Official Report: Minutes of Evidence

The Chairperson (Mr McGuigan): I welcome Nigel Chambers, head of learning disability (LD) and autism in the Department of Health; Maurice Leeson, programme manager, partnerships and emotional health and well-being in child and adolescent mental health services (CAMHS) and disability in the Department of Health; Lyn Preece, director of children's services, South Eastern Health and Social Care Trust; and Maura Dargan, director of children's services in the Northern Health and Social Care Trust. I remind everybody that we have one hour for the session. I will hand over to you for an opening statement. Go ahead, Maurice.

Mr Maurice Leeson (Department of Health): Good afternoon. Thank you for the opportunity to provide the Committee with an update on our work to improve services for children with disabilities, their families and carers. Nigel and I are joined by Maura and Lyn, who are senior colleagues from our trusts, to provide greater insight into the challenges that exist at a local level and on the progress that has been made in recent months. From the outset, we need to be clear and say that we cannot respond in this session to queries on individual placements or the circumstances of individual families. We can discuss our understanding of the issues, the strategic response and the plan to utilise the additional funding to maximum effect.

We provided you with a written briefing in advance of today's meeting. I have been assured that it arrived with you in time for today's discussion. As outlined in the paper, there is a growing population of children with disabilities who are known to social services in Northern Ireland. In 2020, that figure was approximately 4,500, largely comprising children with learning disabilities or autism. Today, that figure is more than 5,600 children with disabilities who are known to social services. That growth can be partly attributed to population changes, but we must acknowledge the reality that more children are slipping into the social care sector. The growth in the population that is known to services has been accompanied by an increasing complexity of need. To give you an example, we have gone from having 422 looked-after children with a disability in March 2019 to having 556 looked-after children with a disability in March 2024.

It is accurate to say that services have been stretched significantly. There are clear demand and capacity gaps for residential and short-breaks services and growing levels of unmet need. Today, 81 children with disabilities have been assessed as being on the edge of care. That number has increased since the families who are here with us today told us their stories in September last year.

Nearly 300 children are on waiting lists for residential short breaks. That number has not decreased in recent months. The Committee will be aware that over half the short-breaks beds have been repurposed to provide full residential placements for children with disabilities. Other beds have been impacted by gaps in our workforce and are operating on a reduced basis.

A key message that we want to communicate today is that short breaks for children with disabilities are fragile. They are fragile because of the volume of children who are in need of the service, the level of risk that families and professionals are managing in homes and the lack of suitable residential placements. That context, the robust evidence base and the views of families and professionals have guided us in the development of a framework for children with disabilities. It sets out our strategic approach to addressing key pressure points in health and social care (HSC); improving our early offer of help in particular; developing additional, effective short breaks and short-breaks fostering; rethinking our approach to residential provision and out-of-home placements; and getting transitions right.

The framework is the agreed strategic position of all of us at who are in trusts and in the Department. As set out in the paper, we have established a dedicated work stream for implementing the framework as part of the strategic reform programme for children's services. Significant progress has been made to better understand need and capacity; improve regional consistency; develop options for recruitment; and scale up the specialist mental health services for children with learning disabilities.

In the context of today's discussion, needs assessments have been undertaken for short breaks and residential care. Significant investment is needed to meet the current level of need, and that will need to increase in line with population projections. Work is under way to cost the full implementation of the framework, including the development of costed options for residential and short-break services. We are very conscious of the challenges that workforce issues present, the vacancy rates in the trusts and the knock-on effect that they have on unallocated cases. The additional funding, which was announced in October last year, accelerates that work and provides a stronger foundation for further investment over a sustained period. Some £13·1 million was allocated on a recurrent basis to improve residential and short breaks while rapidly expanding family, therapeutic and behavioural supports in the community. Up to £2 million was allocated in the financial year, of which £1·37 million has been utilised. It is important to note that the trusts' ability to spend is impacted by central departmental financial processes, the availability of buildings and the workforce.

I will move now to the progress that has been made to date. Trusts have proceeded to deliver measurable improvements to the service and have plans in place to improve short breaks and residential capacity. For example, the Southern Health and Social Care Trust and the Western Health and Social Care Trust have increased short-breaks provision by expanding capacity in existing units and recovering lost beds. The Northern Trust has plans to recover a short-breaks unit in the coming months, with the intention of scaling up capacity to provide five or six beds on a phased basis throughout the year. The Committee will note that there have been challenges to re-mobilise the service in this financial year due partly to a regulation issue that has been resolved. It is important to stress that the Department challenged trusts to develop creative responses to the challenges that are faced. The plans that are in place for the Northern Trust are novel, as they involve a different approach to transitions in adult services that could be scaled up on a regional basis.

The South Eastern Trust has clear plans to reinstate short-breaks provision in Lindsay House by establishing residential provision in Redwood, which is a unit into which Committee members have expressed interest. It is important to note that Lindsay House is a shared facility with the Belfast Health and Social Care Trust and that, therefore, the impact of that work will be significant. That is another example of the challenges that trusts across the region face. The remobilisation of the service can be achieved only by moving looked-after children to other sites. That requires careful planning. Delay in one part of the process can significantly stall the entire exercise. Lyn and Maura can talk about that challenge, which can be fully remedied only by increased residential provision.

Belfast Trust intends to reopen Willow Lodge before the summer, thus increasing residential capacity and reducing the risk of short-break beds needing to be repurposed in the future. In this financial year, there has been an expansion of in-reach services in the scale-up of existing contracts with the voluntary and community sector (VCS).

Members will have noted plans across the region to develop fostering short breaks, which are also known as Share the Care. That model has been established in the Northern Trust and Southern Trust and is now recognised as a way of providing families with greater choice and flexibility. It strives to support the inaccessibility that exists. To be clear, it is not the intention to replace residential short breaks with a fostering service, but it is expected that a greater range of supports will reduce the upward pressure on the residential service.

The Department and trusts are continuing to engage with the families who were profiled by BBC's 'Spotlight', as well as with the National Autistic Society (NAS) and the Children's Law Centre as advocates. We are fully aware of the level of risk that is managed in a family home, and several complaints have been raised in communications. Those issues were raised with the Minister last week, and we intend to convene a meeting of families and chief executives and directors of trusts in the coming weeks.

In conclusion, the challenges that families face in health and social care are significant. The ongoing work that has been progressed at a strategic level has provided a robust understanding of the nature and scale of the challenges. We have a consensus on the way forward, and the additional funding that has been allocated has accelerated our progress. However, it will be necessary to make further investments, otherwise the progress that has been made could be lost over the next 12 months.

I will pause there. I am happy to take questions and comments. Nigel and I will do our best to answer questions on the Belfast Trust, Southern Trust and Western Trust, but we may need to take some of the questions away. Hopefully, the Committee will understand that. Thank you for your patience.

The Chairperson (Mr McGuigan): Thank you. The paper that you sent us references 877 unallocated cases across the trusts. In that paper, you also mentioned 287. Maurice, I think that you just said in your opening presentation that there are now over 300 children with disabilities on waiting lists across all trusts for residential short breaks. That is 1,164 children who have either not been allocated a social worker or are on a waiting list for a residential short break. Are those numbers evenly spread across the trusts, or do any trusts have significantly higher numbers than others? What is being done to address that situation? When do you expect to see significant progress in reducing those figures?

