Edward Timpson speaks about the NHS’s role in support for SEN
This was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government
Children’s Minister Edward Timpson addresses an event hosted by the Council for Disabled Children (CDC) and In Control.
Thanks, Christine [Lenehan, Chair and Director, CDC]. It’s great to be with you today.
And firstly, a huge thanks to you and the Council for Disabled Children and In Control for hosting this important event. The first in a series of 5 that are all over-subscribed - an indication that they are much-needed.
And to NHS England too, for their continued support in bringing these events together and for their work with clinical commissioning groups and my department to help deliver these substantive reforms to special educational needs.
I hope you’ve found it to be a productive day so far and are feeling more confident about what these changes - the biggest for 30 years - mean for the health service.
Now I know that you’ve been through some significant changes of your own in the NHS. I don’t underestimate the challenge this brings. But as your attendance today testifies, I know that you also share our ambition to do much better by some our most vulnerable children - children for whom support has, sadly, too often fallen short.
When I first took on the SEN brief 18 months ago, I kept hearing the same refrain from families; about how they faced an endless and excruciating fight with a system that’s supposed to help them. About how they found themselves falling through gaps in services that failed to work together. And how they had to repeat their stories over and over again to different agencies.
I’m afraid to say that too many singled out health as especially hard to engage and get around the table. This is particularly worrying given the significant number of children needing health support under the current system, but perhaps in some ways it’s not entirely surprising.
I think we would all acknowledge that the existing set-up hasn’t made it easy for you to do your best for these children and join up with education and social care in their interests - something that we know has caused frustration on all sides and that we know is absolutely key in securing better outcomes and a better transition to adulthood.
New duty on health and drive for integration
Which is precisely why we’re overhauling the SEN system, through the Children and Families Bill and the new 0 to 25 code of practice, to provide you with the framework and freedom to support much better integration, both for children with SEN as well as disabilities.
And through the Care Bill, currently going through Parliament, extending the provision of services beyond 18 where this makes sense, rather than using the blunt instrument of a birthday to determine need.
As you’ll already have heard from Christine, Andrew, Amanda and Martin, these changes promise to be truly transformative; requiring much closer co-operation between services and a bigger say for young people and their parents - whether through the local offer, setting out the support that’s available in an area, or through new education, health and care (EHC) plans.
But perhaps the most vital change in all of this is the new duty on health to provide the health aspect of these new plans and to work with local authorities to jointly assess and meet children’s needs.
This represents a real breakthrough; rebooting the relationship between health and social care firmly and decisively in favour of families. Dissolving the barriers in language, culture and approach that divide team from team, department from department, agency from agency. Spurring professionals to no longer just zero in on their piece of the jigsaw, but to see the whole picture from the perspective of the child and their needs.
A truly integrated approach that we’re championing in a number of ways - such as the enhanced role for mediation; making the disputes process less adversarial and, with a single point of redress for health, education and social care, making it much easier for families to navigate.
Now, I know that, with health having different structures for complaints procedures, there was concern about whether families would have to go down separate routes to challenge provision. So I’m pleased that we’ve been able to make improvements and provide greater reassurance in just this area.
We’ve also listened to worries about schools failing to support children with disabilities or medical conditions, with reports of parents being forced to come into schools to administer medication and pupils even being excluded.
That’s why we’ve introduced a new duty to make it easier to hold schools to account on managing medicines. This will be underpinned by statutory guidance - that’s currently out for consultation - based on existing good practice. So parents can have more confidence that their child’s needs, both health and educational, will be met in schools.
But, in many ways, the real acid test will be joint commissioning; with the scope it offers, for instance, to create integrated care pathways with health services. If we can get this right, we’ll not only get a better match between need and the support provided, but also generate better results as well as save costs.
All of which should make your job easier and also more satisfying - and I think it’s important to stress that this is central to our ambitions for a better SEN system. Professionals who are freed and supported to do the very best for their patients.
Now, believe it or not, I don’t want to load you with unnecessary changes on top of the ones you’ve already gone through. Or demands that conflict with your broader work in the health service.
On the contrary. This drive for more collaboration on behalf of children with special educational needs and disabilities (SEND) is very much in line with the NHS constitution and reforms to the wider NHS, which advocate greater integration wherever possible.
And as you know, there’s an objective in the NHS mandate regarding children with SEND - that NHS England will be monitoring clinical commissioning groups against.
So there’s a real opportunity here, on the back of acknowledged difficulties in the past and changes to the NHS, to do things differently and better for some of our most disadvantaged children - with health playing a pivotal role as equal partners alongside social care and education.
It’s an agenda that involves us all. Quite simply, we can’t do it without you.
Progress, pathfinders and personal budgets
As has been said, the Children and Families Bill has completed its passage through Parliament and the legislation will shortly receive royal assent. But this is very much the beginning, not the end of the work that needs to be done.
We all know that the real hard work, the effort that ultimately pays off, doesn’t happen in Parliament, but in classrooms, GP surgeries, nurseries and clinics, not to mention family homes. A change in law must go hand in hand with a change in culture if it’s to have the impact we all want to see.
