Examination of witnesses (Questions 119
- 139)
WEDNESDAY 13 JANUARY 1999
MR STUART
MACDONNELL,
MR MARTIN
BRADLEY, DR
ANNE-MARIE
TELFORD, MRS
THERESA NIXON
and DR PAMELA
HANNIGAN
Chairman
119. A very warm welcome to you and thank
you so much for making this possible. I am conscious that we served
you a rather brisk deadline by writing just before Christmas,
which was obviously leading into the Christmas season, in anticipation
of a meeting today, and we are extremely appreciative of the manner
in which you responded to that so the paperwork was available
to us before we arrived in Northern Ireland. I will just set one
or two ground rules. We have the advantage of knowing, now that
you are sitting down, exactly whom each of you are and we also
have the advantage in advance of knowing what your roles are but
if—and, Mr MacDonnell, I gather you are co-ordinating for
the group—there is anything you want to say of a collective
and preparatory nature on top of the papers we have been sent
by the individual boards before we start, that would be admirable.
Secondly, we seek to make sure the questions follow a logical
order and we may therefore go around the room in terms of the
order in which questions get asked from the horseshoe on our side.
Thirdly, if in retrospect you want to gloss anything that was
given as an answer in writing afterwards, please do not hesitate
to do so; we would be delighted to have that. Equally, we will
reserve the right if there is something which occurs to us after
the event which we should have asked but did not, we will put
it in writing to you. Before we start, let me ask whether there
is anything you would like to say on behalf of the group as a
whole?
(Mr MacDonnell) Thank you, Chairman and good morning
to the Committee. First of all, Chairman, I will make our introductions.
Rather than bring to you the four chief executives of the four
boards, which might have been a bit monotonous, I have brought
me and specialists from the different areas in health and social
services. Dr Telford is a public health doctor and director of
public health in the Southern Board. Mrs Theresa Nixon is from
the social work profession and is involved in learning disability
in the Eastern Board. Mr Martin Bradley is a nurse and the chief
nurse in the Western Board. Dr Hannigan, on my far left, represents
the professions allied to medicine. We hope that by selecting
people on that basis we might be able to cover a greater breadth
of specialist knowledge than might otherwise be possible. Could
I also say at the outset, as you well know, the Health and Social
Services Boards have a general responsibility for all health and
social care needs, and the immediate question which comes to our
minds is the question of balance, and I surmise we will be tested
on that as you begin your questions. We are delighted that this
subject has been taken by the Committee because it does very unusually
allow the spotlight to be put on a very vulnerable client group.
In the clamour of all the pressures which face us in health and
social care, it is very important, we feel, that this client group
is given a hearing alongside all the others which often times
can be much more voluble. The policy and statutory base for the
provision of services for children with special educational needs
I feel was covered when you met with the Education and Library
Boards, but one area of the statute I would like to dwell on for
a few seconds is the Children (Northern Ireland) Order 1995 which
gives some definitions of children with special needs, and that
brings to our minds a much wider definition than that which would
be used in the educational sector. Therefore what you will find
when you ask your questions is that children with special educational
needs are often getting access to universal services, that is
services which are available to all children and in some cases
also to adults, and that brings into play questions of how we
organise the services to ensure children are getting fair access
to those services. We also have to bear in mind the focus of health
and social services, and particularly of social services, on the
child not just within an educational context but within the family
and also on the development of the child into a meaningful role
in society, and again I hope during the question and answer session
you will hear how we address that question. There are a large
number of children with statements of special educational needs,
of course, but it is a very small number compared with the total
number of children who are on what we call our special needs registers;
out numbered probably by a factor of 10:1. Also, I should say
the process of identifying needs starts well before education
in many cases; an initial assessment by health and social care
professionals is the trigger point which directs the education
sector to bring into play the statementing process. Again you
may hear in our answers how we deal with that question. Under
the Children Order, we have a supplementary order called the Children
Services Planning Order and under this Order each board has been
tasked with producing by April a comprehensive plan for the care
of children with all types of needs, and within that process the
boards will have established sub-groups to deal with children
with disabilities. Those are multi-agency and multi-professional,
and we want to indicate to you, as we go forward this morning,
how we work with our colleagues in the other agencies and how
the professions combine together to tackle this very complex needs
group. I do not want to say any more at this stage, I hope those
general remarks may serve by way of backdrop to the questions
you want to ask. Thank you.