Mr Leeson: While families are waiting for a short break, other things will be happening. There will be constant contact with social services, and other types of services may well be in place for those families. You asked about the spread. The Northern Trust is the only trust that shows no unallocated cases, and the numbers for the others range from 34 to 499.

Mr Nigel Chambers (Department of Health): I will add that, at the Committee two weeks ago, you asked for further information in writing. We are putting that together.

I think that you, Diane, raised a question about the breakdown of unallocated cases, the type of support that is being provided to families and what that looks like. We are hopeful that that greater written detail will be with you within the next week.

The Chairperson (Mr McGuigan): I am not quite sure that my second point was answered. When will we see those figures come down? It is OK getting the figures and allocating them to a geographic location, but we are interested in the work to bring them down.

Mr N Chambers: Part of the piece on unallocated cases means that there is a variance in vacancy rates across our children's disability teams. At the time that the decision was made to allocate additional funding in October, the vacancy rates of the children's disability teams were close to 60% in some trusts, which we say in the paper. Those vacancy rates have dropped to upwards of around 30%, but they are still significant. They have a direct impact on unallocated cases. Addressing recruitment and waiting lists may be challenges that you, Lyn and Maura, are both trying to navigate.

Ms Lyn Preece (South Eastern Health and Social Care Trust): I will answer that a bit more broadly. The South Eastern Trust has a higher number of unallocated cases across the region. We have a plan to reduce that number quite significantly, and we are hoping to get it down by November 2025. It is dependent on an available workforce. We all know that there are problems in the social work workforce, but, in the children's disability service, the workforce might not always need to be involved in social work but might need to be social work led. In the context of a skills mix, we hope to recruit staff who will be able to support families in a different and much more flexible way.

It is important to note that our trust and others have taken account of the numbers of children who are on their waiting lists and what their needs are. Robust governance arrangements are in place to manage those cases, and I can say confidently that the children in the South Eastern Trust who are on the waiting list for social work service are children with lower-level support needs. Those children are being seen by occupational therapists (OTs), speech and language therapists (SLTs), child development centre (CDC) clinics and community children's nurses (CNCs). A range of other professionals are involved with those children; it is not that the children are waiting on a service and are not being seen by anybody. I just want to make that point a bit clearer.

The Chairperson (Mr McGuigan): You will be aware that some family members from Tara Mills's 'Spotlight' programme 'I Am Not Okay' are sitting behind you to hear evidence today. That was a very difficult programme for anybody to watch; I found it difficult watching it from the comfort of my own living room. You will also be aware that the Committee informally met the families on Tuesday, five months on from the programme's broadcast. I have to be honest and say that I consider myself to be a hardened politician, but one of the most emotional and difficult engagements that I have had in 25 years was having to listen to what those families are going through and listen to them through tears talk about the issues that they are dealing with. Worse than that, however, was listening to them detailing that when they, quite rightly, reach out to ask for help, relief and respite, they find that it is not there. Even more disappointing is that they are saying that nothing has changed in the five months since their plight was highlighted.

Maurice, you talked about engagement and communication issues. Some families detailed how they have been let down. They were promised respite, but it was cancelled. There was a litany of things that, as a politician, I felt shame about, and I think that we should all feel a collective shame about what we have allowed to happen. We on the Committee listened to those families, and we have given them a commitment that we do not intend to let the issue go. When we question you today, we will try to get answers on how we can collectively make the situation better.

The Department was given £2 million for this year. It was also given £11 million for recurring funding over the next two to three years. Maurice, you detailed some of the things that that is for. You clearly identified respite, residential and short-breaks services. How is the Department ensuring that the respite funding is not simply being allocated to — I am choosing my words wisely — some of the systems and services that are easier to implement but that the money is also being prioritised for those children and families with complex needs?

Mr Leeson: We are trying to have quite a complex arrangement whereby we can attend to the immediate and very pressing needs of families, such as the 'Spotlight' families, while ensuring that we have the types of arrangements in place to make sure that people are supported at an earlier stage and not put in a position where they end up needing a more complex service because we have not been able to respond to their needs. That is quite a complex thing to do, and we will be open to criticism on that journey because we will not always get the balance right. However, we are setting out to ensure that we attend to both.

The Chairperson (Mr McGuigan): Sorry to interrupt, Maurice, but I would like to know what has been done five months on. You are telling me that you are doing two things, which is great, and we expect you to be doing two things. However, I would like a specific answer to the question of what has happened in those five months to address those children with very complex needs and what will happen.

Mr N Chambers: OK. I will give a combined answer for both of us. When the trusts, the Department, the Regulation and Quality Improvement Authority (RQIA) and the Public Health Agency (PHA) met in October, the question was about what could be done in days, weeks and months, not months and years. Aligned with the children's disability framework was recognition of the fact that we need to not only take the approach of attending to the immediate and extreme pressures of today but provide a much greater level of support in the family home to a much larger population that has lower levels of need at the moment but that may require short breaks in the future. Throughout that discussion, it became clear that the proposals on short breaks and residentials would always run into the next financial year.

Family therapeutic and behaviour support could be viewed as things that look good on a spreadsheet, that you could scale up quite quickly, that you could talk about hundreds of families benefiting from and for which we could rely heavily on the VCS by using existing contracts and adding funding to. Most of the activity has been in what could be achieved in the financial year, but there have been nominal increases to the short-breaks service, with the Southern Trust expanding day provision in two of its facilities and the Western Trust recovering lost beds in Rosebud Cottage.

It has been set out, and as you can see across the other trusts, that, in the next financial year, the residential and respite components will start to kick in from April. The real challenge, which we saw by looking at the issue that was profiled on 'Spotlight', is that we have 16 children who live in 26 of the 45 short-breaks beds that are commissioned in Northern Ireland. We could have taken all that £13 million recurrent funding and bought residential placements for those 16 children. The problem is that there are 81 children on the edge of care who would have inevitably slipped into becoming looked-after, and the beds that we have lost and recovered would simply have been lost again over time. Therefore, there was a necessity for us to look at it through the family behavioural and therapeutic piece whilst scaling up what can be done in respite and residential provision.

Maurice's opening remarks were on the details of the plans that have been provided, and the re-mobilisation of short-term breaks can really be achieved only by moving the children around who live in those beds, so that means moving children from A to B to C to get A back again. Those plans are quite fragile in that a lot of moving parts have to move in the correct way at the correct time. As Maurice said, if anything stalls in the process, it can stall all of it. Lyn and Maura will talk to their plans on Redwood and Lindsay House and on Whitehaven, which is in the Northern Trust. Those are two examples of where we need to move children with very complex needs into full-time placements, which take time to get right in compatibility, environment and workforce, in order to recover the short-breaks beds that have been lost.

I understand the frustration about that. Certainly, as I watched the documentary, like you, I was shocked. Collectively, at this table, we feel shame that we work in a system where demand has outstripped supply for a significant period and that, in that environment, families have to paint the very worst picture of how things are. When I have engaged with the families who are behind me and wider than that, I have been shocked to find that the gap in services has brought families to talking about their children in a negative light instead of with pride and about the things that they like doing with them. However, that is the system that we have. We are trying to work our way out of it, and that will take time in the residential and respite piece.

The Chairperson (Mr McGuigan): Can I gauge from what you say that, from April and in the coming financial year, there will be a substantive difference in the plans that you are putting in place and that they will have an impact on those families?

Mr N Chambers: I do not want to speak too much to plans, but in the South Eastern and Northern Trust, from April onwards, you will see expansion of existing facilities and recovery of lost beds.

