Select Committee on Northern Ireland Affairs Minutes of Evidence


Supplementary Memorandum from Northern Health and Social Services Board


Supplementary Questions


  The letter dated 18 December 1998 from the Clerk of the NI Affairs Committee outlined seven supplementary questions regarding Special Educational Needs which the NI Affairs Committee requested in addition to the Board's Memorandum and oral evidence.

  The following document outlines the Board's response to each of the seven questions in tabular form with explanatory narrative.

1. How many children have been referred to the Board for assessment for the purposes of SEN statements in each of the last five years, in total and by type of professional assessment?

  Throughout the Northern Health and Social Services Board's (NHSSB) area, staff respond to requests for advice in respect of statutory assessments of special educational needs from two Education and Library Boards, namely, North Eastern (NEELB) and Southern (SELB) Education and Library Boards.

  The number of requests for initial advice, as well as updated reports for statutory assessments, over the five year period from 1994 to 1998 is as outlined in the following table.
Area19941995 199619971998 Total
Homefirst Community HSS Trust (NEELB & SELB) 258253306 3032691,389
Causeway HSS Trust (NEELB)60 10292102 86442
Total318355 398405355 1,831
The geographical area covered by Homefirst Community HSS Trust includes Antrim, Ballymena, Magherafelt. Cookstown, Larne, Carrickfergus and Newtownabbey Council areas. Causeway HSS Trust includes Ballymoney, Coleraine and Moyle Council areas.
A request for a report in respect of the statutory assessment is not a referral to the service.

  The flowchart in Annex 1 describes the report request and return process adopted within the Board's area, together with the required timescales. Within the NHSSB, the Designated Officer will either be the Senior Community Medical Officer (SCMO) or the Community Paediatrician.

  All requests for initial advice reports are sent routinely to the:

    —  Medical Officer;

    —  Speech and Language Therapist;

    —  Occupational Therapist;

    —  Physiotherapist;

    —  Nursing; and

    —  Social Worker.

  If the Designated Officer knows that other Health and Social Services professionals are involved in the care of the child, for example, Orthoptist, Dietitian or Podiatrist, then these staff will also be asked for a report.

  Irrespective of whether or not the profession knows of the child, a return must be completed. If the child is not known to the service, a nil return is completed.

  The Medical Officer, as the Designated Officer, must complete a report. The Designated Officer (see Annex 2) will have a clear view regarding the appropriate level of involvement of the other professions both with the children and subsequently the assessment process.

  Those professions mostly involved include:

    —  Speech and Language Therapy;

    —  Occupational Therapy;

    —  Physiotherapy;

    —  Social Work (in keeping with the Disability NI Order);

    —  Nursing.

  Currently, Homefirst Community Trust has drawn up and is piloting a statementing screen for the Child Health System which will capture all this information in due course.

2. What has been the average time lapse between referral and actual assessment in each of the last five years, overall and by type of professional assessment?

  As stated previously, the Medical Officer is the only professional who must see every child referred for the purpose of statutory assessment.

  In 99 per cent of cases, this is undertaken and the report written well within the 4 weeks time-frame required (see Annex 1).

  All other professions would not assess a child specifically for this purpose. If the child is known to the service, then a report is written. In order for the advice contained in the report to be up to date, the professional may see the child specifically if the last contact has not been within the previous 12 weeks.

3. What has been the total number of children with statements of special needs to whom the Board has provided support in each of the last five years, in total, and broken down by type of support?

  There are, at this point in time, approximately 1,250 children within special schools and units across the Board's area. Currently, no child can be placed in such a special needs facility without a statement. In addition, there are a number of children in mainstream education with statements.

  In contrast, there are 3,232 children on the Special Needs Register (Module V) of the Child Health System for whom there is health service input.

