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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
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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
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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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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
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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
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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
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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
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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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.
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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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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.
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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.
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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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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
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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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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
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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
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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=
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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[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
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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
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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
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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
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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
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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
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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.
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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.
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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
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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
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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.
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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.
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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
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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
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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
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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
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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
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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
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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
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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
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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.
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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
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Strategic review of children’s disability services in Medway: DRAFT
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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
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Strategic review of children’s disability services in Medway: DRAFT
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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
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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)
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Strategic review of children’s disability services in Medway: DRAFT
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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.
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Strategic review of children’s disability services in Medway: DRAFT
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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.
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Strategic review of children’s disability services in Medway: DRAFT
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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
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Strategic review of children’s disability services in Medway: DRAFT
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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
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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
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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
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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