Ms Preece: I will add to that. The South Eastern Trust has a plan to recover some of the short-breaks beds. We have a short-breaks service, albeit that it is very limited, in Greenhill in Newcastle. We have been able to offer the families that are in the most critical need some limited overnights there, but we need to build on that capacity. In order to do so, our intention is to open Redwood in September 2025. I appreciate that that is quite a time frame, but we need to do some work in Redwood to make it comply with fire regulations and OT recommendations. That work is starting in the next couple of months, and we hope to get it off the ground. When it is open, we will be able to reopen Lindsay House, which has a substantial availability for children across Belfast and the South Eastern Trust. Hopefully, through that, we will be able to recover the beds that we have lost through long-term placements.

I will talk about Redwood, if that is OK and you are happy enough. All those things are dependent on the availability of an appropriate and highly skilled workforce. That has been difficult to achieve across all the trusts. We have had a recruitment day for Redwood, and I am pleased to say that we successfully filled all the posts that we need. It is our intention to bring those staff in earlier to ensure that they are trained and have the appropriate skills and ability to care for the children whom we are asking them to look after, because it is quite complex. Our plan is to recover short breaks through the opening of Redwood, but, as Nigel said, all those plans are very fragile and it requires all those things to align in the right way to be able to deliver them in the time frame that we want.

I have said to a number of families that a lot of our plans are dependent on the number of children who are on the edge of care. In the South Eastern Trust, we have 13 such children. At any one time, any one of those families could need a higher level of support than we are currently offering or are able to deliver. That might cause a bit of disruption to the plans that we have in place.

The Chairperson (Mr McGuigan): Do you want to add to that, Maura?

Ms Maura Dargan (Northern Health and Social Care Trust): Similarly, one of our units is Whitehaven, which, I think you, Danny will be familiar with. That offers between five and six respite beds, seven days a week. Whitehaven continued to provide respite throughout COVID to its full extent, which was an achievement. However, unfortunately, because of the full-time care needs of a number of young people, the unit has been closed to short breaks for some time.

Part of the plan that we had hoped to implement in-year and into next year was the move-on of other young people into another unit, Eden View. That would allow us to move those young people into Eden View, which would inevitably open Whitehaven again for short breaks. The plan for those young people was to move them on and into their forever home in advance of their eighteenth birthday, but, because of regulatory issues, that was a challenge for us. Thankfully, we have managed to overcome that regulatory issue, so we are now able to execute those plans.

We have engaged Positive Futures to deliver those plans, and it is actively recruiting for one of the young boys. The other family will require a home to be purchased. One of the plans is earmarked to happen around the summer time, and the other will happen closer to the autumn because of the purchase of a building. That means that, from the summer, we will begin to open up a level of respite in Whitehaven and that, by the autumn, we should be fully functioning.

Eden View provides full-time care and respite. It is divided in two, and the unit has not provided respite for a good number of years. As a trust, we took over the unit from one of the voluntary organisations, and, for staffing reasons, we have not been able to open the respite side. Like Lyn, we are in the midst of a very robust and aggressive recruitment campaign. A lot of background work is under way, and in the next couple of weeks, we will apply the same approach that Lyn has taken to recruitment. However, we anticipate that the recruitment will take until the summer before we can have trained and skilled staff to deliver the care. A bit like Lyn, we are working with what we know, but also similar to Lyn's trust and a number of others, we still have a number of families who are in a very vulnerable and fragile state. We continue to support them to the best of our ability, but any move on that could damage our plans.

Setting aside the residential aspect, Share the Care was referenced, which is the fostering option for families. It does not meet the needs of young people who present with very challenging behaviours, but it provides a really good service for those children who can be managed in a family environment. The Northern Trust, like the Southern Trust, has a model that has been in existence for well over a decade. We have 110 carers who provide regular respite to 88 children. Some really good things are happening and are in place. The money and investment will help, as Nigel said, with the family support and therapeutic and behavioural engagement that we need for those young people when they are at home and with carers. Obviously, we need to build short breaks as much as we can to sustain as many families as possible and to avoid the full-time care options that need to be there for a percentage of our young people. However, it is a movable feast that involves day-to-day management.

You mentioned communications, and I am not even sure what that is about. Sometimes, something can change every day that creates a different response, and sometimes, communication can be impacted by that. However, staff and everybody else are working to the best of their ability to make good use of the investments that have been made. Without a doubt, there will need to be further investment if we are going to meet the current and future demand.

Mr Leeson: We try to be very careful with dates, because we are very conscious of the fact that, when we offer dates, it is very frustrating for you and the families if we cannot make them. We have tried to be as careful as we can and to be realistic in communicating what will be the result if certain things happen.

The Chairperson (Mr McGuigan): Obviously, that is correct, but we want to see urgency. The families want hope, they want to hear that there is hope and that it is not too far down the track.

I do not want to hog the meeting, because I am conscious of the fact that other members want to come in, but it was very disappointing to hear about the communication issue from the families who opened their doors to make the TV documentary that we all witnessed. Five months after the documentary, the families felt that their voices had not been heard and people were not listening to them. Since they met the Minister last week, a number of meetings have been organised.

It is disappointing in itself that it required a meeting with the Minister, a meeting with Committee members at the Assembly and this evidence session in order for action to be taken. The Committee will therefore be seeking regular updates on the issue overall but particularly on those children with very severe needs. We do not want to hear some of the things that we heard on Tuesday again when receiving those regular updates.

Ms Flynn: I will try to be quick, because I know that we do not have much time left in the evidence session, and everyone else needs to get in. To repeat something that the Chair said, when we had the informal meeting with the families the other day, I was left really frustrated. We all felt heartbroken listening to each of them telling their story, but what annoyed me was that they had to open up and share their raw emotion, hurt and pain over the most precious people in their life: their children. After having gone public on the BBC's 'Spotlight' programme, they again had to open up in a room with MLAs, who are people whom they do not know. They are still having to share that raw pain with the public, which must be devastating to have to do.

We have heard that there are plans in place for beds to open up over the next few months, although the number sounds very low. There is a workforce element to that, of course. The point is that the families have yet to see any difference.

We will not mention individual families, because we cannot go into individual cases, but let us use the example of every family who is dealing with a child with a very complex needs. Why are those families in each of the five trusts feeling that there has been no change since the announcements were made? The announcements were made in response to the crisis of how those families are having to live. I understand all the early intervention stuff. We spoke about that the other day, and no one is going to argue with that. Yes, it is important to put all that infrastructure in place in order to plan for the future and for all the other children who are coming through the system, but the families who brought the issue to the fore in the media and with the public have now passed crisis point. We are five months on, with £2 million having been invested and another £13 million to come, but I am not convinced that, even in the next financial year, you will have the capacity to deal with all those complex cases, which was the reason that the Minister responded in the way in which he did by making that investment.

Ms Preece: I will come in on that. In our trust, I have had the opportunity to meet and communicate our plans to the families. We have acknowledged that some of the things that we are putting in place in-year, because they form part of the early intervention work, will not address their concerns and their living situation now. What I have been able to articulate is what our future plans are. We have been able to offer some limited, overnight short breaks in Greenhill, as I mentioned earlier. I appreciate that our communication with the families could be better. I absolutely acknowledge that. Sometimes, when a communication issue arises, it is because we have had to stand down or cancel at very short notice short breaks that we had planned. I appreciate that that is very difficult and frustrating for families when they had been waiting on a short break to be offered and delivered. Our staff on the ground are trying to find a solution that will work that may involve in-reach and outreach, and I speak for all trusts when I say that we are trying to find solutions very quickly. Doing so is very difficult.

