Examination of witnesses (Questions 140
- 152)
WEDNESDAY 13 JANUARY 1999
MR STUART
MACDONNELL,
MR MARTIN
BRADLEY, DR
ANNE-MARIE
TELFORD, MRS
THERESA NIXON
and DR PAMELA
HANNIGAN
Mr Robinson
140. Good morning. There is an overlap,
a duplication if you like, perhaps even conflict, between the
role of health and social services on the one hand who have responsibility
to provide therapies and on the other hand the Education and Library
Boards who are charged with meeting educational needs including
the therapy of individuals. How apparent or real are those conflicts?
Is there any benefit in having that dual responsibility in that
area?
(Dr Hannigan) We would acknowledge that there
is a conflict here because, as earlier stated, we look at the
health and social needs of the child and the educational provision
is part of that overall continuum. If speech and language therapy
is put in Part 3 of the statement, then education have a legal
responsibility to provide provision of therapy to meet the statement.
Whilst acknowledging that a conflict exists, I would point out
that in general the present arrangements do work, although I would
expect that there are variations between trusts in Northern Ireland
and the fact it does work at the minute is reflected in the relatively
small number of cases which have gone to tribunal to date within
Northern Ireland. However, if the Code of Practice is adhered
to and the ethos of inclusion and provision for these children
is made in mainstream schools, that may well change because the
demands on services, as we know, are under pressure at the moment
and this has been identified as an additional pressure which we
would find very hard to meet. I would also point out that Education
and Library Boards have in the past advocated the transfer of
funding for speech and language therapy in particular to them,
and from an educational point of view there are certainly advantages
to that in that they would not have to negotiate with the trusts,
they would have a dedicated staff to their population and they
would have more control. However, I would also point out that
there are many disadvantages with that from a child's perspective,
in that you would have duplication of effort, where you would
have a therapist in school assessing for an educational need and
a therapist in the community trust assessing for health and social
need, and it is often difficult to differentiate the two. This
would also go against the spirit of the Children Order which emphasises
the need for holistic assessment of a child's needs and, as I
said before, education is just one part of that continuum. There
is also the danger that staff working in such an environment would
be professionally isolated, and Education and Library Boards would
need to ensure a system of continuous professional development
to ensure the practice was in keeping with current best practice
and available evidence of clinical effectiveness. They would also
need to make arrangements for the provision of therapy equipment
because, to date, education provides for seating and toileting
equipment and tables whereas health provides for things like wheelchairs
and all other therapy equipment and testing materials, and it
would be unrealistic to have a therapist in one agency prescribing
from the budget of another agency. Another option which could
be explored would be for Education and Library Boards to purchase
additional therapy from other sources such as health and social
services trusts, and I would point out a precedent has already
been set for this in Scotland. However, being mindful of the recruitment
and retention problems as expressed earlier, these posts would
have to be enhanced to attract appropriately qualified staff.
141. Could I ask you to take a different
angle of vision? Naturally you are looking at it from the point
of view of Health and Social Services Boards, but am I right in
saying an Education and Library Board could be brought before
an SEN Tribunal because the health professionals did not adequately
provide therapy?
(Dr Hannigan) That is correct.
142. What could be done about that?
(Dr Hannigan) We can only provide from within
our resources. We would endeavour to meet the needs of the child
but we can only provide from within our resources. A speech and
language therapist could be held to be professionally irresponsible
if they provide to the dictate of a statement which goes against
what they have assessed as the needs of the child.
Mr McGrady
143. Good morning and thank you for your
attendance. In the area of staff training, the inter-agency agreement
provides that the boards and the trusts must ensure that there
is appropriate training for their staff in schools, and the corollary
of that is that the social services staff need training in requirements
germane to them, particularly the Education Order and the SEN
code of practice. In your assessment, is the training currently
available adequate to cover the health and educational aspects
required in the inter-agency agreement?