And I’m encouraged that we’re starting to see this important shift.
As the bill’s progressed and the 20 pathfinders testing the SEN reforms across 31 local authorities have made inroads, there have been growing signs of a change in the approach, understanding and involvement of health providers.
And as you’ve just heard, families and professionals are starting to feel the benefits.
The pathfinder in Southampton, for example, has developed an integrated health and social care service that has cut right back on duplication of assessments through joint visits and by co-ordinating information provided in previous assessments.
Hertfordshire, another pathfinder, has brought parents and health and education professionals together to better understand the family’s journey through the system and how this can be improved when developing new education, health and care plans.
And there’s the app, developed by Early Support, our SEND delivery partner, which helps families receive, record and share information with all manner of health and education professionals and, in doing so, offers the prospect of useful discussion without endless repetition.
I’ve seen also for myself, on visits to pathfinders in Surrey and Bromley, what a difference this level of engagement can make. How much more involved and empowered young people and their parents feel in drawing up their own package of support through the education, health and care plans.
And also what a rewarding experience it is for the professionals involved. As one consultant paediatrician put it:
I’ve found the new process really positive. The live documents we’ve generated with the parents capture a much better description of the child. Their personality really shines through.
Not something, I think, many health professionals would necessarily have said before.
Personal budgets are also having a similar effect; shifting the focus from the mechanics of provision to the potential of each young person, resulting in better conversations between families and professionals.
And giving children and their parents more choice and control over the support they receive - support such as the dedicated one-to-one health worker who was employed to help a 3-year-old girl with complex health needs that were stopping her attending nursery.
In her case, at the pathfinder in Oldham, education, health and social care joined forces to provide the funding needed to ensure that the child didn’t miss out on her education - which is surely what integration is all about.
As one parent, who is using a personal budget, put it:
It was really lovely to feel…heard on an equal footing…Now I feel part of a team…Now it feels as though there is someone on my side.
All fantastic examples of what can be achieved when services really come together - and examples that I hope will inspire you as you gear up for the new system which, as you know, kicks in this September.
And looking forward, we all want to ensure as smooth a transition as possible for vulnerable families and for them to be able to take full advantage of the new arrangements. So now is very much the time to step up your preparations.
So I’m pleased to see that, in many places, these preparations are already underway, but we know there’s still a lot to do.
Pathfinders tell us that it takes a least a year to get ready, not least for the cultural change to take hold. So it’s essential that everyone involved; the NHS, education, local authorities and others services, intensifies their efforts.
And there’s no need to wait. Wolverhampton and Richmond aren’t pathfinders, but they’ve already begun involving families in developing education, health and care plans and a draft local offer.
Doing more now saves time and energy later and can even lead to savings, so there’s every incentive to act with urgency and make the reforms a success.
And we want to do everything we can to help you with this.
Which is why we’re providing local authorities with a £70 million SEN reform grant that they can use, with no ring-fencing, to work with health and others to deliver these changes.
It’s why we’ve made £30 million available to recruit and train - with the help of the Council for Disabled Children - over 1,800 independent supporters to help families navigate the new system.
And it’s why I’m working closely with Dan Poulter, my ministerial colleague at Health, to provide advice on implementation to clinical commissioning groups, health and wellbeing boards as well as to chief executives and lead members in all local authorities.
We’re also extending the pathfinder champion programme until March 2015, so that local areas can readily draw on lessons from those who have trodden the path, including in the vital area of health.
Listening to young people
But, in many ways, the best guide to how services should be flexed and fused comes from children and young people themselves; brought to home me most powerfully in my regular meetings with EPIC, a group of disabled young people assembled, again, with the help of the CDC. They’ve provided me with valuable advice on the SEN and disability reforms - and held my feet to the fire on a few occasions too! I’m thinking, in particular, of a highly articulate and astute young man called Cory, whose wisdom and practical insight I’ve benefited from hugely.
They remind me, time and time again, that no-one else has a keener understanding of what will make their lives better. And that services could save themselves a lot of time, money and effort if they just took the trouble to sit down and listen to them.
After all, they’re the reason that we’re all here today - because we want children and young people with special educational needs and disabilities to be able to aspire and achieve as other children do.
Because we want them to do well at school, form strong relationships and find success and fulfilment in work and further study as independent adults. Nothing more, nothing less than we want for our own children.
And all of you in the health service are absolutely critical to making this happen.
So I very much hope that you will continue to work with us and work ever more closely with your colleagues in education and social care to make a difference to the prospects of some of our neediest children.
Now I know that this may seem a lot to ask given all the changes that you’ve already been through - and I can’t thank you enough for the hard work and dedication you’ve put in so far.
But with the new duties on health, which reinforce wider changes in the health service, there has never been a better opportunity for you to play a full and active role in transforming SEND provision - backed by the significant support that we’re providing.
The fact we can see that this more ambitious approach is already working wonders in the pathfinder areas and beyond gives us real cause for optimism. Like you, I want families everywhere to be able to enjoy this kind of outstanding support.
Support that fits in with their needs and not the other way around. That sees children’s potential and not their limits. Support that’s truly on their side.