Select Committee on Northern Ireland Affairs Minutes of Evidence

Memorandum from the Western Health and Social Services Board


  With reference to your letters of 11 and 18 December 1998, I now enclose a memorandum outlining how the Board contributes to helping the Education and Library Board meet the needs of children with Special Educational Needs.

  In the time available, we have only been able to give you an overview of how we are approaching this issue. Mr Dominic Burke, Director of Social Care, and Mr Martin Bradley, Chief Nurse in the Board, will be speaking on our behalf at the oral evidence session and can elaborate on aspects of the memorandum as required.

  With regard to the Supplementary Questions attached to your letter of 18 December we are currently preparing a response for the Committee. You will appreciate that some of the detailed information you require is not currently held and we are discussing with Trusts how we might best provide a realistic assessment of activity.[2]


Interagency Co-operation with reference to Special Educational Needs (including Learning Disability Services)

Process involved in formal assessment SENs (Statementing)

A Regional Perspective

Provision of Services to Children with Special Educational Needs in the West

    —  Nursing Services

    —  Community Paediatrics (medical)

    —  Speech and Language Therapy

    —  Occupational Therapy Services

    —  Physiotherapy Services

    —  Other PAMs Services

    —  Pressures and unmet needs in PAMs Services

    —  Social Work Services (Physical and Sensory Impairment)

    —  Child and Adolescent Mental Health Services

    —  Children's Services Plan

    —  Clinical Psychology Services

    Annex 1  School Children and the Disabled Persons (NI) Act 1989—a guide for parents.



  The WHSSB believes strongly in the benefit of interagency co-operation at both a strategic and operational level.

  The Board initiated the setting up of a "Disabled Persons Act" meeting a number of years ago to ensure the implementation of the Act. Since then, the meeting has been extended in membership and it now includes Consultant Community Paediatricians and their staff, Appropriate Officers, the WELB's Special Education Officer and his staff, representatives of health care practitioners, social work staff and the relevant planners at the Board.

  The meeting, which is held approximately three times per year, has carried out the following tasks recently:

    —  Revised the leaflet "A Guide for Parents" which explains how the legislation works and how it can bring benefit to the disabled young person and their family by ensuring the necessary links between the WELB, Trust staff and the family.

    —  Conducted a thorough revision of the WHSSB Disabled Persons Act Protocol to include reference to the Education (NI) Order 1996. This document has been developed to guide professional staff through the statutory responsibilities of the Education and Library Board, the Health and Social Services Board and the Trusts, the definitions of disability and the roles of key personnel. The Protocol draws together the strands of both the Code of Practice of the Education (NI) Order 1996 and the Disabled Persons (NI) Act 1989 with particular emphasis on the effective implementation of transition planning from the review of statements at 14 years to pre-school leaving assessments.

    —  Established a joint Training Sub-Group to plan training for appropriate Health and Social Services staff with reference specifically to:

      —  the Statementing Process

      —  the Disabled Persons Act

      —  the Code of Practice

  This initiative will be supported by the Social Services Training Team and a programme is currently being worked up to ensure that all Social Services staff, including Social Workers, are conversant with all the aspects of the interface between Health and Social Services and the Western Education and Library Board/Schools. Resources have been allocated by the Social Services Training Team to facilitate this initiative and staff from the Community Paediatric Service and from the Western Education and Library Board will contribute to the training.

  This joint approach continues to:

    —  facilitate the sharing of information between the two Boards. It has been possible to facilitate earlier transition planning for potential school leavers this year.

    —  ensure the dissemination of information to and from Head Teachers of Special Schools.

    —  provide a forum for identifying problems and for co-ordinating effort. The meeting is of the opinion that the time and effort given to working on areas of joint interest has paid off though much remains to be achieved.


Learning Disability

  The Health and Social Services Learning Disability Services have traditionally had close links with Special Needs Education (having at one stage been part of one agency!).

