Memorandum from the Eastern Health and
Social Services Board
Further to your letter of the 11 December 1998
and your correspondence of the 18 December 1998 requesting additional
information, I feel it might be helpful to set out the context
and legislative role and responsibility of the Eastern Health
and Social Services Board in helping to meet identified special
educational needs. Responsibility for the healthcare and social
welfare of children with special educational needs rests predominantly
with the Department, through the Health and Social Services.
BACKGROUND
Under Article 4 of the Health and Personal Social
Services (Northern Ireland) Order 1972, the DHSS has a general
responsibility for the provision of integrated health and personal
Social Services designed to promote the physical, mental and social
well-being of the population of Northern Ireland. The Department
of Health sets out its policy objectives and service priorities
in its regional strategy documents. It is a function of each Board
to assess the needs of its population and commission the services
necessary to meet those needs, having regard to the Department's
Regional Strategy for Learning Disability. Regard should also
be made to the Children (NI) Order 1995, which imposes a general
duty to safeguard and promote the welfare of the child.
The definition used for Children in Need includes
a specific reference to disabled children.
The Eastern Board through their commissioning
framework ensures that a range of Health and Social Service staff
are employed in each of the four Community Trusts, including paediatricians,
school doctors, child psychiatrists and psychologists, nursing
staff, speech and language therapists, physiotherapists, occupational
therapists, and social workers, to bring a range of expertise
to special educational needs. It is recognised that these staff
have an important role to play in the child's development.
CONTRIBUTION TO
HELPING ELB MEET
IDENTIFIED SPECIAL
EDUCATIONAL NEEDS
BY TRUST
STAFF
The staff identified above are responsible for
the early, pre-school, identification and assessment of disability
and for notifying the relevant Education and Library Board where
a child is suspected as having special educational needs. This
is a requirement of Article 14(1) of the Education (NI) Order
1996.
They are involved also in the assessment and
annual review of each child's special educational needs and in
the statementing process, which is designed to ensure that such
needs are recognised and met and which is also a requirement of
Article 14(5) of the Education (NI) Order 1996. They provide day
to day specialist support for children in specialist schools,
special units and mainstream schools, which can be in the form
of therapy e.g., speech and language therapy designed to enable
a child to access the educational curriculum, or nursing support
to cater for the medical needs of pupils. They also examine all
14-year-old statemented children to determine whether or not they
are disabled persons as defined by Section 1 of the Chronically
Sick and Disabled Persons (NI) Act 1978. They assess disabled
children for any Health and Personal Social Service needs on leaving
school. This is a requirement of Section 5 of the Disabled Persons
(NI) Act 1989.
Health advice provided may include advice from
the child's GP and the school doctor, and from nurses, therapists,
health visitors and/or child health workers and any other medical
specialist who may be involved, e.g., orthopaedic surgeons and
paediatric neurologists. It may include information on:
— general health and developmental
problems;
— specific medical conditions or treatments;
— emotional behavioural difficulties;
— mental health problems;
— shorter term medical problems necessitating
special arrangements being made on a temporary basis; and
— mobility and functional problems.
Any health advice given usually states the likely
consequences of the child's condition for his/her education. It
may include advice on:
— how best to manage the child's medical
condition in the school context;
— special aids or equipment;
— the management of incontinence;
— administration of medication;
— independence and risk taking, and
participation and supervision in the playground, while swimming
and bathing and taking part in out of school activities;
— any non-educational provision which
may be needed; and
— any adaptations required to the child's
environment.
For some children with complex needs or specific
disabilities or medical conditions, a health perspective is crucial
both in the initial assessment and in any subsequent reviews.
In these circumstances, the staff of the Trusts not only contribute
relevant information on the child's special needs, but also contribute
to the setting of objectives and to the review process, at agreed
stages of the child's development, involving the relevant professionals.
The Eastern Health and Social Services Board
Trusts will also provide the Education and Library Board, through
each Trusts Designated Officer, with any Social Services information
which is relevant to the assessment procedure. In particular:
— if the family is not known to Social
Services, and if there is no reason to suppose from evidence provided
by the school or the Education and Library Board that the Trust
should seek further information, the Trust will indicate to the
Education and Library Board that it need provide no further advice.
— Trusts may consider combining assessment
of children in need, under the Children Order with statutory assessment
under education legislation, and the Trusts may check whether
any information or services might usefully be provided for the
child or family;
— if the child is receiving Social
Services provision and in particular is being looked after, the
Trust will make available to the Education and Library Board any
relevant observations, information and reports;
— details of any Child Care Plan will
be provided;
— the Trusts, staff ensure that any
relevant information about a child who is being looked after is
provided, and that Social Services staff attend assessments and
medical examinations as appropriate.
