Governance & Leadership Local Area Inspection Outcome Letters
Bexley Main Findings The Bexley local area has reviewed the roles and responsibilities of strategic leaders from education, health and social care services to take account of the reforms. Better communication and a common purpose are allowing leaders to work more closely together to acquire an accurate understanding of the area’s strengths and development priorities. They have ensured that there are effective systems for keeping children and young people who have SEND safe. Leaders monitor the local context carefully to ensure that the needs of children and young people who have SEND are met. They are increasingly able to plan for services that will be needed in the future. For example, they have recognised that more children and young people have autism spectrum disorder (ASD) in Bexley than elsewhere in the country and have provided additional services, such as the Bexley Early Autism Service (BEAS), to support these children well. Leaders are working closely with the parent and carer forum, Bexley Voice, to address the concerns of parents who are not satisfied with the support provided for their children. Representatives from Bexley Voice recognise the positive changes that have been made within the local area since the arrival of the current director of children’s services. For example, they now meet regularly with senior leaders to discuss parental concerns. However, some parents have still to benefit from recent improvements and are still experiencing long waiting times, gaps in services and poor communication. Areas for Development Strategic managers from health and social care do not gather a wide enough range of assessment information. For example, the progress score card used at the SEN board meetings to evaluate the effectiveness of the area’s SEN provision only includes academic information. Leaders and board members do not check that children and young people who have SEND are achieving better outcomes in their social and emotional aspects of learning, health, wellbeing, skills for life or engagement with their community.
Bolton Strengths The impact and visibility of staff in specially commissioned named roles, in education and in health, are having a significant positive effect on the progress of the special educational needs and disability reforms. Formal
networking structures exist and more collaborative working across education, health and social care has increased since 2014. Brighton & Hove Main Findings Leaders evaluate the local area’s effectiveness exceptionally well by assessing services’ strengths and weaknesses precisely. Consequently, leaders know clearly what is going well and where further improvement is needed. For example, the recent refreshment of the joint strategic needs assessment (JSNA) and aligning of the child and adolescent mental health services (CAMHS) transformation plan is beginning to drive forward positive change. Of particular strength is the local area’s approach to joint commissioning, without the need for legal arrangements between the local authority and NHS services, known as section 75 agreements. Services buy into leaders’ strong vision to be family-centred. The effective working relationships between services are productive, so they ensure that identified needs in the local area are appropriately prioritised. Furthermore, strong working relationships ensure that safeguarding arrangements for children and young people who have special educational needs and/or disabilities are effective. Co-production, where services and families work together to review and plan provision, is well embedded. Children and young people and their parents attend local area planning meetings, such as the Learning Difficulties Project group, where they have a clear voice. The local advocacy and support organisations, known as Amaze, and the Parents and Carers Council (PaCC), provide a particularly valued service to support families. They have strongly influenced the local area to improve services for families, for example in the development of a disability register by Amaze and commissioned by the local authority that is used by services to improve provision. Strengths Co-production between services, schools at all stages and parents is very strong. For example, cooperation between the educational psychology service, the autistic spectrum condition support service, school leaders and parents has led to high-quality work to improve support for pupils who have anxiety difficulties. The virtual school provides excellent support for children and young people who have special educational needs and/or disabilities who are in the care of the local authority. The co-production of new EHCPs is very effective. Parents report that their views are taken seriously and that they contribute fully. Parents of pupils who have special educational needs and/or disabilities whose needs do not require a formal plan share similar views. Parents’ strong relationships with school leaders and staff ensure that there are useful opportunities to discuss what is going well and what could be better for children. Pupils are also able to make a useful and valued contribution because school leaders work effectively to ensure that the pupils have a voice.
