8 Specialist services
122. A theme running through much of the evidence
to our inquiry was a concern that greater devolution to schools
for commissioning alternative provision and support services could
lead to some services currently provided centrally by local authorities,
such as behaviour support, being outsourced or disbanded completely
as increasing numbers of schools become removed from local authority
control and as the demand for central services becomes less certain.[227]
As Christine Blower of the National Union of Teachers told
us:
if a number of schools can draw on that kind of facility
and professional support, if there is a child who risks exclusion,
we can usually manage to nip it in the bud. The more schools there
are that leave the local authority, the less there is at the centre
in order to be able to do that. We think that that is clearly
a loss for the schools that remain with the local authority, but
it is also something we don't think the academies will be able
to do as effectively. If they need to buy in services, they will
not be doing it on the same basis as local authorities.[228]
123. Ms Blower stressed that the rapid response provided
by core services was "critical" in responding to immediate
need.[229] John Dickinson-Lilley
of the Special Educational Consortium explained the particular
impact the "fragmentation" of central support services
would have on pupils with more complex needs:
it is really difficult to disentangle mental health
disability and behavioural difficulties. There is a real issue
in schools about who is responsible for a child's mental health
[
] One of the key challenges for schools now, certainly
with the changes to the structure of the system, is how to develop
those partnerships. [...] One of our concerns at the SEC is that
we are seeing significant fragmentation already in the traditional
central support services provided by local authoritiessuch
as educational psychologists and so onbecause of the new
academies programme. There is potential for further fragmentation
with free schools, where schools will be required to commission
services. If the money has already been taken away from local
authorities, those services will be lost, and if they are lost,
how will provision be made? It is an absolutely critical question,
but it is one that we are going to find very hard to answer until
the Government can give us an answer about how they are going
to ensure that this provision will continue to be made while education
is being changed in the way that it is being changed.[230]
124. The Government is currently considering the
future role of local authorities in coordinating support to schools.
As the Minister for Schools told us, "if you are asking about
the role of local authorities in a world where an increasing number
of schools are academies, the ministerial advisory group established
by the Secretary of State[231]
is looking at that to see what their role will be and how
it is to be funded. There will always be a role for local authorities
in the provision of education, and in the provision of central
services. Because those services may be purchased by schools,
it may be decided that local authorities will provide those services
funded centrallyfor example, low-incidence special needs.
That is something that is being discussed at the moment with the
local authorities".[232]
125. We await
with interest the outcome of the ministerial advisory group's
study of the future role of local authorities, in particular their
role in co-ordinating support to schools for managing behaviour.
There is a risk that, as schools go through the transition from
being dependent on local authority-provided services to having
greater autonomy in purchasing their own support and services,
some local authority services may be decommissioned, leaving schools,
and more importantly pupils, without access to critical support.
We therefore recommend that local authorities should be required
to maintain and resource a basic core of provisionparticularly
that which is targeted at responding to urgent or critical needuntil
schools' practice in commissioning and procuring their own support
is well established.
126. In the remainder of this Report, we look more
closely at two particular specialist services which are central
to behaviour support for schools: educational psychology services
and child and adolescent mental health services (CAMHS).
Educational psychology services
127. Of particular concern for our witnesses was
the future availability and management of educational psychologists.
The Association of Educational Psychologists (AEP) explained that
"educational psychologists work on a daily basis across a
range of educational settings that include schools, early years,
Pupil Referral Units and within multi-disciplinary settings with
close colleagues from the NHS and Children's Social Care. As such,
they are uniquely placed to ensure consistency and continuity
when managing challenging behaviour, which is the bedrock of any
effective behaviour or discipline policy".[233]
The Association also stressed the role which educational
psychologists played in developing understanding ofand
providing training to teachers onchild development and
the "root emotional, wellbeing or social causes that precipitate
challenging behaviour",[234]
as well as advising on curriculum development and special
educational needs.
128. During our visit to Beaumont Leys School in
Leicester, staff told us that the support which they gave to pupils
could be improved significantly if they had greater access to
educational psychologists and interventions from therapeutic services. At
present the school receives just 30 hours of support per year
from educational psychology services. Difficult decisions have
to be made about what to prioritise, particularly as processing
one statement of educational needs can take up to six hours of
an educational psychologist's time, even before a report is written.