(Dr Telford) Indeed, you are right, Mr McGrady,
training is one of the very important areas in relation to the
agreement but, as we clarified at the beginning of the meeting,
the agreement has just been issued to boards at the end of November
and indeed on the agenda for the next meeting of the regional
group, on 18th January, the whole issue of training is going to
be discussed. Already some of the Education and Library Boards
have started off on a training programme in relation to the Code
of Practice and this, from our point of view, would not just be
for social workers but for health staff as well. We have experience
in joint training between education and health through work led
by the Health and Social Services Boards on the Children Order
and on child protection, and we would see a similar model being
followed and being largely led by the Education Boards in respect
of training in relation to the Code of Practice. So there have
already been discussions in each of the boards between education
and health on training but we would not be satisfied with that,
it is certainly not complete, it is only just starting and we
will be monitoring how this is going over the next year.
144. So, like many of the rest of us, you
are in a transition period; your agreement has been made but not
yet fully implemented! I would like you to expand a little more
and tell us where you see the major gaps which exist at the moment
which have to be dealt with. Has any assessment been made on the
quantum of funding which would be required to do this? Would you
not think that it is time we had some form of accredited training
in both these disciplines?
(Mrs Nixon) In relation to the Code of Practice
and the Education Order, the Department of Education I understand
has allocated a sum of between £3.6 million and £7 million
to implement the Code of Practice, and most of that money will
go to training of teachers, educational psychologists, computerisation
of records, although some of that resource has been devoted to
training of social workers. The Northern Board, for instance,
have received money for the training of 17 social workers recently
and their team leaders and members of their disability teams,
and that was funded by the Education and Library Board. The Western
Board have set up a sub-group to address training needs in relation
to the Disabled Persons Act and the Code of Practice also. The
Southern Board also have agreed joint protocols to operationalise
the SEN code of practice. The Eastern Board have been offered
training through the Education and Library Boards on the requirements
of the SEN code of practice recently. Further in-house training
will be organised by trusts in the 1999-2000 year in terms of
their training plans. With regard to the training in terms of
commonality, there is a view at the moment with regard to the
establishment of a General Social Services Council with regard
to standardising the accreditation and training that social workers
receive and discussion is on-going at the moment and the matter
will be subject to further review. I cannot add much more to that
at this point.
145. As a lay person, I will not pursue
all the trains of thought you have highlighted there but leave
them for further consideration. We would like to have some idea
though, without referring to the headings of agreements and various
other code words which you have used which I do not necessarily
understand, what you think the immediate priorities are, the one
or two top priorities you have to address in training?
(Mrs Nixon) It is really, from the training point
of view, understanding the needs of children, being able to respond
to children who have a plethora of different difficulties in terms
of emotional and behaviourial disturbance, in terms of challenging
behaviour, in terms of looking to live and work in adulthood in
the community. So there are a lot of issues with regard to working
with children, communicating with children with sensory impairments,
physical disabilities, learning disabilities. I would say that
is the essence of the training plans which are now in place within
trusts and there is some joint training now happening with the
teachers in taking forward some of those aspects. I alluded earlier
to the visual impairment and sensory impairment committees which
are chaired certainly in the Western Board by the educational
psychologist, and there is an inter-agency forum there to look
at the training needs not just of social services staff but also
of the teaching staff.
146. Are you telling us that it is the intent
of all these agreements and protocols that the people addressing
the special education needs will all have some degree of specialist
training? As I understand it, and correct me if I am wrong, many
teachers dealing with this very difficult area have not any particular
specialised training, experience or qualification. I can understand
that, but it is obviously not desirable, so is it your intent
as boards, as health and education boards, to ensure that the
persons, teachers or social workers, whoever they are, addressing
these issues will have a reasonable degree of training and experience?
