The Education Committee’s latest evidence hearing for their inquiry on special educational needs and disabilities (SEND) was a round-table discussion with representatives from the health sector, including Caroline Dinenage, Minister of State for Care, about the issues facing the health sector when supporting children with SEND.
The Committee’s SEND inquiry is examining the impact of the reforms introduced in the Children and Families Act 2014. The round-table discussion heard evidence from the 650+ submissions examining how the SEND reforms were developed with health services, how health services are delivering on the SEND reforms, and whether changes are necessary to deliver on the intention of these reforms.
"Do not underestimate our passion in the Department of Health and Social Care to get this right."
Topics discussed ranged from increasing the age at which young people leave children's mental health services; the importance of learning disability and autism training even for non-clinical NHS staff; whether the Children's Act is working; and how services can work collaboratively.
Witnesses giving evidence included:
• Caroline Dinenage, Minister of State for Care, Department of Health and Social Care
• Fran Oram, Director for mental health, dementia and disabilities, Department of Health and Social Care
• Michelle Morris, Consultant Speech and Language Therapist / Clinical Lead for Enhanced Service Development / Designated Clinical Officer – Salford CCG (representing the Royal College of Speech and Language Therapists)
• Dr Sally Payne, Professional Adviser – Children, Young People and Families, Royal College of Occupational Therapists
• Steve Inett, CEO, Healthwatch Kent
• Dr Tracey Crockford, Associate Specialist Community Paediatrician, Designated Medical Officer for SEND, West Cheshire
• Professor Jacqueline Dunkley-Bent OBE, Head of Maternity Children & Young People– Nursing Directorate, NHS England
The problem of accountability
The problem of accountability was brought up time and time again: whose job is it to support children with different needs? Witnesses highlighted that it's a "lottery" as to whether schools are properly resourced to support its pupils with SEND.
Steve Inett, CEO of Healthwatch Kent said: “people are feeling very alone often in terms of how they negotiate the system. [There is a] real lack of coordinator role for parents and families."
This need for accountability was not lost to Caroline Dinenage, the Minister of State for the Department of Health and Social Care. "We have to not be afraid to say things aren’t good enough”, she told the witnesses.
Dinenage called for a "culture change" in relation to providing people with the right support, saying that “making sure that you have the right teams to provide the right support when its needed is very tricky to do” in the current climate of health and social care. "Enabling us to produce much more work where we can really support the CCGs in the way that they commission, supporting best practice, sending out guidance and advice, and allowing us to really share where we see work that’s being done that is ground-breaking”.
"How can agencies be brought together to be most effective for children and families?" was a central question to the inquiry. Integrated teams and commissioning and synergistic collaborations between local and national services were suggested.
Dinenage professed that “we exist in a world […] which hasn’t been naturally designed to work very collaboratively", recognising the structural barriers that make collaboration difficult. "Problems that have been there for a very long time are now being exposed. We’re really shining a light on issues that have prevented the health and care system working collaboratively for a very long time and actually it's painful. It’s a process that is going to take time to get right."
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Mandatory learning disability and autism training for all NHS staff
Dinenage told the representatives that the consultation concerning how this training will look concludes in early August. She deemed the mortality rate of adults with learning disabilities - 14-18 years younger than their non learning disabled counterparts - as "not good enough". Discussion of what constitutes a reasonable adjustment, how to implement reasonable adjustments effectively, how to communicate with people with different needs, and how to make them feel at ease were discussed - perhaps there are facets of the future mandatory training.
The training “is about learning how to listen”, says Dinenage. The importance of centring the individual with different needs and their family was highlighted too, “making sure they are not completely sidelined in a process that is fundamentally about them."
Sally Payne, representing the Royal College of Occupational Therapists, agreed with the necessity to place the individual at the centre: “personalised care is a key component of the legislation which is very important to us as a profession."
Future sessions of the SEND inquiry will include hearing from young people with SEND as well as examining issues including tribunals and mediation. In May, the Education Committee will question representatives from local authorities East Sussex and Newham about the implementation of the SEND reforms.
“Do not underestimate our passion in the Department of Health and Social Care to get this right”, Dinenage said. Let's hope this passion is translated into practice.