  Children with statements of special education receive services and support from a range of disciplines throughout the various stages of the child's life, and in keeping with their changing needs. These include:

Medical Officers/Designated Officer

  Annex 2 details the role of the Designated Officer in respect of his/her statutory role. In addition to this extensive role, the Medical Officer undertakes the following in respect of statemented children:

    —  complete an annual review and report of each statemented child;

    —  undertake ad hoc reviews if there is a specific medical issue;

    —  attend annual review meetings where there is a specific medical problem/issue;

    —  provide advice to parents in respect of the process and the reports;

    —  meet with educational psychology staff in relation to selected children;

    —  request and collate additional information for other medical consultants;

    —  respond to ad hoc requests from schools in respect of medical updates/issues;

    —  assess and designate children as disabled for the purposes of transition planning for transfer to Adult Services; and,

    —  provide training to mainstream school staff in respect of children transferring from special schools.

Speech and Language Therapy

  There are currently 39.10 whole time equivalent (wte) speech and language therapy staff working with children across the Board's area. Of this number, 18.25 wte work exclusively within the special school/unit setting (46.6 per cent).

  Additionally, there are staff who work with pre-school children with special needs (6.13 wte) and a percentage of community clinic-based staff's time would be taken up with writing initial advice reports and providing support to mainstream schools (approximately 0.92 wte). In total, 25.30 wte could be estimated to be working with children in the context of assessing and meeting SENs, which represents 64.7 per cent of the total speech and language therapy service provision to children in the Homefirst Trust area.

  In addition to the models of therapy provision as described in Annex 4, speech and language therapy staff across the Board are involved in the writing of initial advice reports, annual review reports and attendance at annual review meetings. Within the special schools, the speech and language therapist would attend all reviews for children with whom she has contact. For children in mainstream schools, such attendance is rare due to resource constraints.

  In addition to this regular work associated with the statutory assessment process and subsequent support, senior speech and language therapy staff have been heavily involved with special education staff and education psychology staff in the following areas:

    —  preparation for and time spent at Tribunals in respect of special educational needs;

    —  training of education staff by speech and language therapists;

    —  informal meetings with special education staff in respect of a variety of issues around the statutory assessment process and subsequent support;

    —  informal and formal meetings with educational psychology staff in relation to the statutory assessment and ongoing support;

    —  contact with parents in respect of the process and support;

    —  discussion with other Trust staff in relation to children placed in the two regional schools—Thornfield and Jordanstown Schools (see Annex 5 for a breakdown of children from each of the four Boards receiving speech and language therapy in these two schools);

    —  responding to requests for mainstream schools for support;

    —  production of staff guidelines for writing reports;

    —  provision of equipment for therapy use within school;

    —  in exceptional circumstances, provision of computer for communication purposes in school by individual children;

    —  preparation of resource materials and advice for mainstream schools in respect of children with speech and language therapy needs; and

    —  training of mainstream school staff in respect of children transferring from special school.

  Speech and language therapy provision to children with special educational needs is not as a result of them having statements. The provision is dictated by the needs of the children, irrespective of them having a statement. Speech and language therapists work to professional standards and a Code of Practice. It is, therefore, essential that each child's needs are assessed and a suitable therapy programme initiated. Whilst a statement of special educational need may, in some cases, dictate in detail the speech and language therapy provision, it is the professional responsibility of the speech and language therapist to provide a relevant service. She could be held professionally negligent and irresponsible if she provided therapy according to the dictate of a statement which was at odds with assessed need.

Occupational Therapy

  In total, there are 12.21 wte paediatric occupational therapy staff working within the Board's area.

  In the Homefirst Trust area, 3.76 wte work within special education. Additionally, approximately 0.34 wte staff time would account for involvement in the writing of initial reports. In total, this represents 38.7 per cent of total Paediatric Occupational Therapy staffing within Homefirst.

  Paediatric occupational therapy staff are involved in:

    —  writing initial advice reports;

    —  writing annual review reports;

    —  attending annual review meetings as appropriate;

    —  training of mainstream school staff in respect of children transferring from special school;

    —  providing selected equipment for use in school; and

    —  advising on equipment needs within school.

  As with speech and language therapy, these children would be receiving occupational therapy input irrespective of having a statement of special education need.

