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OUTLINE STRUCTURE FOR DISABILITY REVIEW REPORT - Medway Children's

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OUTLINE STRUCTURE FOR DISABILITY REVIEW REPORT - Medway Children's Powered By Docstoc
					      STRATEGIC REVIEW OF
CHILDREN’S DISABILITY SERVICES IN
            MEDWAY


           March 2011
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Strategic review of children’s disability services in Medway:       DRAFT
March 2011


                                  CONTENTS
                                                                   Page
                                                                    no.

  Foreword                                                          ii
  Executive summary                                                 iv


  Section One            :   Introduction and methodology           1

  Section Two            :   Policy and statutory context           4
  Section Three          :   Identified needs                      13
  Section Four           :   Support for disabled children and     19
                             families

  Section Five           :   Transition to adulthood               32

  Section Six            :   Direct investment for disabled        35
                             families

  Section Seven          :   Feedback from children and families   39
  Section Eight          :   Conclusions and proposed vision and   43
                             commissioning themes


  Annex A                :   Terms of reference of the review      48
  Annex B                :   List of consultees                    51
  Annex C                :   Special Educational Need data         52
                         :   End of Year referral figures for
  Annex D                    Disabled Children’s Team, 2009        64
                         :   Independent/non maintained            65
  Annex E
                             expenditure 2008-11
                                   

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Strategic review of children’s disability services in Medway:                               DRAFT
March 2011



Foreword


This review is about the education, health and care of children and young people with
disabilities and their families.

Children and young people with disabilities in Medway, as elsewhere, have said very
clearly that they only want the same things as any other young person, such as friends,
relationships, money, a place of their own and the freedom to do things they enjoy. In
short, they want choice, control and independence over their lives.

In recent years there have been rising expectations among children and young people
with disabilities and their parents and carers - rising expectation and ambition in relation
to the services they are entitled to expect, and of their own independence and
achievement. We now have a varied and accessible programme of short breaks in
Medway which we know are highly valued. We have also seen improvements in the
journey from childhood to becoming an adult, which is now more centred on the needs of
individual young people, following the success of the ‘Getting a Life’ project.

However, there is much more to do.

In order to meet rising expectations at a time of severe financial constraint, we need to
think radically about how we support children and young people with disabilities to
achieve their ambitions for choice and control over their lives. Increasingly, services
offered in the traditional way will not fit the bill.

Nationally, there are seismic changes. Parents will be given more control, with the option
of a personal budget by 2014 and more choice about which school they attend; an
integrated assessment process for each young person leading to an Education, Health
and Care Plan; transference of power to professionals on the front line, local
communities and voluntary agencies, and more openness in how services are
developed and provided. These are part of a wider set of major reforms at every level.

To deliver choice and control, and improved outcomes for children and young people
with disabilities in Medway at a time of budget constraint, we propose whole-system
change with services focusing on the needs and wishes of children and young people
and their carers, rather than service boundaries; this means that we will be seeking to
integrate or join up frontline delivery, processes that support services being delivered,
and strategy and governance arrangements that maintain an overview of what is
planned and how well this is being delivered. We expect there will be an increasing role
for personal budgets and direct payments so that the control of what is purchased is with
the family who are using the service.

This is not a detailed blueprint for the future. Rather, these are suggestions about the
general direction of travel. Making real and lasting improvements will depend on listening



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Strategic review of children’s disability services in Medway:                              DRAFT
March 2011
to, and acting upon, what children and young people with disabilities and their families
say, together with front line practitioners, and managers.

In the coming months, we will be consulting widely on these proposals, and inviting you
to comment on and become involved in shaping these proposals into something that is
workable and meets a variety of needs, and most of all makes a difference to children
and young people’s lives.




Rose Collinson




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Strategic review of children’s disability services in Medway:                                 DRAFT
March 2011



EXECUTIVE SUMMARY

This review has been commissioned by Medway Council (the LA) and NHS Medway
(the PCT). It reviews the range of services and facilities currently funded by the PCT and
the Council to support disabled children in Medway, and proposes a strategic framework
in which to make effective commissioning decisions for the future.

What young people say

‘As disabled young people we only want the same things as any other young person,
such as friends, relationships, money, a place of our own and the freedom to do things
we enjoy. In short, we want choice, control and independence over our lives.’

                                                                              Rite Report 2006

‘Successful relationships and friendships; independence, including choice about whom
they lived with; choice about what to do in their spare time; and the opportunity to work’

                                 Ofsted review of special educational needs and disability 2010

What the evidence tells us

National evidence of best practice on services for children with disabilities highlights key
findings in a number of areas.

Involving children, young people and families: parents know more about their children
than anyone else so it is important to involve them as key partners in understanding
what will help them and their child most. Take-up and satisfaction levels are improved
through consultation with disabled children and young people on access to the quality of,
and the extent of inclusivity of, activities. Decisions about the most appropriate setting
should be informed by what disabled children and families feel is best for them, with the
opportunity to participate in both mainstream and separate activities.

Service structure: early intervention helps improve the emotional health and well-being
of parents, and promote better family relationships. Families of young disabled children
who have a consistent key worker will usually experience better relationships with
services, quicker access to benefits and reduced stress. Early years services should
particularly consider the needs of the whole family, and these services should be
delivered in homely, non-clinical surroundings, through a seamless and integrated inter-
agency process. The most effective services are those that are well planned and
structured, and continue for long enough and intensely enough for families to gain the
benefits.

Value for money: implement programmes that result in positive outcomes, and exercise
caution about large-scale investment in new interventions unless there is clear evidence
of proved outcomes. High quality pre-school education for disabled children helps to
reduce the numbers with an SEN diagnosis in primary school.



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Strategic review of children’s disability services in Medway:                               DRAFT
March 2011
Delivering services: services respond flexibly to whole-family assessments, and while
specialist services may be required, mainstream services should also be able to offer a
differentiated approach when needed. Sensitivity to cultural needs is required and
services should include the needs of mothers, fathers and carers as well as children. All
staff are trained in inclusive approaches.

Auditing and monitoring service delivery: as part of an overall strategy, take-up and
access to services by disabled children and teenagers in services such as preschool
activities, and leisure, sport, arts and cultural services is monitored. Service providers
should are encouraged to evaluate their range of activities for inclusiveness and
accessibility.

National context

Programmes such as Aiming High for Disabled Children have significantly raised
expectations of disabled children and young people and their parents, both in respect of
the services which they are due, and in what can be achieved by children and young
people themselves. But much remains to be done.

The Government’s proposals for change to services for children and young people with
disabilities are wide ranging. Parents will be given more control, with the option of a
personal budget by 2014 and strengthened choice of school place; an integrated
assessment process for each young person leading to an Education, Health and Care
Plan, transference of power to professionals on the front line and to local communities,
and more transparency in the provision of services.

These are part of a wider set of major reforms at every level, to the education system
and to the NHS, including GP Commissioning and Local Authorities promoting the
joining up of local NHS services, social care and health improvement. All this is taking
place at a time of severe constraint on public sector finances.

Key conclusions of review

The key conclusions from this review of Medway children’s disability services are:

     1        Informal links between agencies are generally good, helped by the
              compact nature of Medway, and the fact that many services are
              coterminous.

     2        There is     no overall vision    and commissioning strategy for services for
              children    with disabilities,   and as a result, interagency collaboration
              depends      more on good        relations between individuals than on any
              strategic   lead. This review    is the first step towards creating a coherehnt
              vision

     3        There is a long-standing lack of child focus within health commissioning,
              which has been overly reliant on specified and reviewed block contracts

     4        Delivery of services is too often based around service boundaries, rather
              than around children, young people and families



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Strategic review of children’s disability services in Medway:                              DRAFT
March 2011

      5        Standards of information, transparency and empowerment of parents is
               patchy across services, and there is a general lack of awareness of the
               AHDC Core Offer.

      6        Sharing of information between agencies in relation to children with
               disabilities is, with some exceptions, poorly developed.

In order to meet the expectations of children and young people with disabilities and their
families, in the context of the national requirements for personalisation, choice and
control and integrated working, radical changes in the way services are commissioned
and delivered are necessary. Doing nothing is not a viable option.



                    Medway’s vision and approach

                                    Our Vision

             Medway services work together to empower and support
             children with disabilities and their families; providing
             services which are easily accessible, responsive to their
             needs, identified through integrated assessment, and
             delivered when and where required.




To deliver this vision and improved outcomes for children in Medway, the review
proposes whole-system change with services focusing on the needs and wishes of
children and young people rather than service boundaries; integrated frontline delivery,
processes, strategy and governance. As well as proposing these system wide changes,
the review also makes a number of key recommendations for the operation of the
existing services which link to the overarching recommendations.

Services focusing on children and young people

An essential part of a child-focused service is to provide disabled children and their
families with the national minimum standards for information, transparency, participation
and feedback, on a consistent basis. This will include an easily comprehensible local
offer of all services in Medway supporting children with disabilities or SEN, to say what is
available and from whom. We will develop an information strategy using the national
standards, across the partnership.

Identifying children’s needs early provides opportunities for parents and professionals to
put in place effective support. We will reintroduce the preventative Early Support
programme following good practice models, with improved coordination between the
agencies, and enhanced support for key working and ‘team around the child’
approaches.


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Strategic review of children’s disability services in Medway:                                  DRAFT
March 2011

Personalised budgets help to put choice and control in the hands of parents and young
people, We will introduce these, and extend the availability and transparency of direct
funding, drawing on national best practice. In doing this, it will be important to ensure a
seamless transfer between children’s and adult services.

We will continue to ensure a varied and easily accessible programme of short breaks
providing a break for parents and carers, and enjoyable activities for children and young
people, and helping prevent the escalation of needs. We will review existing overnight
short break provision, with a view to reinvesting in purpose-built accommodation, for
children and young people who continue to need it.


Integrated front line working

Integrated frontline working requires the refocusing of children’s services around the
needs of children and families rather than a professional service boundaries. We will
adopt this as a key principle to be applied in developing new provision and reviewing
existing provision. An important aspect of this is ensuring that services address child-
parent relationships as well as addressing child developmental goals.

We will take full advantage of the opportunity provided by the establishment of the Child
Development Centre in its new location, to enable it to act as the base for a range of
services, with an integrated approach to service delivery.

We will review children’s disability services in light of the principle of integrated front line
working, to establish whether the existing arrangements can be improved. This would
include consideration of single-agency centres such as the Parklands Resource Centre,
which acts as the base for the Disabled Children’s Team.
The voluntary sector has a key role to play in working with disabled children and their
families, and it will be important to involve the sector in decision making at a strategic
level, as well as in delivering specific services.

Integrated processes

Integrated processes are essential for effective multi-agency working. Sharing of
information between agencies is hampered by the lack of joint information systems. The
transition database link is being established to enable sharing of information between
agencies in the field of transition, and we will assess the practicability of this approach
more widely in relation to disability.

Work is already proceeding on a model for a single assessment process in Medway, and
the Government has recently announced its intention to adopt by 2014 a single
assessment process leading to an ‘Education, Health and Care Plan’ for for children and
young people from birth to 25 who currently have a statement of SEN or learning
difficulty assessment.

A shared approach and strategy for children's service workforce development of
integrated working will be promoted. This will cover areas including inclusion, key worker
training, and training support for differentiation within universal services from targeted
and specialist services.


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Strategic review of children’s disability services in Medway:                              DRAFT
March 2011

Integrated strategy

We will develop a strategic commissioning framework for children's disability services in
Medway across education, health and social care, based on full consultation with
parents/carers, young people, voluntary groups and services, and on joint strategic
needs analysis.

We will strengthen joint commissioning of children's disability services within the context
of the new strategic commissioning framework, and also of the government's proposals
for the future of the NHS in which local authorities will be asked to promote the joining up
of local NHS services, social care and health improvement.

An important aspect of joint commissioning will be making best use of resources and
capital infrastructure including buildings, across all the agencies and achieving value for
money. Pooled budgets will be developed as appropriate.

Interagency governance

We will review our performance management systems to ensure that these can give a
clear view of our achievement across the partnership against objectives.

Within the Children's Trust structure, we propose the establishment of a new Board for
Disabled Children to succeed the existing Aiming High for Disabled Children Partnership
Board, the work of which has largely been focused around the commissioning of short
breaks and transition processes.




                                    




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Strategic review of children’s disability services in Medway:                                            DRAFT
March 2011



SECTION ONE : INTRODUCTION

Introduction

1.1     This review has been commissioned jointly by Medway Council and NHS
        Medway (Medway Primary Care Trust – ‘the PCT’) working under the aegis of the
        Medway Aiming High Strategic Partnership Group of the Medway Children’s
        Trust.

1.2     The range of services and facilities currently funded by the PCT and the Council
        to support disabled children in Medway is reviewed, and a strategic framework is
        proposed in which to make effective commissioning decisions for the future.

1.3     The Review was carried out between 10 December 2010 and the end of January
        2011 by Richard Barker, an independent consultant. The terms of reference of
        the review are set out in Annex A.

1.4     The term ‘disability’ is used throughout this document. The Equality Act 2010
        defines a disabled person as someone who has:

        ‘a physical or mental impairment which has a substantial and long term adverse
        effect on his or her ability to carry out day to day activities.’

1.5     The Equality Act definition applies to a wide range of impairments, including
        those which may sometimes be ‘hidden’ such as Attention Deficit Hyperactivity
        Disorder (ADHD), dyslexia, autism and speech and language impairment. These
        impairments may result in a disability if they have a substantial and long term
        impact on carrying out daily activities. The term ‘disability’ includes ‘Learning
        Difficulties and Disabilities’.

1.6     Estimates of the proportion of children with a disability vary, some research
        suggests that around 6% to 7% children are disabled.1 There is a significant
        overlap between disabled children and those with SEN; research suggests that
        around three quarters of disabled children also have SEN2.


1.7     The relationship of the disability and SEN populations to the total population of
        children and young people is illustrated in Figure A below.




1
  Read, J. (2007) Can we count them? Disabled children and their households: full research report ESRC
End of Award report RES-000-22-1725. ESRC, quoted in the SEN and Disability Green Paper, March
2011.
2
  Porter et al: Disability data collection for children's services. DCSF Research Report DCSF-RR 062.
University of Bath, University of Bristol, quoted in the SEN and Dsability Green Paper


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Strategic review of children’s disability services in Medway:                          DRAFT
March 2011
                                        Figure 1

  Illustration of the relationship between children with SEN, Disabilities, and all
                                         children




            Note: not to scale




Review methodology

1.8    The focus of the review is primarily on cross-cutting strategic issues, and on a
       small number of specific service issues referred to in the brief. It has not been
       attempted to describe or analyse provision on a service-by-service basis, nor to
       look at universal provision.

1.9    The methodology underpinning the review involved:

              Desktop research of information provided by the LA, the PCT, national
               policy, and national and regional research incorporating some models of
               good practice
              Semi-structured interviews with 35 key stakeholders and managers
               across core targeted and specialist services provided by the LA and the
               NHS (see Annex A for list).
              Workshop with voluntary/third sector providers of short breaks for
               disabled children in Medway.

1.10   Feedback from children and parents has been obtained from a number of
       sources, including the Medway Parents and Carers Forum, the Medway Aiming



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Strategic review of children’s disability services in Medway:                      DRAFT
March 2011
       High Strategy for Disabled Children (2009), and the draft Medway Every Child
       Matters Needs Assessment (November 2010).

Declarations of interest

1.11   At the time of undertaking the review, the author also had the following work
       interests:
            Commissioning Manager for Aiming High for Disabled Children, Medway
               Council (including short breaks and transition planning)
            Occasional freelance Strategic support to Abbey Court Special School
            14-19 Coordinator, Rochester and Walderslade Partnership of Schools




                                   




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Strategic review of children’s disability services in Medway:                                         DRAFT
March 2011



SECTION TWO : POLICY AND STATUTORY CONTEXT

2.1     This section outlines the key national and local policy drivers, key national best
        practice evidence, and statutory and legal rights and duties.

