Information Governance

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1 Information Governance Dept of ehealth NHS Grampian Rosehill House Foresterhill Site Cornhill Road Aberdeen AB25 2ZG Dear Freedom of Information (Scotland) Act 2002 I refer to your dated 28 th October 2010, requesting: Date 28 th January 2011 Your Ref Our Ref FOI/2010/388 Enquiries to Information Governance Team Extension Direct Line nhsg.foi@nhs.net I note from the recently published Moray Council Consultation Document on local authority spending, that NHS Grampian receives monies on a recurring basis to support the local Child Development service in Moray "MIDAS." Can you advise how much money is transferred from the local authority to NHS Grampian, on a yearly basis and what services are provided by MIDAS to the local authority, including a detailed breakdown of how this money is spent. When was the arrangement set up and can I have a copy of the "service level agreement" or equivalent? Can I also have any documents detailing the rationale for this transfer of monies. Can you also advise on the number of children seen within MIDAS over the last 5 years- broken down into numbers per year, and the waiting time from referral to diagnosis year by year, for this group. How many complaints have been received about the service during this period? I can now respond as follows: Can you advise how much money is transferred from the local authority to NHS Grampian, on a yearly basis and what services are provided by MIDAS to the local authority, including a detailed breakdown of how this money is spent. NHS Grampian has received the following funds in the last three years to support the MIDAS service: , , ,750 These funds have been used to contribute towards the staffing of the MIDAS service as follows: WTE Occupational Therapist 0.4 Speech & Language Therapist 0.3 Speech & Language Therapist 0.1 Physiotherapist Band 0.4

2 Dietetics Band 0.15 MIDAS Co-ordinator hours The combined salaries of these staff in the last three financial years were as follows: 2007/08 69, /09 71, /10 73,040 The Moray Interagency Developmental Assessment and Support (MIDAS) service provides a framework for locally based integrated assessments for pre-school children with significant and complex additional support needs which require the involvement of more than one agency. Central to the work of MIDAS is the team around the child model, which ensures that the focus remains on the needs and aspirations of children and families. The professionals on the team around the child are generally those already known to the family. Links are maintained with out of area specialists where necessary, e.g. Consultants in Aberdeen, Edinburgh and Glasgow. The service has removed the need for families to travel to a regional assessment centre around 70 miles away. It has also improved early identification and intervention, provided parents with a consistent source of support, co-ordinated the input of a wide range of activities, improved transitions to early years education and ensured compliance with The Education (Additional Support for Learning) (Scotland) Act 2004 (ASL) and the GIRFEC principles. The current work of the MIDAS core group involves assessment activities, review and planning meetings, business meetings to consider referrals and procedural issues and development meetings to review the operation of the service and plan future developments. The assessment process begins with a screening assessment undertaken by a professional known to the parents and shared with the core group. The next stage is to nominate a Team Leader (often a person who completed the screening assessment) and the professionals who will be involved in the team around the child. Dates are set for a Team Leader Liaison meeting, at which professionals share information, followed by the Child Support Plan (CSP) meeting with parents to draw up the joint action plan. Following the team leader liaison meeting, and prior to the CSP meeting, the team leader discusses the results of the assessment with parents which ensures that the planning meeting can focus on the next steps rather than the assessment details. Thereafter, the review and planning cycle continues, usually until the transition to Primary School has been completed. The service has been developed over several years by a multi-agency group of practitioners including Educational Psychology, Clinical Psychology, Paediatrics, Social Work and Allied Health Professionals. It is currently managed by a core group of the above professionals plus a specialist Early Years Teacher and Health Visitor. MIDAS reports to a senior management group with representation from education, social work, health and relevant voluntary organisations. The development of a local community based pre-school assessment service removes the need to travel to the regional assessment centre and puts children and families at the centre. The review meetings as much as possible are held near to where the families live. This allows school / nursery staff better access to attend meetings. External evaluation showed that this was working well with positive feedback that came from both parents and professionals.