The speech and language therapy service is cohesive and strong. Exceptional leadership and management mean there are full complements of therapists who support schools very effectively to deliver excellent programmes for children. Derbyshire Main Findings Leaders in the Derbyshire local area have taken effective account of the reforms. Professionals from education, health and social care agencies and other stakeholders are working together more closely than previously to support children and young people who have special educational needs and/or disabilities (SEND). However, the understanding of frontline staff of their roles and responsibilities in relation to the implementation of the reforms varies between agencies. Leaders and managers have devised an effective hierarchy of strategic stakeholder task groups. Staff and stakeholders from across these groups regularly share information and jointly commission and implement the planned improvements. Overall, recent improvements have ensured that the needs of children and young people who have SEND are identified more quickly and are well supported. However, there are some inconsistencies and some children and young people are yet to benefit from the developments. The local area leaders have a very good understanding of how effectively the local area identifies and meets the needs of children and young people who have SEND. Leaders have evaluated their work to implement the SEND reforms effectively and rigorously. They have accurately identified the areas that they need to improve. Leaders understand the challenges involved in successfully implementing the reforms. They recognised at an early stage that to implement the changes fully, not only was a change in organisation and processes required but also a change in the culture and values of the local area. Consequently, leaders have sought to ensure that changes are based on, or reflect, a shared set of principles and values. Stakeholders from across the local area, including children, young people and parents and carers, are well represented and their voices are listened to. Their views are taken into account at a strategic level and to a lesser extent at an operational level. However, the further away children, young people, parents, carers and local area staff are located from key partners, the less informed and engaged they are. Leaders have trialled key changes that they have made before implementing them more widely. This has enabled leaders to evaluate the impact of the proposed changes before they are made and make good use of resources. Derbyshire Parent and Carer Voice and Derbyshire Information, Advice and
Support Service (DIASS), with partners such as the Independent Parental Special Education Advice (IPSEA) and the Education Psychology Service, provide effective support to parents and carers. They also provide local area leaders with valuable feedback representing the views of parents and carers, which helps to shape future arrangements. Leaders have acted decisively to address the increased caseload of health visitors and ensure that the needs of individual children are identified, by recruiting additional trained health visitors. Strengths In those cases where co-production of plans has been strong, either led or facilitated by special educational needs coordinators (SENCos), EHCP facilitators or SEND officers, needs have been met and parents and children and young people believe that they receive good support. A ‘tell-it-once’ approach ensures that some parents, children and young people do not have to repeat their story when they meet with a new professional. The approaches, including one-page profiles and direct referrals to community paediatricians from universal services, were co-produced by staff, parents and young people and support effective communication between services. ‘Tell-it-once’ approaches are increasingly embedded within school SEND practice, therapies and universal health services across Derbyshire. Enfield Main Findings Professionals across all services share a common purpose to identify and support those who have special educational needs and/or disabilities as soon as possible. The early intervention support service and staff within children’s centres identify when children and families need support and help them to access this without delay. This is helping leaders to plan for additional services that will be needed in the future. For example, the educational psychology services (EPS) and child and adolescent mental health services (CAMHS) have a good understanding of the rising levels of need. This is because they track children and young people who are identified as receiving special educational needs and/or disability support from an early age. Areas for development Outcomes for children and young people who have special educational needs and/or disabilities are not always identified, measured or evaluated on a regular basis. Leaders don’t always know if improvements are raising standards. The outcomes for children and young people who attend special schools outside the area are not monitored closely enough. Leaders are therefore unable to evaluate whether they are doing as well as they could be.