National policy context

2.2     Programmes such as Aiming High for Disabled Children3 have significantly raised
        expectations of disabled children and young people and their parents, both in
        respect of the services which they can access, and in what can be achieved by
        children and young people themselves. However, it is clear from the evidence
        submitted to the Government in the preparation of the Green Paper on SEN and
        Disability4 that the aspirations of disabled children and young people and their
        parents are not being met.

2.3     The Government’s proposals for change to services for children and young
        people with disabilities are wide ranging. Parents will be given more control, with
        the option of a personal budget by 2014 and strengthened choice of school
        place; an integrated assessment process for each young person leading to an
        Education, Health and Care Plan, transference of power to professionals on the
        front line and to local communities, and more transparency in the provision of
        services.

2.4     These are part of a wider set of major reforms at every level, to the education
        system and to the NHS, including GP Commissioning and Local Authorities
        promoting the integration of local NHS services, social care and health
        improvement. All this is taking place at a time of severe constraint on public
        sector finances.

2.5     In the Green Paper the Government sets out its vision for future entitlement and
        services for children and young people with special educational needs and
        disability. The proposals include:

                    A new single assessment process and ‘Education, Health and Care
                     Plan’ by 2014 to replace the statutory SEN assessment and
                     statement, bringing together support for children and their families
                     across education, health and social care. The new plan will provide
                     the same statutory protection to parents as a statement of SEN.
                    The practice of over-identification is tackled by replacing the current
                     SEN identification levels of School Action and School Action Plus with
                     a new single school-based SEN category for children whose needs
                     exceed what is normally available in schools


3
 Aiming high for disabled children, better support for families, HM Treasury and DfES May 2007
4
 Support and aspiration: A new approach to special educational needs and disability, DFE March 2011
http://www.education.gov.uk/publications/standard/publicationDetail/Page1/CM%208027


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Strategic review of children’s disability services in Medway:                                  DRAFT
March 2011
                      LAs and other services will set out a local offer of all services
                       available to support children who are disabled or who have SEN
                      there are a number of measures to give parents more control over
                       support their child and family, including the option of a personal
                       budget by 2014 for all families with children with a statement of SEN
                       or a new "Education, Health and Care Plan". There will be trained key
                       workers to help families navigate different services.
                      Parents will have a clear choice of school, either a mainstream or
                       special school. The Government has announced its intention to
                       remove the bias towards inclusion and to improve the range and
                       diversity of schools from which parents can choose.
                      High quality early identification and intervention for all children where
                       they need it, such as the health and development review for children
                       aged between 2 21/2 years, as well as effective integrated support for
                       children with the most complex needs.
                      Improved arrangements for transition to adulthood, including
                       information advice and guidance; access to better quality vocational
                       and work-related learning options post 16, good opportunities and
                       support to secure and retain employment, and a well coordinated
                       transition from children’s to adult health services.
                      Among proposals to support multiagency working, will be developing
                       stronger local strategic planning and commissioning arrangements,
                       local authorities and local health services playing a pivotal role in
                       ensuring that children and young people with SEN or who are
                       disabled receive high-quality support
                      frontline professionals will be given more freedom to work together to
                       develop better services for children and young people and families
                      the way in which services for children and young people with SEN or
                       who are disabled are funded will facilitate integrated and collaborative
                       approaches by local professionals, be more transparent to parents
                       and secure better value for money
                      the government will work with the health sector and with the new
                       Health and Well-Being Boards to consider how the needs of children
                       and young people with SEN or who are disabled can best be taken
                       into account through the Joint Strategic Needs Assessment, joint
                       health and well-being strategies, guidelines and standards from the
                       National Institute for Health and Clinical Excellence and health
                       service outcomes frameworks.

2.6       The last Government undertook a major review of services for disabled children
          in 20065, which led to the report and associated initiative ‘Aiming High for
          Disabled Children.6 Aiming High for Disabled Children (AHDC) focused on three
          priority areas to improve outcomes for disabled children:




5
    The Disabled Children’s Review, 2006




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Strategic review of children’s disability services in Medway:                                                DRAFT
March 2011
                    Access and empowerment through setting a clear ‘core offer’, and give
                     disabled children and their parents the option to be fully involved in
                     local service development
                    Promoting more responsive services and timely support, including in
                     the areas of benchmarking and evaluation of good practice, support for
                     disabled children aged 0-5, and for transition support into adulthood
                    Improving quality and capacity of local services through investment in
                     short breaks7, accessible childcare, community equipment and
                     wheelchairs, and workforce development.

2.7     Three years of funding were provided to implement the AHDC programme,
        ending in 2010-11.

2.8     in 2004 the Government published the long-term strategy for Special Educational
        Needs (including most disabled children) "Removing Barriers to Achievement8"
        which included action to improve SEN provision in mainstream schools and to
        encourage joint working between mainstream special schools.

2.9     The 2008 Children's palliative care strategy9 highlighted the needs of children
        with life limiting or life threatening conditions, most of whom are disabled, and
        some children with disability have palliative care needs.

2.10    The Government also introduced or strengthened underpinning legislation,
        including:
              the Children Act 1989, under which disabled children are defined as
                "Children in Need";
              the Disability Equality Duty, 2005 which required organisations across the
                public sector (including schools and hospitals, local and central
                Government) to be proactive in ensuring that disabled people are treated
                fairly and are included in all aspects of policy development from the
                outset: and
              the Childcare Act 2006 which requires Local Authorities to have particular
                regard to the needs of disabled children as part of their duty to assess the
                childcare needs of families and to secure sufficient childcare to children
                up to and including age 14 (18 for disabled children).

2.11    In the field of health, the National Service Framework for Children, Young People
        and Maternity Services set standards in children's health, and social care
        services health support. There were specific standards to address the
        requirements of children and young people who are disabled and/or have
        complex health needs and their families (standard 8) and to address the needs of
        children and young people who are ill (standard 6).

7
  Short breaks can be defined as opportunities for disabled children and young people to spend time away
from their primary carers. These include day, evening, overnight and weekend activities that take place in
the child's own home; home of approved carer, residential or community setting. The term ‘short breaks’ is
used in preference to respite because of the negative connotations of respite and the importance of
emphasising the positive opportunity both for young people and their families.
8
  removing barriers to achievement: the government strategy for SEN, Department for It and Schools,
Every 2004
9
  Better Care, Better Lives, DoH 2008

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Strategic review of children’s disability services in Medway:                                              DRAFT
March 2011

2.12    The Child Health Strategy 200910 contained a number of measures to improve
        the health of children with disabilities including:

               Children with ongoing acute or additional health needs should have
                services organised around an individual care plan;
               the joint commissioning framework for children's health services
               introducing a national framework for assessing children's continuing
                care11
               Children's Trust partners to work together to provide information on the
                local offer

2.13    The NHS Operating Framework 2010-1112 reiterated the existing commitment for
        all patients who needed it to have access to a comprehensive child and
        adolescent mental health service, including 24-hour cover and appropriate
        services for 16 and 17-year-olds, and appropriate services for children and young
        people with learning disabilities.


Key national best practice

2.14    National evidence of best practice on services for children with disabilities has
        been identified by the Centre for Excellence in Outcomes in Children and Young
        People's Services (C4EO) from literature reviews and examples of validated
        clinical practice in contributions from service managers, children, young people,
        and parents and carers.13

2.15    Involving children, young people and families: parents know more about their
        children than anyone else so it is important to involve them as key partners in
        understanding what will help them and their child most. Take-up and satisfaction
        levels are improved through consultation with disabled children and young people
        on access to the quality of, and the extent of inclusivity of, activities. Decisions
        about the most appropriate setting should be informed by what disabled children
        and families feel is best for them, with the opportunity to participate in both
        mainstream and separate activities.

2.16    Service structure: early intervention helps improve the emotional health and well-
        being of parents, and promote better family relationships. Families of young
        disabled children who have a consistent key worker will usually experience better
        relationships with services, quicker access to benefits and reduced stress. Early
        years services should particularly consider the needs of the whole family, and
        these services should be delivered in homely, non-clinical surroundings, through
        a seamless and integrated inter-agency process. The most effective services are

10
   Healthy Lives, Brighter Futures: Department Of Health February 2009
11
   Children's continuing care is a general term that describes a package of care needed over an extended
time through complex health care needs that arise because of disability, accident or illness.
12
   Department of Health December 2010
13
   C4EO June 2010 http://www.c4eo.org.uk/themes/disabledchildren/


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Strategic review of children’s disability services in Medway:                           DRAFT
March 2011
       those that are well planned and structured, and continue for long enough and
       intensely enough for families to gain the benefits.

2.17   Value for money: implement programmes that result in positive outcomes, and
       exercise caution about large-scale investment in new interventions unless there
       is clear evidence of proved outcomes. High quality pre-school education for
       disabled children helps to reduce the numbers with an SEN diagnosis in primary
       school.

2.18   Delivering services: services respond flexibly to whole-family assessments, and
       while specialist services may be required, mainstream services should also be
       able to offer a differentiated approach when needed. Sensitivity to cultural needs
       is required and services should include the needs of mothers, fathers and carers
       as well as children. All staff are trained in inclusive approaches.

2.19   Auditing and monitoring service delivery: as part of an overall strategy, take-up
       and access to services by disabled children and teenagers in services such as
       preschool activities, and leisure, sport, arts and cultural services is monitored.
       Service providers should are encouraged to evaluate their range of activities for
       inclusiveness and accessibility.

2.20   The former Department for Children, Schools and Families suggested (2008) that
       success in achieving improved outcomes for children is best secured through
       improved integrated frontline delivery, processes, strategy and governance.
       C4EO noted in their literature review that the need for whole, rather than partial
       and ad hoc system change was seen in the strategic and policy documents
       reviewed, and that this can only be achieved by coordinated action within and
       between domains as illustrated in figure 2 below.

                                      Figure 2
                                Whole System Change




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Strategic review of children’s disability services in Medway:                               DRAFT
March 2011




Local Policy Context

2.21   The Medway Sustainable Communities Strategy 2010-26 has a commitment to
       support people with disabilities (particularly learning disabilities) to gain
       employment, but makes no mention of children with disabilities.

2.22   The Medway Children and Young People’s Plan 2009-11 includes a focus on
       improving the life chances and outcomes of children with disabilities and children
       with special educational needs. The Plan contains commitments to offer a
       differentiated Connexions service to young people with learning
       difficulties/disabilities, and importantly, ensure that children with disabilities are
       supported through an increase in availability of short breaks, closer to home, and
       other opportunities which provide support to their families. There is also a
       commitment to improve the reach and effectiveness of child and adolescent
       mental health services.

2.23   The Medway Special Educational Needs Policy and Strategy 2009 – 2014,
       developed following extensive review and consultation, aims to enable provision
       within Medway to become more flexible and responsive to the needs of children
       and young people, with better identification so they are appropriately placed, with
       the possibility of moving back into mainstream from special provision. Among
       other key commitments are the establishment of             additionally resourced
       mainstream provisions within primary and secondary schools who will take
       children who learn within a mainstream setting at a significantly slower rate than
       their peer group. The Strategy also tackles the high level of out-area placements
       from Medway. The Strategy outlines priorities for special schools.


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Strategic review of children’s disability services in Medway:                                                   DRAFT
March 2011
2.24     The SEN Strategy includes detailed action plans around the following objectives:

              1. Developing additional SEN provision within mainstream schools
              2. Strengthening outreach from special schools and other specialist
                 provision into mainstream schools
              3. Strengthening prevention and intervention
              4. Increasing parental confidence through helping them to better understand
                 SEN processes and provision
              5. Achieving a shift in financial spend enabling appropriate funding levels for
                 complex students in mainstream and specialist provision.

2.25    The needs and provision for children and young people with Statements of
        Special Educational Needs are reviewed through the Annual Review process. All
        schools and other educational provision, including Academies and independent
        provisions, have now been asked to complete new Annual Review paperwork
        with effect from September 2010. The new paperwork allows for in depth review
        of pupil needs and move back to mainstream provision from specialist provision
        where appropriate.

2.26    The LA has also agreed to sign up to the NHS Continuing Care guidance and
        consider cases for continuing care jointly.

2.27    The PCT Strategic Commissioning Plan 2010-15 has actions in relation to taking
        forward the Medway CAMHS strategy 2009; the redesign of the Child
        Development Centre service to ensure clear pathways and range of services to
        meet the needs of children and families, and working closely with partners to
        ensure that people with complex disabilities enjoy a smooth transition from
        children's to adult services. It is also plannned to improve the service model for
        children's audiology to ensure children are seen within timescales, and to provide
        more focused and dedicated respite care for children with disabilities to enable
        carers to have a break from caring in a timely and effective way. 14

Legal duties in relation to children with disabilities15

2.28    Legal duties (as opposed to powers) set out mandatory requirements upon local
        authorities or other public bodies. There are two classes of duties: "specific"
        duties which are those to individuals and will be enforced by the Courts, and
        "general" or "target" duties which are owed to classes of people (e.g. all children
        in need) and are statutory.

        Individual duties

2.29    The individual duties in relation to children with disabilities include:



14
   NHS Medway Strategic Commissioning Plan 2010-15
 http://www.medwaypct.nhs.uk/explore-nhs-medway/about/our-priorities/
15
   This section on legal duties draws heavily on ‘Cemented to the floor by law’: Respecting legal duties in a
time of cuts. Steve Broach, Barrister, Doughty Street Chambers November 2010 (Council for Disabled
Children website: http://www.ncb.org.uk/cdc/resources.aspx )

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Strategic review of children’s disability services in Medway:                             DRAFT
March 2011
            the duty to arrange the provisions specified in a child's Statement of
             SEN (S324(5) (a) (i) Education Act 1996)
            the duty to provide suitable education for children who may be without
             such education for any period (S19 (1) Education Act 1996)
            The duty to assess a child's need for "social care" services and, where
             necessary, provide services to meet assessed needs (S17 Children Act
             1989 S2 Chronically Sick and Disabled Persons Act 1970);
            the duty to accommodate children whose parents are "prevented" from
             providing them with suitable accommodation and care (S20(1) Children
             Act 1989); and
            the duty to respect disabled children's right to family and private life under
             Article 8, European Court of Human Rights (ECHR)

       Education duties

2.30   There are two primary domestic law duties which guarantee the right to education
       for disabled children:

            There is an absolute duty on a local authority to arrange the provision for
             a child described in a Statement of Special Educational Needs, and courts
             have emphasised that there is no "best endeavours" defence in the
             legislation
            Section 19 of the Education Act 1996 requires Local Authorities to make
             arrangements for the provision of "suitable education at school or
             otherwise" who are outside education. The Act defines "suitable" as
             meaning "suitable to his age, ability and and aptitude and to any special
             educational needs he may have". This again is an absolute duty.

       The Children Act and Related Duties

2.31   All disabled children are children "in need" under Section 17 of the Children Act
       1989. As such, they are eligible for support under the general duty on local
       authorities under section 17 to safeguard and promote the welfare of children in
       need in the area through providing a wide range of services.

2.32   The mechanism for determining whether a local authority is obliged to provide
       social care services to an individual disabled child is an assessment. There is
       extensive statutory guidance on the form of this assessment issued under section
       7 of the Local Authority Social Services Act 1970 ("Section 7" Guidance). Once
       an authority has made a judgement through careful assessment that a child does
       need support, that support must be provided, and there is no discretion not to
       provide services once such a judgement has been made.

