnerable groups including: young people at risk of child sexual exploitation, those in semi-independent accommodation, unaccompanied asylum seeker children and high risk young people (including those misusing drugs and alcohol and those who are pregnant).

Key drivers

Ofsted (2021): Rated Good in area of the experiences and progress of children in case and care leavers - “Early consideration of planning means that most young people are supported to transition to independence at the right time for them. Pathway plans reflect the needs and skills of individuals, and appropriate support packages are developed for when they leave care. This means that many care leavers can fulfil their potential in completing apprenticeships, getting jobs and being able to parent their own children successfully.”

Key local policies/strategies

• Corporate Parenting Strategy 2022- 2024
• All-Age Commissioning Strategy 2020 - 2025
• Homelessness Strategy 2018 - 2023
• Placement Sufficiency strategy 2020 - 2023
• Children’s Social Care and Early Help Improvement Strategy 2021 – 2024

Key national legislation/guidance

• Children Act 1989 and 2004 - places a general duty on local authorities to promote and safeguard the welfare of children in need in their area by providing a range of services appropriate to those children’s needs.
• Children Act 2004 – places a duty on a range of agencies, including local authorities, the police and health services, to ensure that they consider the need to safeguard and promote the welfare of children when carrying out their functions, make arrangements to promote co-operation with key partners and local agencies, with a view to improving the well-being of children in the authority’s area, and establishes the roles and responsibilities of safeguarding partners.
• Working Together to Safeguard Children - sets out how individuals and organisations should work together to safeguard and promote the welfare of children and young people in accordance with the relevant legislation.
• Children (Leaving Care) Act 2000, Care Leavers (England) Regulations 2010 and Extending Personal Adviser support to all care leavers age 25 – These Acts and guidance sets out duties local authorities have to support young people leaving care from 16 to 25 years of age.
• Care Act 2014 - The Care Act 2014 places a duty on local authorities to conduct transition assessments for children, children’s carers and young carers where there is a likely need for care and support after the child in question turns 18 and a transition assessment would be of ‘significant benefit’.
• Children and Families Act 2014 - The Act brought together a number of changes to legislation around services for vulnerable children and young people and families. The changes cover the family justice system, virtual schools for looked after children, adoption, childcare, shared parental leave and flexible working, and services for children and young people with Special Educational Needs and/or Disabilities (SEND).
• Promoting the health and wellbeing of LAC 2015 - statutory guidance for local authorities, clinical commissioning groups and NHS England.
• Children and Social Work Act 2017- An Act to make provision about looked after children, to make other provision in relation to the welfare of children, and to make provision about the regulation of social workers.

Cohort 2: Young people with SEND

The local area has to identify and assess the special educational needs (SEN) of children and young people.  Some young people receive SEN support from their school or college, however if a young person is assessed as requiring more support than their school can give them, then they may decide to request a statutory assessment for an Education Health Care (EHC) Plan. A local area may continue to maintain an EHC Plan whilst a young person is progressing in education, and this could be up until the age of 25. Once a young person can no longer progress education then the plan should cease.

Local picture

As of March 2022, there are currently approximately 2976 young people aged 0-25 with EHC plans. Of those aged 3 -16 years old there are currently approximately 2159 with an EHC plan and between ages 17-25 years old there are 817 with an EHC plan. Off these approximately just over 50% are educated in specialist provision. 

In recent years there have been increasing numbers of young people with a primary need of Autistic Spectrum Disorder; Social, Emotional & Mental Health; or Speech, Language and Communication Needs identified in their plans. In addition to those with an EHCP, a further 6487 young people have a specialist education need and receive SEN support from their school or college.

Key drivers

Ofsted 2021: Ofsted and Care Quality Commission (CQC) revisited Leicester in May 2021 to assess whether the local area had made sufficient progress in addressing the five areas of significant weakness detailed in the Written Statement of Action (WSOA) issued in 2018. Area 4 of recommendations still required improvement ‘The lack of joint commissioning of services to support young people’s health needs post 19’.

Self-Evaluation Framework: Leicester City Council’s Self Evaluation recognises the need to improve transition arrangements between children and adult services as a key area for development.