Gloucestershire Strengths Leaders have ensured that all school, health and social care professionals understand and consistently implement the local area’s ‘graduated pathway’ approach to identify needs and plan appropriate provision. Throughout the process, staff seek the views of parents and the child or young person. These views contribute to education, health and care plans, which are taking the place of statements of special educational needs. In addition, ‘my plans’ record the early actions taken by professionals and the support provided in schools. Both types of plan set out the support required to meet the needs of individual children or young peoples. As a result, professionals identify the needs of children and young people at an early stage and put appropriate support in place. Leaders in the local area across education, health and social care are reflective and measured in their approach to delivering the special educational needs and disability reforms. They ensure that staff understand their roles and responsibilities and have provided the training required to undertake these roles. The local area has ensured that its approach to the consideration and assessment of children requiring ‘my plans’ and education, health and care plans is understood by all staff and consistently implemented. As a result, health, care and education services work effectively together to deliver a quality of provision that is valued by most parents and families. Areas for development Leaders from education, health and social care do not yet have an agreed strategy for sharing expertise and training staff to benefit children and young people who have special educational needs and/or disabilities. This limits the capacity of leaders to evaluate the impact of this work on pupils’ outcomes. Hartlepool Main Findings Health leaders’ analysis of children and young people’s needs is limited, and the local area’s approach to jointly commissioning services is not focused on the difference these services will make to children, young people and their families. Leaders do not have a clear view of how well the local area improves outcomes for children and young people who have special educational needs and/or disabilities. This is because the outcome measures in plans focus on what services will be delivered and not on the difference these services will make. Strengths
Jointly commissioned education, health and care services are effectively meeting the complex health needs of some individual children and young people. Areas for development Leaders do not make the best use of some of the strongest and most valuable resources in the local area to improve the quality of services. Highly effective practice resides within individual services, settings and schools and too little is done to help professionals ‘learn from the best’. Similarly, leaders do not give sufficient prominence to the views of children, young people and families in evaluating what is working well and where improvement is needed. Inspectors identified weaknesses in leaders’ understanding of the effectiveness and impact of specialist provision. The local area has been too slow to develop an approach to commissioning services which is sharply focused on improving outcomes for children and young people who have special educational needs and/or disabilities. This includes poor arrangements for providing personal health budgets. The outcome measures in education, health and care plans tend to focus on what services will do for children and young people and not on the difference these services will make. As a result, leaders do not know how well the local area improves outcomes for children and young people who have special educational needs and/or disabilities. Leaders in the local area do not analyse outcomes for children and young people who have special educational needs and/or disabilities rigorously enough. The learning and progress of children and young people with different needs, and those who are also looked after by the local authority, are not systematically analysed. This means that leaders cannot evaluate the effectiveness of provision on key groups of children and young people, which weakens future planning. Leaders’ understanding about what is helping children and young people who have special educational needs and/or disabilities to feel safe in Hartlepool is not well developed because leaders do not routinely seek their views.
Herefordshire Main Findings The joint commissioning team has recently been strengthened by the appointment of a joint commissioning lead. Leaders have developed new care pathways and commissioning arrangements in order to streamline children and young people’s access to appropriate services. Leaders acknowledge that there have been difficulties in children’s social care services being able to ensure that they fulfil their duties in the past.
Leadership changes and effective action to recruit and retain staff are now allowing them to become full partners within multi-agency working. Leaders acknowledge that communication with parents needs to improve. Many parents are not aware of the full range of services that are available locally and some do not feel that their voice is heard. A few parents expressed a view that they had not been fully consulted about developing appropriate provision in the local area.
Hertfordshire Main Findings The local area embraced the government’s reforms and sensibly took the opportunity to coordinate the changes in the special educational needs and disability code of practice alongside its other work. For example, the Health and Well-being Board is now well sited in the reforms, and supports the developments through the new all-age autism strategy and the transformation of the child and adolescent mental health service. Leaders of the two clinical commissioning groups provide strong leadership and have established a clear understanding of key priorities with partners across the local area. Over the past year, parents have been well represented at meetings with senior leaders about improving services. However, despite awareness of parents’ views, the local area is not using these views sufficiently to inform improvement work. Strengths Strong partnerships between health and social care professionals have improved the checks and reviews of children and young people who are looked after by the local council. This was an area for improvement highlighted in the previous inspection by the CQC in 2014. Those who undertake the statutory reviews now have a clear picture of the range of health services involved and the contribution of each professional to improving the outcomes for the children and young people. Areas of development Strategic plans focus well on joining services and the processes that support collaborative work, but do not make clear enough the intended outcomes for the children and young people. The plans focus on measuring compliance with or delivery of the reforms, rather than on the difference that the reforms make on children, young people and their families, particularly for improving their life chances and well-being. This impacts negatively on the contribution and perception of those who are otherwise well placed to achieve the vision and, importantly, on the involvement of parents and those professionals working directly with parents and their children.
