SCN0672
Written evidence from NHS England
This submission should be read in conjunction with the supplementary written evidence from NHS England, SCN0680.
1.1. NHS England continues to play a key role in supporting and enabling the implementation of the Special Educational Needs and Disabilities (SEND) reforms
1.2. This written evidence builds on evidence submitted by Department of Education (DfE) and Department of Health and Social Care (DHSC) on 14 June 2018.
1.3. The Chief Nursing Officer, England (Dr Ruth May) is the Senior Responsible Officer (SRO) for the SEND programme.
1.4. The Senior Nurse for Children and Young People (CYP) (Lorraine Mulroney) and SEND Lead has been the National SEND lead since June 2016. This role has significantly increased national co-operation and collaboration with key stakeholders whilst supporting regional and local delivery.
1.5. A key aim of the SEND programme is to ensure that NHS England delivers the mandate set by DHSC in 2015/16 regarding Education Health and Care Plans (EHCPs).
1.6. NHS England (NHSE) local, regional and specialist commissioning teams have responsibility for supporting the 195 Clinical Commissioning Groups (CCGs) and NHS England direct commissioning teams to meet their statutory duties and requirements for SEND within their local areas.
1.7. The SEND programme has been funded through NHS England programme funds since 2016. A total of £299,684 (16/17- £110K, 17/18 – £94,690, 18/19 £94,994) was allocated to support improvements. In addition, regional SEND leads are funded through separate regional nursing budgets.
1.8. The existing SEND programme will close on the 31 March 2019 due to successful delivery of its programme objectives. The current Senior Nurse for Children and Young People (CYP) and SEND will continue to support SEND improvements which will include supporting SEND regional and local leads.
1.9. Within the health system NHS England and other partners are confident that the SEND reforms remain the right reforms and that good progress has been made; but to enable sustained health improvement, more must be done with all partners to support the ongoing changes required in system leadership and culture.
2.1. The four main objectives of the NHS England SEND programme are to:
2.1.1. ensure that the health system is responding to the outcomes from the joint local area inspections;
2.1.2. ensure consistency of application of statutory health duties from the Children and Families Act 2014;
2.1.3. promote the local effective inter-agency approach to delivery, where health settings work in partnership with educational settings and social care to meet the needs of CYP;
2.1.4. improve the health experience for families, characterised by less conflict, having their voices heard and having genuine choice and control over the provision made for their child/and or young person.
4.1. We have strengthened the health governance and accountability for SEND services through:
4.1.1. setting up a multi-sector Children’s Complex Needs SEND Board and three sub-groups (improvement, data and evidence and communications and engagement); and ensuring that SEND features within the Transforming
4.1.2. Care Children and Young People’s Steering and Operational Delivery Group;
4.1.3. supporting the implementation of the Ofsted/Care Quality Commission (CQC) inspections framework for SEND;
4.1.4. supporting the introduction of a two-year trial of SEND tribunal cases, which began in April 2018, extending the remit of the First-tier Tribunal (SEND) to make non-binding recommendations on health and social care elements of EHC plans;
4.1.5. working together across government with DfE, DHSC and NHS England to support and challenge local areas following their Ofsted/CQC SEND inspection, using existing health system quality and assurance frameworks;
4.1.6. aligning with other NHS England programmes that impact children and young people with SEND. The SEND programme has association with other programmes within NHS England including for example, the Transforming Care Programme that focuses on children and young people with learning disabilities and autism, the Children and Young People’s Mental Health programme, and the personalisation programme. The leads from each of these programmes work across the different programme boards and steering groups to ensure cross fertilisation and prioritisation of work.
5.1. To support implementation of SEND, 16 NHS England SEND leads currently based in five regions (London, South East, South West, North and Midlands and East) have specifically focused on:
5.1.1. providing health support for implementation and improvement of SEND services to families;
5.1.2. building clear accountability structures for the health sector and local areas;
5.1.3. implementing the Ofsted/CQC inspection framework (Ofsted/CQC are to assess the effectiveness of SEND services in all local areas by 2021).
6.1. Research into the non-statutory regional roles of designated officers for SEND. This study is being undertaken by the National Children’s Bureau and will be completed on 20 March 2019. There are currently 190/195 CCGs who have designated officers in post.
6.2. Increased co-production with parents, carers, CYP and CCGs at a local level across CYP health services. For example, following concerns raised by parents’ about the Autistic Spectrum Disorder pathway to the Peterborough strategic 025 Transformation Board, local area leaders worked with Family Voice Peterborough. This led to a task and finish group being set up by the LA and CCG specifically tackling the waiting times and lack of support for children and young people with Autistic Spectrum Disorder. This resulted in the implementation of a new pathway that is currently working well.
6.3. In 2018 the development and publication of ‘Quick Guide: Commissioning for Transition to adult services for young people with Special Educational Needs and Disability (SEND)’. Further work on transition continues as a theme in the NHS Long Term Plan, and guidance for health services for children and young people with Special Educational Needs and Disability (SEND).
6.4. Where there have been health related concerns, NHS England has provided both operational and strategic support where local area SEND inspections have resulted in a written statement of action. NHS England local SEND leads have provided detailed health advice and support with challenge at local area meetings with the DfE Advisor.
6.5. The SEND programme lead influenced key changes to the NHS contract in 2016, that relate to the quality and timeliness of Education Health and EHCP. These changes remain in the current contract NHS contract 18/19 (Service Conditions 10.5 Page 13). NHS England regional leads continue to work with CCG colleagues/designated officers to increase the quality and timeliness of EHCP.