Trusts inform the Education and Library Board
of all those who have parental responsibility; and; if the child
is, or may become, subject to Child Protection procedures the
Trusts give appropriate advice.
NURSING, MEDICAL
AND THERAPY
SUPPORT
When considering provision for a child's nursing
and/or medical needs and/or therapy needs, the Education and Library
Board, school and Trusts ensure that the needs are clearly and
accurately described and that the relevant responsible professionals
are consulted as necessary.
Schools are responsible for ensuring that all
relevant staff know about and are, if necessary, trained by the
most appropriate Trust officer in procedures to provide support
required by pupils with nursing and/or medical and therapy needs.
This should be co-ordinated by the designated Trust officer.
Trusts and schools are continuing to work together,
in close partnership with parents, to ensure proper support in
school for pupils with medical, nursing and therapy needs.
Health and Social Services Trust staff, in consultation
with education staff, assess the need for care and assistance
with the tasks of daily living for children, individually and
also collectively where this is appropriate.
On the basis of that assessment, the Trust and
Education and Library Board will arrange for the appropriately
trained staff to provide the service within a setting which should
reflect the policy of "normalisation".
The Eastern Health and Social Services Board
recently agreed with its Trusts to provide care input to special
schools by a person who has NVQ level 2/3 under appropriate supervision.
The Board agreed to pay half the cost of such support to special
schools. The Education and Library Boards agreed to pay the other
half of the cost. Flexibility is retained in such situations by
Trust staff who can employ a nurse to do this work, if it can
justify a case to do so.
It is hoped that written information will be
drawn up (locally) for parents, to advise them on the type of
care services which can be expected as part of the school day
and to help them appreciate the limitations of any reasonable
level of care service in the school in the future.
BUDGET CONSTRAINTS
In recent years the demand for therapy services
in special schools, special units and mainstream schools has increased
due not only to increasing awareness on the part of parents and
others, but also due to legislative changes such as the community
care reforms and the Education Order.
Boards and Trusts have requested increased resources
in developing therapy services within schools to try to meet this
increasing demand. However, this must be seen in the context of
a wide usage of other competing resources facing the Health Service
and inevitably in some schools there are waiting lists for therapy
assessments and treatments.
It seems likely that the implementation of the
Code of Practice arising from the Education Order will create
additional demands for therapy services. It is also anticipated
that the policy on integration into mainstream schools to which
the Department of Health and Social Services and the Health and
Social Services are committed will further increase demands on
the service.
Health and Social Services resources are finite,
and the pressures on Boards' budgets can inevitably limit the
support that can be offered by certain specialists to meet special
education needs.
CO -ORDINATING
MECHANISMS BETWEEN
THE EHSSB AND
THE EDUCATION
AND LIBRARY BOARDS
To address these problems, and in keeping with
an objective of its Regional Strategy that inter-agency links
be formed to better promote practical co-operation, the Department,
with DENI, in 1997 established the Special Needs Regional Review
Group, which is made up of representatives of all four Health
and Social Services Boards and five Education and Library Boards.
This group have a co-ordinating function which allows for information
flow between the four Boards and the Education and Library Boards.
This group has developed principles for the provision of PAM services
to children with special educational needs. An inter-agency agreement
was drawn up by the Regional Review Group in November 1998, which
also sets out the statutory responsibilities of the respective
Boards for the provision of therapy, medical and nursing services
to children with special educational needs. This agreement is
due to be reviewed within 12 months.
The Eastern Health and Social Services Board
Trusts are currently developing local service level agreements
to facilitate the provision of education and social services for
children with special educational needs based on the principles
within the Agreement.
The Eastern Health and Social Services Board
is represented by J McCusker and J McCall and their next meeting
will take place on 18 January 1999.
This group intend to look at a number of areas
of work that it has already identified as priority including:
— Joint education and training of both
Health and Education Staff;
— Introduction and monitoring of the
inter-agency agreement;
— Promotion and development of collaborating
working;
— Developing models for effective resource
utilisation; and
— Joint review of complex needs.
The Regional Group are aware that a review of
the level of support in particular, i.e., nursing support to children
in special schools is required and this work will be taken forward
early in the New Year also.
Finally in relation to your letter of the 18
December 1998 and the annex you attached with the supplementary
questions. I have asked an officer of the Board to seek out a
response from the 4 Trusts to your seven questions. I hope that
our two representatives i.e., John Richards, Director, Social
Services and Mary Waddell, Director, Nursing Services who will
be speaking for our Board, at the oral evidence session on the
13 January 1999, will be able by this time scale to hopefully
provide you with the data you require.
I enclose for your information also a report
compiled by J McCusker (PAMS Commissioning Officer) on Therapy
Provision to Special Schools and Special Units, Academic Year
1997-98.[1]
6 January 1999
1 Not printed; see p. xxix. Back
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