Educational psychologists therefore have very little capacity
to support the school in carrying out preventative work in
a more proactive way. The school has considered establishing
its own educational psychology service but has decided that
this is not financially viable.[235]
The Association of Education Psychologists told us that "the
impact of educational psychologists is being undermined by the
lack of resources on the frontline",[236]
something which it attributed to "a lack of understanding
about the range of work across educational settings that educational
psychologists perform, and the unclear and unsustainable funding
mechanisms for trainees that translate as a result".[237]
129. The Minister of State for Children and Families
has stated that the current system for funding educational psychologists
(whereby local authorities are allocated non-ring-fenced funding
for educational psychology training which they voluntarily contribute
to a central budget each year) is not sustainable.[238]
These voluntary contributions have been decreasing over several
years, with only 16 out of 150 local authorities contributing
in the current financial year. This leaves the service with a
significant shortfall in funding. The Government states that psychology
services are "specialist [
] and demand-led" and
that local authorities need to improve their ability to "assess
capacity in relation to local demand for the service" in
order to advise forward planning.[239]
The Association of Educational Psychologists expressed deep concern
about the future of educational psychology services and recommends
that "the previous funding model, which was to top-slice
all local authorities rather than seek voluntary contributions,
provided for a steady uptake of training places".[240]
130. Educational
psychologists provide critical support and training to school
staff on a wide range of educational issues including child development,
curriculum development and special educational needs. Any diminution
of their ability to help schools to maintain and improve standards
of behaviour could have far-reaching consequences. The voluntary
funding mechanism has proved to be unsustainable. The Government
must find a way forward, and one option might be for local authorities
to continue to be responsible for educational psychology services,
funded through a compulsory levy on schools.
Child and Adolescent Mental Health
Services
131. Evidence from the mental health charity Young
Minds stated that "many children who have a special educational
need, particularly those who are said to have behavioural, emotional
and social difficulties will also have mental health problems".[241]
Staff at Beaumont Leys School in Leicester estimated that
mental health problems were a factor in "maybe 60%"
of behaviour resulting in fixed term exclusions.[242]
However, during our inquiry we heard widespread complaints about
the difficulties which schools face in accessing Child and Adolescent
Mental Health Services (CAMHS) and the speed with which this support
is made available. During oral evidence, Sir Alan Steer said that
the country faced a "national scandal on the issues of children's
mental health", commenting that the situation in some parts
of the country was "dire". He recounted a recent experience
of a child waiting 18 months between referral and first appointment
with CAMHS, with 9 months being reported as a 'normal' waiting
time.[243] Liz
Logie, Head Teacher at Beaumont Leys School, told us that she
had not had any contact with CAMHS in 8 years of her
headship and agreed with Sir Alan that her school's inability
to access CAMHS was a "disgrace".[244]
132. Asked whether the situation would improve if
schools were able to commission CAMHS directly, Liz Logie said
this would only be effective if sufficient funds were made available.
However, Charlie Taylor, Head Teacher at Willows Primary Special
School and Acting Head Teacher of Chantry Secondary Special School
in Hillingdon, pointed out the potential difficulties for schools
in commissioning CAMHS:
We are supposed to be able to commission through
CAMHS, but I thought education recruitment was complicated until
you get into health recruitment [
] The bureaucracy and everything
else around it is such a complete nightmare that in the end you
think it is better if we use the money on what we want. You have
to pay them a huge [
] pimping fee, I suppose, to get any
services into your schools. You end up paying a tip to the NHS
for bringing a worker into your school, so in the end we thought
we would go direct to the workers and recruit our own people.[245]
133. Many
young people with behavioural issues or SEN also have mental health
problems. Schools face major challenges in securing specialist
and therapeutic services in order to make accurate assessments
of need and to implement appropriate interventions. Particular
difficulties in accessing Child and Adolescent Mental Health Services
were raised by a large number of our witnesses. Sir Alan Steer
suggested that a national scandal "hovers around" children's
mental health:[246]
we are in no doubt that the CAMHS situation is scandalous and
that there are very serious shortcomings in access. The Department
for Education and the Department of Health must co-operate in
order to find a way of allowing schools to have easier and speedier
access to Child and Adolescent Mental Health Services. The Department
of Health and the Department for Education should pilot with a
number of Behaviour and Attendance Partnerships a mechanism by
which they can commission CAMHS services accountable to them locally.
134. In our meeting with partners at Leicestershire
County Council, CAMHS commissioner Liz Mair pointed out the commonly
held misconception that all CAMH services are specialist.[247]
The same point was made by the mental health charity Young Minds,
which observed that "many of the services within the concept
of the comprehensive CAMHS are provided by agencies other than
the NHS e.g. social services, and the voluntary sector".[248]
In Leicestershire, CAMHS believes that up to 35% of all young
people referred to specialist CAMHS do not require specialist
interventions (although non-specialist interventions may be required).
However, as Young Minds concluded, the full range of CAMHS servicesspecialist
and non-specialist"need to be functioning effectively
if the whole system is to work properly".[249]
135. Evidence to the inquiry highlighted the importance
of joint protocols and multi-agency information sharing, in order
to improve referrals between the various partners involved in
supporting behaviour, SEN and mental health. Leicester City Council
operates a comprehensive referral system to behaviour support
services, underpinned by an 'Information Passport' which brings
together all relevant information about a pupil being considered
for referral to alternative provision or other forms of support.