2.33   Until recently, there was no duty on local authorities to provide short breaks.
       However, the Children and Young Persons Act 2008 has altered Schedule 2 of
       the 1989 Children Act to make short break provision a statutory requirement. The
       new legal provision makes clear that breaks should not just be provided to those
       carers struggling to make maintain their caring role, but also to those for whom a
       break would improve the quality of the care they can offer.



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Strategic review of children’s disability services in Medway:                                                   DRAFT
March 2011
2.34    The new duty will come into effect in April 2011, and will be supported by
        regulations and guidance to the regulations. Local authorities will be required to
        prepare a statement for carers (by October 2011) on what services will be
        available in local areas and by what criteria they will be accessed.

Eligibility criteria and ‘personalisation’

2.35    Case law16 establishes that eligibility criteria are lawful, so long as they (i) only
        limit the pool of children who are eligible for provision, not the amount of
        provision to be made to eligible children, (ii) do not prescribe a fixed maximum
        amount of support (iii) are applied after (not instead of) a lawful assessment of
        needs and (iv) are set with due regard to the disability equality duty.

2.36    Case law17 makes clear that while Resource Allocation Systems (RAS) schemes
        may be used as a "starting point" to give an indication of the level of funding
        which may be required, they cannot dispense with the local authority's "absolute
        duty" to meet assessed needs through services or direct payments.

                  Health

2.37     There are important general duties on PCTs to:

         (a) ensure that the views of disabled children and their families inform the
         planning and provision of health services (S242 NHS Act 2006)

         (b) cooperate with local authorities to "secure and advance" the health of
         disabled children (S82 NHS Act 2006)

         (c) Cooperate with local authorities and others to "safeguard and promote" the
         welfare of disabled children (S10 Children Act 2004)

2.38    The fundamental duties of the Secretary Of State under sections 1 and 3 of the
        NHS Act 2006 to secure the provision of a "comprehensive" NHS are (currently)
        delegated to PCTs. This duty includes securing the provision of "after-care"
        services for disabled children, which would encompass all the therapeutic and
        other health services disabled children may need.

2.39    Where a PCT accepts (following assessment) that it is necessary to provide
        services to disabled child, it will have a duty to do so under sections 1 and 3 of
        the NHS Act 2006. This will include provision of therapy, child and adolescent
        mental health services, palliative care services for children with life limiting
        conditions, and equipment services, including wheelchairs. As with local
        authorities, once the PCT has exercised its judgement and found that a particular
        service or support is necessary, it would be unlawful for the PCT then not to
        provide it.



16
   R (JL) v Islington in relation to s2 of the Chronically Sick and Disabled Persons Act 1970 and s 17 of the
Children’s Act 1989
17
   Court of Appeal R (Savva) v Kensington and Chelsea

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Strategic review of children’s disability services in Medway:                             DRAFT
March 2011
2.40   Where a child has a "primary" health need, the PCT may need to take lead
       responsibility for the child's care package and may have the duty to provide any
       "short break" care the child requires. A child with a "primary" health need will be
       eligible for "children's continuing care". The process for determining whether a
       disabled child is eligible for continuing care is set out in the National Continuing
       Care Framework and accompanying Decision Support Tool. The continuing care
       pathway established by the National Framework requires three phases to be
       followed – assessment, decision-making and arrangement of provision, and the
       PCT must follow this.

                      Wider obligations

2.41   In addition to the duties described above, there are wider obligations on public
       bodies taking decisions about the future of services for disabled children in
       relation to adequate consultation; the obligations of the Disability Discrimination
       Act (DDA), the general disability equality duty and the duty to safeguard and
       promote the welfare of children established by S11 of the Children Act 2004.




                                    




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Strategic review of children’s disability services in Medway:                                               DRAFT
March 2011


SECTION THREE : IDENTIFIED NEEDS

3.1        It has been noted in a number of national reviews that data about the extent of
           children’s disability are generally insufficient and partial. This is also the case in
           Medway, a situation which this review recommends should be remedied. There
           are however good data about SEN, and although the SEN and disability
           populations are different, as noted in Section 1, the opportunity has been taken
           here to analyse a number of SEN factors in this section and in Annex C which
           can throw some light on disability.

           Disability and deprivation

3.2        It is clear that families with disabled children have higher levels of other
           difficulties:
                  significantly more disabled children are being identified with learning
                     difficulties because of binge drinking in pregnancy: Professor Barry
                     Carpenter18 estimates a 25% increase in children born with learning
                     difficulties in the last 5 years
                  10% of families with a disabled child have more than one disabled child
                  34% of disabled children live in households where there is no adult in paid
                     work compared with 18% of children who are not disabled.
                  32% of disabled children live in single parent families. More live in
                     overcrowded accommodation and have parents who are in poor health
                     themselves.

3.3        The proportion of working age population claiming benefits gives a partial
           indication of deprivation levels, and Table 1 below indicates that the numbers
           claiming Disability Living Allowance (DLA) and associated benefits are higher in
           Medway than the South East and national averages.

                                                Table 1

                                   Medway                 Medway            South
                                                                                        Great Britain
                                    Towns                  Towns             East
                                                                                            (%)
                                  (numbers)                 (%)              (%)
Total claimants                25,100               14.9                 10.7           14.7
By statistical group
Job seekers                    6,430                3.8                  2.4            3.5
ESA and incapacity benefits    9,720                5.8                  4.6            6.7
Lone parents                   3,440                2.1                  1.3            1.7
Carers                         2,180                1.3                  0.8            1.1
Others on income related
                               910                  0.5                  0.4            0.5
benefits
Disabled                       2,010                1.2                  0.9            1.0
Bereaved                       410                  0.2                  0.2            0.2


18
  Professor Barry Carpenter is Associate Director (Special Educational Needs) with the Specialist Schools
and Academies Trust

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Strategic review of children’s disability services in Medway:                                               DRAFT
March 2011
Key out-of-work benefits†         20,500             12.2                8.7           12.4
Source: NOMIS DWP benefit claimants - working age client group 2010 data

     Key out-of-work benefits includes the groups: job seekers, ESA and incapacity benefits, lone parents
†
     and others on income related benefits. See the Definitions and Explanations below for details
Note:% is a proportion of resident population of area aged 16-64



3.4        Figures 3 and 4 in Annex C demonstrate mapping against areas of deprivation
           for children at School Action Plus and with Statements, against the Income
           Deprivation Affecting Children Index (IDACI). These maps suggest that there is a
           link between levels of SEN and deprivation. It is noticeable that there are clusters
           of children at School Action Plus and Statement level in the most deprived wards,
           including Chatham Central, Luton and Wayfield, Gillingham North, Gillingham
           South and Strood North. Figures 5 and 6 in Annex C confirm that children with
           Statements (and School Action/Plus) in Medway as a whole are skewed towards
           the more deprived income groups.

           Referrals to the Disabled Children’s Team

3.5        In 2009, 244 referrals of children with disabilities were made to the Medway
           Disabled Children’s Team, with the proportions of disability types shown in table
           2 below.

                                               Table 2
                                      Most prevalent disabilities19

                                        Disability
                    Autistic Spectrum Disorder                             53%
                    Downs Syndrome                                         3%
                    Epilepsy                                               7%
                    Learning Disability                                    7%
                    Physical Disability                                    14.4%
                    Sensory Difficulties                                   0.3%
                    Speech and Language                                    4%
                    Others                                                 11.3%
                    Total                                                  100%

3.6        72% of referrals were of boys and 28% girls. In terms of ethnicity, 71% were
           white British, and 28% others. Most referrals were from parents/carers (72%) and
           the remainder from professionals.Further information is given in Annex D.


           Special Educational Needs data

3.7        Nationally, the proportion of pupils with statements of SEN has remained
           relatively stable over time, but there has been a considerable increase in the
           number of pupils with SEN without statements, from 10% in 1995 to 18.2% in


19
     Note: some children had multiple disabilities

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Strategic review of children’s disability services in Medway:                                         DRAFT
March 2011
        2010.20 In Medway, the proportion of pupils with statements has also remained
        relatively stable, although at a higher rate than for England. The Medway rate is
        however similar to that of most of our ‘statistical neighbour’ authorities.

                                       Table 321
        Proportion of Pupils with Statements - Medway/England Comparison

             Year            Medway:          Medway %              England %
                            number of
                            Statements
                2006           1,333               3.0                   2.9
                2007           1,299               2.9                   2.8
                2008           1,301               2.9                   2.8
                2009           1,292               2.9                   2.7
                2010           1,331               3.1                   2.7


3.8     In recent years, the proportion of all pupils with SEN (ie School Action, School
        Action Plus and Statements) in Medway schools has also remained relatively
        stable.




                                         Table 422
                    Proportion of Pupils with SEN in Medway Schools

                                 Year           Total SEN (%)
                                 2007                27.2
                                 2008                27.7
                                 2009                27.3
                                 2010                26.1


3.9     Within the total numbers of pupils with SEN, the number of Medway pupils with
        Autistic Spectrum Disorder (ASD) has increased dramatically from 284 in 2004,
        to 952 in 2010, as indicated in Chart 4 in Annex C. There have also been large
        increases in numbers of children with ASD nationally (Chart 5 in Annex C).

3.10    It is understood that the Medway NHS Foundation Trust in 2008 has reviewed
        the assessment process for ASD and the criteria for making diagnoses. A multi-


20
   SEN and Disability Green Paper March 2011
21
   Source: National Pupil Database, SFR June 2010, via Medway Management Information Team. Includes
information from all state funded schools, including Academies.
22
   Source: Medway School Census, from Medway Management Information Team. Strood Academy
included in 2007-09 as Chapter and Temple; no data for Strood Academy for 2010.

                                                16
Strategic review of children’s disability services in Medway:                                        DRAFT
March 2011
        disciplinary process has been piloted in one area, and is now being applied
        across Medway.

3.11    There are many more boys than girls with SEN in Medway. Chart 3 Annex C
        indicates that boys outnumber girls significantly at School Action level, and this
        imbalance becomes progressively more marked at School Action Plus and
        Statement levels. This is the same as the national picture.

3.12    In terms of ethnicity, 2.1% of pupils from minority ethnic groups have statements,
        compared with 2.92% of all pupils having statements.23

3.13    In terms of attainment, the attainment gap (ie the percentage difference between
        achievement of all SEN pupils against pupils with no SEN) for Medway was
        slightly better (50.8%) than the national average of 50.9% for pupils achieving
        Level 4 or above in both English and Mathematics (2009 figures). This
        represented a percentage point improvement over 2008.
3.14    Tables 11, 12, and 13 in Annex C indicate levels of primary need type in Medway
        schools compared with national (and statistical neighbour) levels. It will be noted
        that Medway has a strikingly different pattern of need type than the national
        average, as illustrated in Chart 1 below. It needs to be borne in mind however
        that the classification of need type depends on judgement, and therefore
        differences in patterns may also reflect this.


                                         Chart 124
                          SEN Need types in Medway schools, 2010




23
  Source: Medway School Census for 2010, from Medway Management Information Team
24
  See table 10, Annex C for source data. Relates to School Action Plus and Statement levels, 2010.
*SLD/PMLD =Severe Learning Difficultes/Profound and Multiple Learning Difficulties.

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Strategic review of children’s disability services in Medway:                                               DRAFT
March 2011


3.15    Speech and language difficulties have a higher incidence in Medway compared
        with England (20.60%/16.28%) and the incidence of Autistic Spectrum Disorder
        (ASD) is much higher at 13.59%/8.08%. On the other hand, three need types
        have a significantly lower incidence in Medway – Specific Learning Difficulties25
        (8.15% for Medway compared with 11.43% for England): Moderate Learning
        Difficulties (17.39%/24.2%) and Severe Learning Difficulties/Profound and
        Multiple Learning Difficulties (3.67%/5.49%).

3.16    The percentage of Moderate Learning Difficulty (MLD) children in Medway
        special schools is, at 54.7%, more than twice the England average, a mirror
        image of the position in mainstream schools, where it is about half of the England
        average (Chart 6, Annex C). However the meaning of this is unclear, given that
        MLD schools in Medway now admit pupils with increasingly complex needs.
        Under the Medway SEN Strategy the designation of special schools is kept under
        review.




                     Mental health

3.17    The Medway CAMHS Needs Assessment26 estimated the prevalence of specific
        conditions using national data from 2004 adjusted to Medway using 2009
        Medway population data - see table 5 below.

                                       Table 5
              Estimated prevalence of mental health conditions in Medway

                            Disorder                          5-10 year        11-16           Totals
                                                                 olds        year olds
        Anxiety disorders                                    469             980             1450
        Depression                                           52              322             375
        Conduct disorders                                    1012            1481            2493
        Hyperkinetic disorder27                              323             317             640
        Less common disorders                     (including 271             303             574
        Autism)
        Any disorder (note: figures are not the sum of 1,596                 2,564           4,149
        the disorders referred to in the table)


25
   For example dyslexia
26
   Medway CAMHS Needs Assessment 2009
http://www.medwaychildrenstrust.co.uk/documents/medway-child-and-adolescent-mental-health-services-
needs-assessment-2009-1290681023.pdf
27
   It is not necessarily accepted by all professionals that ADHD/hyperkinetic disorder is a mental health
disorder, rather than a behavioural difficulty.

                                                      18
Strategic review of children’s disability services in Medway:                     DRAFT
March 2011

                 Young People Not in Education, Employment or Training (NEET)


3.18   The seasonally adjusted Medway figure for young people NEET was 5.8% of the
       total population of the same age range, as at January 2011. Of these, 19.74%
       had Learning Difficulties and Disabilities.




                                   




                                           19
Strategic review of children’s disability services in Medway:                           DRAFT
March 2011


      SECTION FOUR : SUPPORT FOR DISABLED CHILDREN AND THEIR
                             FAMILIES

Introduction

4.1    This section gives an overview of the range of services for children with
       disabilities, focusing on targeted and specialist services. Not every relevant
       service is referred to individually. Links with other services are dealt with
       throughout the section. The sub headings of this section are as follows:

              Education
              Social care
              Health
              Early years

Education

4.2    At the time of writing, the LA Special Educational Needs Policy and Strategy has
       been in place for a year, and is well regarded, setting a clear direction both for
       universal and specialist provision in relation to SEN. This review has been
       undertaken within the context of the Strategy and action plan monitoring, and the
       review does not seek to replicate the treatment of issues already being dealt with
       as part of the Strategy.

4.3     A key area which will determine the success or otherwise of the strategy is the
       quality of provision for special educational needs within mainstream schools, and
       the level of support to mainstream schools in meeting special education needs.
       Medway does not retain statemented support funding, and therefore schools
       have the budget to meet the needs of children with SEN on their school roll,
       whether at School Action, School Action Plus or Statemented Levels.

4.4    In order to understand mainstream schools’ processes in relation to special
       educational needs, the LA undertook a ‘Deep Dive’ exercise in 2010, which
       included interviews in schools with key staff; focus groups of special educational
       needs coordinators (SENCOs) and focus groups with parents of children with
       statements.

4.5    The deep dive exercise found that there is confusion in schools about the
       purpose in identifying a child with SEN, and that too often it served to identify
       vulnerability and flag disadvantage or identify children who are underachieving or
       who are low achievers. Across all provisions there was a clear belief that
       identification would enable a child to receive the provision needed. This then led
       to a position where schools’ SEN registers had expanded to include a wide range
       of vulnerable groups and the monitoring and reviewing requirements of the SEN
       Code of Practice became overwhelming and diluted thereby reducing the impact.




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Strategic review of children’s disability services in Medway:                                   DRAFT
March 2011
4.6        Specialist places for children with Statements in Medway, and numbers of places
           purchased from each, are set out in table 9, Annex C.

4.7        In terms of levels of Statements made, Medway is above the national average
           (3.1% compared with 2.7% nationally). However, of the 10 statistical neighbour
           authorities, only three are significantly below those of Medway. A number of
           statistical neighbour authorities are significantly higher in Statemented levels.