120. Thank you, that is a helpful start.
I have one question relating to what appears to be a mild discrepancy
for which I am quite sure there is a ready explanation but it
may be sensible to get it out of the way before I turn to Mr McWalter
to ask the first questions from the Committee. In the Eastern
Board's helpful submission to us, on page 104 there is a reference
to an inter-agency agreement drawn up by the Northern Ireland
regional 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." We have seen a document, indeed we possess
a document, in London which was issued in August of 1998. We are
reasonably confident the two agreements are the same but it would
be helpful out of historical curiosity to learn what is the difference
between August and November.
(Mr Bradley) The documents are the same. August
1998 unfortunately refers to the date the document was in its
final draft but it was not signed off by the boards, either the
Education and Library Boards or the Health and Social Services
Boards, until November of last year. So that accounts for the
discrepancy.
Chairman: That may
affect the questions which Mr McWalter is about to ask you but
I know he will shade his question to reflect the knowledge we
now have.
Mr McWalter
121. Thank you, Chairman, and good morning,
ladies and gentlemen. Perhaps I should begin by apologising to
you, in that, in part, one of the reasons why you suddenly got
shovelled at you a large number of questions about the relationships
between yourselves and the Education and Library Boards was because
the Education and Library Boards had indicated that there was
a flourishing kind of inter-agency co-operation. We suspected
that there were some flaws within that agreement and I think perhaps
events have shown that judgment was probably right; there is still
a long way to go. Having said that, at least there is now an inter-agency
agreement in writing. I suppose the Committee would be interested
to learn what action is proposed to ensure that these principles
are put into practice. Obviously there has not been much time
to get progress on the agreement you have signed but perhaps we
could have your first thoughts about what kind of programme of
action that agreement would precipitate?
(Mr Bradley) First of all, perhaps I could say
that in one of your previous hearings you heard from Mr O'Loane
of the Western Education and Library Board who, along with myself,
is the joint chairman of the regional group who have drawn up
the inter-agency agreement. I would have to say that it has taken
a considerable amount of time to try and get agreement around
that particular document and in some ways that is reflected in
the fact it is very broad in its intent and is a statement of
very broad principles. If anyone were to have a criticism of it
it may well be that it is not specific enough and I think certain
people on the ground may well have wanted it to be more specific.
It seems to me that in the context of working with that agreement,
particularly over the next 12 months, we do have to get down to
some specifics. What the regional group would hope to do over
the next 12 months in order to progress the agreement would be
to carry out an audit on the development of local service agreements
between trusts and schools as far as health and social services
are concerned which facilitate the provision of education, health
and social services to children with special educational needs.
We would want to see some examples of good practice in that area
and be able to spread that good practice and make the system aware
of what might be better ways of doing the business. We also want
to ensure that the needs of these children are incorporated into
the children service plans which you have already heard a little
about and which the boards are currently drawing up. Thirdly,
we would like to facilitate and support training for both education
and HSS staff in the identification and assessment of need as
well as in the working of the code of practice. Although we do
not have any resources, as a regional group the members are in
a position to be able to contribute to that debate within both
the health boards and the education boards in relation to joint
training particularly between educational staff and HSS staff.
As we begin to have an idea of where we are coming from, as two
organisations so we can do the best for these children. Finally,
we would also propose to carry out a review of the nursing and
PAMS support which is offered to these children and make recommendations
to the health and education boards by the summer of this year.
In the discussion about drawing up the agreement and in talking
to people subsequently about it, there are issues which I am sure
some of my colleagues may well allude to later on around in particular
PAMS support and certainly in relation to nursing support for
these children. Personally this is an issue which I do believe
we have to try and address in a much more systematic and rational
way.