I have given a commitment that I will continue to engage with all the families. I will talk to them regularly about what we are able to put in place for them. I have communicated what our plans are, and, hopefully, we will be able to offer them a solution by providing more flexible services, because we try to be as flexible as we can in order to be able to respond to the need on the day.

Mr N Chambers: That will be applicable across the region. What was able to be scaled up in the financial year is the types of supports available for those 81 families whose children are on the edge of care and are past the point of being able to benefit from such interventions.

It is, however, important to stress that, through the current investment and future investment, we need to provide much more robust, multidisciplinary behavioural support in the community. Respite services where there is behavioural challenge are important, but they do not provide the therapeutic support that is needed to help a young person understand their emotions and communicate them in a way that does not result in behavioural challenge. Social work and social care in isolation in a short-breaks unit would not be able to deliver that support. That is the necessity of why we need to grow and why the proposals that we have set out in the plans include greater use of psychology, of learning disability nursing and of support in the home, because, unless we are able to work with the young person to meet their current level of need and address communication and behaviour, having short breaks will simply move the behaviour somewhere else. Short breaks do help families, however, and they are a crucial part of the service, so I am not saying that they are not necessary.

Ms Flynn: One hundred per cent. I appreciate your feedback. Even with all the communication that has taken place, there is still a breakdown in communication somewhere, because we would not otherwise have witnessed what we witnessed with the families the other day. In the years to come, with the best will in the world, what should happen, and is the right thing to do, is that those 81 families about whom you are speaking should be central to how the investment is rolled out, because they know best. They know best because they are living with it, especially those families who, as I said, have now passed crisis point and are, sadly, still waiting for help and support. They need to be central to any conversations on the direction of travel for how the trusts spend the money.

Ms Dargan: I will add that the investment is really welcome. It will kick-start what is desperately needed for the system, but it will not provide for all the families. It just will not.

Ms Flynn: That needs to be communicated.

Ms Dargan: We will require medium- to long-term residential placement beds for young people. We will require additional respite facilities across Northern Ireland. The current investment will not look at providing those to the extent that we know is required, but it is a really good kick-start: for therapeutic interventions and behavioural supports, both of which are currently negligible across Northern Ireland. For us to be able to build on interventions and support is such a welcome opportunity for us. What we are trying to do here is build respite and maximise our existing environment, if you like, but there is no plan for the investment to be used to build a unit. There is just not.

Mrs Dodds: Thank you for coming. First, I will reinforce what Órlaithí has just said. In a society, it is cruel for families to have to appear on television and lay bare their family life. Let us face it: they have been driven to doing that by the fact that they have not got the help that they need. We cannot hide from that fact. That is what happened. They did not get help. They were in crisis and therefore sought a mechanism to try to get themselves that help. What we saw on Tuesday were families who were doubly disappointed. They had opened up their home and displayed all that raw emotion about their family situation. They are now here today, sitting behind you, and they have still not got help. That does not speak well. I am appalled. Like everyone else, I watched the programme and listened to the Minister's announcement, so I was devastated on Tuesday when I heard how little had been done for the families and what had been communicated to them.

I will quickly ask a series of questions, and I would appreciate short answers, because the Chair is very strict about time. How many residential beds, as opposed to respite beds, do we have in Northern Ireland?

Mr Leeson: I will do some mathematics and take your next question, because I have just the numbers by individual trust with me.

Ms Dargan: There are five in the Northern Trust.

Mrs Dodds: Is the number of residential beds the same as what you had before COVID? Do we have more or fewer now? What was the impact of COVID on those beds?

Ms Dargan: The number is the same.

Mr N Chambers: It is the same number.

Mrs Dodds: How many children are now occupying respite beds but are in full-time care?

Mr N Chambers: Sixteen children currently occupy 26 short-break beds out of a commissioned 45 short-break beds. It is therefore over half the service.

Mrs Dodds: Why have we not done anything to resolve the situation?

Mr N Chambers: There are proposals from trusts to recover short-break beds out of the additional investment. The plans are to put some of the children who are currently living in those units into full-time residential placements. That would allow us to recover part of our short-break service. As Maura said, based on rough costings, the entirety of the funding could have been used to buy back residential placements for all 16 children, but, considering the gaps in the community, particularly around family, therapeutic and behavioural supports, and with three trusts not having a fostering short-breaks service to the level that the Northern Trust and Southern Trust do, the beds that would be recovered would be lost again over time. Even with short-break provision, there is a cohort of families with children on the edge of care whose children will end up in residential care. It is a smaller cohort but a cohort of exceptional complexity of need. What will therefore be achieved with the money is that part of the short-breaks service will be recovered through finding residential placements for some of the children who currently live in those beds. We have undertaken a residential capacity —.

Mrs Dodds: May I interrupt you?

Mr N Chambers: Of course.

Mrs Dodds: I have three or four questions. I want to get them all asked, and I want to be respectful to other members. We desperately need respite beds. We desperately need respite beds for children with very complex needs. There are many other children who will require respite beds whose needs are not as complex. Some of them will get a fostering short break. Some of that provision works very well — I have seen it in operation — but it is not an option for the families whom we are talking about, and whom we were talking to on Tuesday. That is not going to happen for them.

How many additional respite beds will we see next year across all the trusts? How many additional respite beds will an investment of £13 million get us next year? [Inaudible.]

Mrs Dodds: Can someone come back to us with a number? It is really poor that we are not getting answers. Those are simple, basic questions.

Ms Preece: For the South Eastern Trust and the Belfast Trust, it is eight. Lindsay House is a facility that —.

Mrs Dodds: Those will therefore be additional to anything that you have had before.

Ms Preece: They are not additional. The investment is helping us recover what we previously had.

Mrs Dodds: We are only recovering beds, so the money will not add any beds.

Mr Leeson: Yes, the money is adding beds. We have opened up additional nights in the Southern Trust in two of its respite units.

Mrs Dodds: Yes, I have spoken to the Southern Trust. You will not be surprised to hear that.

Ms Preece: The South Eastern Trust.

Mrs Dodds: I understand where those beds are. I want to know, and the Committee deserves to know, exactly how many additional beds will be created.

Ms Preece: I will come back in. Lindsay House will be open in the South Eastern Trust, and that will help us recover what we had previously. We are also expanding on what we already have in Greenhill. That will be additionality. We currently have a small number of beds there.

Mrs Dodds: How many additional beds will there be?

Ms Preece: We are hoping that that will offer six. It is six now, and we are hoping to move up to 34. That is not 34 beds but 34 additional nights for children.

Mrs Dodds: To how many beds does that equate?

Ms Preece: I will need to check that.

Mrs Dodds: This is very frustrating. May I move on? I expect the information to be provided to the Committee.

Mr N Chambers: Apologies. To clarify, are you asking for the number of recovered beds and the number of additional beds to be broken down by beds and days?

Mrs Dodds: Yes. I would have thought that that was basic information.

Maurice mentioned the number of unallocated cases of children. I am also interested in how we got into that appalling situation. He said that he had an answer, but he did not share it with us. I will share it with you now, because I have the answer through a question for written answer.