  The following points explain the relationship:

    —  The Learning Disability Teams, comprising the social work, nursing and medical (psychiatric) profession, "know" all the children on the Register. Most of these children attend Special Schools (former "S" and "M" Schools). The Teams in each Trust area deal with both children and adults and are therefore involved at transition.

    —  Liaison with the schools by social workers and nurses is maintained via an "attached" staff member or the child's key worker.

    —  Health and Social Care staff attend Reviews in schools; there are examples of Reviews being brought forward this year to facilitate earlier assessment and planning.

    —  Liaison with schools is vital as respite care arrangements must take account of continuity in education requiring logistical adjustment when children are away from home.

    —  Examples can be cited of staff from each Agency attending reviews etc., organised by the other, e.g., Educational Psychology input to multi professional meetings organised by a Trust and Head Teachers attending case discussions organised by Health and Social Services.

    —  A recent example of good practice where parents, school staff and Multidisciplinary Teams all met (in Strabane) to develop a coherent utilisation of the TEACCH methodology at home and at school in respect of a child with special needs.

  There is therefore some cause for encouragement though the Community Teams are short of resources and the number of children on the register increases every year. The demands of the Children Order in relation to respite care have increased work dramatically leaving relatively less time for direct work by staff.

  The multi-disciplinary teams include 11.59 funded posts for nurses (including a nurse based at Foyleview Special School). The nursing staff focus their attention on children with more complex and profound needs and are in regular contact with the schools, advising staff and parents regarding care and treatment. They also liaise closely with their professional colleagues. The programme includes a funded post for a Clinical Psychologist and 19 Social Work staff at various grades, all of whom have responsibility for adults as well as children.

Support for Children with Disabilities

  Sensory Impaired

  Inter-Agency Support

  1. Western Area Committee for Hearing Impaired:

    Chaired by Chief Educational Psychologist—Membership includes Medical Consultants, Commissioner, Specialist Social Workers, Speech and Language Therapists, Specialist Teachers, Senior Education Officers.

    Role—Needs assessment

        Number of children reviewed annually;

        Information booklet for parents produced;

        Shortfall in services identified.

    Overview of service provided to individual children.

    This is done through case conference system which is chaired by the Medical Consultant.

  2. Western Area Committee for Visually Impaired:

    Chaired by Medical Consultant—Membership includes Chief Educational Psychologist, Specialist Senior Teachers, Commissioner, Specialist Social Workers, Fiona North, Optometrist, Claire McGartland, Orthoptist.

    This mirrors the role of WACHI. An information booklet is being prepared.

    Specialist Social Workers work with individual hearing and visually impaired children and link as appropriate with schools and other professionals. Equipment is provided as appropriate.

Children with Physical Disability

  Assessment and review carried out at a special clinic by Dr Hutton within the Foyle Trust area. There is a PAMs services input to this clinic. Assessment and review are also carried on a multi-disciplinary basis within the Sperrin Lakeland Trust area.

  Social work support is provided for individual child and family as appropriate. Links are maintained with schools and other professionals including after school-support. Some families may be care managed.

  Where statements are in place in respect of children about to leave school, social work follow-up is provided as appropriate.

  The provison of respite care for children necessitates close liaison between the Teams and the schools in order to maintain continuity and conisistency.


Initial Assessment

  Initial notification of proposal to make statutory assessment of Special Educational Needs received by Community Paediatrician from Western Education and Library Board.




  In May 1997 a Regional Group was established to plan for the consequences of the introduction of the Code of Practice for the Identification and Assessment of Special Educational Needs. The group has representation from each of the Education and Library Boards and each Health and Social Services Board.

  As the first part of its work, the Group has produced an Interagency Agreement for the Provision of Education, Health and Social Services to Children with Special Educational Needs.

  The Group has also completed work on guidance for schools on meeting the medical needs of children in school and that work is now with the Department of Education.

  In 1998-99 the group plan to:

    —  review the operation of the Interagency Agreement;

    —  carry out a review of the nursing support to children with special educational needs;

    —  facilitate and support training for both education and health staff in the working of the Code of Practice.