122. Yes. I suppose in part the difficulty
of co-ordination between yourselves and the Education and Library
Boards is there seems to be still quite a range of practices among
yourselves. I was struck by how different the responses of each
of the Boards was. If I take one example of the problems, I am
very pleased that the Southern Board, for instance, mentioned
Attention Deficit Disorder, which looks like the kind of problem
which might be a health problem and might be an education problem
and requires proper co-ordination, but that is the only board
to do so. The Eastern Board hardly said anything about any of
those things at all. There seems to be quite a big problem co-ordinating
your own activities before you can then co-ordinate with the Education
and Library Boards in order to give people a real assurance that
where a child has a difficulty, the agencies responsible for identification
and action on that difficulty are actually going to be able to
do anything, and of course, the vagueness of the set of principles
and the inter-agency working is a concern from that point of view.
(Mrs Nixon) Chairman, could I say that some of
the information was not readily available to pass to you at the
time we sent you the report, and we can provide additional information
on many aspects of good practice which are happening within the
board at the moment and we will do that afterwards.
123. That would be helpful.
(Mr Bradley) I think you are right. As we move
through the training agenda this year there is an issue of making
sure that there is reasonable standardisation of practice across
the boards and we have a reasonable agreement as to what are going
to be the core needs of these children. In relation to the assessment
and identification of need where there are discrepancies. We can
identify those and begin to deal with those, so there is an equitable
provision of services for these children across Northern Ireland.
It does seem to me that is one of the tasks we have to set ourselves.
124. What particularly are you planning
to do to address the contribution that social workers and teachers
can make, given these two groups of professionals report continued
difficulties in working together? Do you think the agreement,
suitably implemented, gives a way of trying to resolve some of
the historical difficulties associated with this relationship?
(Mrs Nixon) It is not the perception of the four
Health and Social Services Boards that social workers and teachers
have continued difficulties working together. In fact there has
been a long history of co-operation and a lot of collaborative
work prior to the regional agreement. That can be evidenced in
many ways in terms of joint multi-disciplinary training on child
protection over many years, the input of specialist teachers to
visually and sensory impaired committees which were set up by
the Health and Social Services Boards which identifies the short-falls
in services. We also have area child protection committees and
pre-school advisory groups with the Department of Education which
have cross-representatives. We also have the Disabled Persons
Act 1989 procedures and protocols which has involved liaising
with teachers and others in the Department of Education. So a
lot of collaboration has gone on in the past and I think we have
consolidated quite a lot and have a very effective relationship
at present. Mr MacDonnell alluded to Children Services Planning
and the Children and Young Persons Committees of the four boards
who are responsible for producing those children services plans,
and that is very much inter-agency and in consultation with the
Education and Library Boards. So I think the perception there
has been a difficulty is not totally accurate. Yes, we would say
the regional agreement should assist in developing further joint
training initiatives and that has commenced between Education
and Library Boards for instance in terms of the Code of Practice
and the statementing procedure. We are also looking at developing
models of effective resource utilisation in terms of the complex
needs, as Mr Bradley outlined. Teachers do play a significant
role in the development of a child's educational needs but also
in terms of looking at that child with social services holistically
in terms of assessing their needs.
125. I accept there has been valuable work
which has gone on, particularly when 18 per cent of the pupil
population are not statemented but are regarded as having special
educational needs. Where there is a clear medical condition I
do not think we are nearly so worried about how the procedures
work, what we are much more worried about is where teachers identify
there is some problem, perhaps mental illness or whatever, how
that gets put into the system. So we are particularly interested,
if you like, in probing the areas which require effective inter-agency
work, which require the agreement and then the implementation
of that agreement in order to get satisfactory working relationships.
(Mrs Nixon) I can say that in relation to, for
instance, children who have adolescent psychiatric problems, teachers
would consult with social workers around that issue and each child
in a school usually has a named social worker, a named key worker,
to allow that collaborative relationship to develop and to look
at the childs needs holistically. Also the designated officers
within trusts (and it is usually the chief medical officer within
the trust and the paediatrician) would be involved in guiding
teachers in terms of the needs of the child and putting resources
jointly into meeting that child's needs in the school and into
the home and social services input into that also.
Mr McWalter: Thank
you for your spirited replies!
Chairman
126. I am following up on questions Mr McWalter
has asked but I am happy to say my questions—not that I
am remotely suggesting Mr McWalter sought to be divisive between
the various boards—will enable you to give a cohesive response.