The lack of clear targets reduces strategic leaders’ facility to measure, monitor and evaluate thoroughly the local area’s contribution to improved outcomes for children and young people. The same is true for the work of health professionals who, in their reports, often write about clinical interventions rather than outcomes that demonstrate the impact on individuals’ well-being, safety and personal independence.
Hillingdon Main Findings Leaders in the local area are dedicated to developing strong joint working practices that result in improved outcomes for all groups of children and young people who have special educational needs and/or disabilities. Their self-evaluation of strengths and weaknesses is accurate. A coherent plan to improve services further in response to local need is in place. Strengths Leaders gather accurate information about the level and type of special educational needs and disabilities in the local area. They work well together to identify emerging needs and commission provision which closely meets these priorities. For example, several schools have opened specialist resourced provision as a result of this work. Leaders are continually seeking to improve services. They have developed plans for a number of interesting and innovative changes to improve the local offer for children and young people who have special educational needs and/or disabilities. Some of these changes are in place, but are relatively new. Others are still in the planning stage. Areas for development Leaders’ checks on the effectiveness of changes that they introduce are not consistently underpinned by reliable information that demonstrates the overall success of the strategy. Too often, leaders rely on case studies or small samples to demonstrate the value of their work. North Yorkshire Main Findings Early identification of needs is a strength of the local area’s work. A new referral system is saving time and speeding up the initial accurate assessment of needs. Strengths The early identification of needs is done well. A range of different groups and services help to ensure that children’s needs are identified early. The local area has recently formulated a single point of access referral system, ensuring that professionals are guided to the right support service when considering the assessment of additional needs. Professionals indicate that
this system is saving time and aiding swifter assessment, because deadlines and procedures have been made clearer. Increasingly, different teams and services are working in the same location and this supports the effective identification of needs. Because different services are located together, for example in child development centres or within the new prevention service, discussions can take place more easily and quickly. Areas for development There is insufficient clarity about the expectations of all agencies’ participation in education, health and care plan review meetings, including providing reports and assessments. Governance arrangements do not carefully monitor the attendance and contribution of different agencies to improving outcomes. There are several long-term plans and strategies in place to help meet the requirements of the special educational needs and/or disabilities reforms. In most cases, these have only recently been established. The impact of plans is yet to be realised in most cases. Plans are not effectively communicated with parents, so some parents remain anxious, for example about post-19 provision. Leaders in the local area do not have a thorough understanding of parents’ and carers’ views.
Nottinghamshire Strengths The integrated children’s disability service, through the short breaks and personalisation service, offers a short breaks scheme. Children who are referred access a package of support that is awarded through a resource allocation system (RAS). This system is usually successful in identifying the needs of the child or young person. Leaders across the local area demonstrate tenacity in improving outcomes for children and young people who have special educational needs and/or disabilities. Leaders in the local area are not scared to try new ways of working by piloting ideas in different areas of the county. For example, the local authority is reviewing how well children and young people’s needs are being met in specialist education provision. Inspectors found that there were numerous examples of how the social care short breaks scheme contributes to improving lifelong outcomes for children and young people.