In the Belfast Health and Social Care Trust, 34 children are waiting for disability services. The figure jumps to 499 in the South Eastern Health and Social Care Trust. It is 180 in the Southern Health and Social Care Trust, while in the Western Health and Social Care Trust it is 140. How on earth could the South Eastern Trust have got so far out of sync, with 499 unallocated cases? Is that not symptomatic of how we have got to where we are at?

Ms Preece: Like all the trusts, the South Eastern Trust has experienced significant issues with recruiting social workers, particularly to its children's disability service. That is as a result of retirements, workforce availability and the availability of social workers across the region. I have looked at our list, and I can say with confidence that the children who are on the list require low-level family support. I have done an exercise that told me that some of those families require only administrative support by way of direct payments. We are, however, in the process of looking at that again in order to assure ourselves. We have a robust governance process in place to look at the cases weekly to make sure that the needs have not changed. To manage that, we are recruiting in a skills mix context. As I said earlier, we want to recruit not social work staff but other grades of staff so that the service can be social work-led, thus ensuring that families get the support that they need. It speaks to the Ray Jones report, because he very clearly said that families need practical support at a time when it is critical to them, and that practical support is not necessarily social work support.

Mrs Dodds: I do not want to be rude, but I want to move on to my final question. Before I do, I will say that that is fine. I am glad that something is being done about it. I am appalled that it has got to the stage that it has got to, however. The South Eastern Trust has 499 unallocated cases for disability services, 118 for family support services and 71 for gateway services. I will compare those figures with those for the Southern Trust, which has 180 unallocated cases for disability services, 27 for family support services and 49 for gateway services. There is therefore need everywhere, and that must mean that the South Eastern Trust has not, for quite some time, addressed that need in an appropriate manner.

This is my final question. There are some serious questions to answer here. You mentioned reopening Lindsay House. Will you explain to me again how that is going to happen?

Ms Preece: Lindsay House is in the South Eastern Trust area and offers a short-breaks service to families in that trust and in the Belfast Trust. We currently have two young people in Lindsay House on a long-term basis. One child's substantive placement is not in Lindsay House, so we want to move the child back to his substantive placement. The other young person will move to Redwood Children's Home when it opens, and it is our intention that it will open in September 2025. As I said earlier, we have recruited staff for Redwood Children's Home, and we are in the process of bringing them in. We intend to train them to work with highly complex children. When that young person moves to Redwood Children’s Home, we will then be able to bring up Lindsay House to its full capacity again in September 2025. Again, that is predicated on nothing else coming up.

Mrs Dodds: Has that been communicated to the family?

Ms Preece: Yes.

Mrs Dodds: OK. To a degree, I imagine. That is fine.

I will finish by saying that the other aspect of Tuesday's meeting that was very disturbing for everybody who was in the room was how you communicate with parents and the communication culture overall. Many of the parents felt almost threatened by some of the potential answers to their dilemma. I suggest that there should be some review of how communication is done, how people are spoken to and how families are dealt with. I was very disturbed by what I heard.

Mrs Dillon: Thank you, all of you. I was not at the meeting on Tuesday. I give my apologies, but I had met the mummies before. I will concur with other members' comments rather than take up more time. To be honest, it is distressing to talk about anyway.

A number of my questions have been asked, so I will not go over them. Diane asked about getting an update on additional beds. The Committee needs not just to hear about the intention but to receive regular updates, as you said, Chair. I want regular updates about what real difference is being made for the families. That has to happen right across the board, at whatever point an intervention is happening.

I am concerned at the difference that there is among trusts. To me, that is a departmental responsibility. Trusts can do what they do in their own area, but the Department needs to look at every trust area to see what is happening.

The point about communication is really important. I am not saying that it is the intention of anybody in the room not to deliver for the children and their families, but there is a cultural issue involved. To me, that culture comes from the top down and from the bottom up. We all have a responsibility to change the culture. Across the board, it has been poor for those children and their families. It is a general responsibility, not an individual responsibility. Do not feel the need to respond to that. On the Policing Board, we deal with cultural issues all the time. Anything that we say here is said to make things better for those children and their families. It is not a personal attack on anybody. I want to make that clear.

We want to know what the additional funding is used for, and we need to receive regular updates. We need to understand what is happening. Be as open and transparent as you possibly can. We are here to help.

I want to understand whether there a correlation between the number of unallocated cases for social work services and the lack of services provided? I ask for honesty and transparency on that. Do social workers leave because they cannot cope with having to deal with families for whom they cannot deliver?

Mr N Chambers: Based on the data that we have on vacancy rates and unallocated cases, we can see that there is a correlation between high vacancy rates and services provided. Diane, you detailed the number of unallocated cases in the South Eastern Trust. Although it now has vacancy rates that are comparable to the other trusts, last year the South Eastern Trust had vacancy rates of 55%.

Ms Preece: Yes.

Mr N Chambers: The trust is therefore coming from a position in which its children's disability team was depleted by over half.

You also asked about regional variance. There are two pieces to that. On additional funding, all the trusts' respite and residential services were at different starting positions. On availability, we have talked a couple of times about the Share the Care scheme, which is available in the Northern Trust and the Southern Trust. The other trusts are in a different place at present wit that service, but they are working towards providing it.

Moreover, as part of the children's disability work stream, we have undertaken a regional consistency review, because there is a piece — you will be aware of it from our other evidence sessions on adult LD — to be done on the lack of regional consistency across children's disability and adult learning disability services.

That review has been completed, and there has also been a review of the criteria used in those trusts. Until we achieve a level of regional consistency and, to be honest, until we commission a sufficient level of residential placements, we will always have a service that is regionally inconsistent.

The residential review that we have undertaken is not finalised yet, but the indicative figures show that what is needed for residential capacity over the next five to 10 years is sizeable. Until we address that, we will have a short break service that is fragile and under threat. As Lynn and Maura have reflected, if something goes wrong in someone's home, the whole service stops; it collapses. That is the point. We have a residential pressure across all five of our trusts, and it is impacting on everything upstream, from short breaks to family support, but, most importantly, the family home.

Mrs Dillon: I have another quick question. There was a comment earlier about respite provision not being a replacement for therapeutic support, which I agree with. However, will you clarify whether therapeutic support happens in the respite setting?

Ms Dargan: Yes, the care that is provided is in the context of the therapeutic framework — 100%.

Mrs Dillon: I ask that because I know that families are not getting the therapeutic support that they need at home, but, like all of us — these children are no different from the rest of us — when you get a break and get some kind of therapy for a couple of days, it can rejuvenate you for a number of weeks. It can offer relief to families for a period. I am not saying that it is the answer; it is not, and I understand that.

My final question is about that respite offering and the general question about multidisciplinary teams (MTDs). I am not asking for this right now, but can we get a sense or understanding of what that the multidisciplinary team will look like, because, again, it takes the pressure off any individual in those residential or respite settings? Is that very much in place and embedded, or are we still trying to invest in that?

Mr N Chambers: The CAMHS intellectual disability (ID) .

Mr Leeson: We would ideally like to get to a position where we have complete wrap-around support for families that combines the short break with additional support for the families themselves. That is where we would like to be. With regard to therapeutic support, we are developing our CAMHS ID service. There is a very well developed service, as Diane will probably know, in the Southern Trust area, which has proved to be a model for us to look at for the rest of Northern Ireland. We have invested in an additional member of staff for each of the trusts to begin the journey towards building the CAMHS ID service that will offer therapeutic support.