There are some similarities between children in need as defined
by the Children Order and children with special educational needs
as defined by the Education Order. These similarities would point
to the possibility of multi-disciplinary assessment. Is that an
issue which has been addressed and has there been any move towards
such an approach with the boards?
(Mrs Nixon) Multi-disciplinary assessment of need
is not something new in terms of moving to multi-disciplinary
assessment; it has been around for a number of years and has been
the practice with regard to transition planning and with regard
to the completion of educational statements. Views are sought
from health and social service staff including social workers
who assess a child's needs in terms of their health and their
welfare and that takes account of the child's educational needs,
their environmental and emotional needs. Those assessments are
beginning to be combined now with the statutory assessment of
need under the Children Order. It is logical and desirable that
we move towards more commonality of approach in terms of multi-disciplinary
assessments and that may be an issue which will be taken forward
under the regional agreement. I think it is important to say that
specifically with regard to children who are looked after, the
care plan addresses the educational needs as well as other needs,
and there are some excellent examples of working relationships
between social workers and teachers in this regard. The Northern
Board, for instance, recruited a retired teacher to assist with
the homework needs of children in residential care. So I would
want to emphasise that multi-disciplinary assessment of need has
been around and is working fairly effectively at this point in
time, but we do and will continue to look at what we can do better.
127. Having said that I was not seeking
in any way to be divisive, and I am not, it would be quite interesting
if those from other boards could shade that answer a bit as to
how far it actually reflects common practice.
(Mr Bradley) Chairman, multi-disciplinary assessment
of need is the way in which we want this service to work and we
are trying to do our best with that. Ultimately it seems to me
that there are some drivers in the system at the moment which
are going to help us, in particular the development of children
services plans which you have heard about already. I know that
within my own board that has led to a fairly wide debate with
our colleagues certainly in education. Also where it has been
appropriate with the police, with the Housing Executive and other
agencies, about how we will put in place plans to meet the needs
of children over the next four to five years. Taking one of the
previous issues on board, certainly as far as children with emotional
and behaviourial disturbances are concerned, that has been a focus
within certainly one aspect of the plans which have been drawn
up within my own Board. We could not have done that without full
consultation with a fairly wide constituency and we are now going
to go out formally to consult on those plans with the other agencies,
in particular education, to ensure we are actually heading in
the right direction. Where it is possible, where we can pool resources
to deliver on those plans, we want to try and encourage everybody
to put their money into the same pot so we can deliver on some
of these services. So it is a complicated task, certainly the
effort is going into it at the moment and we will get some movement
in that arena.
(Dr Hannigan) Could I contribute from the Northern
Board, Chairman, and confirm what my colleagues have said with
regard to multi-disciplinary assessment? This does happen in the
community. I would point out that many of the health and social
care staff carry out an assessment before the statutory assessment
for special educational needs takes place, so we are actually
assessing for two different needs within two different time frames
which does create some difficulties. However, within the health
and social care arena we do have child development clinics where
there is very much a multi-disciplinary assessment which takes
place looking at the total needs of the child. Within the Northern
Board we have carried out needs assessment and we have independently
commissioned a Young Minds review of child and adolescent psychiatry
and we would be happy to furnish the Committee with that report
at a later date.
(Dr Telford) From the Southern Board I would say
that the actions that we take are in line with those of our colleagues
in other Boards, and it is a fairly consistent approach.
128. I think I may be picking up on something
Mr Bradley said a moment ago, given the spirit of the agreement,
what resource implications does it have? Will extra money be put
against delivering what emerges from the agreement?
(Mr Bradley) I think that is the 100,000 dollar
question, Chairman.
129. In that case I hope you get 100,000
dollars for it!
(Mr Bradley) I am moving forward in hope here!