Interagency agreement

  The Agreement is between the Health and Social Services Boards (HSSBs) and the Education and Library Boards (ELBs) and sets out the respective responsibilities for the provision of therapy, medical and nursing services to children with special educational needs.

  Under the Agreement, the ELB, in conjunction with schools and Health and Social Services Trusts, will develop local Service Level Agreements to facilitate the provision of education and health and social services to children with special educational needs based on the principles and within the spirit set out in it.

  The role and responsibilities of all parties are set out to ensure the provision of a comprehensive, high quality, effective and efficient level of service to children with special educational needs.

  All parties will work together within the available resources to meet the needs of the child taking into account the wishes of the child (where these can be ascertained) and those with parental responsibility.

Nursing, Medical and Therapy Support

  In relation to the provision of health care support, the following principles have been developed:

    —  When considering provision for a child's nursing and/or medical needs and/or therapy needs, the ELB, School and Trust should 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 shall work together, in close partnership with parents, to ensure proper support in schools for pupils with medical, nursing and therapy needs.

    —  HSS Trust staff, in consultation with education staff, will assess the needs 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 ELB will arrange for the appropriately trained staff to provide the service within a setting which should reflect the policy of "normalisation".

    —  Written information should 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.

Planned Service Development

  The Agreement advocates that protocols must be in place to facilitate discussion of any future service development or proposed changes in service at the earliest opportunity, to enable service planning by Trusts and, where required, funding by commissioners of services. This needs to reflect the needs of both agencies, for example ELBs need to know if the Health and Social Services are planning changes including the withdrawal or change of personnel or additional investment.


  It is to be hoped that the Interagency Agreement will facilitate a more planned and rational approach to meeting the needs of these children and greater co-ordination between Health and Social Services and Education.


  Up to 20 per cent of the school population may have special educational needs at some point in their school career. A smaller number of pupils, estimated to be around two per cent or less, will have more complex needs which will require a statement of special educational needs. Within the Western Board two per cent of pupils currently have statements of need. This is consistent with the recent Government guidelines (Green Paper: "Excellence for All" suggested target of overall statementing level 1.5 per cent to 2 per cent) and recognises the need to promote the inclusion of children with special educational needs within mainstream education wherever possible. Therefore, when considering the contribution of health and social care professionals, it is important to recognise that their services are offered to, and required by, a much larger group of children than those who have been formally statemented.

  The demand for these services is also likely to grow as the mortality rates for premature babies and post-accident trauma cases improves and there is a subsequent increase in the number of profoundly or multiple disabled children. The increased awareness and identification of children with specific learning difficulties, speech and language difficulties, autism and emotional behavioural difficulties will also lead to an increasing pressure on these services.


  A minority of children with special educational needs require formal assessment (statementing). The remainder are managed according to the stages set out in the Code of Practice.

  The majority of these children are identified to the School Health Service by:

    —  Health visitors (pre-school entry);

    —  Parents via the Health Appraisal forms at school entry;

    —  Educational Psychologists;

    —  Speech Therapists;

    —  Teaching Staff.

  Once identified, they have vision and hearing checks carried out by the School Nurse and are seen by the Staff Grade doctor at the routine school medical. Each school is visited once in the school year, and the School Nurse liaises with the parents and school (usually via the SENCO, the school's Special Educational Needs Co-ordinator). The SENCO frequently requests information about medical problems which might affect the child educationally and this can be given, with parental consent.

  The school nursing service also provides information and training for school staff on children with specific medical problems in school, e.g., children at risk of anaphylaxis who have adrenaline syringes for use in school, asthmatics who have nebulisers in school, etc.

  By far the majority of children seen for selective medical examination in school are those with special educational needs but without statements.