This single referral form avoids the need for all concerned agencies
to make multiple separate referrals to support services and improves
the quality of information shared between partners. CAMHS is not
party to the Information Passport used by the Leicester Education
Inclusion Partnership. CAMHS is, however, a recipient of information
gathered through Common Assessment Framework processes and also
shares information with schools about pupils accessing its services.[250]
The case for common assessment and referral systems was supported
in written evidence from NFER which stressed that "clear
systems for referral and information sharing improve the decision-making
process. A shared assessment tool can avoid duplication and promote
early identification of need".[251]
136. There is
a lack of agreement and understanding between schools, local authorities
and health services as to how referrals to CAMHS should work and
who should be referred. Having commonly agreed referral mechanisms
would go some way to addressing this. Where Behaviour and Attendance
Partnerships are in place, they should be directly involved in
developing and agreeing these mechanisms.
137. Liz Mair told us that CAMHS workers feel that
greater awareness of the differences between mental health problems
and conduct disorders is required amongst front-line workers in
order for young people and their families to get the help they
need at the earliest opportunity.[252]
Partners agreed that the Government-funded Targeted Mental Health
in Schools (TaMHS) programme[253]
had been helpful in improving the skills of front-line workers,
and evidence to our inquiry also showed widespread support for
the programme.[254]
138. Any programme which improves the skills of frontline
workers in identifying mental health problems and encourages innovation
should be supported. The
Government should review the Targeted Mental Health in Schools
programme and the SEN Green Paper should set out how it should
be taken forward in future.
139. The children's communication charity I CAN attributed
the failure of CAMHS to provide responsive and joined-up services
to schools to the current split in commissioning budgets and priorities
across the different agencies providing CAMH services.[255]
The Schools White Paper The Importance of Teaching
proposed that local authorities should continue to hold the role
of "convenor of local services" as well as "champion
for vulnerable pupils in their area".[256]
Similarly, it proposed that local authorities would continue to
ensure that disabled children and those with special educational
needs (SEN) could have access to high-quality provision that met
their needs. Local authorities would also be responsible for funding
provision for pupils with statements of SEN. Mental health is
dealt with separately in the White Paper, with a sole commitment
to "work with the Department of Health to develop and publish
a mental health strategy" by January 2011. It is not clear
from these proposals how a 'continuum' of provision will be constructed
to ensure that young people do not fall between the gaps where
services are provided by different agencies and where different
thresholds for interventions exist.
140. I CAN referred to a recent proposal made by
a group of children's representative bodies to the Secretary of
State for Health, which suggested fundamental changes to the way
in which CAMH services are funded. The group suggested that the
Government "builds on its plans to locate the public health
commissioning function within local authorities, by also identifying
the local authority (working closely with GP consortia) as lead
commissioner and budget holder for all local children's community
health services".[257]
141. We support
the suggestion by I CAN and other children's representative bodies
that the Government consider passing the responsibility for budgets
and commissioning of all children's community health services
(including CAMHS and Speech Language and Communication specialist
services) to local authorities in order to provide a more streamlined
service to young people and their families, bridging the gap between
'specialist' and 'non-specialist' interventions.
227 e.g. Ev 116 Back
228
Q 38 Back
229
Q 38 Back
230
Q 198-9 Back
231
The Secretary of State for Education wrote to all local authorities
on 26 May 2010 inviting them to partake in a dialogue about how
to make the vision for a new school system a reality. In July
2010 a Ministerial Advisory Group was established to consider
the role of the local authority in relation to education and children's
services, to enable ministers and local authorities to consider
the future partnership between central and local Government. Back
232
Q 298 Back
233
Ev 94 Back
234
Ev 94 Back
235
Annex 2 Back
236
Ev 94 Back
237
Ev 94 Back
238
HC Deb, 18 October 2010, col. 774 Back
239
HC Deb, 18 October 2010, col. 773 Back
240
Ev 96 Back
241
Ev 153 Back
242
Annex 2 Back
243
Q 91 Back
244
Annex 2 Back
245
Q 159 Back
246
Q 91 Back
247
Annex 2 Back
248
Ev 154 Back
249
Ev 154 Back
250
Annex 2 Back
251
Ev w152 Back
252
Annex 2 Back
253
TaMHS is a three-year pathfinder programme, started in April
2008, aimed at supporting the development of of innovative models
of therapeutic and holistic mental health support in schools for
children and young people aged five to thirteen at risk of, and/or
experiencing, mental health problems; and their families. 25 local
authorities and their Primary Care Trusts have worked together
on the pathfinder. Back
254
For example see Ev 154, para 6.4, Q 190 Back
255
Ev 146 Back
256
The Importance of Teaching, para 5.40 Back
257
Ev 146 Back
|