Agenda item

Liz Brighouse (Cabinet Member for Children, Education and Young People’s Services) and Anne Coyle (Director of Children’s Services) have been invited to present the most recent Local Area Partnership SEND Report, with a particular focus on the Health and Wellbeing implications on Children.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

The following were invited to respond to the Committee’s questions concerning the recently published Local Area Partnership SEND Report; Liz Leffman (Leader of the Council), Liz Brighouse (Deputy Leader and Cabinet Member for Children, Education and Young People’s Services), Anne Coyle (Interim Director of Children’s Services), Stephen Chandler (Executive director – People, Transformation and Performance), Rachel Corser (Chief Nursing Officer- BOB ICB), Daniel Leveson (Place Director Oxfordshire – BOB ICB), and Victoria Baran (Deputy Director, Adult Social Care).

The Chair explained that this report came against the backdrop of the Cabinet having considered the Education Commission report on Tuesday the same week; and that HOSC were looking at this particular SEND report that had highlighted significant concerns and systemic failures in SEND provision for Children. The Chair confirmed that the Committee had also had sight of a statement that was released on the BOB Integrated Care Board’s website, which included statements from many representatives of the senior leadership of the Local Area Partnership who were also present during this meeting.

The Committee emphasised that whilst the report highlighted challenges in the Local Area Partnership, it also highlighted some positive aspects of the partnership that were indeed working well.

The Chair also reiterated that in terms of the format of scrutiny for this SEND report, this Committee would scrutinise this report’s findings with as much a focus as possible on the health and wellbeing of children, and that the People and Overview Scrutiny Committee would scrutinise this report separately at a future date. It was emphasised that both scrutiny committees had a remit over certain aspects of SEND issues, and that it must be ensured that this discussion was centred around the implications on the Health of Children.

The Committee AGREED it would hold off from issuing any recommendations until the People and Overview Scrutiny Committee had had an opportunity to scrutinise the OFSTED report. Upon both committees having scrutinised the report, the Chairs, Vice-Chairs, and officers of both committees would meet and agree on a separate list of recommendations from each committee that did not conflict with each other.

The Chair invited the registered speakers to address the Committee.

1.    Statement by Terez Moore:

Terez Moore began by stating that the battle for their children has been hard and lengthy with no end of distress. Nothing she had ever experienced when fighting for her children had been centred on them and their needs. The County Council and health system could improve on trying to put children first. Terez gives an example of behavioural incidents and experiences of her child at school that she felt were not appropriately addressed or dealt with; with the head teacher refusing to accept her child’s diagnoses. She then expressed the traumatic nature of her child’s experiences with suicidal thoughts and stated that she felt there was a lack of support for her child and that their voices were not being heard strongly enough. The school refused to apply for an EHCP assessment for her child, forcing her to seek a parental one. Terez explains that she experienced lengthy delays in receiving support, and felt that the system did not focus on her son’s needs as an individual. Terez also stated that the Ombudsman found that her son was failed by Oxfordshire Country Council. Her son had to move far from home to receive the education that he required because his placement was denied by Oxfordshire Country Council. She had to attend an education tribunal for her son and also experienced delays with this being arranged, which resulted in her son’s condition worsening. She was then given an emergency tribunal date. OCC informed the Judge that they did not have an appropriate setting for her son. Terez explains the trauma and financial strain this experience has caused on herself and her family. Terez explains that she and her husband have had to cover enormous costs for her child’s legal fees. She has been waiting for an ASD (Autism Spectrum Disorder) and ADHD (Attention Deficit Hyperactivity Disorder) assessment for her second child since January 2021, who is currently diagnosed with chronic motor tick due to stress. Terez applied for a new EHCP but emphasized that an educational psychologist had written a report without having met her child in person or physically seeing them. Terez stressed and felt that the process for receiving support for SEND was not as child-centred as it should have been. Terez concluded by urging for a better system for SEND provision that also takes the mental health of children into account.

2.    Statement by Kimberly Morgan:

Kimberly Morgan stated that she was a disabled single mother to her disabled seven-year-old son. Her son had been out of formal education since April 2022 and had been diagnosed with Autism, ADHD, profound school-based anxiety, a vomiting disorder and three separate language disorders. Her son was found to have a significant fine motor delay, and experienced a rapid decline in his mental health and was experiencing suicidal thoughts. His school was later found by SENDIST to have ignored his disabilities as he had no diagnosis at the time. Kimberly highlighted that her son’s mental health deteriorated as a result and that he was yet to receive any treatment from CAMHS over a year and a half later. Kimberly stated that there was currently no support being offered for her son despite the challenges he was facing. Kimberly added that although her son’s motor skill deficits were clearly identified by the NHS, they were not receiving any services and that being a disabled single mother unable to pay privately for therapy did not help either. Kimblery also expressed that she felt that Oxfordshire County Council had not been fulfilling their legal duties under Section 19 and Section 42, and that the County Council needed to acknowledge that her son’s needs could not be met in a mainstream school.