3 In the early days of the development it was recognised that a central administrator was essential in order to assemble information, co-ordinate assessment activity, organise meetings and to act as a single point of contact for parents and professionals. The administration for MIDAS is currently based at The Glassgreen Centre in Elgin. More recently the administrator has incorporated the role of co-ordinator when the post was vacated in As part of that role they have been mentoring the new Team Leaders and supporting them through the MIDAS process. The role of the administrator has a high degree of flexibility as the service is continuing to evolve and every family is treated individually for example travelling to a locality where it is more accessible to the family Consequently, the MIDAS team has to approach each family at their level of capability and gauge their level of understanding and confidence. This affects whether or not the family feels themselves to be at the centre of the process. MIDAS currently has over 21 children within the service (November 2010), all at different stages within the process. Due to the unprecedented number of referrals during the last period the MIDAS core team have had to review the referral criteria: The child has to live in Moray The child is 0-5years Have more than 2 professionals working around the child The number of children is limited to the numbers of MIDAS team leaders (key workers). MIDAS approached the senior management team to put in some Team Leader training. Two facilitators from SNIP delivered a 2day course on a role of a team leader. Over 23 professionals from three different sectors attended the course. The core team are very conscious of the number of children who need the MIDAS service, and they regularly review the service to allow children who are well placed in the Education System to be graduated from MIDAS, therefore allowing more new referrals into the service. The team agreed that limiting the numbers to no more than 20/25 children would allow a better quality of service to our families. MIDAS has been recognised nationally as an example of good practice through the Children in Scotland seminars Good Practice Report on the implementation of the ASfL Act. It was also a central feature of an Enquire national newsletter for all parents published in Members of the clinical group have presented at a national care coordination conference and it is recognised as good practice across Moray and the NHS Grampian area. Areas of Good Practice Compliance with the principles of GIRFEC, the Early Years Framework, Curriculum for Excellence (Health & Wellbeing) and Child Protection guidelines Early intervention - identification and support for parents, including pre-diagnosis Child Support Plans importance of planning and reviews to monitor progress Single integrated assessment A flexible service tailored to meet the needs of the child and family using a coordinated approach, one point of contact and an identified lead professional Capacity to respond, change and innovate Regular professional collaboration and inter-agency working Strategic overview across Moray of pre-school additional needs

4 Service Developments As a service we regularly evaluate MIDAS to identify any gaps in service, with both parents and professionals who have been involved in the MIDAS process. External evaluation in 2004 Update in 2007 Annual team days i. Duplication of meetings. As an ongoing development, wherever possible, MIDAS will combine with other processes, e.g. developmental playgroup reviews, in order to reduce duplication. This is also evident in transition planning. ii. Evaluation has highlighted that the language used by professionals can be difficult to understand. There is an ongoing review of MIDAS materials with reference to the Plain English campaign and a Parents group. A family friendly leaflet is in development. iii. Graduation from MIDAS (usually at transition to P1). Parents reported finding transition sudden, that there was a lack of support and loss of team lead. iv. Clinical Psychology. There is an identified gap in service, however a Clinical Psychologist is now attending Business Meetings to support team decision making. v. Restrictions on multi-agency working. Members of teaching staff have found it difficult to take time out to attend meetings - MIDAS works with nurseries / schools to arrange place and time of meetings to suit team members where possible. When was the arrangement set up and can I have a copy of the "service level agreement" or equivalent? Can I also have any documents detailing the rationale for this transfer of monies. There is no formal service level agreement, and NHS Grampian has no documentation detailing the rationale for the transfer of funds; s17 of the Act refers Information not held. Can you also advise on the number of children seen within MIDAS over the last 5 years- broken down into numbers per year, and the waiting time from referral to diagnosis year by year, for this group. The number of children seen in the MIDAS service in each year since 2005 is as follows: (as at 31 st October) 30 The average waiting time from referral to diagnosis is not recorded; s17 of the Act refers Information not held, however, we can advise that the average waiting time from referral to the first MIDAS Child Support Plan stage is approximately 20 weeks. School holidays play a major factor in the length of waiting times. How many complaints have been received about the service during this period? NHS Grampian has no recorded complaints about the MIDAS service.

5 Under section 20 (1) of the Act, if you are dissatisfied with the way NHS Grampian has dealt with your request, you have a right to request a review of our actions and decisions in relation to your request, and you have a right to appeal to the Scottish Information Commissioner. A request for review must be made within 40 working days and should, in the first instance, be in writing to: Directorate of Corporate Communications, Ashgrove House, Foresterhill, Aberdeen, AB25 2ZN or by to grampian@nhs.net Requests for appeal should be made in writing to: Scottish Information Commissioner, Kinburn Castle, Doubledykes Road, St Andrews, Fife, KY16 9DS Telephone: , Fax: enquiries@itspublicknowledge.info Yours sincerely Chris Morrice Information Governance Manager NHS Grampian

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