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3.1.7 Multi Agency Panel for Children with Complex, Multiple and High Level Needs

Contents

  1. Introduction
  2. Criteria for Presentation to Multi Agency Resources Panel (MARP)
  3. The Panel
  4. The Role of the Panel
  5. Membership of the Panel
  6. Operational Procedures
  7. Appeals Process
  8. Emergency Placements
  9. Planned Placements
  10. Referral to the Multi Agency Resources Panel
  11. Outcome of the Panel
  12. Funding Arrangements
  13. Monitoring and Reviewing

    Appendix A: MARP Process for Packages of Care Requiring Social Care/Education Funding Plus Health Funding

    Appendix B: MARP Referral Form


1. Introduction

The protocol for Multi Agency Financial Agreement in Children’s Placements (January 2009) is being revised to reflect the changing demands on meeting the needs of vulnerable children. In keeping with the provisions of the Children Act and good childcare practice all professionals working with children and families should, whilst giving priority to the safeguarding of all children and young persons, maximise efforts to support children remaining at home with their families.

However there will be situations when a multi agency provision is required either because of family breakdown, safeguarding concerns, the lack of a suitable education or health provision.

The aim of this revised document is:

  • To support and enable practitioners to develop creative and flexible local support packages that will enable children to remain in the local community wherever possible;
  • To monitor local services and develop a range of local provision that is geared to meeting the needs of children with complex, multiple and high level needs;
  • Where this is consistent with meeting the needs of children, to reduce the overall number of residential placements made – as the outcomes from such placements are often poor – and work towards returning children in residential placements to local placements that enhance their inclusion and meet their needs;
  • To make full use of the monitoring and review of placements in order to move from a needs-led approach to one that is focussed on outcomes.

All financial decision-making within the local authority must represent value for money. Whilst decisions about children’s placements will not be led by finance alone, cost and value for money must be significant factors when making decisions about how best to meet the identified and assessed needs of looked after children (LAC) to ensure accountability of public funds.

This revised procedure describes how the local authority will evidence best value in decision-making in children’s placements. This will run in parallel to the statutory process of reviewing looked after children and decisions about financial arrangements need to be in place before each statutory review.


2. Criteria for Presentation to the Multi Agency Resources Panel (MARP)

The population of vulnerable children/young people for whom these multi agency funding arrangements are designed for are those:

  • Who have severe, complex and enduring emotional, social and behavioural difficulties; or
  • Who have complex care needs arising from a physical and/or learning disability; and
  • Where the usual processes for coordinated multi-agency and community based interventions have been unable to deliver adequate outcomes; and
  • Where there is reason to believe that resourcing at a higher level is likely to produce better outcomes;
  • Children and young people who have been placed in Secure Accommodation and require forward planning;
  • Whose current placement is in imminent danger of breakdown and no viable alternative can be identified in Hillingdon.

In relation to the above at least two – and preferably all three of the following descriptors about the young person’s needs should apply:

  • A child/young person who has an Education, Health and Care Plan for whom additional resources agreed locally, are not meeting their educational needs;
  • A child/young person who has difficulties consistent with a severe and long term psychiatric disorder or severe and complex health care needs and for whom Continuing Care assessments identify that their health needs cannot be met by existing resources within Hillingdon;
  • A child/young person whose care needs cannot be met from within the family or kinship network and is therefore looked after or, without the necessary resources being available, will need to be looked after.


3. The Panel

The Multi Agency Resources Panel for Children and Young People is a multi agency panel that considers and makes decisions on cross agency issues & joint/triparte funding applications from practitioners for complex care packages.

The Purpose of the Panel is to:

  • Ensure consistent application of the criteria to the needs of all children and young people for whom the Local Authority and Clinical Commissioning Groups (CCG’s) are responsible for;
  • Ensure best use of available resources;
  • Promote effective decision-making and the avoidance of unnecessary disputes;
  • Reach agreement on joint funding for complex care packages;
  • Advise the Children’s Joint Commissioning Board on any issues arising from the complex care process.


4. The Role of the Panel

The Panel does not replace the statutory care-planning process. Its role is to ensure that each placement meets the identified and assessed needs of the child or young person as set out in their care plan within an agreed level of resources.

It will achieve this by discharging its main functions, which are:

  • Ensuring services provided are meeting the needs of the child or young person, wherever possible within their local community and via universal services;
  • Ensuring that the needs of the child or young person could not be met in a more cost effective manner;
  • Ensuring that the outcomes for the placement are clearly identified and monitored;
  • Ensuring procured services are provided as detailed in the contract;
  • Having a defined and finite timescale for the required funding;
  • Ensuring a review date is set for the funding agreement; 
  • Ensuring that the commissioning process is informed and modified by an ongoing evaluation of the use of resources;
  • Reviewing the level and trend of internal resources;
  • Commissioning of specific pieces of work, reviews or analysis as determined by the panel;
  • Taking a planned approach to identifying appropriate resources on the basis of a thorough joint assessment;
  • Considering circumstances of children presented by any of the three agencies with the expectation that prior consultation, assessment and planning have taken place between colleagues from other agencies at a local level. Any funding requested from health will need to have gone through Clinical Commissioning Groups (CCG’s) approval processes prior to MARP;
  • Ensuring the views of the child, young person and their family are fully considered and used to inform decision making.


