Select Committee on Northern Ireland Affairs Minutes of Evidence

Examination of witnesses (Questions 119 - 139)




  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!


  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.

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