6.6. All SEND leads worked with DfE delivery partners and undertook an exercise of self-assessment of each CCG’s position using evidence-based toolkits developed to measure progress using the code of practice to improve their SEND services.
6.7. The National SEND lead provided expert advice and intelligence generated from the SEND board to both the DfE and DHSC commissioned reviews by Dame Christine Lenehan. This has resulted in a joined-up approach to taking forward the recommendations with DfE and DHSC.
6.8. The National SEND lead provided expert advice and intelligence generated from the SEND board to contribute to the publication of the 6 weeks health advice
6.9. Regional SEND leads provided expert advice and intelligence to support NHS Digital to increase data submissions and improve relevant SEND indicators within Community Services Statistics for Children, Young People and Adults. This is evidenced by improvements to the submissions of 12 relevant indicators for CYP with SEND.
7.1. The first Ofsted/CQC One Year On Report of the SEND inspections, noted that there were areas for improvement for health. The SEND programme has broadly worked on the areas for improvement, as evidenced in Table 1.
Table 1 The contribution of the SEND programme to the SEND inspections
SEND inspection1 year on report | SEND programme/leads actions for Improvement |
“the commissioning of health services for up to 25 was inconsistent.” | To support inspections and local improvements regional SEND leads work closely with NHS England direct commissioning teams at a local level. |
“giving the designated medical officer (DMO) or designated clinical officer (DCO) sufficient time resulted in improved joint commissioning arrangements.” However, the role of the designated medical officer (DMO) or designated clinical officer (DCO) was underdeveloped or under resourced. | Actions have been taken locally post inspection and vacant posts have been filled in many CCGs. The resource variability has been analysed in the research report due on 20 March 2019 when recommendations will be made. |
“there were common weaknesses in the process for securing the statutory contributions from health and care professionals to assessments.” | Designated officers have been working with SEND Local Authority leads and planners to improve local process and audits. The positive impact of this partnership working is evidenced in the Southwark inspection report.
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“The promotion of personal health budgets had been particularly poor” | The personalised care team have been working with the SEND leads to support local areas to increase uptake. This is also in the Long Term Plan. |
“Leaders’ strategies to implement the reforms were weak and lacked impact” | SEND leads have been: working with local areas including CCGs and health providers to monitor and assess impact. sharing examples where leaders have had greater impact, evidenced in the West Sussex inspection report. |
7.2. NHS England local SEND leads have been working with DfE advisors to ensure that local areas are formally monitored during post inspection follow up visits from the Department for Education (DfE) and NHS England. The publication outlining the first area to have an Ofsted and CQC inspection revisit (Rochdale) stated that: “Inspectors are of the opinion that local area leaders have made sufficient progress to improve each of the serious weaknesses identified at the initial inspection”. As a result, they stated that “leaders of the local area have made sufficient progress against all the weaknesses identified in the written statement”. This was a positive outcome for all involved.
8.1. We recognise that there is still work to be done on joint working/joint commissioning, to meet needs and improve outcomes and experiences of CYP across the system. The announcement of the DfE leadership board and focus on joint commissioning will be key to unlocking this ongoing system challenge. To support the ongoing improvement in joint working, NHS England have:
8.1.1. established a national online forum network for designated medical officers and designated clinical officers;
8.1.2. established a national online forum network for children’s commissioners;
8.1.3. improved health membership on the DfE funded regional networks
8.1.4. shared resources to support joint self-assessment and peer review;
8.1.5. funded and worked jointly with DfE partners to run events and support local areas on specific topics of work. For example, co-production, improving data and EHCP processes;
8.1.6. funded five CCG colleagues to attend the SEND leadership programme and legal training for all local authorities and their health partners to ensure they are clear on their statutory responsibilities.
9.1. Prior to successful completion of the current SEND programme of work, the National SEND lead is completing a programme closure report that will be discussed with regional and local leads and other key SEND delivery partners (DfE, DHSC, NNPCF, Council for Disabled Children, Contact, Mott Mc Donald and National Development Team for Inclusion).
9.2. The closure report will detail the continuation of SEND beyond the life of the current SEND programme, and will refer to the inclusion of the SEND agenda in the soon-to-be formed Children and Young Peoples Programme Board, responsible for delivering the CYP chapter of the NHS Long Term plan. The closure report will also include a commitment to:
9.2.1. ensuring that where an EHCP is needed, the plan specifies clear health outcomes;
9.2.2. providing ongoing support for CCGs/Integrated Care Systems, in their role as commissioners for children and young people with SEND, including improved strategic planning, leadership and joint commissioning;
9.2.3. continuing to monitor the impact of the designated officers for SEND;
9.2.4. continuing to monitor the impact of the community services data set and community tariffs for CYP with SEND;
9.2.5. ensuring that the CYP workforce plans across health reflect the needs of children and young people with SEND;
9.2.6. continuing to promote the use of effective practice, wider data intelligence and independent assessment (including information from the Ofsted/CQC inspections and peer reviews) to drive improvement;
9.2.7. ensuring that further to the alignment of NHS England and NHS Improvement, SEND inspection outcomes will be shared with NHS Improvement as the health provider regulator and health improvement plans will be jointly supported by NHS England and NHS Improvement.
9.3. The Education Committee’s inquiry and ultimately its final report will help to inform NHS England’s plans for ongoing improvement to the SEND system.
February 2019