4.8        The purchase of places in special schools and units (see table 11, Annex C) is
           currently undertaken on an annual basis. SEN managers are in the process of
           introducing a medium term planning mechanism, supported by better forecast
           demand figures, and more detailed assessments of accommodation capacity.
           Ways of achieving a better feed-through of information on children with higher-
           level needs from early years and health services, in order to provide an improved
           forecasting model, are being explored.

4.9        A key aim of the SEN strategy is the control of expenditure on independent non-
           maintained and tuition placements, which in February 2009 was estimated at
           £5.6 million28, and has been rising sharply in recent years. It is reported that there
           has been success over the last year in controlling out-area placements, not least
           through ensuring a robust defence in SEN tribunal discussions, but that the
           overall cost of placements will continue to rise for some time owing to the
           numbers already approved. Where a pupil already attends an independent/out of
           county placement, the LA seeks to bring them back into maintained provision
           where appropriate, usually at phase transfer.


4.10       There are good working relationships between SEN managers and their social
           care counterparts, but the relationship with health commissioners has been
           weaker. This is exemplified by the difficulties experienced with the tripartite group
           looking at the highest need complex placements (Joint Service Provision Group),
           where it has been difficult to engage with PCT representatives, and there has
           been a lack of common ground on health funding for these cases and in relation
           to the basis of operations of the Continuing Care Group. The work of the Joint
           Operational Group (JOG) which identifies local alternatives to making placements
           outside Medway for their health, social or educational needs, is also severely
           hampered because of the lack of a PCT representative.

4.11       Following the publication of a national framework and decision making tool on
           Continuing Care for children and young people29, a Kent and Medway multi-
           agency policy on Children’s Continuing Care is being developed. This is being
           supported by the establishment of Kent and Medway community nursing teams
           to undertake health assessments.

4.12       There is not a specific statutory responsibility linked to the provision of children's
           continuing care packages. However, there are statutory responsibilities placed
           upon PCTs and LAs that enable them to provide children's continuing care

28
     Quoted in Medway SEN Strategy 2009-14
29
     National Framework for Children and Young People’s Continuing Care, DoH 2010.

                                                   21
Strategic review of children’s disability services in Medway:                              DRAFT
March 2011
       packages. The National Framework for Children's Continuing Care places a
       requirement upon Primary Care Trusts to act as the lead agency in
       commissioning the provision of children's continuing care packages, in
       partnership with their coterminous LA.

4.13   There is currently no mechanism for the systematic sharing of data on children
       with disability across education, health and social care. (Although the social care
       Disabled Children's Team do have access to the education SEN database). The
       establishment of a database link, with feed-in from the databases of each of the
       separate agencies would facilitate sharing the information both on individual
       children, and in relation to planning and aggregate level.

4.14   There has been some dissatisfaction among providers in relation to the planning
       and collaboration for post 16 SEN provision, and the LDD Forum, which has
       traditionally been the mechanism for these discussions, has met infrequently in
       recent times. In order to address these issues, and facilitate a closer involvement
       of mainstream providers in planning post 16 SEN opportunities, the LDD Forum
       is being reestablished as a subgroup of the 14-19 Strategy Forum.

4.15   It is recommended:

            that the LA and PCT rapidly take forward existing discussions at senior
              management level, with a view to developing an agreed funding protocol
              and decision making arrangements for high need complex cases where
              there are multi-agency responsibilities in line with the national continuing
              care guidance for children and young people
            That a database link be established, so that information about children
              and young people with disabilities can be shared across education,
              health and social care, perhaps along the lines of the multi agency
              transition data link, already under development, in order to help deliver
              personalised support.


Social Care

4.16   Social care services to children with disabilities and their families are provided by
       the Medway Disabled Children's Team, from a small adapted and extended base
       in Gillingham (Parklands). Parklands has a dual role in acting as an
       administrative base, and provides a range of services for children and their
       families including:
            After School Club for severely disabled children
            Saturday Club on 2 days a month for disabled children aged 6-16 years
               with drop ins for the whole family once a month
            Sibs Club called ‘Reflections’, which provides opportunities for non-
               disabled siblings to share their thoughts and feelings
            Youth Club for moderately disabled teenagers (13-18), meeting weekly in
               term time only
            Holiday Play schemes at Easter and Summer for disabled children aged
               6-16 years.


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Strategic review of children’s disability services in Medway:                                                DRAFT
March 2011

4.17     Parklands also provides a range of highly regarded support services for parents
         and carers:

               Daisy Programme: a six week parenting skills training and support
                programme for carers of children under 6 years diagnosed with ASD
               Daisy Plus: a similar programme for carers of ASD children aged 6-12
                years
               Daisy Teens is about to be launched for carers of ASD young people
                aged 13-18 years.
               Dads’ Club for male carers. This is provided one evening a week each
                month.
               Sensory room a free service including free training for parent/carers to
                use for their own children.

4.18    The Disabled Children's Team currently has a caseload of approximate 265, of
        whom 150 are being actively managed by social workers. The other 155 are
        receiving short break and other services. The actively managed cases provides
        for the following need types:
              learning difficulties and disabilities – severe and moderate
              ASD, including Asperger's Syndrome
              physical impairment
              complex medical
              LAC with disabilities

4.19    The LA commissioned in 2010 a report on the services provided by the Disabled
        Children's Team30 which came to the following conclusions in relation to the
        team:
             The team offers a range of high quality services to a relatively small
            number of children with disabilities and their families. It has developed
            services as needs have been identified and resources became available
             well-respected by users and partner agencies; all of its services are at or
            close to capacity
             quality of the casework is good
             at the operational level, relationships between agencies are good, but
            depend on individual relationships rather than at a strategic inter-agency
            level

4.20    The review concluded that in terms of strategy, services for children’s disability
        were not well joined up, and that there was a shortage of short breaks provision
        in all its forms.

4.21    The 2010 report noted that the ground floor accommodation of Parklands was
        not fully used during the day, and this situation persists to some extent, despite
        the managers of the centre making efforts to increase usage.



30
 Highlight report on an "inspection" for service of services for children with disabilities in Medway- Ken
Adams April 2010

                                                    23
Strategic review of children’s disability services in Medway:                            DRAFT
March 2011
4.22   The Disabled Children’s Team is geographically isolated from other
       disability-related services at Parklands. This does not represent modern good
       practice in terms of provision through multi-agency service hubs.

4.23   Personal budgets and direct payments in Medway children’s social care are less
       well developed than in adult social care services. Plans are in process to
       increase rapidly personalised budgets following good practice guidance,
       including full consultation with parents and carers.

              Short breaks provision

4.24   Mainly daytime short breaks in Medway are offered through Parklands, as part of
       its overall service. From a budget currently of £330k, Parklands offers the
       following services:
             a small number of direct payments (currently about 40)
             family-based overnight short breaks offered through a fostering scheme
               and the voluntary "link" scheme (25 children)
             mentoring/befriending scheme for weekend/holiday times where children
               are taken out on a 1:1 basis, and some home sits (about 75 children)
             personal care packages, where carers come in to families (approximately
               17)
             the afternoon and evening groups at Parklands referred to above
             overnight residential short breaks at Aut Even and Preston Skreens (see
               below for numbers)

4.25   The family-based overnight short breaks have reduced in number in recent years,
       partly because of the low remuneration levels for carers. The direct payment
       scheme is under review, and will be increased significantly in future.

4.26   Since 2009, short breaks have also been separately commissioned through the
       Aiming High for Disabled Children (AHDC) commissioning team, funded through
       specific grant under the Government's AHDC initiative, with a budget of
       approximately £1.1m in 2010-11. The AHDC team commissions short breaks
       from a wide range of providers, both voluntary sector and local authority services,
       and they are generally, but not always, for children at lower need levels than
       those dealt with by Parklands. This represents a substantial increase in short
       break provision as demonstrated in Chart 2 below.




                                           24
Strategic review of children’s disability services in Medway:                                       DRAFT
March 2011


                                            Chart 2




4.27   An interim evaluation31 of the Aiming High Short Breaks programme in Medway
       was reported to the Medway Children's Trust Board in October 2010 and the
       main conclusions were that:

           The Aiming high for disabled children funding from the DCSF/DFE has
            enabled a radical enhancement of short breaks provision Medway over the
            last two years
           a postal survey of parents and carers of children and young people
            disabilities has confirmed that they now now find it much easier to access
            short breaks in Medway compared with two years ago
           Messages from children and young people and parents and carers about the
            short breaks programme in Medway are overwhelmingly positive
           The six brief case studies illustrate the powerful impact that short breaks can
            have on children and young people and their families. Several indicate that
            higher-level interventions can be avoided through short breaks with
            consequent substantial financial savings.
           While some of Medway's core offer of short breaks for children and young
            people with disabilities has been achieved, considerable work remains in
            terms of influencing universal services to provide, for example disability-
            friendly extended school/after-school activities.

                Overnight residential short break services

4.28   Overnight residential short breaks are provided by two small residential units –
       Aut Even, within Medway, and Preston Skreens in Minster, Isle of Sheppey,

31
  An Interim Evaluation of the Medway Aiming High Short Breaks Programme, Medway Children’s Trust
Board 20 October 2010
http://www.google.co.uk/search?source=ig&hl=en&rlz=&q=evaluation+of+short+breaks+in+medway&aq
=f&aqi=&aql=&oq=


                                               25
Strategic review of children’s disability services in Medway:                              DRAFT
March 2011
       which is a joint provision with Eastern and Coastal Kent PCT. Admission to the
       units is through the Residential Allocation Panel (RAP) with the heads of the two
       units together with the DCT manager and health representation. The Panel
       consider recommendations which have had an Initial Assessment. All referrals
       are level 4 and usually have complex needs. The needs of the family as well as
       the child are taken into account. Preston Skreens has traditionally taken the more
       high-level medical complex medical cases, but both provisions are capable of
       this.

4.29   Aut Even occupies a former police house in Twydall and has a 5 bed capacity,
       with 46 young people provided for on a regular basis. At the time of the review
       individual children and young people received five nights of respite care every 12
       weeks equating to approximately 20 nights annually. Aut Even is funded jointly by
       the PCT and LA, with the Foundation Trust providing the nursing staff with the
       PCT funding. Currently the unit is only open five nights a week owing to non-
       replacement of staff by the Foundation Trust, for budgetary reasons. Referrals to
       Aut Even have reduced recently, and the unit has some spare capacity. Partly
       because of the underuse of the unit, the cost per bed night is high –
       approximately £450.

4.30   Preston Skreens is a seven-bedded unit located in Minster, Sheppey,
       approximately 16 miles from Chatham. The unit is operated by the Medway
       Foundation Trust and is jointly funded by Medway PCT and Eastern and Coastal
       Kent PCT. Currently there are approximately 32 young people from Medway on
       the books and 23 from Swale. Each child/young person receives approximately
       40 nights of respite care annually. Numbers of referrals from Medway have fallen
       in the last two years as Medway has increased its use of Aut Even. There is no
       waiting list. The distance from Medway makes it difficult to offer "local" activities
       to Medway children. The premises are not ideal, with a somewhat institutional
       feel. The cost per bed night at Preston Skreens is £xxx [figure awaited]

4.31   Both Aut Even and Preston Skreens offer a ‘medical’ model of provision,
       whereas a ‘social’ model would be more in keeping with recent thinking on short
       breaks. There are disadvantages with Preston Skreens in terms of its location,
       and to some extent its premises. Discussions have been held with the PCT and
       Foundation Trust with a view to the management of Aut Even being transferred to
       the LA, and operating under a social care model.

4.32   Experience nationally with the wider availability of non-residential overnight short
       breaks funded under the Aiming High programme, and with the advent of direct
       payments for children and young people, is that demand for the traditional
       residential overnight breaks declines.

       It is recommended:

             That the LA review the future of the Disabled Children’s Team base at
              Parklands, which is geographically isolated from other disability-related
              services, with a view to relocating the services within a multi agency hub,
              in order to facilitate the integrated approach to services recommended by
              this review.


                                            26
Strategic review of children’s disability services in Medway:                            DRAFT
March 2011

              that the LA and PCT invest in home-based overnight short breaks as part
               of the wider short breaks offer, and assess the volume required, delivery
               model, and premises, of non-family based residential overnight provision.
               This should include the option of investing in new, purpose-built premises,
               as a replacement for existing provision.
              that in future all Medway short break services should be planned
               strategically as a whole, with joint commissioning between the Disabled
               Children’s Team and Aiming High.

Health

4.33   Children's disability health services in Medway are provided by The Medway
       Foundation Trust and Medway Community Healthcare (MCH). The latter is due
       to become an independent social enterprise organisation from April 2011. In
       relation to mental health, the provider for Tier 3 CAMHS is the Kent and Medway
       NHS and Social Care Partnership Trust (KMPT).

4.34   An underlying factor, which has affected links between services, particularly
       those of the Foundation Trust and MCH, is the sudden closure of the Sanderson
       Ward at the Medway Maritime Hospital, which was the base for the Child
       Development Centre (CDC). The constituent parts of the CDC were dispersed,
       both within the hospital and in the case of therapeutic services, to a number of
       locations throughout Medway. The services offered by the CDC as an integrated
       unit are now fragmented across Medway although there are plans to re-establish
       it in a different location in 2011.

               Medway Foundation Trust

4.35   The relevant community services provided by the Foundation Trust include:

              Community Paediatric Team
              Chaucer Assessment Nursery
              Special Needs Nursery
              School Nursing Team
              Community Nursing Service
              Short Breaks (respite) – Aut Even and Preston Skreens

4.36   Medway Maritime Hospital is also home to the Oliver Fisher Ward, a regional
       neonatal unit. There is a view that the existence the unit has improved the
       survival rates of premature babies and those with specific conditions, some of
       whom subsequently go on to have disabilities.

4.37   A key issue for senior professionals in the services concerned is a perceived
       weakness in the commissioning for children with disability. The lack of a child
       focus to commissioning by the PCT has been a long-standing issue over many
       years. This has resulted in gaps between the work of the Foundation Trust and
       Medway Community Healthcare (MCH) and differences of approach between the
       two organisations. There is a lack of clarity over the specification of a number of


                                           27
Strategic review of children’s disability services in Medway:                                 DRAFT
March 2011
           the services in the PCT’s block contracts for services and a lack of resource to
           support children’s health commissioning.

                    Medway community healthcare

4.38       MCH provide a range of therapeutic services, including speech and language,
           occupational therapists, physiotherapists, podiatry, dieticians and a continence
           service. The therapeutic services work closely with a range of other agencies. A
           particularly close relationship was that with the community paediatrician team
           within the Foundation Trust. However that has been affected by the closure of the
           Sanderson Centre, with therapeutic services dispersed to different locations in
           Medway.

4.39       The Speech and Language Service has suffered from significant waiting lists,
           although this has been brought down to 16 weeks from two years formerly. The
           manager of the Therapeutic Service has recently met with groups of parents to
           address their concerns about lack of speech and language provision, under the
           aegis of the Medway Parent Carers Forum. A service level agreement is currently
           being developed between the LA and the Speech and Language Service, in the
           context of discussions on priorities for service delivery.The Service has been
           working closely with mainstream schools to provide training for Teaching
           Assistants in undertaking speech and language work under the direction of
           therapists, and thus build capacity in schools to deliver less specialist
           interventions, thus freeing up therapists and making best use of their time.

4.40       The Speech and Language Service is critically important in meeting the needs of
           many children with Statements of SEN, both in mainstream schools and special
           schools. The service has not had the capacity to meet all of the demands within
           special schools, which has resulted in special schools buying-in therapists, either
           from the service itself, or, in the case of one school, privately. The latter method
           has resulted in some difficulties between the school and the service.