Social Work

  In 1992, within Homefirst Trust, two dedicated social work teams for children with disability were created (one in the Larne/Carrickfergus/Newtownabbey area and one in the Antrim/Ballymena/Magherafelt/Cookstown area). There are currently 13.5 wte staff in post, 3.5 wte of which have been more recent appointments.

  Similarly, in 1998, a dedicated social work team comprising 6.0 wte and 1.0 wte Team Leader was created in the Causeway area.

  These three teams work with appropriately 750 children and their families across the Board's area, approximately 70-75 per cent of whom would have statements. A range of support services are available to all of these families although these services will normally not be directly as a result of the statement of special educational need.

  In addition, there may be children with disabilities and their families who may be in receipt of mainstream social services where the reasons for contact with social work staff are other than specifically related to disability.

  The range of support services include:

    —  writing initial and annual review reports;

    —  attending selected annual review meetings in schools;

    —  providing assistance for attendance at playgroups and nurseries;

    —  providing both family-based and residential respite services;

    —  providing domiciliary support;

    —  providing classroom support (in exceptional cases);

    —  providing transport support (in exceptional cases);

    —  providing Summer Scheme support; and

    —  providing social work support to children and young people and their carers, particularly at significant milestones in their life, i.e., diagnosis, school commencement/leaving and transition to adulthood.


  Health Visitors throughout the Board's area undertake developmental assessments of children between the ages of 0 to five years often during which potential or existing disabilities are identified.

  Currently, within the Homefirst area, the children's nursing service has 3.27 wte specialist Health Visitors for children with physical disability. These staff, along with the family health visitor, will be involved in writing initial advice reports and annual review reports. They are also involved in training school staff (mainstream and special school) in specific procedures with individual pupils on a needs-led basis (e.g., catheterisation) and advice on equipment. These staff would also be involved in liaison with carers and support within the home of these children on a needs-led basis.

  Within the Causeway area, although there are no specialist Health Visitors for children with a physical disability, there are 2.0 wte nurses providing support for children with learning difficulties.

4. What clinical psychology/psychiatric services does the Board provide for children and young people of school age; what resources are committed to this; to what extent are the services provided separately from services to adults; and to how many persons have such services been provided in each of the last five years?

  The Board has deployed significant resources in securing an area-wide child and adolescent mental health service, which is delivered by two multidisciplinary specialist teams. These existing teams operate from two bases in Antrim and Ballymoney and are each led by a Consultant Child and Adolescent Psychiatrist. The funded establishment is as follows:

    2.0 wte Consultant Child and Adolescent Psychiatrists

    1.0 wte Senior House Officer (attachment)

    2.0 wte Consultant Psychologists

    2.0 wte Psychologists

    1.0 wte Assistant Psychologist

    1.0 wte Specialist Nurse Therapist

    1.0 wte Specialist Nurse

    1.0 wte Senior Social Worker/Family Therapist

    2.0 wte Social Workers

  The Ballymoney team provides an outreach service in the Cookstown and Magherafelt areas two days per month. Both teams provide a consultation service for other professional staff in contact with children and young people.

  The resources directly associated with the two teams amounts to approximately £442,000 (at 1998-99 levels), however children and young people with mental health problems may also access other generic health and social services.

Referrals to Child and Adolescent Psychiatry Service

    1993-94: 597

    1994-95: 716

    1995-96: 751

    1996-97: 612

    1997-98: 670
Contacts with Child and Adolescent Psychiatry Services by Profession
1995-961996-97 1997-98
Consultant Psychiatrist1,006 1,2461,516
Psychologist1,6951,477 1,124
Nurse Specialist700 548791
Social Worker513382 685
Total3,9143,653 4,116
Figures for 1993-94 and 1994-95 were not available at the time of writing.

  Children's inpatient services are provided in the Children's Unit at Foster Green, Greenpark Health Care Trust. The Board commissions 687 resident days and during 1997-98 there were 13 inpatient episodes during 651 resident days.

  The Board commissions, on an ad hoc basis, places for a small number of adolescents who require more intensive treatment over a longer period, at the Young People's Centre in South and East Belfast Health and Social Services Trust.