(Mr Bradley) I think that the answer to that is
yes, that would be the intention, but you do raise the issue yourself
that this training has to be at a variety of levels depending
on what people's roles are within the system. It seems to us that
certainly there is an issue about making sure within the educational
system generally, and more specifically around aspects of health
and social care provision, for up-dating around the Code of Practice.
What the Code of Practice means, what its implications are going
to be and how people prepare themselves for the statementing process.
How we involve parents in that and how we make sure as a result
of those statements we make the best use of our resources. That
in itself has been part of the training strategy, and I know that
in most of the Boards and certainly within the Western Board we
have a sub-group currently working on this. There are then more
specific issues it seems to me in the context of the particular
training that is needed for the co-ordinators of the services,
particularly within the school, the Special Needs Co-ordinator
has to pay special attention to that, and my understanding is
that the Education and Library Boards have been paying attention
to that. As far as we are concerned, the co-ordinating officer
within the trusts, and there should be a designated officer within
the trust, will need special attention and we have within the
Western Board been bringing those officers together in conjunction
with the Education and Library Board to provide special up-dating
and training for them as far as the Code of Practice is concerned.
Out of that there are going to be wider training issues about
how these children are managed within the schools. Some of those
will be about very practical issues which we are not, I think,
at the moment quite co-ordinated on, where we do need to identify
what some of those training needs are going to be, to make absolutely
sure that people are ready and willing to work the system. Part
of that also is about dealing with attitudes. I have said before
there is an attitude around our understanding of normalisation,
and whether everybody is signed up to that. It may well be that
within the education system—and this would be a personal
observation—maybe not all teachers are necessarily tuned
into the concept of normalisation. There is an issue there, which
I think the regional group have identified, which we need to work
at. Part of that may also be a perception on the teacher's part
of a lack of support from the health and social services side
which we need to work on. I think we can overcome those issues
but those are all going to be part of that training agenda and
that is going to have to be developed over this next year.
Mr McGrady: Thank
you very much for your very full answers. We look forward to the
implementation of all these agreements and the transformation
from shadow to substance.
Chairman
147. I think Dr Hannigan wanted to enlarge
on the answer.
(Dr Hannigan) Could I come in from the therapy
point of view? I would concur with what other colleagues have
said but I would also point out that therapy staff, particularly
on the speech and language side, have undertaken joint training
with colleagues in the Education and Library Boards around the
Code of Practice and the Education Order. It is planned in March
of this year to provide training to the special needs officers
in mainstream schools on supporting children in that environment
with communication difficulties. Education in return are to provide
curriculum training to speech and language therapy staff. Therapy
staff have also provided training to teachers in mainstream schools
where pupils have been transferred to that setting from special
schools, and we would also provide on-going training to nursery
school staff, so there is quite a bit of training on-going on
the ground already.
Mr McGrady: Thank
you very much indeed.
Chairman: We have
concluded the agenda which we wanted to pursue, but Mr Donaldson
has one, possibly two, supplementary questions he wants to ask
arising out of having listened to your answers.
Mr Donaldson
148. Thank you, Chairman. Good morning.
I wanted to pick up first of all on the question of nursing provision
in the schools and particularly Mr Bradley's comments. Mrs Nixon
indicated that the Eastern Board have made some progress on this
issue and I know of the situation in the Down and Lisburn area,
and in my own constituency with particular reference to Parkview
School we have made some progress there in terms of nursing care.
The question of training was raised by Mr Bradley and the review
which I think we would welcome in terms of the medical needs of
these children and provision by the boards, whether health or
education. You mentioned the possibility that, in some circumstances,
it might be more appropriate, rather than providing nursing care
on site, that you would look towards training the staff in the
schools. Having talked to and met some of the teachers and listened
to what the Education Boards have had to say, I think there is
an issue in terms of the general competence and training of education
staff in the schools vis-a-vis the needs of special education
children. To what extent will this review examine whether teachers
are willing to take on the responsibility of providing this level
of medical care because with training, when one is trained at
a certain level to do things, comes also responsibilities, and
there is already quite an enormous pressure on these teachers
in terms of the existing responsibilities they have in very difficult
circumstances. So what measures and what steps will you take to
take into account the views of the teaching staff in terms of
their willingness to participate in that kind of scheme?