Key local policies/strategies

• SEND 3-year Strategy 2019 - 2022
• SEND Self Evaluation Framework
• SEND Preparing for Adulthood (PfA) Strategy 2021 - 2025
• Leicester, Leicestershire and Rutland (LLR) SEND Joint Commissioning Strategy 2021 – 2024

Key national legislation/guidance

• Children’s Act 1989 – places a general duty on local authorities to promote and safeguard the welfare of children in need in their area by providing a range of services appropriate to those children’s needs.
• Children’s Act 2004 - places a duty on a range of agencies, including local authorities, the police and health services, to ensure that they consider the need to safeguard and promote the welfare of children when carrying out their functions, make arrangements to promote co-operation with key partners and local agencies, with a view to improving the well-being of children in the authority’s area, and establishes the roles and responsibilities of safeguarding partners.
• Equality Act 2010 - is a law which protects you from discrimination. It means that discrimination or unfair treatment on the basis of certain personal characteristics, such as age, is against the law in almost all cases.
• Children and Families Act 2014 - The Act brought together a number of changes to legislation around services for vulnerable children and young people and families. The changes cover the family justice system, virtual schools for looked after children, adoption, childcare, shared parental leave and flexible working, and services for children and young people with Special Educational Needs and/or Disabilities (SEND).
• Care Act 2014 - The Care Act 2014 places a duty on local authorities to conduct transition assessments for children, children’s carers and young carers where there is a likely need for care and support after the child in question turns 18 and a transition assessment would be of ‘significant benefit’.
• Special Educational Needs and Disability (SEND) code of practice 2015 - 0-25 years: Guidance on the special educational needs and disability (SEND) system for children and young people aged 0 to 25, from 1 September 2014.
• NICE Guideline – are evidence-based recommendations for health and care in England. They set out the care and services suitable for most people with a specific condition or need, and people in particular circumstances or settings.
• Mental Capacity Act 2005 – provides a statutory framework to empower and protect vulnerable people who are not able to make their own decisions. It makes it clear who can take decisions, in which situations, and how they should go about this. It enables people to plan ahead for a time when they may lose capacity.
• Mental Capacity Act 2019 – introduces a new process for authorising deprivations of liberty for persons who lack capacity to make a particular decision.

Cohort 3: Entering adult services

Statutory responsibilities

If a child is likely to have social care needs when they turn 18 the local authority should complete an assessment of their needs. On the basis of this assessment, local authorities must suggest whether the young person is likely to have eligible needs for support from adult social care and advise on what can be done to meet eligible needs/what can be done to prevent or delay the development of additional needs.  The local authority must continue to provide a young person with children’s services until they reach a conclusion about their situation as an adult so that there is no gap in provision. 

There are clear criteria set out in the Care Act (2014) which determine whether a young person is eligible for adult social care. Just because a young person has received support from children’s services this does not mean they will be eligible for adult social care.  A person is deemed to have eligible needs if they meet all of the following: i) they have care and support needs as a result of a physical or a mental condition, ii) because of those needs they cannot achieve two or more of the outcomes specified, iii) as a result there is a significant impact on their wellbeing.

People with complex primary health needs may be eligible for Continuing Care funding where needs cannot be met by specialist or universal services alone. Continuing Care is organised differently for children and young people than for adults so upon turning 18 young people have to be reassessed under the adult framework.  This can impact the amount of funding that health will contribute, which in turn impacts the level of support families can expect from Adult Social Care.

Local picture

On average the transitions team currently assesses just under 70 young people per year, of whom approximately 43% are found to be eligible for support. The majority of young people who access adult social care through the transitions team have a primary support reason of learning disability.  Not all young adults (18-30) make contact with adult social care through the transitions team; approximately 3154 young people receive assessments from adult social care per year.  Of these people just over 38% are found to be eligible for support.  While learning disability remains the primary support reason for the majority of cases, mental health support and physical support are much more prevalent for young people who do not access the transitions team and are later referred to adult social care. 

Key drivers

Making improvements to transitions is referred to explicitly in the Adult Social Care strategic priorities, noting that “We [Adult Social Care] will continue the work with children’s social care, education (SEN) and health partners to improve our support for young people and their families in transition into adulthood”.