  The School Nursing Service provides a care surveillance developmental and immunisation programme to children with special educational needs. The method of screening may vary according to need but basically adheres to the following format:

School nurse

(a) Sees all school age children who are for:

    —  Initial assessment special education needs: for height, weight hearing, vision checks, as requested by Medical Officer

    —  Transition Plan

    —  Annual Reviews

  All statemented children have yearly hearing and vision[3] checks done. The latter are carried out in special schools by the School Nurse working with the Orthoptist. In addition, she assists the Orthoptist and Staff Grade doctor at the Community Ophthalmology Clinic.

(b) Special Schools

  Each school has a named School Nurse. Each child is seen by the School Nurse as per the routine school health programme, e.g., P1 Health Appraisal, height, weight, vision and hearing checks, routine immunisations etc., but also as above. Each school is visited yearly but the nurse can be contacted by phone at any time.

  The School Nurse assists the Medical Officer at selective medical examinations (children with medical problems associated with their learning difficulties). She can give advice and information regarding specific problems to the school (with parental consent).

(c) Special Educational Needs in Mainstream Schools

  The School Nurse is involved with children with special educational needs in mainstream (statemented and non-statemented).

    —  routine core school health programme;

    —  yearly vision and hearing checks;

    —  assists Medical Officer at school medicals;

    —  gives advice to parents, e.g., referral to other agencies, e.g., speech therapy, behaviour management etc;

    —  gives advice and information to the school (with parental consent), e.g., soiling, diet, etc. In a significant number of cases where children have serious medical problems resulting in them having special educational needs, the School Nurse has been involved in helping to provide information and training to school staff, e.g., children with severe asthma and epilepsy and children at risk of anaphylaxis.


  Providing services for children with special educational needs forms a major part of the work of community paediatricians.

  The work involves:

    (1)  Identification for the WELB of those pre-school children who, due to their health problems, are likely to have special educational needs. This includes children with congenital abnormalities, developmental delay and complex multiple problems.

    (2)  Identification of those children who, after an illness, disease or road traffic accident develop special education needs.

    (3)  Carrying out detailed medical and other assessments of children with special educational needs for the Education and Library Boards for the purpose of statementing.

    (4)  Co-ordinating the response to the Education and Library Board regarding the assessment of children with special educational needs for the purpose of statementing.

    (5)  Providing ongoing therapy and assessment of children with special educational needs.

    (6)  Providing regular updates on the progress of children with special educational needs to the educational psychologists, schools, special education officers, specialist palipatetic teachers and other appropriate Education and Library Board personnel.

    (7)  Attending and contributing to meetings regarding children with SENs both locally at special schools and centrally with Education and Library Board officers.

    (8)  During preparation of transition plans for age 14+ children with statements, Medical Officers provide reports and an Opinon as to whether the child is "disabled" under the Disabled Persons Act 1989.

  The assessment of children with SENs for the purpose of statementing is given top priority by Community Paediatricians, alongside the developmental assessment of children who may have SENs and require a referral to educational psychology.

  It is estimated that over 50 per cent of the time of Community Paediatricians is spent on activities relating to children with SENs, recognising the importance of helping Education and Library Boards see that these children maximise their educational potential.


  Speech and Language Therapists interpret children with SENs to be those children who fall into the following categories:

Learning Disabled

  Special schools


Specific Language Impairment (SLI)



Hearing Impaired

  These are estimated to be 655 children with SENs involving Speech and Language Therapy input in Foyle Health and Social Services Trust and 376 children with SENs involving Speech and Language Therapy input in Sperrin Lakeland Trust.

  The two Trusts in the Board that provide Speech and Language Therapy Services have given information on input to the various categories as follows:

Foyle HSS Trust

    Hearing Impaired — 1.5 Wte

    Special Needs — 3.5 Wte

    Specific Language Impairment — 4.8 Wte

Sperrin Lakeland Trust

    0.6 Wte

    3.4 Wte

    3.6 Wte

  In both Trusts, this equates to approximately 50 per cent of the funded establishment.

  The Speech and Language Therapist often sees children with special educational needs from a very young age and provides input to educational psychology reports. This group of children also receive speech and language therapy advice and where appropriate, treatment as part of the statementing process.