Obviously it is only so much rhetoric and words if we cannot actually
back it up with some money. The civil servant answer to give to
you, at least to start with because I know other colleagues will
want to come in, is that, at this early stage, the agreement allows
us to put a focus and spotlight on the needs of these children
and in the context of planning within our boards it is to try
and move their needs up the priority agenda and to make sure that
in planning we undertake not only to identify the resources required
but maybe lead to a re-ordering of some of the priorities in which
those resources are used. In relation to the training agenda,
there is money going into that at the moment, and in the context
of us being more focused in reviewing the services we are giving
to these children, so far as the Western Board is concerned we
are currently doing that. We have a major review of the needs
of children with disabilities about to take place this year. Ultimately
out of that we are going to have to look for new resources. The
fact the regional group itself is committing itself to a review
of the support given by PAMs and nursing to these children may
actually lead to a need for extra resources coming in. But if
you were to ask me the factual question, is there any specific
new money coming into the system to support the agreement as far
as health and social services are concerned, as far as this agreement
is concerned, then the answer to that at the moment would be no.
We still have to make the case for getting those resources in.
It seems to me it will be a consequence of some of the actions
we take over the next 12 months that we will have to make the
case for those resources. My other colleagues, I think, will want
to add to that because there are substantial resources being spent
in the delivery of these services already and what the agreement
will do is try and make sure it will be a more efficient and effective
use of those resources.
(Dr Hannigan) From a therapy point of view, this
area of need has been highlighted within the Department of Health
and Social Services in the Comprehensive Spending Review and we
are hopeful of getting some additional funding in now, although
we would note that this does not reflect the totality of needs
in this area at the moment.
(Mrs Nixon) I will agree with what other speakers
have said, we are waiting for additional resources and we will
look at our priorities within that.
Chairman: In the context
of the development of the agreement and in the course of the next
12 months a totally incidental accompanying factor will be such
report as we issue. If that in any way contributes to the resolution
of resources, we can only express pleasure that will have been
an outcome.
Mr Grogan
130. Good morning. Can I ask you for a response
in two areas of shortage identified by the Education and Library
Boards in their evidence? The first one is speech therapists.
What is your response to that?
(Dr Hannigan) In general, there are retention
and recruitment problems with speech and language therapy throughout
the UK. In relation to Northern Ireland, a number of the students
training here at Jordanstown come from Southern Ireland, so naturally
when they graduate they return home to work. A significant number
of graduates also go to the mainland because they have in effect
the pick of jobs there. I would also point out that, currently,
the Department of Health and Social Services is trying to up-date
the methodology for identifying needs in terms of manpower planning
in partnership with the boards and trusts. However, this is a
relatively developing area and significantly more work needs to
be done, and we would acknowledge that. I would also point out
that there may be variations between trusts as to the level of
therapy provision in special schools and units. Within our own
board, the Northern Board, 46.6 per cent of speech and language
therapy is actually delivered in a special school or educational
setting towards effectively 2 to 2.5 per cent of the school population.
These figures do not, as has been pointed out, take account of
the significant number of children who would be at stage three
within the Code of Practice who will have special educational
needs but who will not necessarily be in receipt of a statement
as such.
131. The second area is psychiatric services.
It is well-known that there are long waiting periods for assessments
and placements to child or adolescent psychiatric services, what
are the Health and Social Services Boards doing in this field?
(Dr Telford) I would like to say that the child
and adolescent psychiatric services have had a particular focus
within the boards and within Northern Ireland over the last number
of years. Each of the boards has been progressively extending
the services for that group to meet their mental health needs
and look at the whole range of needs for children who present
to that service. Two of the boards, the Western and Eastern Boards,
have recently completed an in-depth review of their services for
child and adolescent psychiatry and the other two boards are in
the process of completing reviews. We have already talked about
the children services planning process, which is a statutory process,
to be completed by April and each of the boards are required by
April to look and develop children services plans, and one aspect
of that is a service for young children with mental health problems.
So at board level we have been paying a lot of attention to that.
At the Department they have been looking at access to in-patient
services and that has been a concern to us and this will be particularly
for adolescents. Just yesterday at the Department level within
the Specialty Advisory Committee for psychiatric services there
was a paper being discussed about extending provision within Northern
Ireland with a new unit in Omagh and Belfast. It is at an early
stage in the discussions but it is on the agenda. Also at the
end of this month, on 28th January, all of the boards are getting
together with the Department for a meeting led by the chief medical
officer to look at the reviews we have undertaken in child and
adolescent psychiatry, bringing over speakers with experience
and looking at how we can further develop our services based on
the best knowledge at present. So we all recognise that there
are some difficulties, that provision could further be extended,
but there has been a particular focus on this area in recent times.