Key local policies/strategies

• Supported Living and Extra Care Strategy 2021 - 2031
• Learning Disability Strategy ADD
• Joint Integrated Commissioning Strategy for Adult Mental Health 2021 - 2025
• Autism Strategy ADD
• Carers Strategy ADD

Key national legislation/guidance

• Care Act 2014 - The Care Act 2014 places a duty on local authorities to conduct transition assessments for children, children’s carers and young carers where there is a likely need for care and support after the child in question turns 18 and a transition assessment would be of ‘significant benefit’.
• Social Care Reform white paper - The white paper sets out a 10-year vision for care and support in England and is based around three key objectives: People have choice, control and support to live independent lives. People can access outstanding quality and tailored care and support. People find adult social care fair and accessible.
• NICE Guidelines - are evidence-based recommendations for health and care in England. They set out the care and services suitable for most people with a specific condition or need, and people in particular circumstances or settings.
• Transforming Care - all about improving health and care services so that more people with a learning disability and/or autistic people can live in the community, with the right support, and close to home.
• Mental Health Act 1983 - The Mental Health Act (1983) is the main piece of legislation that covers the assessment, treatment and rights of people with a mental health disorder.
• Mental Capacity Act 2005 - provides a statutory framework to empower and protect vulnerable people who are not able to make their own decisions. It makes it clear who can take decisions, in which situations, and how they should go about this. It enables people to plan ahead for a time when they may lose capacity.
• Mental Capacity Act 2019 - introduces a new process for authorising deprivations of liberty for persons who lack capacity to make a particular decision.

Key priorities

On the basis of what we know about each cohort, a number of key priorities have been identified which will help achieve the ambition and aims outlined in the strategy. In order to demonstrate the relevance and significance of each action in the context of the strategy, the high-level outline explicitly links each action with the aims it supports.

This high-level summary is underpinned by a detailed delivery plan which breaks down each priority into the supporting actions and identifies the person responsible, the deadline, necessary resources, critical messages and a quality measure for each action. The previous iteration of the action plan was framed around the 3 cohorts. Based on the experience of delivering the strategy the action plan is now framed around 5 new key focuses in order to ensure the workstreams are working in a joined-up way.

Key focus one

Action

Key focus two

Action

1. Develop a method to help identify the future needs of those using services to predict the number of young people who may require transitions support - Link to aims: Integrated service, Effective planning

2. Develop a set of data that allows for monitoring of care experienced young people likely to require adult social care services and captures the performance of the support provided - Link to aims: Effective planning
3. Develop a set of data to help identify those who will require respite support including the type of need and provision - Link to aims: Effective planning
4. Review numbers of young people who enter Children’s Social Care at a late age and identify gaps in provision - Link to aims: Effective planning

Key focus three

Action

Key focus four

Action

Key focus five

Action

Useful links

National legislation and guidance

• Care Act 2014
• Children (Leaving Care) Act 2000
• Children Act 1989
• Children Act 2004
• Children and Families Act 2014
• Children and Social Work Act 2017
• Equality Act 2010
• Heath and Social Care Act 2012
• Homelessness Act 2002
• Homelessness Reduction Act 2017
• Mental Capacity Act 2005
• Mental Capacity Act 2019
• Mental Health Act 1983
• National Health Service Act 2006
• NICE Guidelines: Transition from children’s to adults’ services
• Promoting the health and wellbeing of LAC 2015
• SEND code of practice: 0 to 25 years
• The Care Leavers (England) Regulations 2010
• Transforming Care for people with learning disabilities
• Working Together to Safeguard Children

Local strategies and policies

• Corporate Parenting, 16 Plus and Leaving Care Strategy 2022-2024
• Homelessness Strategy
• Leicester City Council Adult Social Care strategic purposes and priorities
• Leicester’s strategy for supporting children and young people with Special Educational Needs and Disabilities (SEND) 2017-2022
• Placement Sufficiency Strategy 2020-2023
• Preparing for Adulthood Strategy 2021-2025
• SEND Self Evaluation April 2018

Ofsted feedback

• Ofsted report Inspection of services for children in need of help and protection, children looked after and care leavers 2021
• Ofsted report LA SEND inspection report 2021