Mr N Chambers: In addition to that is the necessity for the multidisciplinary team part of it. For behaviours of concern, it is moving away from previous instances where there has been diagnostic overshadowing. For example, it has simply been seen as, "That person has a learning disability, and that is the behaviour". Now, it's about recognising it fully, particularly for a population that has learning disabilities, co-occurring autism and can be non-verbal. A series of unmet needs can result in behaviours of concern. You talked about the importance of a therapeutic short break — a break for everybody. Equally, for this population, if an unmet physical healthcare need is not picked up, as trivial as toothache or an ingrown toenail sounds, it can present in the same way. If a child is not happy in school, if the environment is not right in school or at home or if they are having a mental health crisis — this very much touches on Maurice's point about CAMHS ID — social work and social care in isolation can never understand and respond appropriately, and that is why a multidisciplinary service to wrap around that child is a necessity.

In rethinking our approach to residential care, it is very clear that, yes, it will need to remain a social work-led service, but learning disability nursing and allied health professionals (AHPs), specifically speech and language therapists and occupational therapists (OTs), need to be on site for that type of service going forward, because, in isolation, social work and social care are not enough.

Mrs Dillon: Those families are the same families who face all of the challenges. That is why I said that there is a cultural issue that we need to address. The same families cannot access the multidisciplinary teams, they cannot access percutaneous endoscopic gastrostomy (PEG) surgeries and different types of surgeries, and they cannot access occupational therapists. Our children’s services are failing our children.

Mr Donnelly: I found the documentary and our meeting with the families on Tuesday very unsettling, raw and emotional. Unfortunately, I was not able to stay for the whole meeting. Hearing the families say that nothing had changed and, in fact, that things had got worse since the documentary was shameful. Children are being looked after by their families, who are struggling and doing everything that they can. They are calling out for help, and things have worsened since they opened their doors to the documentary teams. That is shocking.

The families describe very dangerous situations. We are talking about physical harm to parents, and there is the potential for worse — very serious injury. People are incredibly distressed and living on their nerves. I cannot imagine the level of stress that they are constantly under. It was shocking to hear that nothing had changed and that things had got worse. As you have been speaking at the Committee today, the families behind you have been listening, and there has been a lot of head shaking. Some of the things that you have said do not seem to match their experiences. In answer to one particular question, Maurice, you mentioned that other services are available for those families. Can you detail those services?

Mr Leeson: I was referring to the waiting list for unallocated cases.

Mr Donnelly: What is available for those families?

Mr Leeson: As Lyn has laid out, other health services and voluntary sector organisations are involved. Some assessment of the need will be done, and potentially, there will be a referral to other support services in the voluntary and community sector.

Mr N Chambers: A number of the proposals have been scaled up to provide day breaks for families who are eligible for care, which are short breaks delivered in the home, or a young person will be taken out. We fully concede —.

Mr Donnelly: Have those been taken up?

Mr N Chambers: The short breaks have a high uptake across the trust. We fully concede that they are not overnight short breaks.

Mr Donnelly: They are being offered and being taken up.

Mr N Chambers: I can talk only about the population. We cannot talk about the families who are sitting behind us.

Mr Donnelly: I am not asking you to do that. I am asking for a general answer.

Mr Leeson: I was talking about the unallocated cases. Sorry. I was not referring to the families who are in the room with us.

Mr Donnelly: I am talking generally.

Mr Leeson: Sorry. I wanted to be clear about that.

Mr N Chambers: Apologies. We have uptake of day breaks and short breaks.

Ms Preece: Other types of support are being offered in the absence of overnight short breaks. I previously said that we offer other support that has been taken up. I appreciate that some of the overnight short breaks have been cancelled at the last minute.

Mr Donnelly: The stress of that must be phenomenal.

Ms Preece: Yes. Absolutely. Sometimes that happens as a consequence of an unavailable workforce. Some of our staff in the residential facilities and short-break facilities are experiencing some of the things that you have heard about from the families, which is very distressing for the families and our staff. It accounts for some of our staff vacancies, and we cannot recruit into those posts.

Your question was about our families taking up outreach. Yes, we have outreach from my trust. I cannot speak for other trusts. The South Eastern Trust has an outreach service, and that has delivered a small amount of outreach. We have been able to deliver outreach more extensively for the families who require a lot more. The outreach has been put in place: sometimes, it is twice or three times a week, and it is also delivered at short notice. If, for example, a short break is cancelled, we put outreach support into place that will take the child or young person out of the home for an extended period to deliver a short break, albeit it will not be overnight.

Mr Donnelly: How long is that for typically?

Ms Preece: It could be for a morning.

Mr Donnelly: A couple of hours?

Ms Preece: A couple of hours during the day. I reiterate that there can be issues with the young person's school placement. It is a whole-system, cross-departmental issue, because a number of the children whom we are talking about are not in school because of issues with their behaviour in school. They cannot be managed and have challenging behaviours. Those children are being sent home to very broken families, as you have heard.

Mr Donnelly: They are broken families because the system has made them broken. The system has done this to them. Absolutely.

Ms Preece: It is a whole-system approach. There are things that everybody can do to try to manage the situation and things that we will take forward to try to manage or try to do. However, this is not just a health issue. A system-wide approach, including a regulatory element and education, is needed to be able to manage it. Yes, outreach services are being offered and are being taken up.

Mr N Chambers: On your concluding point — "broken families" — yes, the significant gaps that we have across services in Northern Ireland have eroded the resilience of families. They have changed the perspective of family life, and, inevitably, children are ending up in the care system. Potentially, had we got support through the door much earlier, had we had a more resilient short-break service and had we had shared care arrangements as families were making their way through a continuum of need, we could have kept more families together. There will always be a cohort that will, inevitably, end up in a residential care service, and, as they transition, they will most likely end up in supported living or a high-cost type of adult accommodation service.

Mr Donnelly: On top of that is a cohort of people who are forced into that situation and should never have been there.

Mr N Chambers: Yes. Some of our numbers have got worse. At the time of the funding decision, 70 families were assessed as edge of care. Today, there are 81. The waiting list for short breaks has not improved. Some of the numbers have not improved or have got worse.

Mr Donnelly: I want to go back to Órlaithí's point that those 81 families should be at the centre and that care should be built around them. Those families are on the edge. You referred to it as "edge of care", but it is the edge of crisis. That is where those families are. The support should be ploughed into them to try to stem the flow into residential care.

What will you do in the future to ensure that respite services are protected and that that number, 81, does not increase? What are you doing to ensure that respite services will continue to deliver despite pressures from elsewhere?

Mr N Chambers: We have set out four key areas of work in our children's disability framework. I will answer your question directly and quickly: the only way in which you will be able to protect that short-break service properly is to have a sufficient number of residential placements. Otherwise, you put your short-break service at risk of being repurposed, so you need to reduce that pressure coming down from above. You need to ensure that there are proper residential placements so that, when a child enters care on a planned basis, not on an emergency basis — we need to move away from that — we have sufficient capacity in the system. Otherwise, your short-break service will always be fragile.

Equally, look at what is set out in the children's disability framework on early intervention and community-based support. By getting to families much earlier, when their children are quite small — ideally, far ahead of adolescence — you can delay the inevitability that those families will need short breaks. In some instances, you can avoid the necessity for short breaks, so we need to enhance that community piece as well. We concede that we need an increased short-break service, but we need to diversify the service as well. That is not unique to children's disability. Certainly, what we have set out is the importance of residential short breaks, fostering short breaks, day breaks and the use of direct payments. As per our previous discussions, that is exactly the same approach as we are taking to adult learning disability. Yes, residential short breaks are important, but so are those other types of support: shared care, managed budgets and direct payments. It is about having a menu of options to enable families to bring in care that is personalised to them.