4.41       While therapeutic services have worked on their own initiative with other
           agencies, there has been a lack of strategic direction or framework in relation to
           disability services provided by the PCT.


           Child and Adolescent Mental Health Service (CAMHS)

4. 42 The Tier 3 CAMHS service in Medway is commissioned jointly with Kent and
      provided by the Kent and Medway NHS and Social Care Partnership Trust
      (KMPT)32 and a Tier 2 service by the Child and Adolescent Support Team
      (CAST) jointly funded by the LA and the PCT. The Tier 4 CAMH service is also
      commissioned on a Kent and Medway-wide basis and will shortly be provided by
      the South London and Maudsley NHS Foundation Trust. Complementary
      services are provided by the Education and Child Psychologist Team, and the
      Onside Project (a partnership between the LA and the DeHaan Charitable Trust
      for therapeutic work in schools and at Silverbank Park Pupil Referral Unit).

32
     An audit is to be undertaken of safeguarding practice within CAMHS service.

                                                     28
Strategic review of children’s disability services in Medway:                                                     DRAFT
March 2011

4.43     CAMH services have been included in this review, not only in relation to children
         and young people with disabilities who also have mental health issues, but also
         because mental illness which has a substantial, adverse and long-term effect on
         a person’s ability to carry out normal day-to-day activities is a disability in its own
         right.33

4.44     CAMHS was previously judged as inadequate but significant improvements have
         been made such that CAMHS currently has a score of 14 against the Vital Signs
         performance indicator (PI 51), with a target of 16 (meeting the full specification)
         by March 2011. There continue to be challenges to meet high demand for tier 3
         services within the resource envelope and detailed work with the provider and
         other services providing emotional well being support at a lower level has
         reduced pressures in the service, but there is more to do. Kent and Medway are
         currently considering the option for retendering tier 2 and 3 services together
         across the region.

4.45     Since 2008, initiatives have been taken by the LA/PCT joint commissioning team
         to take forward the Medway CAMHS Strategy34, including the establishment of a
         single point of access for Tiers 2 and 3 and the commissioning of a service for
         17-year-olds (to be started shortly). The single point of access was introduced in
         2009 for all Tier 2 and 3 referrals to Medway CAMHS, organised and run through
         the CAST Team.

4.46     The single point of referral has enabled a speedy and effective response (over
         the telephone) to many referrals, and reduced the number going to Tier 3.

4.47     However, the level of provision by the Tier 3 CAMHS remains the subject of
         concern. This particularly focuses on the following areas:

                 Provision for 0 – 5 year olds: while this is part of the overall CAMHS
                  provision for 0-17s, is there is a perception among services that the Tier 3
                  service will not cater for them. KMPT point out that referrals at 0-5 age


33
  Disability Discrimination Act
34
  Approved by the LA’s Cabinet in September 2009, the CAMHS strategy 2009-11 had the following
aims:
        1. an integrated service: Medway’s CAMHS service will coordinate universal and targeted
              services relevant to mental health within an overall planning process so that they support
              each other, and are able to offer a transparent and accessible service to users, using integrated
              care pathways.
        2. a single point of access
        3. a focus on early intervention
        4. improving input from children and young people
        5. community-based delivery
        6. moving from a medical to a social model: we will promote a social model of CAMHS
              delivery, where the medical aspects of a child or young person are assessed as part of their
              wider needs, including social or psychological needs.
        7. Achieving 16 on the Vital Signs for CAMHS



                                                      29
Strategic review of children’s disability services in Medway:                              DRAFT
March 2011
              range are few and that primary behavioural issues are unlikely, but that
              nevertheless CAMHS will see them if required.

            There continues to be a gap for high level learning disability emotional
             support at tier 3 which is currently assessed and provided on a spot
             contract basis with other providers but commissioners are fully aware of
             this issue and have plans to bridge the gap.

            Waiting lists: there continue to be disproportionately long waiting lists for
             the CAMHS Tier 3 service which are being addressed with the provider.

4.48   Whatever the technical answers are to the issues set out above, what is clear is
       that there remains dissatisfaction with the current level of Tier 3 CAMH services
       as it relates to disabled children. KMPT for its part, feels that it is not resourced
       sufficiently to provide the level of service that it would wish.

              CAST Tier 2 Service

4.49   The CAST Tier 2 service is a multidisciplinary team which has established
       generally good links across education, health and social care. There is however
       room for improved collaboration with the Education and Child Psychology (ECP)
       Team where there is evidence of the same pupil being consulted on by both
       teams.

4.50   The team has been active in providing training (using the ‘Solihull’ approach) to a
       wide range of agencies including schools, and has recently stepped up the
       training to twice a month. There is also a train the trainers programme. CAST has
       an outreach service for children and families with physical or learning disabilities.

4.51   In summary, some progress has been made in relation to the single point of
       access and early intervention objectives of the Medway CAMHS strategy through
       the Tier 2 service (see footnote above). There remains dissatisfaction with the
       Tier 3 service by professionals in other services, and parents. Commissioners
       continue to work to resolve these difficulities which are Kent wide and in large
       part arise from the configuration of the whole emotional well being system in both
       Medway and the rest of Kent.

4.52   It is recommended:

            that a joint review is carried out by the LA and PCT of all health-related
             input to special schools and resourced mainstream SEN provision,
             including therapeutic, nursing and mental health services, with the aim of
             establishing agreed funding and service arrangements for the health input.


             that commissioners must take account of the specific needs of children
              with disabilities in the reconfiguration of emotional well being support
              across the area, particularly children with ASD, ADHD and other high
              level learning disabilities. The reconfiguration to take account of related
              services, including:


                                            30
Strategic review of children’s disability services in Medway:                                           DRAFT
March 2011
                     o    parent practitioners delivering multisystemic therapy
                     o    Education and Child Psychologists who will be delivering
                          Cognitive Behaviour Therapy and already work with children and
                          young people with significant mental health needs
                     o    Virtual teacher for Looked After Children

Early Years Provision

4.53    The LA Individual Children's Support Service supports preschool children who
        have complex additional needs. The service comprises three distinct services:
             The Portage Home Visiting Service
             The Portage Sensory Service
             The Advisory Teacher Service

4.54    The LA Inclusion Advisers have an establishment of four posts and give support
        to the early years settings (rather than to individuals) in relation to additional
        education needs.

4.55    The Sure Start Children's Centres (school-based, apart from All Saints) host
        targeted work with individual families or children, including speech and language
        services and sensory facilities.

4.56    A nursery for SLD/PMLD children aged 3-5 has recently been established at
        Abbey Court school. The school nursing input to the nursery is currently being
        funded by the LA on an annual basis. Health inputs to the school as a whole
        should be included in the overall review of health inputs to special schools and
        resourced mainstream provision, recommended above.

4.57    Medway Community Healthcare has for some years provided an Early Support
        Service,35 however the service has recently been discontinued owing to lack of
        funding.

4.58    The Foundation Trust Provides the Chaucer Assessment Nursery for children
        between 2-5 years, and the Special Needs Nursery providing for up to 45
        Children between 18 Months – 5 Years who have significant cognitive or learning
        difficulties (Delayed by at least 12 Months) and/or Physical Disabilities. The
        Special Needs Nursery takes a wider range of children than Abbey Court
        nursery, and children who are appropriate for Abbey Court tend to move there at
        age 3. However, the transfer arrangements need to be improved as the special
        needs nursery frequently receives little notice of children moving.

4.59    The nursery is currently occupying temporary leased accommodation in
        Rainham, which is not fit for purpose and is poorly located for accessibility by all
        but a few parents. It is already proposed that the Nursery, along with the Chaucer
        assessment Nursery, is integrated in the new CDC on the former Temple School
        site, and this will greatly benefit links of the nursery with other services. The

35
  Early Support is a national programme to improve the way that services for young children with
disabilities in England work together and with families. It implements government guidance, Together from
the start, published in 2003.

                                                   31
Strategic review of children’s disability services in Medway:                        DRAFT
March 2011
       Special Needs Nursery has entirely health staff, who operate a development
       programme, but do not use Early Years Foundation Stage guidelines. The
       nursery would welcome teaching input.

4.60   Medway currently has several multiagency panels which make decisions about
       the allocation of developmental and educational sources for preschool children
       with special needs. These include:

            The Information Sharing and Assessment Panel (ISAP)
            the Preschool Review (PSR)
            the Decision-Making Group (DMG) (considers requests for a Statement of
             SEN at any age)


4.61   The benefits of the "Early Support" approach of preventative family support and
       key working which has recently ended in Medway, highlights the need
       for continued coordination across agencies.

       It is recommended that:

          the LA Early Years team lead a brief review of multiagency coordination of
           services and provision for very young children with complex needs, with a
           view to introducing new arrangements with full multiagency backing.
          the LA broker a discussion between the Special Needs Nursery and Abbey
           Court School, to put in place appropriate collaborative arrangements.
          teaching input to the Special Needs nursery be secured, at the same time as
           the integration into the CDC.




                                   




                                           32
Strategic review of children’s disability services in Medway:                                               DRAFT
March 2011

SECTION FIVE : TRANSITION

5.1     Transition is the planned process that occurs when adolescents with disabilities
        move to adulthood. It generally covers the age range 13 – 19+. This involves
        changes to roles and relationships with family and friends, support staff and wider
        community.

5.2     The Ken Adams Review36 said the following about transition planning in April
        2010:

               ‘Medway does not have a multi-agency Transition Service in place though all those
               directly involved in this process interviewed would like there to be one. It was not
               clear why this level of integration has not happened.

               At an operational level there are good working relationships between professionals
               but the lack of integration, protocols and resources makes the process more
               difficult than it needs to be.

               There is no protocol in place between the Children with Disability service and the
               Adult Disability Service. It is important that one is put in place. The two services,
               CWD and Adults use different electronic recording systems and neither has access
               to the others. There are also issues regarding the transition of young people with
               mental illnesses and again there is no protocol in place to enable planning.

               Transition planning for children with special educational needs (SEN) start when
               they reach 14 years. However, currently effective planning for young people with
               complex needs in the CWD does not get underway until they are 17 years old. This
               is too late.’

5.3     Concern was also expressed by the National Transition Support Team. In the
        light of these concerns, a new Medway Transition Strategy was put in place in
        the Summer of 2010. Significant progress has been made since then in relation
        to a number of strands of the strategy as set out below.

                 Governance

5.4     The lead multiagency group for transition planning – The Transition Strategy
        Steering Group – has been strengthened by the addition of a number of key
        managers, including the service manager for children's disability services and the
        equivalent for adult disability services. The Transition Operational Group now has
        clearer terms of reference which relate to the work of the lead group, and there is
        a clear reporting mechanism to the lead group. The Transition Operational Group
        considers individual complex cases, but does not yet have the data to enable it to
        be able to look at the performance of the transition planning system as a whole.
        This will however be possible with the advent of the new transition datalink(see
        below).



36
  Highlight report on an inspection of services for children with disabilities in Medway, commissioned by
the LA from Ken Adams, April 2010

                                                   33
Strategic review of children’s disability services in Medway:                                        DRAFT
March 2011
                 Working relations and protocols

5.5     Links between the Disabled Children Team and adult services have been
        strengthened in relation to transition, although capacity issues remain in relation
        to the number of transition workers. Assessment for adult services provision has
        now begins from age 16 in most cases, apart from those which were not
        previously known to services, or who move into Medway from elsewhere.

5.6     Medway Youth Trust is a key partner in the delivery of the Transition Strategy,
        and is making major improvements in its timescales for completion of the section
        139 (a) ‘Moving On plans’ for young people with disabilities in relation to their
        post 16 pathway. The Trust has met its target of all school leavers having a
        Moving On plan signed off, and is now targeting all school Year 10s to have a
        draft plan on the system by April 2011. There is a further target to have Moving
        On plans in place for all Year 9s by July 2012.

5.7     A new overall transition protocol and pathway is in draft, and is expected to be
        completed by March 2011.

                 Data sharing

5.8     As indicated in the Ken Adams Review, agencies involved in transition currently
        have their own databases. Where there has been sharing of information, for
        example between the LA SEN team and Medway Youth Trust (Connexions) this
        has been hampered by difficulities in extracting information from the LA SEN
        database.37

5.9     A link between existing agency transition databases has been commissioned,
        through extending the Medway Youth Trust NCCIS database, and is expected to
        be operational by Summer 2011. This database link will have feed-in of
        information from other databases, and will enable detailed online sharing of
        information about individual young people, and also handling and analysis of
        performance management data, which will support the work of the individual
        agencies, the Transition Operational Group and the Transition Strategy Group. It
        should also reduce the number of young people who become known to transition
        workers at a very late stage, and improve the experience of services for young
        people, and their outcomes moving into adulthood.

                 Person centred planning

5.10    Medway was one of the pilot areas for the "Getting a Life" person centred
        planning approaches, and this has now been completed. The pilot has led to a
        wider introduction of person centred planning for transition reviews, more
        particularly in special schools than mainstream, and the lessons from the pilot
        need to be rolled out.



37
  Work is in hand to improve the accuracy of SEN database reports through use of Crystal reporting
software.


                                                  34
Strategic review of children’s disability services in Medway:                               DRAFT
March 2011


              Post 16 opportunities

5.11   The recent transfer of responsibility for post 16 commissioning and funding of
       students with Learning Difficulties and Disabilities from the Learning and Skills
       Council (LSC) to the LA has resulted in a major increase in workload and change
       in responsibilities for the SEN Assessment team. It is not yet known whether the
       budget which transfers will fully reflect the needs in Medway. It is our policy to
       increase local provision at 16 years so fewer young people have to leave
       Medway to continue their education. Local Authority officers are working with
       headteachers and senior college staff to plan specialist provision and individual
       support to mainstream courses. Medway also works closely with the 'South-East
       7' group to plan regional provision.


5.12   As indicated in section 4 above, more work is needed on post 16 pathways for
       young people with learning difficulties and disabilities, and and this also needs to
       include more joined up working in relation to post 19 destinations, for example
       employment, supported employment and independent living.




                                    




                                           35
Strategic review of children’s disability services in Medway:                          DRAFT
March 2011

SECTION SIX : DIRECT INVESTMENT FOR DISABLED FAMILIES


6.1    This section sets out an overview of the financial contributions from the partner
       agencies to children's disability services and SEN. Table 6 below give revenue
       budget figures for 2010-11.


                                       Table 6
                 Net Budget 2010-11 [2011-12 figures to be substituted]
           LA                                                        £000s
           Children's & Families
           Social Work Team (CWD)                                         539
           Parklands                                                      448
           Parklands Saturday Club
           Aut Even                                                        99
           LAC CWD                                                         24
           S17 CWD                                                        354
           Parents Groups                                                  64
           Transition to adults                                             0
           Sub Total                                                    1,528

           Funding of residential care for children with complex
           needs
           P& V Residential                                            1,331
           Secure Accommodation                                          175
           SubTotal                                                    1,506

           SEN
           SEN Team                                                      390

           Educational Psychology Team                                   716

           Special schools - non-Medway placements (includes
           £1.3m recoupment for placement in other LA schools)         8,014
           Physical & Sensory Team                                       279
           Provision in 4 Special Schools                              9,623
           Specialist provision in primary and secondary schools       3,946
           Speech and Language Therapy                                   198
           Tribunals                                                      56
           SENCO Training                                                100
           SEN Transport                                               4,485
           Sub Total                                                  27,807
           Early Years SEN                                               451
           Aiming High Short Breaks and Transition support             1,103
           LA Overall Total                                           32,395
           Medway Community Health Care (2011-12 budget)
           Medway Therapies
                                             36                        1,169
           Pooled Speech and Language Therapy budget                     395
Strategic review of children’s disability services in Medway:                              DRAFT
March 2011
[Note: budget figures from Medway NHS Foundation Trust awaited.]




