Supplementary memorandum submitted by
I CAN
When I gave oral evidence to the Education Select
Committee on 29 October, I promised to write with some additional
information.
1. INTEGRATED
COMMISSIONING FOR
CHILDREN WITH
SEND
In discussion with Members of the Committee,
the issue of specialist support to children with behaviour problems
came up, particularly as regards Child and Adolescent Mental Health
Services (CAMHS), where support needs to come from the NHS. All
too often it proves very difficult for schools to access CAMHS
and other specialist health support such as Speech and Language
Therapy in schools because commissioning budgets and priorities
are neither integrated nor aligned across agencies. As a result
children fail to receive help and support that is vital to their
attainment and behaviour.
It was in this context that I mentioned a radical
proposal put forward in response to the Liberating the NHS White
Paper by myself, Paul Ennals of the National Children's Bureau,
Christine Lenehan of the Council for Disabled Children and Anita
Kerwin-Nye of The Communication Trust. I attach the letter to
Andrew Lansley MP, Secretary of State for HeaIth, that I referred
to in Committee, which outlines this. We suggest that 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.
We propose this because we consider that Commissioners
should be in a position to commission in the round for children's
services. The most effective services for children with SEND integrate
provision made by NHS therapists with that provided by local authority
advisory teachers and special units/schools, and local authority
social care services; the most effective early years services
integrate the work of health visitors, speech and language therapists
and early years practitioners.
Without overall commissioning, uncoordinated
services serve children poorly and mean that the collaborative
practice which underpins effective practice is impossible. Commissioners
should be in a position to commission services that operate seamlessly
at universal, targeted and specialist levels. Any separation of
these levels of commissioning risks removing the incentive to
invest in cost-effective interventions to reduce service demand
later.
I hope very much indeed that members of the
Education Select Committee will consider the arguments put forward
in the letter carefully, with a view to recommending the transfer
of NHS child health commissioning budgets to Local Authorities
we advocate. Improving attainment and behaviour in our schools
depends on being able to marshal a range of well integrated specialisms
from a number of agencies to support children with SEN and others.
This can only happen if there is an integrated approach to budgeting
and commissioning across agencies locally.
The present fragmentation of commissioning
across Local Authorities and the NHS serves children very ill.
Children with SEND are particular losers in this.
2. YOUNG PEOPLE
WITH SLCN: A HIDDEN
POPULATION
I offered to circulate the table below to illustrate
the point that both John Dickinson-Lilley from SEC and I were
making about the shift in SEN designations that occurs between
primary and secondary school.
As you will see from the table below, school
census data indicate that the incidence of SLCN are as high as
24% in primary school years and fall dramatically to 6% in secondary.
In contrast, BESD in primary years is around 17% and rises to
over 30% in secondary years. It is unlikely that nearly 20% of
SLCN disappear between primary and secondary or that BESD rates
increase without any links to communication needs and skills.
Indeed studies have shown that over time young people with SLCN
make progress in language development but remain significantly
behind their peers; the underlying language deficit remains.
The possible reasons for the fall in reported
numbers are varied, a central one being the difficulty in identifying
language difficulties. SLCN in adolescents are often described
as "hidden". Language difficulties may be misinterpreted
as bad behaviour rather than be seen for the difficulty it is.
3. SPEECH LANGUAGE
AND COMMUNICATION
NEEDS: LINKS
TO BEHAVIOR
I thought it might be useful for the Committee
if I summarised some of the evidence linking Speech, Language
and Communication Needs and poor behaviour that I drew on in my
oral evidence:
— Without intervention, SLCN impacts on
literacy development, educational outcomes, emotional and social
development.
— Children with SLCN are at increased risk
of emotional and behavioural difficulties (often undetected) and
frequently excluded from school.
— Although there is uncertainty around
the exact relationship between emotional and behavioural difficulties
and SLCN, there is a strong correlation with both internalising
(eg anxiety, depression) and externalising (eg anti-social behaviours)
difficulties in adolescence.
— Studies indicate that the incidence of
communication difficulties among children with behavioural, emotional
and social difficulties (BESD) to be between 55 and 100% compared
to a typical prevalence of around 5%.
— Two-thirds of 7-14 year olds with behaviour
problems have a communication difficulty.
— A recent study from the University of
Sheffield concluded that "for a high proportion of secondary
age pupils at risk of permanent school exclusion, language difficulties
are a factor in their behaviour problems and school exclusion."
— Those with a history of communication
difficulties are at a higher risk of developing mental health
problems. Unsupported, around one third of children and young
people with SLCN will go on to require treatment for mental health
problems.
— 60-90% of young offenders have SLCN.
November 2010
| 