Mr Leeson: To protect the short breaks, the residential piece is key, which is why we have prioritised getting that assessment of need done.

Mr Donnelly: I notice that the report states that the assessment has been done but that you have not seen it yet, so what will it cost? [Inaudible.]

Mr Leeson: My apologies for talking across you. We have done our first cut of that and looked at each of the trusts. We need to go back to all of the trusts again and ask, "This is what we understand the need to be on the basis of information that we have across all of the trusts. Are you content that that is accurate, and can that be the basis on which we plan?" Obviously, at a different reporting point, we will be quite happy to come back and talk about that with the Committee.

Mr Donnelly: I look forward to seeing that, because that will give us a scale of the problem and the cost of the solution. Do you understand what I am talking about? That is where we have to get to in order to —.

Mr N Chambers: That very much applies to Maurice's points as well. That is why there is such a necessity for sustained investment. Unless we get ahead of the residential demand —.

The residential demand of today is inflated by the gaps in the service that we have had to navigate to get to this point.

Mr Donnelly: The system is graded —.

Mr N Chambers: Until we address these gaps —. We may get to a point where that residential demand will drop, once we add the community piece and have a much more resilient short-break service. However, we have the demand of today, and it needs to be paid for.

Mr Donnelly: In finishing, I hope that those 81 families who are on the edge of care or crisis can get as much support as is possible at the minute. They should be offered as much support as they could possibly need in order to keep them psychologically supported. I know from the documentary that other members of the extended family are impacted on by this, including siblings. There should be support right around those families. Thank you.

Mr Robinson: The old saying is that there is no future in the past. However, the issues that are before us today and that have been with us for the past few months are nothing new. They have been highlighted by families for quite some years now. Some could even date back a decade. It begs this question: why have trusts failed to detect the levels of demand over all these years and plan accordingly? I also ask this very direct question: did it take the 'Spotlight' programme to release that money? Did it take that programme to get these delivery plans before us?

Mr N Chambers: I will start with your second question. It should not take a 'Spotlight' programme to enable a decision in this area of work. What the programme achieved was that it made it very clear to our Minister that the time to act is now. As a Committee with a much broader remit, you will be aware of all the pressures on Health and the exceptional shortfall of our budget in meeting them.

In answer to your initial question, yes, trusts were able to see this coming towards them. To a degree, they could have made different decisions for individual families, but that would have been offset by making different decisions for others. We live in a system with single-year Budgets. Even taking the issue of transitions, we know that about 300 to 400 children will move into the adult LD service in the next couple of years. We can see those children and have known about them since health visiting picked them up and they entered the social care service. However, on a single-year budget, it is exceptionally difficult to plan or to know what money we will have next year and the year after that. Workforce delivery is a significant constraining factor for us.

Mr Robinson: Nigel, you said the key line: "the time to act is now". Surely, if the Department and trusts were aware of the trajectory some years ago, why was the time to act not then?

Mr N Chambers: The other key part is that the strategic work was already under way. Our children's disability framework had already been developed. It had set out the four priorities for Health. This is the regionally agreed position of all trusts: early intervention; community-based support; improvement of the short-break service; and a rethink of residential care and transitions. Therefore, the strategic approach was agreed. Work had already been progressed on the children's disability work stream as part of the children's services strategic reform programme, which is the implementation of Ray Jones's work. Work was already under way.

This funding, quite simply, rapidly accelerates a lot of the work that we have done to date. When we convened the trusts back in October, the question or challenge to them was this: what can be done today? What can be done within days and weeks, not months and years? We really challenged trusts to think creatively, within our legislative and regulatory framework, about how we can think about this problem differently. Certainly, what is happening in the Northern Trust and the South Eastern Trust — it is happening in the Belfast Trust's proposal about dual registration — is thinking about things very differently within the legislative and regulatory framework that we have. Where we encounter barriers, we are pushing our way through them in a risk-managed way.

Mr Robinson: Chair, I am conscious of time and that other members are looking in. We could sit here all day.

Mr McGrath: The majority of you are new to post, so these insults cannot be directed at you, but it is an absolute mess. The entire system has broken down. I do not think that it is on the edge of anything; I think that it is broken and that families are being left to pick up the pieces.

Echoing earlier remarks, I, having watched the 'Spotlight' programme, met the families and met them again this week, found that one of the most disturbing matters has been that the families have told us that there has been no input from services. If, following the airing of that programme five months ago, their cases were not deemed desperate enough to merit intervention, that can only mean that the services that have been provided in the past five months have been going to others whose cases are deemed even more severe. The fact that that is the severity level of cases out there is beyond disturbing.

It is matched by the fact that £13 million sounds like a lot of money on an individual budget line. However, we have seen scenarios where people are being physically assaulted in their own home and no support is being provided, resulting in breakdowns, and £13 million is what we have come up with to resolve it. It feels as though money could have been invested much sooner.

I want to build on Alan's question. How far upstream should we have been to see these problems coming? Is there a system in place to monitor and decide, "We need to intervene now, because, if we do not, the problem is going to grow"?

Notwithstanding some of the individual circumstances — Lyn, I will put you on the spot on this one — nearly 500 cases are unallocated. One of the scariest facts is that we have a workforce in part of our health service that is depleted by 60%. Has an alarm bell been sounded for that?

At what point do you think that being 20% down in staff is a bit worrying, or does it need to be 30% before you do something about it? When you get to 60%, what happens? Well, we can see what happens; we have all watched 'Spotlight'.

Where is the red flag? Is there a system to assess a situation and decide that you need to make sure that you do not get to that situation again? I could be smart and say that maybe there are no alarm bells left because the Minister has taken them all to power his irony klaxon. Do we now have systems in place to check whether 30% or 40% is too much and will cause problems?

Ms Preece: Those vacancies are being very carefully monitored by us and through the office of the Chief Social Work Officer. There is social worker depletion across the piece, not just in children's disability services. In my trust, it has been most acutely felt in children's disability services, with 55% vacancies last year, which has now reduced to 30%.

If you have that depleted service, you can offer a very reactive service that responds to those in greatest need and at times of crisis, but you cannot deliver early intervention, which is critical. I think that you are referring to what can be done before a situation gets to a crisis point. The investment will help us to develop our early intervention models. I appreciate that we have said that throughout the meeting.

Mr McGrath: I get that. We have heard that a few times. At what point does the Department step in if it gets worried about staffing levels? Do you say that 15% of the staff team being missing means that there will be a problem, or is it 20%? Obviously, given that it reached 55%, somebody in the role before you has thought that 50% was all right and that they did not need to intervene. What have the lowest staffing levels been for you in the Northern Trust?

Ms Dargan: In our children's disability service, we have around 25% to 28%, which is not unusual across children's services.

Mr McGrath: It is at 20-odd per cent, and, in one trust, it is 60%. If I were looking at that on a bit of paper, I would think that I needed to intervene. Does the Department intervene and help the trust to formulate some sort of services to try to address that?

Mr Leeson: Depending on the issue, there will be an escalation process at different stages. There is a new system for that now. That includes highlighting the issue with the trust, what is being done about it and what the plan is to make it better.

