SEN0822

Written evidence submitted by Better Communication CIC

This evidence is submitted by Marie Gascoigne, Director, Better Communication CIC and creator of the Balanced System Framework and methodology.  Better Communication CIC is a not-for-profit community interest company established in 2011 in response to the ongoing demand for support from children’s services across health and education in relation to supporting children and young people’s speech, language and communication needs (SLCN).  Since then, Better Communication CIC has supported over 40 local area systems to understand the needs of their population, develop specifications for joint commissioning, facilitate transformation of local whole system provision for children and young people and develop tools and systems to support integrated services and impact measurement.  Marie Gascoigne has been commissioned by the Royal College of Speech and Language Therapists (RCSLT), the DfE via the Communication Trust and Scottish Government to provide guidance around integrated services, joint commissioning for children and young people with SEND or additional needs.  The initial focus on speech, language and communication needs as extended across other children’s therapy needs and broader SEND provision.  For more information a summary can be accessed at https://www.thebalancedsystem.org/downloads/balanced-system-information-for-commissioners/.

Our recent experience is that we are supporting Local Area systems to use the Balanced System framework across occupational therapy and physiotherapy areas and for instance in Essex, the Balanced System structure of the Five Strands of Family Support, Environments, Workforce, Identification and Intervention is being used to underpin the Essex Inclusion Framework for SEND.

Evidence is submitted under the three key headings in the consultation focusing on those elements where we have specific comments or evidence of practice to share.

Support for young people with SEND

Pressure on EHCNA and EHCP systems due to poor availability of therapies

Our experience across the systems we have been or are currently working, is that the pressure of EHCPs is skewing the potential to support more children and young people with SEN at School Support.  We echo the findings of the National Audit Office that there is evidence of children and young people in some areas needing an ECHP solely to access therapies.  This vicious cycle (represented below) is something that we bring to the fore when working to implement the Balanced System Framework within an area.  It should never be the case that the only reason for an EHCNA is access to therapy assessment and support.

Figure 1: Illustrating the 'vicious cycle' of not focusing on the development of the whole system response[1]

In order to challenge the vicious cycle there has to be time and resource from the therapy workforce to work on the system enablers and this activity needs to be valued even in the context of waiting lists for therapies.  The use of this specialist expertise to develop the wider system is money well spent in terms of quality assuring the offer across system partners and contexts.  More about our proposed model for supporting children and young people with SEND is provided below.

Confidence of parents and families is crucial to any change on the demand for EHCPs.  There needs to be better understanding that SEN is a relative term and that, for some children and young people, a special educational need may be evidenced in one context but not another, and that the support required to meet a special educational need is context related and not predicated on a diagnosis.

Current and future models of SEND

Ordinarily Available Provision

Our experience of working across systems to understand need and support integrated service transformation is that there is huge variability between Local Areas.  Some areas have clearly articulated Ordinarily Available Provision (OAP) whilst others have little consistent guidance and support for schools and settings.  Another parameter of variation is the extent to which the OAP is viewed as part of the support available to all children and young people as opposed to being viewed more specifically through the lens of inclusion of those already identified with SEN.  In these instances, the focus then becomes on difference as opposed to adapting the learning situation for all children and young people.  The consistency with which the OAP is evidenced across schools and settings in a given area is also variable.

Could the committee consider national guidance and standards for Ordinarily Available Provision?

The Balanced System is a population based, needs led approach to organising support across an area to anticipate need rather than wait for children and young people to struggle.  It pre-supposes, based on the evidence of population risk factors, where there may be additional levels of need in the population and enables local systems to tailor provision to anticipate need through a full range of universal and targeted approaches as well as more specialist and individualised support.

The Balanced System provides a systems outcome framework based around Five Strands of Family and young person support, Enabling Environments, Developing Workforce, Early Identification and Effective Intervention at all three levels of universal, targeted and specialist offer.  The accompanying delivery model emphasises the following key principles:

1. Focus on impact and functional outcomes for individuals but also for the whole system
2. Easy access to expertise in places that children and families find familiar
3. Placed based support – therapists working in homes, settings, schools, FE and workplaces – not health settings as the default
4. Ensuring the full range of offer to meet need across universal, targeted and individualised support across all of the Five Strand areas
5. Providing consistent high quality accessible information

As more areas are transforming local provision towards a Balanced System approach there is emerging evidence of how the easy access and placed based working for therapists along with developing the targeted offer to provide a bridge between universal services and individualised or specialist provision are reducing the waiting lists that are causing the pressure in the system that is driving the ECHP vicious cycle (https://www.thebalancedsystem.org/downloads/rcslt-conference-presentation-2023/).

The Balanced System Pathway tool was created as part of the Early Outcomes Fund project in the East Midlands and was developed and is hosted by Better Communication CIC.   More areas are including their offer which can be navigated by parents and professionals through the structure of the Balanced System.  It is being considered as a potential for sharing the SEND offer as a whole with the appropriate additional content.  https://pathway.thebalancedsystem.org

The Balanced System Scheme for Schools and Settings Accreditation is enabling schools and settings to understand their school or setting ‘system’ and focus on enhancing their offer for all children and young people thereby dovetailing with the OAP and incorporating support from therapy services (https://www.thebalancedsystem.org/schools/what-is-scheme-for-schools/)

Implementing an approach such as the Balanced System requires cultural transformation in most areas we work with as it is counter to the medical model of ‘refer-assess-treat’.  Applying this to the SEND crisis, the potential for anticipating needs and providing enhanced support in the Early Years through all phases of education has the potential to radically change the experience of children and young people, their families and those who work throughout the system to support them.  The distinction between ‘health’ and ‘education’ responsibilities is unhelpful.

Could the committee consider recommending a common outcomes framework for SEND that integrates the offer across health and education provision?

Finance, funding and capacity of SEND provision

The capacity of local systems to adequately address the needs of their population is also variable in our experience.  Our extensive work with therapy services has resulted in a significant dataset which we interpret using population analysis so as to understand the capacity against the need in the system.

Our experience echoes the findings of the Children’s Commissioner in 2019 in terms of the variations in funding from one part of the country to another.  We are aware of efforts to commission a modelling methodology that will allow more tailored modelling of workforce to meet need but alongside this there needs to be a common approach to whole system delivery where funding is ideally put into joint commissioning but at the very least there is an agreement to align budgets.

We are currently supporting the Greater Manchester system to transform towards a needs led joint approach to supporting children and young people with speech, language and communication needs.  This approach could be extended more generally to the whole SEND arena.

In summary,

• Refocus the local system partnerships between ICBs and LAs on the ambition of joint commissioning for all therapy support for children and young people including children and young people with SEN
• Require impact measurement towards jointly agreed functional and meaningful outcomes for children and young people and their families to be incorporated into ‘business as usual’ and the measurement of jointly commissioned service provision
• A culture shift is necessary away from the ‘health’ vs ‘education’ vs ‘social care’ portfolios so that a population led approach to understanding need and delivering provision becomes the norm
• A recognition that, as stated in the opening paragraph of the National Audit Office report, that SEND is a relative descriptor and that in an ideal world the ‘ordinarily available provision’ should a) include therapy contributions and b) result in less need for families to have no alternative other than pursue an Education, Health and Care Plan for their child or young persons’ needs to be met.

January 2025