5. Membership of the Panel

Membership of the panel should be restricted to decision makers who are able to commit funding from their respective budgets. The membership of the panel should include managers with a designated commissioning responsibility from the Clinical Commissioning Group and Local Authority and representatives from these organisations to advice the panel and assist the Panel on relevant issues. Other professionals may be requested to attend a Panel to assist with specific cases.

  • Deputy Director Children and Families;
  • Service Manager – Looked After Children;
  • Head of Access and Inclusion;
  • Data and Finance Officer – Special Educational Needs;
  • Service Manager Children’s Resources;
  • Executive Director of Commissioning, Clinical Commissioning Groups (CCG’s);
  • Clinical Commissioning Groups (CCG’s);
  • Head Teacher Virtual School;
  • Interagency Transitional Co-ordinator;
  • Panel Administrator.

Agenda, minutes, decisions and reports will be circulated to all members of the panel and to the:

  • Service Manager - Family Support Services;
  • Team Managers and Assistant Team Managers presenting cases to the Panel;
  • Placement Team.

Frequency of Panel Meetings

The panel will meet every four weeks, however if urgent decisions are required on cases which do not meet this four week cycle, then by exception they may be added to the agenda for the Access to Social Care Panel weekly meetings as long as the relevant pre-planning has been conducted.


6. Operational Procedures

Scope

The following procedures apply to practitioners and managers in all three funding agencies and cover:

  • The initial identification of need and multi agency assessment as appropriate;
  • Joint health and social care assessment if there is a health need;
  • Stage 1 of the agreed process – multi-agency professionals meeting to develop recommendations (may be virtual if time frame does not allow for a face to face meeting);
  • Stage 2 of the agreed process – options sourced for the recommendation by the multi-agency professionals meeting, costs identified and funding pre-approved by each agency (health costs need to be agreed by the Clinical Commissioning Groups (CCG’s) Executive Team prior to MARP);
  • Referral to the Multi Agency Resources Panel for children with complex, multiple and high level needs;
  • Stage 3 of the agreed process – consideration by the Panel;
  • Notification of Panel decision;
  • Funding arrangements;
  • Monitoring and review of placements;
  • Response to placement change.

A process flowchart can be found in Appendix A


7. Appeals Process

There are appeal rights for the parent/guardian, GP, specialist themselves if their preferred package is not authorized by MARP. This appeal can either:

  • Be directed back to MARP for reconsideration (if new information has been submitted or is available from external sources (such as NICE, SIGN guidance) and requires re - consideration);
  • Or if an appeal is requested on the basis of policy/procedure, to the independent Appeals Panel to review all evidence previously submitted.

The independent Appeals Panel will include membership from the following parties:

  • LA Elected Member for Children’s Services;
  • One Executive Director from the Clinical Commissioning Groups (CCG’s);
  • One Executive Director from the Local Authority – Designated Director for Children and Families;
  • One practising clinician.

The Appeals Panel will have the ability to co-opt further members should additional expertise be required, or seek independent advice

To ensure independence, none of the above members can have been involved in the original MARP process for the specific case.


8. Emergency Placements

The Mutli Agency Resources Panel is not designed to respond to the need for emergency arrangements. In these circumstances where a placement is required at short notice, the following will apply:

  • Any placement arranged at short notice will have been agreed by the placing agency's representative on the Panel or, in the case of Social Care, the Deputy Director of Children and Families;
  • All appropriate checks will have been undertaken to ensure that the provider agency meets service specification;
  • Agreement to placement will only be given up to the date of the subsequent available Panel.


9. Planned Placements

Any practitioner who concludes that a child/young person for whom they are responsible may need to access local or national resources potentially funded by the Multi Agency Resources Panel process should take the following steps:

  • An Assessment in line with Working Together 2015 must have been undertaken by appropriate professionals and involving the child/young person and their parents/carers. Where appropriate a joint assessment with health professionals should also be undertaken at this stage and alert Clinical Commissioning Groups (CCG’s), for example where there are significant health issues;
  • A case may only be considered by the Multi Agency Resources Panel if it has first been considered at a multi agency professionals meeting and agreement to that action reached. This is to ensure that all options have been explored to support the child/family at home;
  • The development of a Care Plan identifying the most appropriate way to meet the assessed needs, including any specialist services that may need to be involved;
  • All services/placements should be fully costed including health, education and social care elements, together with any extra costs e.g. transport. Any health costs above £50k will require approval from the Clinical Commissioning Groups (CCG’s) Executive Team prior to the MARP meeting;
  • All referrals to the panel must be on a fully completed application form. Incomplete referrals will be returned to the responsible worker and removed from the scheduled case list if not completed fully by the deadline for referral submissions;
  • Children in transition or leaving care would be expected to have a pathway plan;
  • The relevant Service Manager or equivalent must approve all referrals to Panel and ensure all relevant actions have been completed and all options explored.