(Mrs Nixon) I understand from my communication
with the Education and Library Board yesterday that Stanton Sloan,
the Senior Education Officer, has been asked by the Minister to
set up a strategy group in the Province to review special education
needs which will include children with child and adolescent psychiatry
problems. That undoubtedly will involve further inter-agency discussions
with health and social services staff to take forward any recommendations
arising from that review. In addition to that, could I say that
the Western Board have allocated money over the next six month
period to carry out a pilot programme to assess the issue of waiting
lists and screening children who effectively could be dealt with
by other services.
Chairman: Thank you
for that real-time development.
Mr Salter
132. Good morning. We are given to understand
that teachers in special schools, and particularly those for children
with severe learning difficulties, sometimes find themselves having
to carry out basic health care duties, inserting feeding tubes
or whatever, due to lack of available health service staff. Apparently,
there are also difficulties in special schools in covering for
sickness. One, are these things actually happening? Two, what
is your reaction to them? Three, what steps are you taking to
minimise the effect on the children themselves?
(Mr Bradley) First of all, if I can deal with
the reaction: obviously it is fair to say we understand and know
this is a matter of concern for teachers and parents and it has
been one of the reasons why we wanted to review the provision
of support services, including nursing services, to these children.
If there is one thing which has come out of the last 12 months,
it has been the concern about the support for these children.
You will note in the inter-agency agreement which we now have
it 5.4 states, "Health and social services 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 the board [and the school] will
arrange for the appropriately trained staff to provide the service
within a setting which should reflect [where possible] the policy
of normalisation." It is quite true that across Northern
Ireland there is a different approach given individual circumstances
as to how this is brought forward. We want to look to see whether
or not we can have some standardisation of that approach and make
absolutely sure from a professional point of view that we are
happy with the level of support that is being provided particularly
from my own profession, which is the nursing profession. Within
the regional group we have also been keen to see the publication
in Northern Ireland of the advice available to teachers in schools
in England in supporting pupils with medical needs. That guidance
was issued in England in 1996 by the Department for Education
and Employment and the Department of Health. Within the regional
group, we have drawn up a Northern Ireland version of that guidance
and have added to it. Currently that is with the Department of
Education and we would hope to see that released fairly shortly.
That would be an added impetus to making sure we look at the needs
of these children and try to get better advice and guidance particularly
to teachers within schools but also to carers within schools as
well. In relation to the coverage as far as therapists are concerned,
I will let my colleagues deal with that.
(Dr Hannigan) I would concur with what has been
said. There are difficulties in providing cover when staff are
off on long-term sick leave. I would point out this is also problematic
for education, when staff are off on training courses which do
not coincide with holidays and which happen during term time,
but they are on these courses as a requirement of continuous professional
development so they are providing practice to the current best
standard. Again, I would refer to the recruitment and retention
problem. We have this problem particularly with speech and language
therapy where we can offer permanent contracts. It is extremely
difficult to get staff to cover short-term sick leave as we do
not have a pool of unemployed therapists on whom managers can
call and, due to the large waiting lists in the community, there
are difficulties in pulling staff from community clinics to provide
a service for special education schools. There is no flexibility
in the system. Even if that were possible, those therapists may
not have the necessary skills required to treat those children
in the educational setting. I would also point out that trusts
do not as a rule pull staff from an educational setting to deal
with the ever growing waiting lists and shortfall that exists
in our community clinics at the moment.
133. So, after all that, you have produced
a strategy document but it is just going to get worse? Yes?
(Mr Bradley) No, I would certainly hope it would
not get worse.
134. On what basis do you reach that conclusion?
(Mr Bradley) If you take the Eastern Board as
an example, certainly during this past year they have come to
an agreement with the South East Education and Library Board in
lieu of having a further review of the services to children in
special schools, that they will jointly fund on a 50-50 basis
the support that is required, in particular nursing support that
is required for these children. My own board, the Western Board,
is funding a nurse full-time in one of our special schools, not
in the other schools I have to say but they do have designated
nurses attached to the schools from whom the schools can get advice.