  Younger teenagers are sometimes admitted to paediatric wards within the Board's area where Child and adolescent mental health Services provides support and advice to medical and nursing staff.

  The Board has allocated resources to fund a psychologist and family therapist post to provide dedicated specialist support to young people in residential care in the Board's area.

  Eight places are also commissioned from regional care centres for young people with challenging behaviour, all of whom have access to psychological assessment and support.

  The Board will also have access to the regional service to be provided by the family trauma centre where psychotherapy and family therapy will be offered to children and families in need.

  Each year, approximately 12 young people between 14 to 16 years of age are admitted to adult psychiatric wards as a last resort and are cared for by professionals in the adult service. Generally these young people are returned to the care of child and adolescent mental health Services when they are discharged from hospital. The Board acknowledges that this is an unacceptable position and is currently investigating means of avoiding such situations.

5. How many children in residential care in the Board's area had SEN statements in each of the last five years, and what percentage was this of the total such population?
Year19941995 199619971998
Total number in residential care42 424242 42
Number with Statement3 6912 14
Per cent of total in care with Statement 7.1414.3021.40 28.5733.33

  The reasons for the increase in the percentage of children in residential care with a statement are complex. Children with severe disabilities and emotional difficulties are remaining longer in residential care due to difficulties in supporting these children and meeting their individual needs within family based settings.

6. What training has been given to social services staff (and social workers in particular) regarding the requirements of the Education Order and the SEN Code of Practice and what financial and other resources have been devoted to this?

  Although this question focuses on training for social services staff, the Board and local Trusts have also recognised that the Education Order and the Code of Practice have significant training issues for the community medical, speech and language therapy, occupational therapy and physiotherapy professions.

  Training has been provided by NEELB for 17 social services staff, including social workers for specialist teams for children with disabilities, their team leaders and training staff.

  In addition, training in relation to children with disabilities has been provided as part of the Board's Children Order training and included specific training on topics such as children with mild-severe reading difficulties and children with difficult and disturbing behaviour. Approximately £7,000 has been made available for training in relation to children with disabilities.

  No specific financial resources have been devoted directly to Education Order and SEN Code of Practice training within the last five years. However, the following training, all initiated by Health and Social Services Board staff, has been provided:

    —  preparation for the writing of guidelines for health and social services staff in respect of the statutory assessment procedure for the identification of special educational needs;

    —  community medical staff training with special education staff;

    —  social work staff training in both Causeway and Homefirst Trusts, facilitated by the social work training unit, with participation from special education staff.

    —  feedback from Homefirst Trust staff who had experienced the first SEN Tribunal in Northern Ireland to selected speech and language therapy staff from Trusts throughout Northern Ireland;

    —  speech and language therapy staff training in March to Special Education Needs Co-ordinating Officers (SENCOs) in mainstream schools on supporting children with communication difficulties.

    —  Education and Library Board curriculum training for speech and language therapy staff throughout the Board.

7. What has been the Board's actual expenditure related to assessing and meeting special educational needs in each of the last three financial years, and what is your projected spend in 1998-99, 1999-2000 and 2000-01?

  Current accounting mechanisms within the Board preclude precise expenditure profiles for the assessment and meeting of special education needs. Budget profiles reflect the focus of care provision that is holistically meeting the identified health and social care needs of children irrespective of whether or not they have a statement of special educational needs.

  In the Homefirst Trust area, for example, the following funding has been made available for children with special needs:
Respite care872,000
Children's Occupational Therapy276,000
Social Work Teams331,000
Speech and Language Therapy657,000
Specialist Health Visitors76,000
Clinical Medical Officers286,000

  Over the past three years, the Board has directed Children Order funding specifically towards meeting the care needs of children with disabilities as follows:

    1996-97: £200,000

    1997-98: £147,000

    1998-99: £339,000.

  It is likely that the involvement of health and social services staff with education staff will increase steadily over the next few years. In particular, in relation to speech and language and occupational therapy, there is a clearly identified increase in the number of requests from mainstream schools for support and in other activity associated with collaborating with education staff in supporting children in schools.

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