10. Referral to the Multi Agency Resources Panel

Upon receipt of the referral (on the proforma and submitted within the timescale in advance of the panel) the panel will:

  • Agree whether the required processes for assessing and meeting agreed needs have been followed to that point. This includes confirming that fostering has been fully explored for all looked after children and that evidence of this has been provided;
  • Establish for those children accommodated out-borough whether sufficient attempts have been made to set up an improved local package of support in the child’s area;
  • Determine whether, if the above options are not viable, it is necessary to place the child in a multi agency funded placement in an approved out-borough establishment in order to ensure that their care/education/health treatment needs are met;
  • Authorise funding for a named placement over a defined period and specify any requirements such as contingency arrangements, transition arrangements, monitoring and review arrangements and additional specialist services for the child/young person in question;
  • Agree the respective financial contributions of each of the agencies in relation to any resources allocated. (Members of the Joint Agency Panel represent their respective agencies and are authorised to commit resources on their behalf within agreed budget limits. For Clinical Commissioning Groups (CCG’s) this limit is based on the prior approval of the funding by the Clinical Commissioning Groups (CCG’s) Executive team for a specific case;
  • Agree all operational decisions relevant to funding will be finalised by the Panel, e.g. determining the lead agency;
  • Agree reviews of agreed packages. The current agreed frequency is that all residential placements are reviewed at least every 6 months whilst non residential placements are reviewed as a minimum annually.


11. Outcome of the Panel

Decisions from the Panel will be summarised and signed off by the Chair of the Panel and representatives of each the agency contributing to the funding of the case. In addition the Panel Administrator will ensure that:

  • Agendas are circulated at least two weeks prior to each meeting;
  • Team Managers or Deputy Team Managers are advised when their attendance is required;
  • That a summary of the discussion, key action points and decisions with rational are duly recorded and circulated;
  • Notes of meetings and decisions are circulated to all members and relevant officers within 1 week of meeting;
  • That the individual young person’s report is updated with the decision and key action points and return to the relevant TM and DTM with copy retained;
  • That a copy of the decision is placed in the child’s or young persons placement file.


12. Funding Arrangements

  • Where the breakdown of educational cost is provided then SEN meets the full educational costs. Where costs are not broken down then the panel will consider the proportion of contribution based on needs for the following types of placements;
  • 52 Week Placement
    38 Week Placement.

Educationally related transport costs to the placement will be shared.

Where there is an assessed and identified health component which is not available through the universal services and the Clinical Commissioning Groups (CCG’s) have agreed to fund the provision of that service; the level of funding will be based on the defined health need and cost of the service as provided by the service provider and agreed by Clinical Commissioning Groups (CCG’s) Executive Team.

  • Tribunal decisions involving residential placements will need to be funded according to this policy.


13. Monitoring and Reviewing

  • For all residential and high costs IFA placements (i.e. where therapy and or education is provided) the Independent Reviewing Officer (IRO) will be required to check the level and quality of service provided. This does not interfere with the reviewing officer’s independent role, and the usual process of reviewing the care plan will be adequate to complete this monitoring role;
  • The IRO will complete the monitoring form and raise issues of concern with the placements team/relevant team manager for social care for further consideration or action;
  • Clinical Commissioning Groups (CCG’s) will be responsible for ensuring that health providers follow CPA and monitoring that treatment plans are effective against defined outcomes from the treatment plan;
  • In the event that a placement or arrangement authorised by the Multi Agency Panel is disrupted, the Lead Professional must immediately convene discussions with relevant staff/the Team Around the Child about potential responses and make arrangements for the case to be discussed at the next available Panel;
  • In such circumstances, funding will be terminated in accordance with the contract made with the service provider or within a maximum of one month from the date the child left the placement (whichever is the sooner);
  • Where a young person already in a joint-funded placement moves to a planned new placement, Clinical Commissioning Groups (CCG’s) should be informed without delay and the matter should be referred back to the Panel only when it is proposed to vary the number of weeks or the type of placement or the new placement will cost substantially more.


Appendix A: MARP Process for Packages of Care Requiring Social Care/Education Funding Plus Health Funding

Click here to view flowchart


Appendix B: MARP Referral Form

Click here to view form

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