Select Committee on Northern Ireland Affairs Minutes of Evidence

Memorandum from the Southern Health and Social Services Board


  The Southern Health and Social Services Board (SHSSB) is responsible for commissioning health and social care on behalf of its resident population. In the Southern Board there are 98,225 people under the age of 19 and 75,305 under the age of 14.

  There are four Health and Social Services Trusts in the Southern Board responsible for the delivery of services to children.

Special Education Needs

  The term "Special Educational Needs" (SEN) is defined as "a learning difficulty which calls for special educational provision to be made". Learning difficulty is used to describe (i) a child who has significantly greater difficulty in learning than most children of the same age, and/or (ii) has a disability which restricts the use of standard educational facilities. Children with special educational needs may present to health and social services either before or after school entry.

  It has been estimated that approximately 20 per cent of the child population have special educational needs and approximately 2 per cent have "statements" of their special educational needs. In the Southern Board, around 2.1 per cent of the school population have "statements" in relation to their special education needs. The Southern Board has experienced an increase in the number of "statemented" children in the last few years similar to other parts of Northern Ireland.


  The SHSSB commissions a range of medical and social care services covering the areas of child health surveillance, diagnosis and assessment, and ongoing care of children with SENs. This includes the provision of information, advice and support to educational staff regarding the likely impact of a child's disability or medical condition on their education.

  The objective of services is to ensure that children with special educational needs are recognised at the earliest stage possible to enable appropriate remedial/supportive interventions to begin during the child's early formative years.

  There is a regionally-agreed child health surveillance programme in Northern Ireland. In the pre-school age group this is carried out by members of the primary care team in the community. When problems are detected, children are referred to community child health services. In school age children, child health surveillance is undertaken by the school health service doctors (under the supervision of a Community Paediatrician/Senior Clinical Medical Officer) and nurses.

  The Child Development Clinic, located in Craigavon Area Hospital, provides a specialist multidisciplinary developmental paediatric service for children with complex disability. This service is mainly for children in the pre-school age group who require combinations of therapy, advice and treatment.

The "Statementing" process

  The Community Paediatrician/Senior Clinical Medical Officer in each of the Trusts in the SHSSB is the "designated officer" who co-ordinates the health services' role and contributes to the statementing process. The assessments undertaken depend upon the nature of the disability—assessments are undertaken on all children by community paediatric/clinical medical officers who draw on information from other medical staff such as child and adolescent psychiatrists, orthopaedic surgeons and clinical psychologists, speech and language therapists, occupational therapists, physiotherapists and social services when a child is known to their services.

  The services provided for a child vary reflecting the diverse nature of the assessed needs of any child and the wide range of conditions that lead to SEN. Care is provided across a number of settings e.g., hospital, community, school and in the child's home. While care can usually be provided within the Southern Board, there are occasions where it is necessary to refer the child outside the Southern Board, for example in the provision of specialist treatment/intervention for children with sensory impairment.


  There is a long history of close working, at both strategic and operational levels, between the Southern Health and Social Services Board, local Health and Social Services Trusts, and the Southern Education and Library Board. Health and social care professionals from local Health and Social Services Trusts meet regularly with colleagues in the SELB on issues relating to Special Educational Needs. This includes regular scheduled meetings between Trust staff and SELB officers and ad-hoc meetings/contacts, on a day-to-day basis, between service professionals to discuss management of individual children. In the school health service, named medical and nursing staff work in schools and are available to answer queries as they arise about pupils or health matters, e.g., meningitis case in a pupil attending a school. Specific examples of service co-ordination at strategic and operational level with the SELB include the following:


  Development of Service Level Agreement between Education and Health and Social Services Boards

  A regional interagency working group has drafted an interagency service level agreement between Health and Social Services Boards and Education and Library Boards outlining the roles and responsibilities of health and educational staff for effective interagency working. The SHSSB expects to work closely with the SELB in the future in relation to the implementation and monitoring of this agreement.

Child Protection

  SELB are represented on the Southern Area Child Protection Committee (SACPC) and have actively co-operated with SHSSB on a number of initiatives including the joint funding of multi-disciplinary training posts, the introduction of the "Kidscape" child protection programme in schools and the amendment of that programme for use with children with disabilities.

Children Order

  The SELB was represented on the SHSSB multi-disciplinary planning group which was set up in 1995 to consider the implications of the introduction of the Children (NI) Order 1995. Co-operation has continued with a quarterly meeting of SHSSB, Trust, and SELB representatives to address issues of joint interest in relation to the working of the Order. SELB has also provided support to individual schemes such as the "Adolescent Projects" operating within each of the Trusts in the Southern Board.

Early Years

  This is an area of close co-operation with the SELB being an active member of the Early Years Committee Forum and the SHSSB taking a full role in the SELB-led Pre-School Education Advisory Group. This has included the joint funding of administrative support to the Committee and the development of a geo-mapping data base to support the allocation of European funding and the more general strategic planning of early years services.

Children's Services Plan

  The SELB Chief Executive is a member of the Southern Board Children and Young Peoples Committee which has established a strategic planning framework to take forward multi-agency co-operation in planning services to vulnerable children. Eight planning sub-groups have been formed with representatives from the relevant agencies and disciplines. SELB officers are key members of a number of these planning groups, in particular the groups considering the following issues: children with school related difficulties and young people in conflict with the law; Children with disabilities (including children with SEN) family support and child protection (SACPC), Early Years (SAEYC), children with a mental health problem, and young carers.


Child Development Clinic

  An educational psychologist attends the Child Development Clinic in Craigavon on a weekly basis where an educational assessment is commenced and the appropriate referral is made to local education services.

Rathfriland Hill Pilot project

  A jointly funded pilot project between the SHSSB and SELB is under way in Rathfriland Hill school in Newry. This is targeted at pre-school children with complex disability and provides therapy and education. The pilot project started in 1997 and will be evaluated after the pilot phase is completed in 1999.

Attention Deficit Hyperactivity Disorder

  A new clinic for children with this condition, which is sometimes associated with SEN, will open on a pilot basis in Kilkeel at the end of January 1999. The clinic will be run by an educational psychologist and community paediatrician. The effectiveness of the service will be evaluated after the pilot phase.

Autistic Spectrum Disorder

  Research has shown that this condition can affect up to 1 per cent of the total population. These children require special interventions and learning environments. Currently within the Southern Board there is a working group consisting of health and educational professionals agreeing procedures for streamlining the assessment of children with this condition and the services that will be required in the future.

DENI Code of Practice

  Two Trusts within the Southern Board have developed arrangements with SELB and agreed protocols for operationalisation of this.

Health Promotion

  There is a Youth Officer post for health promotion in the Southern Area which is jointly funded by the SHSSB and SELB.


  Within the broad context of relatively fixed resources, but increasing demand for health and social care provision, the SHSSB has continued to develop services to meet the specific health and social care needs of children with SENs.

  An additional recurrent sum of £146,000 has been invested in therapy posts, i.e., speech and language therapy, physiotherapy and occupational therapy in the Southern Board since 1995 for the management of children with SENs. Prior to this, the SHSSB funded a unique training initiative focusing on developing the competencies and skills of therapists. Designated staff rotated through the Child Development Clinic, special units, schools and community settings for children with a disability and, under supervision, gained experience and skills in managing and supporting children with special needs.

  Children Order funding has been used to develop services for children with a disability. Since 1996 this has amounted to £220,000 which is approximately 25 per cent of the money available for the Children Order. It is anticipated that this level of investment will continue for the next three to five years.

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Prepared 14 April 1999