(Mr Bradley) This is a key issue, Mr Donaldson,
and one which certainly within the regional group we are very
focused on at this moment in time. Obviously any planned review
has to take into account the views of teachers because, no matter
how supportive we are, no matter what training we put in place,
unless there is a willingness and understanding from teachers
involved then I do not think it is going to work. I have personally
had some dealings with some of the teacher trade unions around
this issue and I am very conscious of the views of teachers in
this area. It seems to me that that is one of the reasons why
we need to review this. I do not want to go into too much detail
here in relation to some elements of this as that may not be appropriate,
but just to say that there are issues about what level of support
you can expect to give children who have fairly uncomplicated
needs but may have a requirement, let us say, to be taken to a
toilet, taken off a toilet again and the general activities of
daily living which one might describe as a parent or somebody
acting in loco parentis being able to carry out. There
is an issue about making sure we are quite clear about those needs
and how we should meet those needs, as opposed to the more complex
and medical needs which were referred to earlier like aspects
of feeding. It is in those areas that I think we have not yet
made up our minds as to what the level of support should be. But
the policy at the moment is predicated on normalisation and, as
we have more disabled children living within the community, we
have had higher expectations as to what not only parents will
do, but also what members of the public will do in the context
of making society a place where these children can live reasonably
normal lives. So there is a fine balance about whether or not
you by default begin to turn some of these schools into mini-hospitals,
which I think would be wrong, as opposed to making sure we have
the right level of support, but support which people are happy
with. I am conscious at the moment that there are people in the
system who are not happy with the level of support. We need to
address that, and I am convinced that we will address that in
the next 12 months. It does mean that the solutions may well be
different for different places as to how that is addressed, but
there is an issue of talking people through that and getting their
agreement. Certainly part of that is going to have to be talking
actively to teachers as to what they want to do. Teachers are
also concerned with other matters such as sexual abuse and they
may be concerned over intimate contact with these children. These
are some of the policy issues which have arisen in our society
in the last couple of years which do not help this agenda, do
not help us to move forward on some of these issues, but it seems
to me that we need to sit down and talk this through. Training
then becomes important so that we have clear expectations as to
what each of us is going to do to help these children and we understand
each other's roles. I am personally very committed that that has
to be a major focus in this coming year because this issue is
not going away, it has been a subject of discussion in other circumstances
and we will have to get some agreement around it, but a reasonable
agreement on everybody's part. I am sorry, that is a fairly long-winded
answer. It is quite obvious that we are only beginning to tackle
it at this stage and we need to have a more focused approach to
it, but we are committed to doing that.
(Mrs Nixon) The nursing support at the Parkview
School at the moment is a pilot scheme. We will monitor and evaluate
from that pilot whether nursing is required. I wanted to emphasise
that.
149. It is a very useful pilot not just
in the context of that local area but perhaps feeding into the
whole question of the wider review of Northern Ireland. Can I
also touch on another issue and that is concerning the response
for therapy provision? From one of the comments made earlier,
it appeared that the approach of the health boards was influenced
by their concern that, if therapy provision were to pass to the
Education Boards, you might end up with a situation where you
had duplication of assessments and so on. How does that sit with
your desire to achieve multi-disciplinary assessments in terms
of these children?
(Mr MacDonnell) I think the nuance of this point
is that our assumption would be that the assessment which will
be carried out in an educational context would be solely to do
with educational needs. Dr Hannigan could probably elaborate on
this, but in that context assessment is carried out by a professional
working in a health and social care context, and there is a much
wider ambit to the assessment we need.