You asked could we not see trouble coming. Again, to go back to Nigel's point, that is the work we do with the trusts and the Department on our framework for children's disability. That is how we identify what is wrong in the system and the priorities that we need to fix. I want to emphasise that. We feel that, across the four priorities in that framework, if we do not get them all right we will continue to have problems. If we do not get early intervention right, we get pressure points with respite. If we do not get respite right, we get pressure points with children's disability.

Mr McGrath: Yes. I do not want to be disrespectful, but we obviously failed spectacularly at that because we are in this situation. If you say that you have the ability to see where there are problems and intervene in response, and we are seeing how families are being left in the community, we are spectacularly failing. I do not mean that that is due to your individual faults, but the system is supposed to have an ability to identify where the problems are, yet we end up with the problems that we have. It is obviously wrong. Have you any —?

Mr Leeson: It is an overall workforce issue.

Mr McGrath: That is what I am asking. What is causing us to be in this state? Do more people need care? Are there fewer staff? If there are fewer staff, why is that? If people are not going into these roles, where are they going? Are there individual personnel issues in trusts? If one trust is 60% down and the others are 28%, it is logical to think that there must be something different in that trust. What has caused the problems?

Mr N Chambers: In short, we will come back to you in writing. We have already committed to getting you some quantifiable data on the social work vacancies and the unallocated cases. As part of that request, we will engage with our colleagues in the office of social services and try to understand the drivers behind the figures. Are there more children? Yes, there has been a sizeable increase in the children's disability population known to social services. At the turning point of the pandemic, that population was 4,500. It is now 5,600, which is a huge jump.

Mr McGrath: Is a piece of work being done to try to work out why that is the case? That is nearly a 20% uplift in the figure, and we need to understand that. Is somebody trying to find out why this is happening?

Mr N Chambers: Part of it is down to the growth in population, but we have to accept the reality that more children are slipping into our social care and social work system because we are not picking them up earlier. Comparatively, with special educational needs, we have seen sharp increases in the population size since 2020. Growth in the SEN population has gone from about 5% per academic year pre-pandemic to, at times, spikes of between 15% and 20% per academic year. We see a similar trend in the health and social care piece. We have to accept that COVID has had an impact on our ability to identify children early in the home. Equally, we are seeing an increased complexity of need throughout the system and a different profile of child whom our services do not have the reach or workforce to support well.

The Chairperson (Mr McGuigan): We heard from a couple of parents on Tuesday that money did not seem to be an issue. They were offered direct payments. A number of parents talked about having £10,000 that they could not use. It seems that the Department has access to money. Maybe it needs to look at how it is using that money. Carers, for example, are not being paid a salary that fairly reflects the work they are doing. Colin has asked a question. I am not involved in the Department or a trust but, off the top of my head, I know, if somebody is offered x amount of money for doing one job and y amount of money for doing a job that is much less stressful, what they are going to do? Social workers can earn equal amounts of money in the mainstream sectors. I am not a Minister: I am Chair of the Committee. I am not in the trusts, but if I were I would immediately look at how we pay our workforce to do those jobs. If employment is a problem and you are throwing money at parents that they cannot use, a simple alternative is to direct that money to pay people more appropriately and fill the vacancies to get the job done. I am just making that point: I do not expect anybody to respond to it.

Mr A Chambers: I watched the 'Spotlight' programme as well. It was raw and it was shocking to see parents being screamed at, punched and kicked by someone for whom they deeply love and care. If you could make open-ended interventions and money was no object, what mitigations would you offer those families to stop that from happening? Is there any way of stopping that from happening in the home setting, or is it just a fact of life that nobody can do anything about? It is a really sad situation.

Ms Preece: We try to replicate positive behaviour support plans with families. There are techniques that we can teach parents. We talk to them about how to respond when a situation escalates. That can be difficult to implement for a parent who is under extreme stress all the time. Those behaviour support plans are in place and are implemented wherever the child is — in school, in a short-break unit, in a residential unit or at home — but we acknowledge that they can be difficult for parents to implement when they are under extreme stress and pressure.

Mr N Chambers: There is a recognition that a multi-disciplinary approach is most likely required to understand what is driving the behaviours. I listed a few things earlier, such as the school environment and the home environment. Undiagnosed physical healthcare needs are huge for the learning disability population. Unless we get paediatrics around them, or doctors around them when they are adults, we cannot understand why they present in the way that they do. We need to do that before we can move to the next step, which is working with them on how to communicate and interact with the world and understand their emotions. Unless you have all of those tools together, you are setting a path of behavioural challenge. Across health and social care, that is not the reality that families or the people who are being supported should have to accept. Unmet need presents with behavioural challenge, so we need to address all the unmet needs for each child. Part of those unmet needs may be about where that child is living. As I said, it is inevitable that a small cohort of our disabled children will go into residential care at some point in their lives. Historically, that was provided at Muckamore, but they now go into a residential placement.

Mr A Chambers: That is very sad. Thank you.

Ms Preece: May I add something? I am so sorry that I could not find this earlier. To answer Diane's point about additionality, we will have four beds a week in addition to the provision in Lindsay House, if that opens. The additionality will be four beds a week through the provision at Greenhill.

Mr Donnelly: I want to pick up on Whitehaven, which was mentioned, Maura. I asked questions about it in October or November. We were told then that it would open in a couple of weeks, but it did not. It is still closed. You mentioned today that you hope that it will begin to open in the summer and that it should be fully open by the autumn. That will be nearly a whole year late. I am concerned that it is dragging on and that families in east Antrim are losing that respite availability. We expected that unit to reopen, but its five beds have been completely gone for a whole year. That is an issue of concern, so I ask you to keep us up to date on when it will open. A lot of families are very concerned.

Ms Dargan: We completely accept that, Danny. We would have liked it to open earlier. The problem relates to the complexity of a number of our young people and the care that they require. Some movement on that has just not made it possible for us, but we are working hard to get it moved forward as much as we can. I am happy to keep you updated.

Mr Donnelly: The respite that it offers is precious to a lot of families.

Mr N Chambers: Whitehaven was an example of having to move somebody from A to B to C to free up A. There was a regulation challenge in transitioning two young people into a supported living service. We have worked with the Northern Trust, the RQIA and Positive Futures to resolve that regulatory challenge. The delay is frustrating for Maura, her team and the families that are supported, as well as for the Department. However, it is a new model for transition. Historically, for children who entered residential care, everything changed when they turned 18: they had to move, and a new staffing team and funding policy had to be found for them.

With the approach that the Northern Trust is taking, it is essentially getting ahead of the accommodation needs for those individuals before they turn 18. When they become adults, there will be no moving: the staffing team will still be with them and they will be on an adult programme of care.

Mr Donnelly: Is that what we are waiting for? Are we waiting for the two individuals to age out?

Ms Dargan: No. I really do not want to get into the particulars of the individuals, but it is about other young people in another unit.

Mr N Chambers: Sorry if I was not clear. It is not an ageing out piece; it is a proactive approach to transitions in terms of accommodation need.

Mr Donnelly: Good. I am glad to hear that.

Mr Leeson: As Nigel said, the positive thing is that, whilst the Northern Trust has had all the frustration with it, there is potential benefit from that approach across all of Northern Ireland.

The Chairperson (Mr McGuigan): I have to cut that conversation short. We have asked for regular updates and a particular piece of information. We look forward to seeing that.

Maura, Lyn, Nigel and Maurice, I really appreciate you coming to the Committee and taking those questions. Thank you very much.