6.2    A breakdown of the annual costs of independent and non maintained placements
       by need type is given below.

                                           Table 7

 Independent/Non-Maintained and Tuition Placements by Need and with
                        Cost at January 2011

                                  No. of        Total Cost
         Primary Need             Pupils           (£)        Average Cost per Pupil (£)
       Autistic Spectrum           82           2,346,474              28,616
     Behaviour Emotional           56           1,508,929              26,945
      Hearing Impairment           16            549,662               34,354
 Moderate Learning Difficulties    13            313,859               24,143
               PD                   2            130,296               65,148
  Profound, Multiple Learning
           Difficulties              2            186,562                93,281
      Speech Language
    Communication Needs              14            252,228              18,016
  Severe Learning Difficulties        5            523,256              104,651
 Specific Learning Difficulties      19            364,501              19,184
       Visual Impairment              1             38,343              38,343
                                    210           6,214,110

N.B.
Most pupils in Independent/Non-Maintained and tuition placements will have needs in more
than one of the categories listed above
Costs inclusive of fees for part-year pupils' placements during 2010/11 (which may have
ceased or continued by/after Jan 11)
Costs and numbers do include Social Services pupils' placements that are part-funded by
SEN
Costs include part-elements of fees paid by Social Services for 8 SEN pupils' placements


6.3    Annual figures for independent/non maintained expenditure over the 2008-11
       period (see Annex D) show a large growth in 2009 over 2008, and a slower
       growth thereafter. Numbers of children funded declined by 6 in 2011 compared
       with 2010, although total costs increased by 2.5%. The largest increase in need
       type in both numbers and costs, by some margin, is autistic spectrum disorders
       (with challenging behaviour).


SEN and overnight short breaks transport


                                             37
Strategic review of children’s disability services in Medway:                                          DRAFT
March 2011
6.4      The cost of SEN and overnight short breaks transport has increased by 29.4%
         since 2007-08, and is projected as £4.5 million for 2010-11, as indicated in table
         7 below. Transport is currently procured through a framework agreement with a
         number of transport operators. The transport procurement team are proposing
         changes to this arrangement for 2011-12, consisting of two streams of
         procurement:


              1. A small framework for ad hoc emergency provision
              2. Contracts open to any operator for most provision in which operators are
                 invited to provide services on optional 4/6/8 year contract basis.

6.5      Transport policy is currently under review.

                                        Table 8
                     SEN and overnight short break transport costs38

          Category           2007-08         2008-09          2009-10          2010-11 (Est’d)
                                 £               £               £                    £
      Medway schools        £1,991,261      £1,801,656     £1,939,565         £2,452,193
      and units
      Out area provision    £1,087,386      £1,237,427     £1,316,290         £1,397,727
                                                                                      39
      Aut Even              £6,931          £3,218         £18,534            £27,582
      Preston Skreens       £39,332         £36,992        £38,718            £33,147
      Mainstream/other      £340,166        £448,424       £488,697           £573,899
      Totals                £3,465,076      £3,527,717     £3,801,804         £4,484,547

6.6      Information on property related to children’s disability services is given in Table 9
         below.




38
  Source: Medway Transport Team
39
  Transport costs for Aut Even have increased significantly in 2010-11 owing to increased numbers of
children being placed there.

                                                   38
Strategic review of children’s disability services in Medway:                          DRAFT
March 2011




                                            Table 9

             LA Children’s disability related property valuation and costs40
          [Awaiting information on basis of valuation]

                    Property              Valuation       Running       Maintenance
                                                          Costs         Costs
                    Aut Even Respite       £673,809.00     £15,448.16     £10,909.96
                    Care Centre,

                    Parklands Resource     £784,700.00     £64,699.86      £7,209.32
                    Centre,
                    Silverbank Park,      £3,882,259.00   £493,640.00            N/A
                    Abbey Court           £5,957,881.00                   £33,254.00
                    Community School,
                    Strood
                    Abbey Court Special   £5,969,387.50
                    School, Rainham
                    Bradfields School,    £4,747,390.00                  £751,884.00
                    Danecourt             £3,089,807.75                   £34,780.00
                    Community School,
                    Rivermead School,     £1,261,900.00                   £73,723.00




                                          




40
     Source: Medway Property Team

                                               39
Strategic review of children’s disability services in Medway:                              DRAFT
March 2011

SECTION SEVEN : FEEDBACK FROM CHILDREN AND FAMILIES

Aiming High for Disabled Children Core Offer

7.1    Aiming High for Disabled Children (May 2007) provided a framework for services
       in considering information for children and families, and seeking their input to
       shaping services. Aiming High saw this as empowering disabled young people
       and their families in relation to the following areas:

                     Improved provision of information and greater transparency in
                      decision-making
                     putting families in control of design and delivery of their care
                      package and services
                     supporting disabled children and young people and their parents to
                      shape services

7.2    Collectively, this was known as the Aiming High ‘core offer’. The Government
       designed a Performance Indicator (National Indicator 54) which use surveys of
       parents’ experiences to rate services against a range of sub indicators. PI 54
       information is available for Medway for November, but the indicator has since
       been discontinued.

7.3    The overall score given in that year for Medway was 59 and somewhat below the
       national average figure of 61 (scores range between 57 – 67). Results had been
       received from 215 parents, and were scored against a number of headings
       including information they had received from that service; their opinions about the
       assessment process used for making decisions about the service the child would
       receive, transparency about decisions made; the extent they were consulted
       about decisions made about their child and and the extent to which they were
       asked for their opinion or feedback.

7.4    Generally, health services scored highest across most of the indicators, with
       education next, and care and family support lowest. For example, in relation to
       information, around half of respondents on health and education felt that they had
       been given enough information about their child's disability or condition, and only
       about 10% of respondents in case of care and family support. It should be noted
       however that a smaller number of respondents replied in relation to care and
       family support, and on some questions numbers were not high enough to make a
       judgement, and are therefore not quoted here.

7.5    In relation to participation, 57% of respondents in relation to health felt that they
       had been consulted about decisions being made about services their child
       received, and 40% in relation to education services. There were too few care and
       family support responses to give an accurate number. In relation to feedback,
       parents were asked whether they or their children had been asked for their
       opinion or feedback about the services they receive. 25% of health respondents
       said they had been asked for their opinion; 26% of education respondents and
       8% of care and family support.



                                            40
Strategic review of children’s disability services in Medway:                                   DRAFT
March 2011

Consultation with Children and Parents for Medway Aiming High strategy

7.6       An extensive consultation was undertaken with disabled children and their
          families prior to preparing the Medway Aiming High Disabled Children Strategy41
          and the key points of discussions with children are set out below:

                         Young people expressed the wish to have more things to do and
                          have places to go in the evenings, and be able to access after
                          school, holiday and youth clubs near their homes
                         young people also raised the issue of transport which is accessible
                          without relying on parents.

7.7        Consultation with parents and carers gave the following key points:

                         Disabled children should have the same choices as non disabled
                          children
                         staff should be special needs trained
                         more holiday provision was urgently needed
                         any short break should help extend social skills
                         there is a need to allow for children and young people to be
                          gradually introduced to activities, and to be able to be part of a
                          group activity for a short period of time
                         parents of older children and young people felt that it would be a
                          very positive step for their child to attend activities with someone of
                          a similar age as of the friend or mentor
                         there was a consensus that the key times in the year when
                          families would like short breaks from caring, for the children to be
                          involved in positive activities, are during the school holiday periods
                          and after school
                         parents of older children and young people want to see further
                          options for young people to attend activities in the evenings and
                          weekends in their local areas. The types of activities mentioned
                          included creative arts and dance. Trips were seen as a valued
                          option for short breaks.
                         Some parents expressed a wish for a wider range of choices for
                          children under five during the holiday periods and weekends
                         parents/carers were clear that short breaks should enable them to
                          be able to undertake an activity which is a priority to them as
                          individuals providing a consistent and reliable service on a weekly
                          basis, a minimum of 2 1/2 hours without any caring responsibilities
                          would be the baseline for a short break period
                         there was a unanimous view that they need to be certain that their
                          child or young person was being cared for and supported by
                          people they could trust and who were equipped with specific
                          knowledge of the child's individual needs
                         transport was often cited as a barrier for parents and carers

41
     Medway Aiming High for Disabled Children Strategy March 2009

                                                  41
Strategic review of children’s disability services in Medway:                                  DRAFT
March 2011
                        some parents indicated in the survey response that there was a
                         lack of access to information for parents and young people.

7.8       In summary, children and young people with disabilities and their parents/carers
          were asking for more places to go and things to do, particularly after school, at
          the weekends, and during school holidays. It was felt helpful to be introduced to
          activities gradually, perhaps with a friend or mentor of similar age. For parents, it
          was critical that their child was being looked after by someone they could trust,
          and who knew their child’s needs well. Parents/carers felt that 2.5 hours without
          any caring responsibilities was a minimum time for a short break.

Knowledge of, and responses to, the AHDC Core Offer

7.9       As part of this review, interviewees were asked about their service’s response to
          the AHDC core offer. Most respondents were unaware of the AHDC core offer.
          Services generally said that they took into account the views expressed by
          children and parents at the time the service was delivered, but relatively few
          services were able to say that they took responses into account on an aggregate
          basis in service planning. Many services appeared to have no particular policy
          about transparency and individual entitlements.

Messages from young people and parents from Getting a Life project

7.10      The main messages from young people and parents expressed during the
          ‘Getting a life’ person centred transition planning project were as follows:

         Service criteria - Familes would like to know whether they get a service when
          their child is an adult - if they can be told well in advance they can plan for this.
          Not knowing causes a lot of unecessary worry for the family,
         Aspirations- Few young adults and families at the start of the project had
          expectations and aspirations to enter paid employment. Families fed back that
          they thought organisations e.g. school did not have an aspiration of employment
          for their young adult.
         Role models - Few young adults and families knew anyone with additional needs
          in employment in Medway. It was therefore hard for families to see 'what is
          possible'/alternative futures or their young adult with additional needs.
         Using existing funds diffently - No families would swap their short break funding
          or social care funding to employ a job coach - so what is offered as a core offer
          to families is really important. For example - families were happy to have a job
          coach to support their young adult into employment opportunities but only if this
          was offered in an additional sum to the social care funding (which was funding
          their leisure/short break activities). If only leisure-type opportunities were offered
          families will not want to progress from this to employment
         Family leadership courses- Families would like somewhere that families can
          learn together - e.g. about direct payments, housing, jobs, which is not linked to
          individual money. Families would like to learn and meet families who have tried
          different options - learn by example.
         Accessing the community - Very few families had been to their local community
          centres - so they have limited experience of what is available free in the
          community on their doorstep. With limited experiences and knowledge of what is


                                               42
Strategic review of children’s disability services in Medway:                                   DRAFT
March 2011
           on offer in a locality families and young people will assume that it is necessary to
           pay for everything, - whereas in fact many community resources (e.g. gardening
           groups, radio station) are free for people to use and could provide a free short
           break to families.

The Medway Parent and Carer Forum

7.11       Recent feedback from the Medway Parent and Carer Forum was that:

                           There was a lack of information about criteria for assessment for
                            special educational needs and about School Action and School
                            Action Plus42
                           information presented to children or parents/carers all at once
                            could be overwhelming, and therefore needed to be given in
                            tranches
                           families were not involved sufficiently in the way that services were
                            planned
                           there were examples of special schools which were inflexible in
                            the dates of transition review meetings, or where parents were not
                            given sufficient notice of transition review meetings
                           sometimes there were long waiting lists for therapeutic services –
                            one parent had been waiting nine months for an appointment for
                            the podiatrist, and in relation to (hospital based) physiotherapists,
                            had been told to ‘call back in two months time to book an
                            appointment’
                           the existing direct payment scheme as operated is unclear and
                            somewhat arbitrary in its approach
                           in the recent consultation on the new CDC, there was a large and
                            unanimous view among parents that the CDC should be based at
                            a high quality site.

Recommendations

7.12       It is recommended that:

                           clear standards for information, transparency and empowerment
                            be agreed and adopted across Medway children's disability
                            services
                           in the context of services as they stand, the Family Information
                            Service be recognised across services as a central focus for
                            information on children's disability services, and enhancements
                            made to the information on FIS website and the team's expertise
                            continue to be developed in relation to disability
                           that work on the current draft partnership agreement with the
                            Medway Parent and Carer Forum be completed and the
                            Agreement be adopted across all services.
                                           
42
     This has now been recognised and actioned.

                                                  43
Strategic review of children’s disability services in Medway:                                 DRAFT
March 2011

SECTION EIGHT : CONCLUSIONS AND PROPOSED COMMISSIONING
THEMES

8.1        This section draws overall conclusions, and in the light of these, proposes a
           vision and basis for a strategic commissioning framework going forward. Key
           operational recommendations are also made for existing services.

Conclusions

8.2        The key conclusions from this review are:

                1       Informal links between agencies are generally good, helped by the
                        compact nature of Medway, and the fact that many services are
                        coterminous.

                2       There is no overall vision and commissioning strategy for services for
                        children with disabilities, and as a result, interagency collaboration
                        depends more on good relations between individuals than on any
                        strategic lead. This review is the first step in developing that vision

                3       There is a long-standing lack of child focus within health
                        commissioning, which has been overly reliant on loosely specified
                        and reviewed block contracts

                4       Delivery of services is too often based around service boundaries,
                        rather than around the needs and wishes of children and young
                        people with disabilities and their families

                5       Standards of information, transparency and empowerment of parents
                        are patchy across services, and there is a general lack of awareness
                        of the AHDC Core Offer.

                6       Sharing of information between agencies in relation to children with
                        disabilities is, with some exceptions, poorly developed.

Strategic recommendations

8.3        In order to meet the expectations of children and young people with disabilities
           and their families, in the context of the national requirements for personalisation,
           choice and control and integrated working, radical changes in the way services
           are commissioned and delivered are necessary. Doing nothing is not a viable
           option.


8.4        Working on national evidence-based good practice,43 and findings in Medway,
           this review offers a suggested vision and commissioning themes which can be


43
     Centre for Excellence and Outcomes (C4EO) Disability resources, 2011.

                                                    44
Strategic review of children’s disability services in Medway:                             DRAFT
March 2011
       developed into a strategic commissioning framework for support to disabled
       children and their families.


                                            Our Vision

                     Medway services work together to empower and
                     support children with disabilities and their families;
                     providing serviceswhich are easily accessible,
                     responsive to their needs, identified through integrated
                     assessment, and delivered when and where required.


8.5    To deliver this vision and improved outcomes for children, this review proposes
       whole-system change with services focusing on children and young people;
       integrated frontline delivery, processes, strategy and governance.


       Services focusing on children and young people

8.6    An essential part of a child-focused service is to provide disabled children and
       their families with the national minimum standards for information, transparency,
       participation and feedback, on a consistent basis. This will include an easily
       comprehensible local offer of all services in Medway supporting children with
       disabilities or SEN, to say what is available and from whom. We will develop an
       information strategy using the national standards, across the partnership.

8.7    Identifying children’s needs early provides opportunities for parents          and
       professionals to put in place effective support. We will reintroduce            the
       preventative Early Support programme following good practice models,           with
       improved coordination between the agencies, and enhanced support for           key
       working and ‘team around the child’ approaches.

8.8    Personalised budgets help to put choice and control in the hands of parents and
       young people, We will introduce these, and extend the availability and
       transparency of direct funding, drawing on national best practice. In doing this, it
       will be important to ensure a seamless transfer between children’s and adult
       services.

8.9    We will continue to ensure a varied and easily accessible programme of short
       breaks providing a break for parents and carers, and enjoyable activities for
       children and young people, and helping prevent the escalation of needs. We will
       review existing overnight short break provision, with a view to reinvesting in
       purpose-built accommodation, for children and young people who continue to
       need it.


