Memorandum from the Northern Health and
Social Services Board
INTRODUCTION
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.
LEGISLATIVE AND
POLICY BACKGROUND
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.
MEETING NEEDS
AND CO-ORDINATING
MECHANISMS
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) |
| Profession | Number (WTEs) |
| Speech and Language Therapist (SLTs) |
| Working in an educational setting | 18.78 |
| Working with children: Total | 36.24 |
| Paediatric Physiotherapists (PPs) |
| Working in an educational setting | 6.57 |
| Working with children: Total | 12.61 |
| Paediatric Occupational Therapists (POTs) |
| Working in an educational setting | 4.11 |
| Working with children: Total | 12.21 |
Note:
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).
PRIORITISING NEEDS
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.
ANNEX 1
TABLE 1
Children with disabilities in contact with Social Services, September 1998 |
| Trust | Learning
disability | Visual
impairment | Hearing
impairment
| Physical
disability | Total |
| Homefirst | 171 | 38 | 30 | 112 | 351 |
| Causeway | 106 | 10 | 14 | 34 | 164 |
| NHSSB TOTALS | 277 | 48 | 44 | 146 | 515 |
Source: NHSSB Children's Statistical Indicators.
Note:
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. |
TABLE 2
Children on the Special Needs Register, January 1999 |
| Antrim | 257 | |
| Ballymena | 315 | |
| Magherafelt | 322 | |
| Cookstown | 312 | |
| Newtownabbey | 602 | |
| Carrickfergus | 242 | |
| Larne | 205 | |
| HOMEFIRST TOTAL | | 2,255 |
| Ballymoney | 304 | |
| Coleraine | 537 | |
| Moyle | 136 | |
| CAUSEWAY TOTAL | | 977 |
| NHSSB OVERALL TOTAL | | 3,232 |
| Source: Child Health System. |
TABLE 3
Special school provision in NHSSB, 1998 |
| Special school | District council | Category | Approximate
number of pupils |
| Beechgrove | Ballymena | Physical Disability | 24 |
| Dunfane | Ballymena | MLD | 160 |
| Rostulla | Newtownabbey | MLD | 160 |
| Hill Croft | Newtownabbey | SLD | 76 |
| Kilronan | Magherafelt | SLD | 80 |
| Loughan | Ballymena | SLD | 76 |
| Muckamore | Antrim | SLD | 37 |
| Roddensvale | Larne | SLD | 56 |
| Sandelford | Coleraine | SLD | 100 |
| Thornfield | Newtownabbey | Speech and Language | 80 |
| Jordanstown | Newtownabbey | Hearing and Visual Impairment | 107 |
Source: NEELB/NHSSB.
Note:
This excludes a small number of children from the Northern Board who attend special schools in the Board's area. |
TABLE 4
Special units by school, type of unit and number of pupils attending, August 1997 |
| | Category | Number of Units | Number of Children |
| Primary School |
| Ballymoney Model | PHU | 1 | 5 |
| Cookstown Primary | MLD | 3 | 28 |
| Ballsally, Coleraine | MLD | 2 | 17 |
| DH Christie Memorial, Coleraine | MLD | 1 | 12 |
| Harpurs Hill, Coleraine | MLD | 1 | 12 |
| Glenview, Maghera | MLD | 2 | 20 |
| Maghera | MLD | 1 | 7 |
| Moyle, Larne | MLD | 1 | 11 |
| Rathenraw, Antrim | MLD | 2 | 21 |
| St. Brigids, Ballymoney | MLD | 1 | 19 |
| Holy Trinity, Cookstown | MLD | 1 | 8 |
| Antiville, Larne | MLD | 1 | 10 |
| Secondary School |
| Ballee Community | PHU | 1 | 4 |
| Ballymoney High | PHU | 1 | 3 |
| Ballymoney High | MLD | 2 | 30 |
| Our Lady of Lourdes, Ballymoney | MLD | 1 | 28 |
| Coleraine Boys' Secondary School | MLD | 1 | 13 |
| Larne | MLD | 2 | 22 |
| Monkstown Community | MLD | 1 | 24 |
| Maghera | MLD | 2 | 20 |
| St Patricks, Maghera | MLD | 2 | 20 |
| Cookstown High | MLD | 3 | 23 |
| Garvagh | Physical Disability | 1 | 5 |
| 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.
TABLE 5
Disability Living Allowance (February 1998) |
| District council | DLA claimants under 18 | Per 1,000 under 18 population |
| Antrim | 269 | 20.6 |
| Ballymena | 255 | 16.5 |
| Ballymoney | 122 | 17.2 |
| Carrickfergus | 183 | 20.7 |
| Coleraine | 227 | 16.5 |
| Cookstown | 256 | 24.5 |
| Larne | 129 | 16.9 |
| Magherafelt | 222 | 18.5 |
| Moyle | 75 | 16.6 |
| Newtownabbey | 400 | 20.1 |
| Total | 2,138 | 18.9 |
| Source: DHSS. |
7 January 1999
4 See Appendix 13, p. 162. Back
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