(Dr Hannigan) That is the case. Many of these
children, as has been already pointed out, are already known to
the therapy services long before they ever get to the stage of
having formal assessment for a statement of special educational
needs. As I pointed out earlier, it is often very difficult to
differentiate between health and social needs and what is purely
an educational need. It appears that there is duplication where
you have a therapist working with one agency at a later stage
coming in and reassessing for a particular part of the continuum
in the child's needs.
Mr McGrady
150. Generally, in my constituency office
I receive many complaints about what parents consider to be an
unacceptable delay between the issue of a referral and a formal
statement. This is a period which is obviously very stressful
for the family and is detrimental to the child both educationally
and physically. I would like to know what is the length of time
on average between the initial referral to the statement being
made. Is there any hope that this time lag can be shortened or
indeed virtually abolished?
(Dr Telford) That relates to one of the supplementary
questions that we were asked, and I think we were all squirreling
around trying to get an answer for the Committee. Over the last
week, we have taken a random sample from across our trust areas
and we found that the average time lag between referral and assessment
report being produced is 5.8 weeks, with the statutory limit being
six weeks. We think you would probably be pleased with that.
151. That sounds like a massaging of statistics!
(Dr Telford) I have to say that that is an average
figure and, as you would expect, almost 80 per cent of those records
we sampled were completed within six weeks and 90 per cent were
completed within eight weeks. I think the approach we adopted
was similar to a random sampling approach which we read about
in the Northern Ireland Audit Office report when they were trying
to do a similar assessment, because we have not had time to look
at every individual record. Sometimes there are delays because
parents of children do not come along and attend their appointments,
sometimes there is delay in getting consent, and there are practical
organisational problems. But we were actually quite pleased when
we had taken that random sample and looked at that. So we thought
we would tell you that with pleasure this morning if you asked
about it!
Mr McGrady: The moral
of the story is that I am getting the complaints about cases which
are not taking 5.8 weeks. I hope that will improve dramatically
for all cases. Thank you, Chairman.
Chairman
152. I will add one footnote to Mr McGrady's
question. If 10 per cent are taking more than eight weeks and
the average is 5.8 it suggests quite a number are actually done
reasonably quickly. On the other hand, the margin of 0.2 of a
week, which I have not even bothered to calculate, is a narrow
margin and it must make for an element of excitement as you come
up to the deadline. However, deadlines are things with which Members
of Parliament are themselves familiar and this Committee has been
given something of a deadline because the Secretary of State is
going to hold a press conference on the other side of the divider
shortly. We are extremely grateful to you for having come, we
are extremely grateful for the preparation which went into the
material you sent us in advance, we are extremely grateful for
the way in which you have answered our questions today. I will
conclude with one final question which I have asked others on
other occasions, is there any question which you were surprised
we did not ask?
(Mr MacDonnell) I am sure we can think of a lot,
Chairman, but I am not going to tell you what they are! May I
conclude from our side by thanking you for taking the time to
hear us. I did say at the outset, and I want to re-emphasise it,
how delighted we were this subject is on your agenda. I was struck
as I was driving here through the rain this morning by the main
item on the news which was about the need to increase the capacity
in the Royal Victoria Hospital so people can have their hips pinned
faster, particularly elderly people, and I was thinking, does
that not contrast with the other end of the spectrum, and yet
we are responsible for both ends of that spectrum and everything
in between. I want to assure you, and you did touch on it subtly
in your comments in the middle, that we would hope the report
which is produced at the conclusion of this will help us to give
priority in the clamour for resources from all parts of health
and social services to this very important area. It does touch
on the questions which Mr Robinson and Mr Beggs were particularly
hinting at, we must not hide behind these fine agreements, we
have to resource them adequately and we reassure you again that
we are working with our colleagues in education intensively. At
the end of the day, we have to make very difficult decisions to
put our money behind the agreements to augment the service in
the way that you and I would like to see happen. I would like
to leave you with that last comment. Thank you very much.
Chairman: Thank you
very much indeed.
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