Plymouth Main Findings Leaders complete a reliable analysis of information so that they have a generally accurate view of their performance in relation to national figures. The areas of strength in assessment, provision and outcomes, and those that need development, are understood and well known. However, the clinical
commissioning group (CCG) has not completed a self-evaluation of its performance. On this basis, it is not clear how the group is identifying areas for development and improvement without knowing gaps, for example in the low completion rates of ante-natal visits, a lack of resources to support the health needs of children looked after and significant delays in accessing speech and language therapy (SALT). There has been a clear commitment from senior leaders to implement the reforms and ensure that children and young people who have special educational needs and/or disabilities are safe. At strategic level, the board’s co-commissioning, co-location, and pooled budget arrangements are contributing to a close working integrated multi-agency approach, particularly around the needs of young children and their families and for foster or residential placements for children and young people. Rochdale Main Findings Leaders do not have a comprehensive understanding of the area’s strengths and weaknesses in the delivery of the SEND reforms. It is not clear from leaders’ self-evaluation how the local area interrogates outcomes for specific groups of SEND pupils, such as those on SEN support. It is difficult to determine what the key issues are for improvement and how the local area can deploy its diminishing resources to best effect in having maximum impact. Education, health and care services have a clear, shared vision to deliver an integrated approach to meeting the needs of children and young people. There are good examples of co-location of services to facilitate more effective joint working. The Rochdale parent carer forum is engaged at a strategic level and is increasingly involved in shaping existing and future provision. Strengths Approaches to joint identification of needs and review of progress against outcomes are well developed in therapy services, with effective tracking of the achievement of therapeutic goals. Health visitors are engaged in multi-agency assessments and planning meetings to enable targeted support to children and their families who are experiencing difficulties. Where personal budgets are used well, they enable a range of creative, individually tailored support and activities to be provided for children with complex health needs. Such arrangements are helping to promote wider understanding of the wishes and needs of children, young people and their families. Co-production at a strategic level is developing well. The parent carer forum is firmly established as a partner in strategic developments for children and young people. For example, it has been instrumental in helping to establish a new single point of access, which is a system to help deal with referrals and provide a coordinated response to the assessment of health needs. It is also involved in the appointment of key professionals within the local area and has helped to establish new services, such as ‘#Thrive’ – a service to support
young people with emotional health and well-being issues from birth to 19 years. Where there are contributions from all services, children, young people and their parents or carers, EHCPs are of good quality with clear aspirations articulated. The majority of plans are outcome-focused and promote childcentred approaches. This means that children, young people and their parents or carers are well informed and supported and are clear about the next steps in their journey. Sefton Main Findings Leaders have been too slow to set up joint commissioning between education, health and care. Only very recently has a model been agreed and put in place.
Stoke Main Findings Leaders’ evaluation of how well the local area is implementing the reforms is broadly accurate. It is informed by a clear understanding of strengths and weaknesses. There is a tangible desire from all partners to implement the reforms well. Strengths The local area has responsive commissioning arrangements specifically tailored to the children and young people of Stoke-on-Trent. The joint strategic needs assessment (JSNA) has been revised to ensure that current and emerging needs are communicated to the health and well-being board. The new strategy is now more focused on outcomes and there is a direct link between the JSNA health and well-being strategy and the SEND joint commissioning strategy. Public health, the CCG and the local authority are all working together effectively to deliver this. Surrey Main Findings Leaders recognise the need to improve performance and rebuild relationships of trust with parents and carers. Leaders’ summary evaluation correctly identifies most of the areas where significant and urgent improvement is needed. Changes in senior local authority leadership in the last year are welcomed by parents, schools, health commissioners and providers. Nevertheless, parents and school leaders are clear that insufficient improvement is evident. The joining together of the six clinical commissioning groups, under the Surrey CCG Collaborative, has established a solid foundation on which to build a commissioning partnership with the local authority. A joint
commissioning strategy is in preparation for launch in December 2016, in line with the progress of other authorities nationally. The leadership of Guildford and Waverley CCG within the collaborative is strong. Leaders have been unsuccessful in promoting the ‘local offer’ of provision to all parents. Many of the parents whom inspectors met were not aware of this central facility, despite it being developed and then redesigned in partnership with parents’ representatives. Furthermore, the required plan, setting out as part of the offer how statements will be transferred to education, health and care plans (EHC plans), is not complete. The local area identifies relatively low numbers of pupils needing school support for their special educational needs, while identifying relatively high numbers requiring statements or EHC plans. Leaders have rightly identified that this indicates weaknesses in the early identification of special educational needs. Areas for development Weaknesses in the local authority’s information management systems limit coordination between the county’s local areas and the central administration. Furthermore, these systems do not provide a ready analysis of the progress being made in meeting statutory requirements, to hold leaders at all levels of the organisation to account. These issues are recognised by leaders, but action to rectify them lacks urgency and is only at the stage of an options paper, which is under consideration. Any decision is yet to be proposed, or indeed made.