Select Committee on Northern Ireland Affairs Minutes of Evidence

Memorandum from the Northern Health and Social Services Board


  The content of this Memorandum addresses the issues raised in the letter, dated 11 December 1998, from the Clerk of the NI Affairs Committee, to the Board's Chief Executive namely:

    "how the Board contributes to Education and Library Boards meeting identified SENs; the co-ordinating mechanisms between the Board and the Education and Library Boards; and how the Board prioritises Special Educational Need requirements against other calls on its budget".

  In order to facilitate the Committee's deliberations, this Memorandum also identifies a number of areas which are important in informing the commissioning and delivery of services. In particular, it deals with the framework provided by legislation and policy, definitions of special educational need, and the role and relationships the Board has, as a commissioner of care, with that of the Department of Health and Social Services (DHSS) and provider Trusts.


  Whilst acknowledging the primacy of the Department of Education for Northern Ireland and local Education and Library Boards in securing and providing appropriate education for children with disabilities, under 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. This responsibility is exercised through the four Health and Social Services Boards, Health and Social Services Trusts and General Practitioner services.

  It is the function of each Board to assess the needs of its population and commission, principally from Trusts, the services necessary to meet those needs having regard to the resources available, legislative requirements and Departmental policy.

  While the Boards carry primary statutory responsibility for children with disabilities, the provision of services for children with disabilities has been delegated to Trusts following the Health and Personal Social Services (NI) Order 1994.

  The main legislative framework for the commissioning and provision of services is the:

    —  Disabled Persons (NI)Act 1989;

    —  Education (NI) Order 1996; and

    —  Children (NI) Order 1995.

  The Children (NI) Order brings together most public and private law relating to children and establishes a new approach to services provided by Trusts for children and their families. Apart from the Disabled Persons (NI) Act 1989, Trusts' functions towards children with a disability are covered by the Order.

  The Children (NI) Order provides a legal framework for the provision of services for children with disabilities and seeks to ensure the integration of these services. This requires Trusts to offer children with a disability the benefit of those powers and duties which they have in respect of all children.

  The specific provision in the Children (NI) Order in respect of services to children with disabilities are:

    —  Article 27(9) requires that where a Trust provides accommodation for a child whom it is looking after and who is disabled, it shall, so far as is reasonably practicable, ensure that the accommodation is not unsuitable to his particular needs.

    —  Schedule 2, paragraph 3 places a requirement on Trusts to open and maintain a register of children with a disability in their area.

    —  Schedule 2, paragraph 4 provides that a Trust may assess a child's needs for the purpose of the Children Order at the same time as any assessment under certain other legislation.

    —  Schedule 2, paragraph 7 requires Trusts to provide services for children with a disability which are designed to minimize the effects of the disability and enable children to have the opportunity to lead lives that are as normal as possible. Trusts should adopt a positive approach and plan services which are designed to give such children opportunities to lead their lives to their full potential.

  In this context, the Board's responsibilities apply to children with disabilities, who are children in need as defined by the Children (NI) Order which therefore encompasses a much greater number of children than those specifically with Statements of Special Educational Needs.

  In addition, practice has been shaped by a number of important policy guidelines including:

    —  Code of Practice of the Identification and Assessment of Special Educational Needs, DENI (1998).

    —  Supporting Pupils with Medical, Nursing and Therapy Needs, DENI (1998).

    —  Children First: A Guide to the Needs of Disabled Children in School.


  This section outlines the measures in place within the Board's area to maintain co-ordination with the Education and Library Boards and also the contribution of health and social services staff to meeting special educational needs.

  At its meeting on 7 October 1996, the Chief Executive of the Health and Social Services Executive and the four Board Chief Executives agreed the establishment of a regional review group to develop principles for the provision of services by professions allied to medicine (PAMs) to children with special educational needs.

  The Department of Education for NI formally endorsed this approach and Education and Library Boards nominated their Special Education Officers as their representatives on this group.

  This work has led to an Agreement which sets out the responsibilities of both Education and Health and Social Services Boards with respect to children with special educational needs.

  The work of this Regional Group is continuing and issues to be addressed include:

    —  Joint education and training of both HPSS and education staff.

    —  Implementation and monitoring of the Interagency Agreement (Guidance).

    —  Promotion and development of collaborative working.

    —  Development of models for effective joint resource utilisation.

    —  Joint review of complex needs.

  In 1996, the Board, with the North Eastern Education and Library Board (NEELB), established a forum to exchange information on needs assessment, services and strategic planning. This forum is considered by both Boards to be very successful in identifying areas of shared developmental needs. The forum has provided opportunities for workshops for practitioner staff in both organisations to enable them to further develop working relationships and understanding of specific roles and services. A positive outcome has been to jointly fund services for marginalised young people who may be excluded from mainstream education and who also display emotional and psychological difficulties.

  As a consequence of the Children (NI) Order, the Board has set in place a comprehensive Children's Services Planning process which provides further opportunities for coordinating planning across a range of agencies and disciplines. Within this Board, a sub-group has been established dealing specifically with issues relating to families and children with disabilities. This sub-group includes a Senior Education Officer and Senior Educational Psychologist from the NEELB, together with staff from a range of medical, nursing, professions allied to medicine and social work staff in the Northern Board, Homefirst Community, Causeway and United Hospitals Trusts.

  Alongside the co-operation and coordination at a strategic level, the Board has over the years promoted and supported the development of arrangements at an operational level to ensure that professional staff can provide appropriate support in contributing to assessment and care planning. Within Community Trusts in the Board's area, Senior Clinical Medical Officers/Community Paediatricians have been designated as the lead professionals for securing assessment reports from other health and social care professionals.

