Select Committee on Northern Ireland Affairs Minutes of Evidence

Examination of witnesses (Questions 140 - 152)



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.


  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.


  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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