3.    Statement by Claire (spokesperson of Oxfordshire SEND Parent Action)

Claire stated that she was an autistic mother of an eight year old autistic child, who was now educated at home due to school trauma; and that she represents OxSEND Parent Action (a group of over 90 parents and carers whose children have been impacted by some of the challenges highlighted in the Ofsted/CQC report). Claire expressed that affected parents felt that no service seemed to be taking responsibility and that children and young people appeared to be bounced between services. She asked where, in this multi-agency partnership, did the key responsibility lie, and asked for clarity on who the Senior Responsible Owner for the quality and delivery of SEND service provision was, as well as who carried responsibility for the risks of the systemic failures highlighted by the SEND report.

Claire proceeded to highlight three areas relating to Health in the findings of the SEND report:

1.    She felt that Health and Social Care were often missing or lacking in EHCPs, and that they often may not be consulted at all.

2.    Waiting times were too lengthy.

3.    That Multi-agency work between services were often non-existent (particularly for children with mental health difficulties).

Claire also emphasised some key points relating to how affected parents also felt including the following:

1.    Mental Health Services for children in Oxfordshire were not as widely available as they could be, and parents feel that they are managing their child’s mental health crisis with little support.

2.    CAMHS interventions were not as autism friendly as they could be, and that waiting lists for CAMHS services were too lengthy.

3.    The practice of CAMHS referrals from schools was creating unnecessary

barriers and delays. Schools appeared to not perceive it as their responsibility. Claire also emphasised that Health services should try to accept referrals directly from parents.

Claire moved on to state that her family had been pushed to breaking point, and that had they not have been able to gain access to a private autism diagnosis and some private mental health support, she would not know where they would be now. She also outlined that CAMHS discharged him despite the fact that he still couldn’t access school.

Claire called for a fundamental rethink of how SEND services were delivered, and emphasised that Health, Education, and Social Care had to take increased responsibility and accountability if any improvements were to be made.

Claire concluded by proposing some key recommendations which were:

1.    All communication and actions must be transparent, of sufficient quality, and timely in nature      .

2.    Co-production with parents was pivotal.

3.    Work on Improving staff skills and retention was required.

4.    Ensuring that OCC services had stability, good governance and effective scrutiny, and that there should be work on building a culture and practice of learning and reflection at all levels.

The Chair thanked the public speakers for their statements and participation, and proceeded to a question and answer session between the Committee and the invitees.

The Committee initiated with an overarching question around what the immediate response of the Partnership would be, as well as how the Partnership would produce a response and an action plan in a timely way in light of the SEND report’s findings. The Committee also asked specifically about the timescale in relation to the action plan, as well as what would be demonstrated in the action plan; including the role of co-production. The Executive director for People, Transformation and Performance responded by highlighting that the CQC and Ofsted have asked the Partnership to produce a priority action plan within thirty working days since the publication of the report. Oxfordshire was the seventh County in the County to undergo this particular framework of inspection. Ofsted and the CQC were very explicit around the importance of ensuring the draft report was not shared widely, but that they did share this with the stakeholders such as the Oxfordshire Parent Carer Forum. Since the publication of the report, the Local Area Partnership had agreed a series of workshops to produce the priority action plan; and that these workshops would include all of the key stakeholders that they would be expected to include, initiating with the Parent and Carer Forum, which was independent from the local authority.

The Committee asked about the voices of families in the role of action planning, and reflected on the personal experiences of some of the Committee members who were present about the challenges they have been facing with close loved ones who experienced SEND. There was a sense of relief at the report’s publication, that the systemic failings have been aired publicly. The Committee enquired about how it would be ensured that people’s voices are heard, and how they would receive regular communication regarding the status of their application for help and for SEND services. The Executive director for People, Transformation and Performance responded that part of the action plan and the response was to ensure that families and their voices were strongly taken into account, and that all members of the Partnership would work towards this. It was highlighted that only time, evidence and stories would eventually convince the Committee as well as the wider public that the Partnership was taking family voices into account.

The Committee cited how the SEND report talked about leadership and how this was key; and proceeded to ask what the role of leadership would be, what this would look like, and how effective it would be. The BOB ICB Chief Nursing Officer first thanked the public speakers for their stories and felt incredibly moved by this, and proceeded to apologise on behalf of the ICB as to the failings that have been identified in the recent SEND report. She highlighted the importance of good and coordinated leadership to ensure that the NHS had the operational oversite of delivering the requirements of the action plan. The Chief Nursing Officer also referred to the close relationship between the ICB and OCC in working closely to drive improvements forward, and expressed a commitment to working with parents as part of this improvement journey. Cllr Leffman also responded that elected representatives had a responsibility to residents of the County to make sure that not only are they heard, but that they receive the services that they require. The leader highlighted that whilst there were nationwide challenges with SEND provision, that did not take away responsibility of the County Council to ensure that residents were treated as human beings and in the appropriate way. The Leader also expressed apology that affected families have had difficult times, and at how people have had difficulty in receiving clear communication, and that good leadership was key, particularly through ensuring good coordination with NHS partners also. The Leader acknowledged that there was a lot that needed to change, and assured the Committee that the leadership would change the way they work; despite the challenges related to limited funding. Cllr Leffman concluded in her response that parents did have to be adequately listened to throughout this process as well as throughout their journey for seeking support for SEND.