  Staff offer support and guidance on a regular basis to outreach and support teachers, SENCOs in mainstream schools and teachers in special units.

  The WHSSB, the Trusts and the WELB are currently looking closely at the possibility of appointing an Advisory Speech and Language Therapist to mainstream schools and nurseries.

  Children with SENs receive a high priority with the therapy being delivered by specialist Speech and Language Therapists.


  The Occupational Therapy service contributes to the Trusts' input to meeting identified SENs in the first instance by submitting an assessment report for consideration within the statementing process.

  The Occupational Therapy (OT) assesses and provides treatment and/or recommends appropriate equipment.

  The OT devises a treatment programme to develop skills and advises teaching staff how to maximise the child's abilities.

  The OT advises on alternative approaches to the task, adapting the equipment where necessary.

  In addition, the OT will contribute to the general care of the child within the school environment by offering advice on:

    —  appropriate manual handling of the child;

    —  specialist equipment required;

    —  requirements in relation to daily living activities.

  Currently there are eight Whole Time Equivalent posts dedicated to paediatrics, the vast majority of which is involved in dealing with children with special education needs.

  Formal and informal links between the Trusts' Occupational Therapists and staff in educational establishments have been formed in order to maximise the potential of all children referred to the service.


  Physiotherapists have an input via the Community Paediatrician at the assessment stage of the statementing process.

  Follow-up treatment and reassessment is carried out in both Trusts in the WHSSB. These activities are carried out at schools—both special and mainstream, in the patient's home and in clinic facilities.

  The Foyle Trust have four whole time equivalents physiotherapists assessing and treating the needs of children with special educational needs while the Sperrin Lakeland Trust have three.

  Physiotherapists have developed formal and informal links with staff in special schools, meeting them on a daily basis. Local groups of Trust physiotherapy staff and Education and Library Board staff meet on specific cases if and when required.


  Other professions allied to medicine that are involved in the assessment and treatment of children with SENs are dieticians, podiatrists and orthoptists.

  It is estimated that, in any one year, each of the professions will have the following input to children with special educational needs:

ProfessionPercentage of total contacts given to children with SENs

  Relevant staff meet at multidisciplinary meetings with the Education and Library Board on specific cases.


  The Education Order and the timescales within it have increased pressures on PAMs staff.

  Other pressures have arisen and will continue to increase as more premature babies survive and those born with a disability live longer.

  As the public and professionals become more aware of language difficulties, speech and language therapists have increased demands made on their services. It is now estimated that one in 5 children require some therapy whereas previously the ratio was one in 12.


  There are 18 social work staff working in the field of physical disability in the WHSSB. In addition, the Trusts employ specialist staff to work on a dedicated basis in the area of sensory impairment. Staff are based in local offices and within Specialist Sensory Support Centres in Londonderry and Enniskillen. There are 12 full-time and one part-time staff of various grades undertaking work with sensorily impaired people, both adults and children. Some are employed directly by the Trusts, others are employed by voluntary organisations which receive funding from the Trusts who, in turn, contract with the Board.

  Services to children and young people and their families are delivered on an individual casework basis but input is made with reference to education during and after the initial statementing, the review of statements and at pre-school leaving assessments in keeping with the Disabled Persons Act requirements.

  This involves attendances at pre school-leaving conferences, liaison with staff and the completion of reports in respect of children with special educational needs.

  Staff have been able to assist young people in preparing for further and higher education by setting up packages of support, including domiciliary care and advice regarding welfare and housing arrangements.

  Specific help is given in the Foyle Trust to young people who have suffered from head injury, in relation to training, support and placements.

  Close liaison is maintained with the Community Paediatric Services.


  The Board's Child and Adolescent Services began in 1992 with the establishment of a Multi-Disciplinary Team comprising psychiatry, psychology, nursing and social work. In 1995 a second team was set up to cover the Sperrin Lakeland area. This allowed for a base to be created in each Trust area, in Londonderry and Omagh.