       Integrated front line working




                                           45
Strategic review of children’s disability services in Medway:                               DRAFT
March 2011
8.10   Integrated frontline working requires the refocusing of children’s services around
       the needs of children and families rather than a professional service boundaries.
       We will adopt this as a key principle to be applied in developing new provision
       and reviewing existing provision. An important aspect of this is ensuring that
       services address child-parent relationships as well as addressing child
       developmental goals.

8.11   We will take full advantage of the opportunity provided by the establishment of
       the Child Development Centre in its new location, to enable it to act as the base
       for a range of services, with an integrated approach to service delivery.

8.12   We will review children’s disability services in light of the principle of integrated
       front line working, to establish whether the existing arrangements can be
       improved. This would include consideration of single-agency centres such as the
       Parklands Resource Centre, which acts as the base for the Disabled Children’s
       Team.

8.13   The voluntary sector has a key role to play in working with disabled children and
       their families, and it will be important to involve the sector in decision making at a
       strategic level, as well as in delivering specific services.

       Integrated processes

8.14   Integrated processes are essential for effective multi-agency working. Sharing of
       information between agencies is hampered by the lack of joint information
       systems. The transition database link is being established to enable sharing of
       information between agencies in the field of transition, and we will assess the
       practicability of this approach more widely in relation to disability.

8.15   Work is already proceeding on a model for a single assessment process in
       Medway, and the Government has recently announced its intention to adopt by
       2014 a single assessment process leading to an ‘Education, Health and Care
       Plan’ for for children and young people from birth to 25 who currently have a
       statement of SEN or learning difficulty assessment.

8.16   A shared approach and strategy for children's service workforce development of
       integrated working will be promoted. This will cover areas including inclusion, key
       worker training, and training support for differentiation within universal services
       from targeted and specialist services.

       Integrated strategy

8.17   We will develop a strategic commissioning framework for children's disability
       services in Medway across education, health and social care, based on full
       consultation with parents/carers, young people, voluntary groups and services,
       and on joint strategic needs analysis.

8.18   We will strengthen joint commissioning of children's disability services within the
       context of the new strategic commissioning framework, and also of the
       government's proposals for the future of the NHS in which local authorities will be


                                            46
Strategic review of children’s disability services in Medway:                           DRAFT
March 2011
       asked to promote the joining up of local NHS services, social care and health
       improvement.

8.19   An important aspect of joint commissioning will be making best use of resources
       and capital infrastructure including buildings, across all the agencies and
       achieving value for money. Pooled budgets will be developed as appropriate.

       Interagency governance

8.20   We will review our performance management systems to ensure that these can
       give a clear view of our achievement across the partnership against objectives.

8.21   Within the Children's Trust structure, we propose the establishment of a new
       Board for Disabled Children to succeed the existing Aiming High for Disabled
       Children Partnership Board, the work of which has largely been focused around
       the commissioning of short breaks and transition processes.

Operational recommendations

       Cross cutting

8.22   Focus on disabled children, young people and their parents/carers:

             clear standards for information, transparency and empowerment be
              agreed and adopted across Medway children's disability services
             in the context of services as they stand, the Family Information Service be
              recognised across services as a central focus for information on children's
              disability services, and enhancements made to the information on FIS
              website and the team's expertise continue to be developed in relation to
              disability
             that work on the current draft partnership agreement with the Medway
              Parent and Carer Forum be completed and the Agreement be adopted
              across all services.


8.23   The LA and PCT take forward existing discussions at senior management level,
       with a view to developing an agreed funding protocol and decision making
       arrangements for high need complex cases where there are multi-agency
       responsibilities


8.24   A database link be established, so that information about children and young
       people with disabilities can be shared across education, health and social care,
       perhaps along the lines of the multi agency transition data link, already under
       development, in order to help deliver personalised support.

       Education

8.25   The LA broker a discussion between the Abbey Court School and the Special
       Needs Nursery to put in place appropriate collaborative arrangements.


                                           47
Strategic review of children’s disability services in Medway:                             DRAFT
March 2011
8.26   The Special Needs Nursery has entirely health staff, who operate a development
       programme, but do not use Early Years Foundation Stage guidelines. The
       nursery would welcome teaching input, and it is recommended that this be
       secured, subject to resources, at the same time as the integration into the CDC.

8.27   The LA Early Years team lead a brief review of multiagency coordination in early
       years provision, with a view to introducing new arrangements with full
       multiagency backing.

       Health

8.28   A joint review is carried out by the LA and PCT of all health-related input to
       special schools and resourced mainstream SEN provision, including therapeutic,
       nursing and mental health services, with the aim of establishing agreed funding
       and service arrangements for the health input.

8.29   Commissioners must take account of the specific needs of children with
       disabilities in the reconfiguration of emotional well being support across the area,
       particularly children with ASD, ADHD and other high level learning disabilities.
       The reconfiguration to take account of related services, including:
                    o parent practitioners delivering multisystemic therapy
                    o Education and Child Psychologists who will be delivering
                         Cognitive Behaviour Therapy and already work with children and
                         young people with significant mental health needs
                    o Virtual teacher for Looked After Children

       Social care

8.30   The LA review the future of the Disabled Children’s Team base at Parklands,
       which is geographically isolated from other disability-related    services, with
       a view to relocating the services within a multi agency hub,      in order to
       facilitate the integrated approach to services recommended by this review.

8.31   The LA and PCT invest in home-based overnight short breaks as part of the
       wider short breaks offer, and assess the volume required, delivery model, and
       premises, of non-family based residential overnight provision. This should include
       the option of investing in new, purpose-built premises, as a replacement for
       existing provision.

8.32   In future all Medway short break services should be planned strategically as a
       whole, with joint commissioning between the Disabled Children’s Team and
       Aiming High.

8.33   The LA and PCT consider investing in home-based overnight short breaks as
       part of the wider short breaks offer, and assess the volume required, delivery
       model, and premises, of non-family based traditional residential overnight
       provision. This should include the option of investing in new, purpose-built
       premises, as a replacement for existing provision.

                                    

                                           48
Strategic review of children’s disability services in Medway:                           DRAFT
March 2011
                                        ANNEXES

                                          Annex A

                            Terms of reference of the Review

Purpose
To set out the range of services and facilities currently funded by the PCT and the
council to support disabled children in Medway at all levels of need to provide the
strategic framework in which to make effective commissioning decisions for the
future (drawing on the aiming high needs assessment and existing up to date
reviews of service).

Specific aims:
1) To identify the services available for assessing and identifying the needs of disabled
children eg SEN, Community Pediatric service etc
2) To identify the current range of respite services supporting children with medium and
high level needs
3) To identify and describe the full range of services funded to support universal,
targeted and complex needs of disabled children to meet all their needs eg health, safety
and education and identify current resource expenditure against needs levels
4) To identify all buildings, estates and physical resources supporting disabled children
eg Aut Even and Preston Skreens setting out ownership, value and condition
5) To identify all national requirements to support and assess disabled children's
needs including the recent duty to provide respite care and the key groups of disabled
children whose needs the PCT and LA would reasonably be expected to support
7) To identify any services/physical resources that are currently at risk due to
unsustainable funding or poor performance
8) To establish what processes and procedures are in place to support transition
9) To set out the current arrangements for engaging with and consulting disabled
children and their carers
10)Identify need and whether current services meet that need taking into account good
practice
11) Identify gaps and overlaps in provision
12). Look at geographic placement of services and whether in the appropriate place

Within the above, specific areas for investigation will include:

      Respite provision
      Links between children’s and adults disability services
      Issues thrown up by needs assessment and comparisons with other LA areas,
       such as:
           o Out-area placements
           o SEN/disability transport
           o High levels of ADHD
           o Higher statementing levels than elsewhere
      SEN nursery provision




                                             49
Strategic review of children’s disability services in Medway:                             DRAFT
March 2011
A position statement to be provided by mid-January 2011, summarising key issues
identified and broad findings at that stage, including within the specific areas for
investigation referred to above.

Draft final report to be completed by end of January 2011.


Having established this the Aiming High partnership group could develop key care
pathways for key user groups eg ADHD, ASD etc and identify any major gaps in service
provision at all levels of need (universal, targeted and complex) this would help focus the
commissioning activity for disabled children and the work of the aiming high project that
will conclude at the end of March 2011.

This work would be able to draw on existing work done on physical resources, speech
and language and wheelchair service and the Aiming High Needs Assessment.

KEY STAKEHOLDERS TO BE CONSULTED IN THE DEVELOPMENT OF THE
WORK will include:
      National Policy Context – Martin Cunnington Kent
      Identified Needs - Aiming High Needs Assessment and key service
        managers
      Medway’s support – Liz Bailey and Carole Campbell, MCHC, Didge Eldred
        and Nigel Leonard Medway Council, Aut Even manager, Preston Skreens
        Manager, Foundation Trust Kate Taylor, Head of Paediatrics, Head of
        Nursing Parent’s Forum, Voluntary sector providers from Sue Edmed
      Education – 4 special school heads, Juliet Sevior, Ian Townsend
      Transition – Richard Barker
      Investments – Phil Watts Council, Jonathon Bates PCT, Contracts Sue
        Edmed
      Feedback and Involvement – Michelle Lofting/key parental groups


The final report will include:

             OUTLINE STRUCTURE FOR DISABILITY REVIEW REPORT

   1       Purpose of the review – To set out the range of services and facilities
           currently funded by the PCT and the council to support disabled children in
           Medway at all levels of need to provide the strategic framework in which to
           make effective commissioning decisions for the future

   2       Approach of the review – who involved ie key providers and commissioners
           (MCHC, Medway Council, Foundation Trust, Voluntary Sector) and parents
           groups consulted to collect the information

   3       National Policy context – setting out key policy drivers and must do as
           statutory duty and would likes including new duty on respite care, SEN and
           Social Care




                                            50
Strategic review of children’s disability services in Medway:                                  DRAFT
March 2011
   4       Identified needs – ie groups of children likely to need support and
           prevalence from JSNA split by level of need: universal, targeted,
           specialist/complex

   5       Medway’s support for disabled children and their families –
           with sub sections on a) facilities/buildings used by Medway families b)
           key services, c) points of entry and information for families

   6       Transition – setting out transition issues and what is in place or being
           developed to address these

   7       Direct investment for disabled families – overview of the
           financial contributions from partner agencies ie total budgets added up and a
           marginal amount from wider support services. Unit costs and other relevant
           values eg property values

   8       Feedback from children and families – what arrangements are in place
           and what does their most recent feedback tell us

   9       Priorities for future commissioning – either from feedback on analysis of
           relevant data collected or from identified gaps eg palliative care or as a result
           of emerging policy from the Coalition Govt




                                            51
Strategic review of children’s disability services in Medway:                                  DRAFT
March 2011


                                          Annex B
                                 List of people consulted



                              Name                                     Organisation
       Didge Eldred                                          LA Social Care
       Nigel Leonard                                         LA Social Care
       Gurmit Sandhu                                         LA Commissioning
       Graham Cummings                                       Manager, Aut Even
       Jane Jarmain                                          Manager, Preston Skreens
       Liz Bailey                                            Manager, MCH
       Carole Campbell                                       Manager, MCH
       Kate Taylor, Manager, Children’s Directorate          Medway NHS Foundation Trust
       Mary Brennan Head of Nursing
       Dr Folake Durowuju (Lead community
       paediatrician)
       Aung Soe, Clinical Director, Children’s Directorate
       Sharon Gray                                           Special Needs Nursery
       Jane Marriott                                         Service Manager, Psychology and
                                                             Inclusion
       Juliet Sevior                                         AD Inclusion
       Bernadette Keogh, Denise Naven, Jane Elworthy         PASS Team
       Ian Townsend
       Gary Lindsey                                          Transport Procurement Team
       Claire Cooper                                         Autism Team
       Jennifer Daly                                         Autism Team
       Mark Holmes                                           LA Early Years
       Keith Clear                                           Co Chair, Medway Parent and
                                                             Carers Forum
       Helen Gulvin                                          AD Children’s Social Care
       Karen Joy                                             Headteacher, Abbey Court School
       John Somers                                           Headteacher, Danecourt School
       Kim Johnson                                           Headteacher, Bradfields School
       Ron Alexander                                         Chief Executive, Carers First
       Sally Morris                                          AD Commissioning and Strategy
       Simone Miles                                          Medway Youth Trust
       Hilary Gerhard                                        LA Advisors Team
       Claire Jones                                          LA Research Team
       Sheena Bolland                                        Manager, CAST
       Hilda Nunn                                            Manager, CAMHS Tier 3, KMPT




                                               52
Strategic review of children’s disability services in Medway:                                      DRAFT
March 2011
                                                              Annex C
                                                    Special Educational Need Data
                                                              Table 10
                                        Specialist education provision for pupils with SEN44

                                                                                Places    Places    Places    Places
                                                  School / Unit
                                                                                2007/08   2008/09   2009/10   2010/11
                                                     Danecourt                  119.75    126.08      124       126
                                                     Bradfields                 235.25      235       238       241
                            Special
                                                   Abbey Court                    140       140       146       151
                                                    Rivermead                     95        95        105       107

                                                 Riverside VI Unit                11         6         4         4
                                                Riverside ASD Unit                                               6
                                              Twydall Junior PD Unit              26        26        26        26
                                               Twydall Infant PD Unit             17        17        17        18

                            Primary           Horsted Junior PD Unit               7         6         6         6
                             Units            Horsted Infant PD Unit               0         0         0         0
                                           Warren Wood Language Unit              32        33        33        32
                                                 All Faith's TC Unit              18        18        21        22
                                       Hoo St Werburgh & Marlborough Centre       54        54        54        58
                                           Chalklands EBD Unit (Elaine)           18        18        19        19

                                               Robert Napier VI Unit              13        11        11        11
                                           New Brompton College SPLD              33        36        39        37

                           Secondary       New Brompton College SP & L            40        47        49        49
                             Units         St Werburgh Centre for Autism          28        28        34        37

                                               Robert Napier (A2M)                           8         7         8
                                          Woodlands Primary (Buttercups)                               5         8

                                            T O T A L                             887     904.08      946       974




44
     Source: LA SEN Assessment Team

                                                                           53
Strategic review of children’s disability services in Medway:                                         DRAFT
March 2011


                                                                        Table 11


                          Table 11: SEN School Action Plus and Statements in Primary Schools by need type


                                                                      Medway           South East           England
                                    Primary Need                   Count     %       Count      %        Count      %

                                    Specific Learning Difficulty      409     8.15     13490     12.06     79610      11.43
                                    Moderate Learning
                                    Difficulty                        873   17.39      24390     21.81    168580      24.20
                                    Severe Learning Difficulty        136    2.71       4350      3.89     28770       4.13
                                    Profound & Multiple
                                    Learning Difficulty                48    0.96       1360      1.22      9480       1.36
                                    Speech & Language                1034   20.60      18950     16.95    113410      16.28
                                    Hearing Impairment                117    2.33       2530      2.26     15530       2.23
                                    Visual Impairment                  55    1.10       1140      1.02      8570       1.23
                                    Muti-Sensory                       11    0.22        130      0.12       870       0.12
                                    Physical Disability               163    3.25       3980      3.56     26480       3.80
                                    Behaviour, Emotional &
                                    Social Difficulties              1182   23.55      27820     24.88    158000      22.68

                                    Autistic Spectrum Disorder        682   13.59      10240      9.16     56250       8.08
                                    Other                             289    5.76       3440      3.08     31020       4.45
                                    Total                            5020             111820              696550

Source: DfE: Special Educational Needs in England: January 2010. The table reformatted by the Research and Information Team:
http://www.dcsf.gov.uk/rsgateway/DB/SFR/s000939/index.shtml




                                                                            54
           Strategic review of children’s disability services in Medway:                     DRAFT
           March 2011
                                  Table 12: SEN School Action Plus and Statements in Primary Schools by need type