My own personal feeling is that across Northern Ireland that provision
is different in relation to the different boards. We do need to
review that, which we will be doing over the next six months,
with recommendations to the boards as to how we should establish
and organise that service and make recommendations for the resourcing
of that service. There is also an on-going debate, to be fair,
between education and health around the concept of normalisation,
and there is a balance to be struck on how you support children
within the community who have medical needs and who are currently
being looked after at home and not in institutional settings.
There is a line to be drawn between at what point you turn a school
into another health care type institution as opposed to giving
the support and guidance that is required to support these children
in a more natural environment and train up people who would be
capable of caring for the child during the course of the school
day, making sure they have got adequate resources to do that and
also adequate access to professional advice where it is required.
It may not always be appropriate to put in a fully qualified,
trained nurse for the whole of the day; that may not be the best
use of the resource. We need to have that debate with schools
and come to some conclusions and agreements which may not always
be there at the moment.
(Dr Hannigan) I would like to point out that it
is not necessarily individual one-to-one therapy that we provide.
The philosophy within health and social services is very much
supporting the child and supporting the teachers, and where a
therapist may be off on long-term sick leave we do endeavour to
provide support and advice so that the needs of the child are
met, albeit not maybe in the way we would like them ideally to
be met, until such time as the therapist returns.
(Mrs Nixon) To give you an up-date on the Eastern
Board's position in terms of what we have done about this, Mr
Bradley has alluded to the 50-50 funding agreement between the
Education and Library Board and the Eastern Board to fund a care
support post. There was a meeting held yesterday with regard to
two schools and a further meeting will take place in a fortnight's
time to look at the provision within special schools in this area.
I also understand in the Down and Lisburn area that nursing staff
have commenced work in their two schools as of this week. So that
gives you an up-to-date position. North and West Belfast already
had provision in their two schools for some considerable period
of time.
135. It seems to me from your answers that
the problem is not likely to improve until the on-going problems
around recruitment and retention are improved, which is not necessarily
within your gift. Would that be a fair assessment?
(Dr Hannigan) Yes, that would be a fair assessment
although, as has already been pointed out, there is a need to
review the service provision that is going in to this particular
group to make sure that the services we are providing are used
as effectively and as efficiently as possible, given that we have
a finite resource.
Mr Beggs
136. Good morning. When visiting special
schools, the Committee's attention was drawn to some dispute over
responsibility for provision of therapies when the child's residence
was in one trust and the school was sited in a different trust.
Are there ways in which such disputes have been resolved?
(Mr MacDonnell) Mr Beggs, a few years ago, when
we moved to implement the last Government's health and social
services reforms, the whole basis of funding of health and social
services, as you know, was changed, and what had previously been
based on the services within the boards' geographical areas was
changed and the boards were given money on a capitation basis
based on a weighted formula for their populations. In theory,
we were then to take out agreements to secure services for our
residents wherever they secured the services and, as you say,
they may secure them in an area outside our own boundaries. When
we moved to look at that issue, we quickly discovered in the area
of special education needs that it was next to impossible to quantify
the precise volume of inputs given to children and, secondly,
were it possible to do that, it would have been hugely bureaucratic
to track and to fund on that basis. So I do acknowledge there
was a time when we thought we were going to slavishly go forward
on that basis but we quickly decided we would not do that and
the situation is now clear, although there may still be people
who do not understand it, in that the trust and board where the
facility is are geographically responsible, they are responsible
for the care of the children who receive the services in that
particular special school or special unit. Obviously a very small
number of children would be affected by this, but nevertheless
it was important to get that sorted out. To conclude on that,
the funding arrangement, which is imperfect, is borne by each
board on a quid pro quo basis, or, as you would say in
another walk of life, a knock-for-knock basis; no money changes
hands, in other words.
137. Will the future provision of children
services plans help to overcome the concern expressed from time
to time by teachers and social workers about the lack of collaboration
and failure of both sides to share information?
