Select Committee on Northern Ireland Affairs Minutes of Evidence

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.


  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.


  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;

    —  feeding;

    —  lifting and handling;

    —  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.


  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.


  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.


  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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