                                                                                                    Primary School pupils
                                                             Profound
                                                                          Behaviour,     Speech, Language
                     Specific      Moderate      Severe          &                                                                         Multi-                   Autistic
                                                                          Emotional            and            Hearing       Visual                    Physical                         Other
                     Learning      Learning     Learning     Multiple                                                                     Sensory                  Spectrum
                                                                           & Social      Communications     Impairment    Impairment                  Disability                Difficulty/Disability
                     Difficulty    Difficulty   Difficulty   Learning                                                                   Impairment                 Disorder
                                                                          Difficulties        Needs
                                                             Difficulty

2010                    %             %            %            %             %                 %               %             %             %            %            %                  %               %


ENGLAND                     10.2        24.9           1.5          0.4           18.5               26.5           2.2           1.2           0.2          3.9          6.5                    4.0    100.0


Lancashire                  12.1        26.0           0.9          0.2           17.3               23.3           2.6           1.4            x           4.8          5.6                    5.6    100.0
Northamptonshire             8.0        22.9           2.2          0.7           20.3               26.1           2.1           1.2            x           4.6          7.9                    3.9    100.0
Dudley                      10.1        28.8           0.5           x            10.9               35.7           2.5           1.1           0.2          5.5          3.0                    1.4    100.0
Telford and Wrekin          10.3        34.6           0.7          0.0           18.9               20.9           4.0           1.3            x           4.2          2.7                    2.3    100.0
Southend-on-Sea              5.6        44.9           1.5          0.5           18.9               16.1           0.8           1.3           0.0          1.7          3.9                    4.8    100.0
Thurrock                     6.0        34.2            x           0.0           20.6               21.6           2.2           1.2           0.0          4.8          3.7                    5.5    100.0
Bexley                       9.0        16.2           0.6          0.5           15.2               35.9           2.2           1.5           0.0          2.6        11.9                     4.4    100.0
Havering                     8.9        28.0           2.5           x            17.3               25.0           2.4           1.2            x           3.9          6.8                    3.6    100.0
Kent                         8.5        16.0           1.5          0.5           24.6               28.3           2.1           1.2           0.1          4.6          9.6                    3.1    100.0
Medway                       7.4        13.8           1.1          0.3           19.4               32.6           2.6           1.2            x           4.3        12.1                     5.2    100.0
Swindon                     12.0        29.5           1.5           x            18.4               21.1           2.1           1.3           0.5          4.9          4.9                    3.6    100.0




                                                                                                      55
Strategic review of children’s disability services in Medway:                                                              DRAFT
March 2011

                            Table 13: SEN School Action Plus and Statements in Secondary Schools by need type



                                                                                               Secondary School pupils
                                                              Profound
                                                                           Behaviour,     Speech, Language
                     Specific      Moderate       Severe          &                                                                          Multi-                   Autistic        Other
                                                                           Emotional            and            Hearing        Visual                    Physical
                     Learning      Learning      Learning     Multiple                                                                      Sensory                  Spectrum     Difficulty/Dis   Total
                                                                            & Social      Communications     Impairment     Impairment                  Disability
                     Difficulty    Difficulty    Difficulty   Learning                                                                    Impairment                 Disorder         ability
                                                                           Difficulties        Needs
                                                              Difficulty

2010                    %             %             %            %             %                 %               %              %             %            %            %              %            %


ENGLAND                     16.3          24.5          0.9          0.1           30.3                7.8           2.4            1.3           0.1          3.4          6.6              6.2   100.0


Lancashire                  19.8          20.2          0.4            x           24.4                7.5           3.9            1.6            x           5.2          6.4            10.5    100.0
Northamptonshire            12.6          25.6          1.1            x           27.0                6.0           2.2            0.9           0.0          3.9          8.1            12.5    100.0
Dudley                      15.3          38.1          0.3            x           18.2                6.3           3.2            1.9            x           4.9          7.5              4.0   100.0
Telford and Wrekin          15.6          31.4            x          0.0           26.4                6.1           2.8            1.1            x           3.3          4.6              8.5   100.0
Southend-on-Sea             11.4          53.7          0.9          0.0           20.8                4.5           1.2            0.7           0.0          2.0          2.4              2.5   100.0
Thurrock                    23.4          37.0          0.7          0.0           23.3                4.7           2.2            1.1           0.0          2.0          2.3              3.4   100.0
Bexley                      17.2          21.4          0.7            x           21.7               12.8           2.6            2.4            x           2.5        11.8               6.4   100.0
Havering                    13.5          35.3          2.6            x           26.0                6.2           2.7            1.2           0.0          3.5          6.7              2.3   100.0
Kent                        13.0          18.2          1.0          0.1           40.1                8.0           2.5            1.1           0.1          3.7          8.7              3.4   100.0
Medway                      11.6          12.5          0.4          0.0           36.2                8.5           2.6            1.3           0.6          2.6        15.5               8.2   100.0
Swindon                     15.1          26.3          0.5          0.0           32.5                6.8           4.6            1.2            x           4.0          4.2              4.6   100.0




                                                                                          56
Strategic review of children’s disability services in Medway:                          DRAFT
March 2011
                                       Table 14 : Statements in Special Schools by need type45


                                                                                                 Special School Pupils
                                                               Profound
                                                                             Behaviour,     Speech, Language                                                                         Other
                      Specific     Moderate       Severe           &                                                                          Multi-                   Autistic
                                                                             Emotional            and            Hearing       Visual                    Physical                  Difficulty
                      Learning     Learning      Learning      Multiple                                                                      Sensory                  Spectrum                  Total
                                                                              & Social      Communications     Impairment    Impairment                  Disability                /Disabilit
                      Difficulty   Difficulty    Difficulty    Learning                                                                    Impairment                 Disorder
                                                                             Difficulties        Needs                                                                                 y
                                                               Difficulty

 2010                    %            %             %             %              %                 %               %             %             %            %            %            %          %


 ENGLAND                     1.1          20.7          23.7           8.6           14.5                4.8           1.7           0.9           0.2          4.6        18.6           0.6    100.0


 Lancashire                  1.5          25.3          18.8          10.2           15.7                5.2           1.4           0.4           0.3          4.2        16.5           0.6    100.0
 Northamptonshire            3.0          22.3          22.1           4.0           17.7                5.6           0.8           0.5            x           2.3        21.1            x     100.0
 Dudley                        x          35.3          17.0           5.8           13.5                6.6            x             x            0.0          0.8        19.4            x     100.0
 Telford and Wrekin          1.9          18.5          28.9          14.1           12.7                4.4            x            0.0           0.0          1.5        17.9           0.0    100.0
 Southend-on-Sea               x          14.3          18.9          10.7           21.1                7.0           0.0            x            0.0          1.8        23.9           1.3    100.0
 Thurrock                    1.7          30.6           8.2           9.9            3.4               11.2           0.0            x            0.0          3.7        31.0           0.0    100.0
 Bexley                      0.0          27.7          25.2           4.8           18.9                1.6           0.0           0.0           0.0          0.0        21.0            x     100.0
 Havering                    0.0          28.8          40.7          15.7            6.4                3.0           0.0            x            0.0          0.0          4.7           x     100.0
 Kent                        0.2          11.2          19.4           6.3           20.7                3.8           4.3           0.9           0.0          4.3        29.0           0.0    100.0
 Medway                        x          54.7          19.8           7.8              x                1.0           0.0           0.0           0.0           x         14.6            x     100.0
 Swindon                       x          27.9          26.2           9.8           20.8                  x           0.0           0.0           0.0           x         13.5           0.0    100.0




45
     Source: National Pupil Database, SFR June 2010, via Medway Management Information Team. Includes information for Academies.

                                                                                            57
Strategic review of children’s disability services in Medway:                                           DRAFT
March 2011

                                                        Figures 3 and 4
                                      Non SEN/SEN Medway Pupils plotted against IDACI scores46




46
     Note: quintile 1 is least deprived. Information is for Medway pupils for 2010. Source: Medway LA Management Information Team, from DFE data

                                                                             58
Strategic review of children’s disability services in Medway:                                         DRAFT
March 2011


                                                             Chart 3
                                     Gender breakdown for Medway Pupils against Level of SEN47




47
     Numbers of Medway pupils against SEN level split by gender, 2010. Source: Medway LA Management Information , from Impulse data

                                                                            59
Strategic review of children’s disability services in Medway:                       DRAFT
March 2011


      Figure 5: Map showing residency of children at School Action Plus against Income Deprivation Affecting Children Index
                                                            (IDACI)48




48
     Source: Medway Management Information Team

                                                                60
Strategic review of children’s disability services in Medway:                   DRAFT
March 2011


 Figure 6: Map showing residency of children with Statements of SEN against Income Deprivation Affecting Children Index
                                                        (IDACI)




                                                                61
Strategic review of children’s disability services in Medway:                                        DRAFT
March 2011



                                                                 Chart 4
                                                   Numbers of Medway children with ASD49




49
  Numbers of Medway children of school age with a medical diagnosis of Autistic Spectrum Disorder. Source: Medway Autism Team, 2010. No data available
for 2009.

                                                                          62
Strategic review of children’s disability services in Medway:                                        DRAFT
March 2011




                                                                        Chart 5

        Increases from 2007-10 in numbers of ASD children in Medway and England primary and secondary schools50




50
  Shows % increases in actual numbers of children with ASD at School Action Plus/Statement levels between 2007-2010. Source: DFE National Pupil Database,
via Medway LA Management Information Team.

                                                                           63
Strategic review of children’s disability services in Medway:                                     DRAFT
March 2011


                                                            Chart 6
                            Percentages of MLD pupils by school phase: Medway/England comparison51




51
  Data shows % of MLD of total SEN School Action Plus/Statements by phase, for 2010. Source: DFE National Pupil Database, via Medway LA Management
Information Team

                                                                        64
Strategic review of children’s disability services in Medway:                       DRAFT
March 2011
                                              Annex D

             End of Year referral figures for Disabled Children’s Team, 200952
                                   Category breakdown         Number (% of total)

     Total referrals received                                 244 (100)
     Gender:                       Male                       178 ( 72)
                                   Female                      66 (28)
     General ethnicity:            White British              172 (71)
                                   Others:                      72 (29)
     Sources of referral:          Parents/carers             175 (72)
                                   Professionals               69 (28)
     Age ranges:                   Pre school <5               23 (11)
                                   5-6                         16 (7)
                                   primary                     90 (36)
                                   secondary                   98 (41)
                                   post secondary 16+          12 (5)
     Most prevalent disabilities   ASD spectrum                53 % of sample

     NB: some children had         Learning disability           7%
     multiple disabilities.
                                   Physical disability          14.4 %

                                   Speech and language           4%

                                   Epilepsy                      7%

                                   Sensory difficulties         0.3 %

                                   Downs syndrome
                                                                 3%
                                   Others
                                                                11.3 %

     Categories of service         Advice and information       13.3 % of sample
     request
                                   Respite (not Parklands)      34.5 %
     NB: some families requested
     more than one service.        Parklands services           33.3 %

                                   Allocated worker from         9%
                                   DCT

                                   Other service, including     9.9 %
                                   sits, direct payments.



52
     Source: Medway LA Disabled Children’s Team

                                                  65
Strategic review of children’s disability services in Medway:                                           DRAFT
March 2011


                                  Annex E
   Independent/non maintained expenditure 2008-11, broken down by need type

                                                Table15

 Independent/Non-Maintained and Tuition Placements by Need and with Cost at January
                                       2011

        Primary Need                 No. of Pupils        Total Cost (£)        Average Cost per Pupil (£)
       Autistic Spectrum                  82                2,346,474                    28,616
     Behaviour Emotional                  56                1,508,929                    26,945
      Hearing Impairment                  16                 549,662                     34,354
  Moderate Learning Difficulties          13                 313,859                     24,143
               PD                          2                 130,296                     65,148
   Profound, Multiple Learning
           Difficulties                    2                 186,562                      93,281
        Speech Language
     Communication Needs                   14                252,228                       18,016
  Severe Learning Difficulties              5                523,256                      104,651
  Specific Learning Difficulties           19                364,501                       19,184
       Visual Impairment                    1                 38,343                       38,343
                                          210               6,214,110

N.B.
Costs inclusive of fees for part-year pupils' placements during 2010/11 (which may have ceased or continued
by/after Jan 11)
Costs and numbers do include Social Services pupils' placements that are part-funded by SEN
Costs include part-elements of fees paid by Social Services for 8 SEN pupils' placements



 Table 16 Independent/Non-Maintained and Tuition Placements by Need and with Cost at
                                  February 2010

        Primary Need                 No. of Pupils        Total Cost (£)        Average Cost per Pupil (£)
       Autistic Spectrum                  87                2,321,341                    26,682
     Behaviour Emotional                  59                1,439,137                    24,392
      Hearing Impairment                  13                 532,297                     40,946
  Moderate Learning Difficulties          13                 314,247                     24,173
               PD                          2                 121,714                     60,857
   Profound, Multiple Learning
           Difficulties                    2                 184,072                      92,036
        Speech Language
     Communication Needs                   15                229,407                      15,294
   Severe Learning Difficulties             7                493,176                      70,454



                                                  66
Strategic review of children’s disability services in Medway:                                           DRAFT
March 2011
  Specific Learning Difficulties            16              297,041                       18,565
       Visual Impairment                     2              130,489                       65,245
                                           216             6,062,921

N.B.
Costs inclusive of fees for part-year pupils' placements during 2009/10 (which may have ceased or continued
by/after Feb 10)
Costs and numbers do include Social Services pupils' placements that were part-funded by SEN
Costs include part-elements of fees paid by Social Services for 8 SEN pupils' placements



 Table 17 Independent/Non-Maintained and Tuition Placements by Need and with Cost at
                                  February 2009

        Primary Need                  No. of Pupils      Total Cost (£)         Average Cost per Pupil (£)
       Autistic Spectrum                   76              2,011,944                     26,473
     Behaviour Emotional                   55              1,282,760                     23,323
      Hearing Impairment                   13               471,747                      36,288
  Moderate Learning Difficulties           15               390,368                      26,025
               PD                           5               308,204                      61,641
   Profound, Multiple Learning
           Difficulties                         2           166,888                       83,444
        Speech Language
     Communication Needs                    14              215,861                       15,419
  Severe Learning Difficulties               8              674,580                       84,323
  Specific Learning Difficulties            14              257,406                       18,386
       Visual Impairment                     2              130,910                       65,455
                                           204             5,910,668

N.B.
Costs actually £5.6 million due to recharges.



  Table 18: Independent/Non-Maintained and Tuition Placements by Need and with Cost
                                  at February 2008

        Primary Need                  No. of Pupils      Total Cost (£)         Average Cost per Pupil (£)
       Autistic Spectrum                   49              1,498,790                     30,588
     Behaviour Emotional                   47               858,484                      18,266
      Hearing Impairment                    9               292,530                      32,503
  Moderate Learning Difficulties           10               391,730                      39,173
               PD                           2               196,465                      98,233
   Profound, Multiple Learning
           Difficulties                         2           146,129                       73,065
       Speech Language
     Communication Needs                        9           148,533                       16,504

                                                    67
Strategic review of children’s disability services in Medway:                                           DRAFT
March 2011
  Severe Learning Difficulties              6               536,669                       89,445
  Specific Learning Difficulties           12               195,257                       16,271
       Visual Impairment                    1                42,081                       42,081
                                          147              4,306,668

N.B.
Costs inclusive of fees for part-year pupils' placements during 2008/09 (which may have ceased or continued
by/after Feb 08)
Costs and numbers do include Social Services pupils' placements that were part-funded by SEN
Costs include part-elements of fees paid by Social Services for 8 SEN pupils' placements




                                         




                                                  68

				
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