  The Teams take referrals from GPs, other health professionals and the Educational Psychology Service. The target age group is those under 16 years of age and a very wide range of disorders present themselves to the Teams, including emotional, conduct, hyperkinetic and development disorders. The Teams also deal with children and young people with eating disorders, habit disorders, post traumatic syndromes, somatic disorders and psychotic disorders.

  There is significant contact where appropriate with schools in relation to the children and young people. Many of the young people may not be statemented but their wellbeing and, no doubt, capacity to learn and achieve will be affected by their emotional distress. The assistance of the Teams is vital in securing their wellbeing.

  A recent Review of the Service indicates the need for other elements of a Child and Adolescent Service and this is the subject of ongoing planning.

  A wide range of interventions is provided by highly skilled and trained professional staff, including family therapy. The current funded establishment comprises 1.9 Consultant Psychiatrists, two Clinical Psychologists, two Senior Social Workers and four Nurses. The total revenue budget for the Teams is £513,000.

  In addition, the Western Board purchases residential treatment services for young people and children at the Foster Green Hospital and the Young People's Centre in Belfast at a cost of approximately £180,000 per year. It has also been estimated that in-house treatment and care costs amount to somewhere in the region of £150,000 per year.

  The Board is alive to the many challenges facing young people and the necessity to develop further resources. The component parts of the service envisaged for the West are included as recommendations in the report—"With the Young in Mind".


  In accordance with the Children (NI) Order (1995) which became law in November 1996, Part 4, Boards and Trusts have a responsibility to provide services for children in need and to seek the collaboration of other statutory agencies and voluntary agencies in achieving this objective.

  A child is "in need" if:

    —  he is unlikely to achieve or maintain or to have the opportunity of achieving or maintaining a reasonable standard of health or development without the provision for him of services by the appropriate authority;

    —  his health or development is likely to be significantly impaired or further impaired, without the provision for him of such services;

    —  he is disabled.

  The Board has issued a draft Children's Services Plan for consultation. The finalised document will provide the template for planning and operationalising services for children and young people into the next millennium, including "looked after children",. "disabled children", and "children with emotional, behavioural, psychiatric or psychological difficulties".

  The draft document references the number of children subject to Statements of Special Educational Needs in the Western Area throughout 1998.

Number of Children Subject of Statements of Special Educational Needs in Western Area, October 1998
CategoryNumber of Children
Learning Difficulties786
Specific Learning Difficulties41
Emotional/Behavioural Difficulties80
Speech and Language Difficulties98
Medical Conditions88
Total Statemented1,337
Number of Statements in process248
Number of pre-school children with Statement8
Source: WELB

  The document fully acknowledges the implications of the Code of Practice for the Identification and Assessment of Special Educational Needs (DENI 1998).

  Interagency co-operation is highlighted by the document as per "All of the agencies and groups will work towards agreement about the approaches and services needed to maximise support for children and young people. Assessment of need will be developed and discussed between agencies and opportunities for collaboration in the planning and provision of services will be pursued positively."

  The Board plans to commission a major and specific Needs Assessment project in respect of disabled children and young people in 1999.



  At the moment there is one full-time Grade B Clinical Psychologist working in the Child and Adolescent Team in Sperrin Lakeland. The Psychologist works with children between the ages of 0 and 16, all whom would be assessed as having special needs of an emotional mental health nature.

  There is one vacant Clinical Psychology post in Learning Disability which has not yet been filled.


  Foyle Trust have had one full-time Grade B and 0.5 Grade A Clinical Psychologists working in the Child and Adolescent Team in the Trust's area for the past six months. The children in this Team have also been assessed as having emotional/mental health special needs.

  In addition, there is one vacant Clinical Psychologist post in Learning Disability which has been advertised on a number of occasions.

6 January 1999

2  See also Appendix 14, p. 169. Back
3  Note by Witness: In special schools, vision testing is done by the school nurse with the orthopist-this relates only to Fermanagh. Back

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