(Mr MacDonnell) There are two issues, it seems
to me here, Mr Beggs. There is the collaboration needed by the
different agencies to plan for the future disposition of services
and there is the collaboration needed by individual practitioners
and professionals in dealing with the specific needs of the individual
child. At the agency-to-agency level I have to say we are very
pleased with the level of co-operation we get from our local North
Eastern Education and Library Board, which you will have some
intimate knowledge of, and we actually share the same building
which obviously facilitates matters somewhat. So, as we go forward
on the children services planning arena, senior officers of the
Education and Library Boards are members of our committee drawing
up those plans. I would want to see the plans which come forward
to my Board to be ones which are endorsed in the same time frame
by the Education and Library Board. I think that takes care, to
my mind, of the agency-to-agency co-operation but maybe I will
ask some of my colleagues to come in and talk about collaboration
between agencies in dealing with the needs of the individual child.
(Mrs Nixon) From the point of view of the Children
Services Planning process and inter-agency co-operation, the Belfast
Education and Library Board and the South Eastern Education and
Library Board and in particular the Eastern Board have been involved
and have drawn up an action plan with regard to the needs of children
with learning disability, which we will hopefully action in the
coming months. So there is considerable work now being done to
look at the needs of those children in terms of respite, in terms
of treatment and in terms of handling children with difficult
and challenging behaviour, and I think you will see a considerable
improvement being made hopefully in the next one to three years
period as we implement our Childrens Services Plan. With regard
to looking at the co-operation in terms of dealing with the individual
child, there is a designated officer appointed from different
trusts to liaise with teachers and social workers, and there is
a key worker system now in place in most trusts, so that a child
has a named worker, and the parent and headteacher know who that
key worker is and who will provide information about the child's
needs. There is daily contact also in terms of social workers
going in and out of schools, talking to teachers, managing challenging
behaviour. There has been some joint training actually with regard
to learning disability and the implementation of the `teeach'
methodology, which is a very structured way of working with children,
and there has been some joint training in terms of the SEN Code
of Practice also. There is much more collaboration than hitherto,
and I am delighted to say that is the case.
Mr Barnes
138. Can I pursue the point you have just
been discussing with Mr Beggs and which was raised earlier as
far as inter-agency provision is concerned by Mr McWalter, responded
to by Mrs Nixon, about the relationship between social workers
and teachers and co-ordination at the level of the school itself
rather than at the level of general inter-agency planning? Within
any one special school there may be many social workers who have
responsibility for individual children. There are clearly going
to be problems in terms of communication and co-ordination between
social workers and teachers and I know you have addressed the
key worker system as a method of trying to overcome some of these.
I was wondering what you saw those difficulties as being and what
it is that the key worker is directing himself towards. Is addressing
it through the key worker system what the boards see as the method
of resolving the difficulties, or has it got other ideas which
may be needed to be developed?
(Mrs Nixon) Children are seen in terms of their
family and also community, and because of that you will have a
number of different social workers visiting different schools
to look at the needs of children with teachers. Insofar as it
is possible, the team leaders for the disability teams, have a
very close working relationship with the Principals of the schools,
and I would expect that they will give the information with regard
to the named worker to the headteacher and that would be up-dated
annually. Also the designated officer from the different trusts
will have close liaison with the headteachers and social workers
concerned in terms of pulling together information with regards
to the statementing needs of children, and that is an-going process
and will continue to happen in the future. I think it is important
to say that teachers and social workers at ground level are very
integrated in how they are working with children, for example
children who are in special accommodation, looked-after children.
Teachers frequently attend reviews, social workers frequently
attend transitional reviews and pre school-leaving conferences
in schools to ensure there is continuity and a continuation of
services into adulthood for children who are leaving schools.
We obviously are aware of a lot of issues with regard to respite
provision and the need for after school clubs, and there is on-going
negotiation at present between the Education and Library Boards
and social work staff with regard to the development of some of
these initiatives.
139. Are there differences in degrees of
difficulty of co-ordination and co-operation depending upon the
category of children we are discussing? Is it that there is a
greater problem with children with learning difficulties than
other areas?
(Mrs Nixon) On the contrary, I think there has
been a long established history of a close working relationship
between social workers on the ground and children with learning
disabilities because the social workers are known to a lot of
those children from a very early stage, they follow them through
the pre-school provision, school provision and afterwards, so
in that particular category I would not envisage there being tremendous
difficulties in terms of a working relationship between teachers
and social workers, and generally very good, robust care plans
have been developed for these children.
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