The Chair then highlighted the important role of the Committee, as well as other committees within the Council, to ensure that challenges with SEND provision were not overlooked, and that partners, including the Committee, worked together to drive for improvements to SEND services.

The Committee then emphasised the imperative for the NHS to work closely with schools, and that schools should not be required to shoulder additional or excessive responsibilities, particularly around providing healthcare support for children experiencing SEND. The Committee thanked Cllr Leffman for being forthcoming about the challenges with SEND provision, and urged for taking on board the feelings that affected parents had expressed.

The Committee referred to how the report stated that Children’s and Young People’s needs were not consistently identified accurately or assessed in a timely and effective way right from the start; and asked about what was being done to ensure swift diagnoses of SEND for Children who may be suspected of exhibiting this. The Executive director for People, Transformation and Performance responded that waiting for something may not be straightforward; people may be waiting for CAMHS appointments, EHCPs, occupational therapy treatments, speech and language therapy treatments and so forth. Only four percent of EHCPs at the beginning of the year were being met by the 20 week deadline. Council had approved an additional half a million pounds, and there has been an improvement to forty three percent and that by August there was a further improvement to sixty-six percent. Therefore, the Partnership had not been waiting for the report’s findings on waiting times, but had already pre-emptively been working on making improvements to waiting times. The BOB ICB Chief Nursing Officer reiterated that lengthy waiting times were not acceptable, and that this was indeed a national challenge, but that there were issues being worked through with local healthcare providers, particularly with Oxford Health who had been recovering from the recent cyber attack they were subjected to; all of which had helped with accessing necessary data on affected children/patients. The Partnership is also committed to providing additional support to families whilst they were waiting for services. The BOB ICB Place Director also cited that coordination and personalisation of care around the families was critical.

It was enquired as to whether person-centredness would be a part of the commissioning and procurement processes. Cllr Brighouse responded that the Partnership had known that this report’s findings on waiting times was imminently being published; and that knowing what the issues were was a relief in that all partners could work together to address the challenges in SEND provision. Some PCNs (Primary Care Networks) across the County had now commissioned services through their social prescribing budget to provide support to children presenting to GP surgeries with anxiety and autism; this means that whilst they are awaiting an autistic assessment, they are receiving help and support through a social prescribing budget. Therefore, it was emphasised that money did also exist in the social prescribing budget that could help with providing support in the context of waiting times for assessment.

The Committee emphasised that it was crucial for data around EHCPs to be transparent and adequate in its availability, and that it was not only important to ensure the timeliness of EHCPs, but that they were also accurate in their quality.

The Committee urged that parents needed to be able to see all that is offered, and that there may be a reluctance to push for support as they may not be aware of what was on offer or the benefits of what may be on offer in terms of SEND services.

The Committee emphasised whether lessons would be learned from other Counties and systems that had good SEND provision that we could learn from. The Executive director for People, Transformation and Performance affirmed that there would be lessons learned by the Partnership and these lessons would be taken on board; and that there were discussions with the Parent Carer Forum also to identify how to address the concerns raised by the SEND inspection.

The Committee referred to how the report stated that within schools, staff were not always well supported to understand and meet the different needs of children and young people with SEND. The Committee therefore enquired the following; whether there were particular reasons as to why or how staff were not being sufficiently supported in this regard; what the statutory obligations were on training and whether these obligations had been met; and importantly, what could be done to increase support for school staff to enable early identification and intervention to avoid any potential negative outcomes on the mental and physical health of affected children. The Executive director for People, Transformation and Performance replied that it was incredibly important that staff received adequate training, and that the local authority had a school improvement team, and it was being assessed as to whether resources were adequate for training provision and whether work was being focused in the appropriate areas. The role and accountabilities of the local authority had been less explicit since the advent and increased independence of academies. The academy structure had also required the local authority to step back. However, the Executive director for People, Transformation and Performance still insisted that this did not imply that the local authority had no role at all in this context; and that the practice of role modelling by the leadership of the Partnership for front line staff was also crucial. The BOB ICB Chief Nursing Officer added that the key challenges were centred around some of the specialist roles that existed in the health and therapy sector, again not unique to Oxfordshire; but that opportunities did exist about thinking differently regarding what potential roles currently existed, and where the system could work collaboratively to work to redesign the career pathways. Staff would also not feel satisfied to be working for a service where they felt they were not helping Children and Young Persons, and it would be incredibly demotivating for staff to feel that they were not working for a system that made a difference to people’s lives for the better.

The Chair concluded the item by pertaining to the complementary aspects of the SEND report regarding the services that were working well; and how when people did access services, they felt the support they received was organised, enthusiastic, and professional; but that there needed to be adequate focus on the shortcomings to work on turning things around for Children and young people with SEND.