  By way of example the table below sets out the staff resources currently available for staff in professions allied to medicine within the Board who are working with children with disabilities.

Staff in professions allied to medicine (PAMs) in the Northern Board area (January 1999)
ProfessionNumber (WTEs)
Speech and Language Therapist (SLTs)
Working in an educational setting18.78
Working with children: Total36.24
Paediatric Physiotherapists (PPs)
Working in an educational setting6.57
Working with children: Total12.61
Paediatric Occupational Therapists (POTs)
Working in an educational setting4.11
Working with children: Total12.21
SLTs, PPs and POTs are the professional staff automatically asked for a report by the SCMO. Referrals may also be made to Dietetic, Orthoptic and Podiatry staff.

  There are three special social work teams within the Board's area working with children with disabilities and their families, comprising three team leaders and 11 social workers.

  Further details are presented in Annex 1 in respect of:

    —  Children with disabilities in contact with Social Services.

    —  Children on the Special Needs Register.

    —  Special School provision in the NHSSB area.

    —  Special units by school, type of unit and number of pupils attending.

    —  Disability Living Allowance.

  Building on existing inter-professional linkages, an innovative development currently being piloted is a scheme operating throughout the Board's area, involving Speech and Language Therapy staff from Trusts working with Educational Psychologists from the Education and Library Board to improve the referral process.

  Another innovative development, as a result of Board funding, is the implementation of the TEACCH programme in both Community Trusts in the Board's area.

  Furthermore, there is a continuing programme of training events where HSS professional and Education and Library Board staff can train together, for example, training provided by the Area Child Protection Committee and joint training and development in relation to services to pre-school children (the Early Years initiative).


  It is recognised that children with statements have special needs which are often complex. In commissioning services and making resource decisions, the Board's focus is on ensuring that all children in need have access to universal services whilst at the same time ensuring the appropriate development of specialist services. Service provision, therefore, is provided in response to identified needs, and children with statements of special educational needs will, for the most part, receive services from health and social services staff who provide a range of care for other children with disabilities and their families. Consequently, budgets are not identified for care inputs specifically for children with assessed Special Educational Needs, it being considered more appropriate that this is set at a higher level.

  Routine information collection reflects these factors and it is for this reason that certain, very specific, information on activity and expenditure, as required in the Clerk of the Committee's letter of 18 December 1998, cannot readily be provided by 13 January 1999, as this in a number of areas will require a manual search of records to identify the particular nature of work done by various professionals with children with Statements. This will be provided as soon as possible.[4]

  The provision from the Department of Health and Social Services of specific Children Order funding has enabled the Board to further develop, with a number of voluntary organisations, community groups and Trusts, an enhanced range of services, in particular by increasing family support and opportunities for respite care.

  The needs of children with disabilities have been given further impetus by the Children's Services Planning sub-group for children with special needs and the resulting Plan for the Board's area will address, on an interagency basis, the prioritised needs of this group.

  Decision making at Board level is also assisted by multi-disciplinary Programme of Care teams which provide information on needs, taking into account the views of voluntary organisations and professional staff in Trusts and other organisations.

  The Board has undertaken an extensive review and analysis of the needs of both adults and children with learning disabilities in order to inform its commissioning and expenditure priorities. This has also informed the development of a strategy entitled "Promoting Ability—A Strategy for the Development of Care for People with a Learning Disability". A priority of this strategy is the further development of services provided by the professions allied to medicine and this will be of direct benefit to children in need, including those with special educational needs. The Board has committed itself to realising the implementation of this strategy, within available resources, within the next five years.

  The Board's ability to implement these developments, however, will be influenced by the extent to which other priorities are identified, the need to meet pressures across the spectrum of health and social services and the level of funding made available to the Board by the Department.


Children with disabilities in contact with Social Services, September 1998
NHSSB TOTALS2774844146515
Source: NHSSB Children's Statistical Indicators.
There may be children who are in receipt of social services where the reason for referral was other than specifically disability-related. Such children do not appear in this data.

Children on the Special Needs Register, January 1999
Source: Child Health System.

Special school provision in NHSSB, 1998
Special schoolDistrict councilCategoryApproximate
number of pupils
BeechgroveBallymenaPhysical Disability24
Hill CroftNewtownabbeySLD76
ThornfieldNewtownabbeySpeech and Language80
JordanstownNewtownabbeyHearing and Visual Impairment107
This excludes a small number of children from the Northern Board who attend special schools in the Board's area.

Special units by school, type of unit and number of pupils attending, August 1997
 CategoryNumber of UnitsNumber of Children
Primary School
Ballymoney ModelPHU15
Cookstown PrimaryMLD328
Ballsally, ColeraineMLD217
DH Christie Memorial, ColeraineMLD112
Harpurs Hill, ColeraineMLD112
Glenview, MagheraMLD220
Moyle, LarneMLD111
Rathenraw, AntrimMLD221
St. Brigids, BallymoneyMLD119
Holy Trinity, CookstownMLD18
Antiville, LarneMLD110
Secondary School
Ballee CommunityPHU14
Ballymoney HighPHU13
Ballymoney HighMLD230
Our Lady of Lourdes, BallymoneyMLD128
Coleraine Boys' Secondary SchoolMLD113
Monkstown CommunityMLD124
St Patricks, MagheraMLD220
Cookstown HighMLD323
GarvaghPhysical Disability15
Source: NEELB and SELB.

  The following table details the number of claimants under 18 years of age in each District Council within the NHSSB area.

Disability Living Allowance (February 1998)
District councilDLA claimants under 18Per 1,000 under 18 population
Source: DHSS.

7 January 1999

4  See Appendix 13, p. 162. Back

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries

© Parliamentary copyright 1999
Prepared 14 April 1999