Clinical commissioning groups (CCGs), local authorities and health professionals must work together to provide co-ordinated services to support children and young people with SEND.
Clinicians and therapists already provide health services for children and young people with SEND, from early identification, throughout their school and college years and into the transition to adulthood.
Much of the health care for children and young people will be delivered through universal, preventative services. There will be times when adaptations are required for some pupils in mainstream settings and targeted delivery may be required for the few with EHC plans.
From September 2014 CCGs must:
- commission services jointly for children and young people (up to age 25) with SEND, including those with Education Health and Care (EHC) plans
- work with the local authority to contribute to the Local Offer of services available
- have mechanisms in place to ensure practitioners and clinicians will support the integrated EHC needs assessment process
- agree Personal Budgets where they are provided for those with EHC plans
CCGs and health bodies must co-operate with local authorities in carrying out their functions, including those for providing information and advice. The joint commissioning arrangements that local authorities and CCGs must have for commissioning education, health and care provision for children and young people who have SEN or are disabled must include arrangements for considering and agreeing what information and advice about education, health and care provision is to be provided, by whom and how it is to be provided.
Local authorities and CCGs must assess the needs of the local population of children and young people with SEN and disabilities and plan and commission services for them jointly. They must have joint commissioning arrangements which cover services from birth to 25 years old for children and young people with SEN or disabilities.
In their joint commissioning arrangements CCGs and local authorities must include arrangements for securing EHC needs assessments, and the education, health and care provision specified in EHC plans.
Joint commissioning arrangements must include arrangements for considering and agreeing:
- the education, health and social care provision reasonably required by local children and young people with SEN or disabilities
- which education, health and social care provision will be secured and by whom – partners must be able to make a decision on how they will meet the needs of children and young people with SEN or disabilities in every case
- what advice and information is to be provided about education, health and care provision and by whom and to whom it is to be provided
- how complaints about education, health and social care provision can be made and are dealt with
- procedures for ensuring that disputes between local authorities and CCGs are resolved
Local authorities, CCGs and NHS England should develop effective ways of harnessing the views of their local communities so that commissioning decisions on services for those with SEN or disabilities are shaped by users’ experiences, ambitions and expectations.
Partners must set out in their joint commissioning arrangements their arrangements for agreeing Personal Budgets. A Personal Budget is an amount of money identified by the local authority to deliver provision set out in an EHC plan where the parent or young person is involved in securing that provision.
Health professionals will have to work with the local authority to describe the services they offer which lend themselves to the use of Personal Budgets. There are clear overlaps between Personal Budgets for children and young people with SEN or disabilities and Personal Health Budgets and consideration should be given to how these can be aligned to ensure that the process is as smooth and as manageable as possible for families.
The Designated Medical/Clinical Officer
Partners should ensure there is a Designated Medical Officer (DMO) or Designated Clinical Officer (DCO) to support the CCG in meeting its statutory responsibilities for children and young people with SEN or disabilities between the ages of 0 and 25.
This is a non-statutory role which would usually be carried out by a paediatrician, but the role can be undertaken by a suitably competent qualified and experienced nurse or other health professional in which case the role would be the Designated Clinical Officer.
The Local Offer
CCGs, NHS England, NHS Trusts or NHS Foundation Trusts and Local Health Boards must co-operate with local authorities in the development and reviewing of the Local Offer. The Local Offer must include information about provision made by health professionals for children and young people with SEN or disabilities. This must include:
- services assisting relevant early years providers, schools and post-16 institutions to support children and young people with medical conditions
- arrangements for making those services which are available to all children and young people in the area accessible to children and young people with SEN or disabilities.
It should also include:
- universal, preventative services and specialist services
- therapy services including speech and language therapy, physiotherapy and occupational therapy and services relating to mental health, such as arts therapies (these must be treated as special educational provision where they educate or train a child or young person
- wheelchair services and community equipment, children’s community nursing, continence services
- palliative and respite care and other provision for children with complex health needs
- other services, such as emergency care provision
- provision for children and young people’s continuing care arrangements
- support for young people when moving between healthcare services for children to healthcare services for adults
Local authorities must consult children with SEN or disabilities and their parents and young people with SEN or disabilities in preparing the Local Offer and reviewing it. Local authorities must also publish comments from them about the Local Offer along with details of what action they intend to take in response.
Health in schools and colleges
Maintained schools must make arrangements to support children with medical conditions and have regard to statutory guidance on this. Health professionals have a role to play in supporting staff in identifying and planning for SEN and disabilities in schools and colleges and in supporting those with medical conditions.
Health professionals, schools, colleges and LAs should work together to ensure there are clear paths for identifying and supporting children and young people with SEN or disabilities, both with and without EHC plans.
Health professionals will need to work with the SEN Co-ordinator (SENCO) and/or class teacher to consider appropriate equipment, strategies and interventions in order to support the child’s progress and build self-esteem and confidence. They can be involved at any point for help or advice on the best way to support a student with SEN or disabilities.
EHC needs assessments
CCGs must co-operate with local authorities in relation to EHC needs assessments and plans and health commissioners must secure the health care provision specified in EHC plans. Local authorities are responsible for ensuring that there is effective co-ordination of the needs assessment and development process for an EHC plan. Health partners must respond to the local authority’s request for advice for EHC needs assessments within 6 weeks.
Information sharing is vital to support an effective assessment and planning process. Health partners should work with the local authority and other partners to establish local protocols for the effective sharing of information which addresses confidentiality, consent and security of information. This should lead to a ‘tell us once’ approach so that families do not have to repeat the same information to different agencies or different practitioners.
Drawing up an EHC plan
Health professionals will need to contribute to section G of the plan: Any health provision reasonably required by the learning difficulties or disabilities which result in the child or young person having SEN. Information should be included as follows:
- Health provision should be detailed and specific and should normally be quantified, for example, in terms of the type of support and who will provide it
- It should be clear how the provision will support the outcomes, including the health needs to be met and the outcomes to be achieved through provision secured through a personal (health) budget
- Clarity as to how advice and information gathered has informed the provision specified
- Health care provision reasonably required may include universal services, specialist support and therapies, a range of nursing support, specialist equipment, wheelchairs and continence supplies. It could include highly specialist services needed by only a small number of children which are commissioned centrally by NHS England
- The local authority and CCG may choose to specify other health provision reasonably required by the child or young person, which is not linked to their learning difficulties or disabilities, but which should sensibly be co-ordinated with other services in the plan
The health care provision specified in section G of the EHC plan must be agreed by the CCG (or where relevant, NHS England when acting as commissioner) and any health care provision should be agreed in time to be included in the draft EHC plan sent to the child’s parent or to the young person.
As part of the joint commissioning arrangements, partners must have clear disagreement resolution procedures. Once health care provision is specified in section G of the plan the CCG must secure it.
Health care which educates or trains a child or young person must be treated as special educational provision but will be covered under joint commissioning