Joint commissioning arrangements for children and young people with SEND

In September 2014 the Children and Families Act became law, the Act set out the reforms for Children with special educational needs and disabilities.

The Code of Practice was published in January 2015 and set out the statutory guidance for health bodies and local authorities. One of the requirements as set out in Chapter 3 ‘Working together across health, education and care to improve outcomes’ is that local areas must make joint commissioning arrangements for education, health and care provision for children and young people with special educational needs or disabilities.

It is important to note that this is for those with or without an Education Health and Care Plan and involves strategic planning and decision making through to individual child joint commissioning decisions.

Joint commissioning arrangements must be agreed by partners and must be published. The Code of Practice described the commissioning cycle as:

1. Establish partnerships: across education, health and care and with parent groups, children and young people

2. Joint understanding

3. Joint planning

4. Joint delivery

5. Joint review to improve service offer

This cycle will bring improved outcomes for 0 to 25 year olds with special educational needs or disabilities, including those with an Education Health and Care Plans.

The aims of joint commissioning

The local authority, the NHS and its partners are responsible for commissioning services to meet the needs of children and young people with special educational needs or disabilities. We collectively recognise that in some instances this would be better done together.

Joint commissioning in North Yorkshire aims to:

• deliver more personalised care and involve children, young people and families in their own health, care and education delivery and decisions
• transform service planning and delivery moving away from a fragmented experience to a more integrated and coordinated system which could be achieved through joint commissioning of services or improved and aligned pathways of support
• have regular dialogue with local providers, clinical professionals and parent carers and children and young people to shape joint commissioning strategy and the delivery of the service improvement and integration
• achieve some efficiencies from changing service access, for example early identification and intervention
• ensure outcomes are met into adulthood through effective transition pathways

Emerging evidence from case studies and SEND inspection feedback suggests common factors associated with successful joint commissioning include good system leadership alongside a structure and process with clear accountability.

The North Yorkshire SEND Joint Commissioning Group has representation from Bradford and Craven CCG, North Yorkshire ICB Place and Local Authority Inclusion, Education and Social Care. The following diagram outlines the governance and accountability of the group in the context of the SEND programme.

Accountability

SEND governance consists of three areas:

1. Health

Bradford District and Craven Health and Care Partnership

This partnership is headed up by the NHS WY Integrated Care Board together with the WY Integrated Care Partnership, which both oversee the BD and C Partnership Board. The following groups then report directly into the BD and C Partnership Board:

• Finance and Performance Committee
• Quality Committee
• People Committee
• Clinical Forum
• Citizen's Forum 
• Partnership Leadership Executive - this group also has a number of sub groups reporting into it including Healthy Communities, Access to Care, Healthy Minds, Workforce Development and Children and Young People

Humber and North Yorkshire Health and Care Partnership

This consists of the Integrated Care Board and Integrated Care Partnership which together oversee the Quality Committee. The System Quality Group reports directly to the Quality Committee. 

The following groups then report into the Quality Committee as well as collaborating with each other:

• NE and Y NHSE SEND Group
• Y and H SEND Group
• National DMO and DCO Forum
• North Yorkshire and York Partnership
• Humber Partnership

2. Partnership

This is headed up by the Health and Wellbeing Board which oversees the SEND Partnership Board. A number of groups report into the SEND Partnership Board as well as collaborating with each other:

• Autism Strategy Group
• PfA Forum
• JSNA and Joint Commissioning Group
• Local Area Strategy Implementation Group
• SEMH Strategic Group
• Locality Board

3. Local authority

The Executive oversees the Overview and Scrutiny as well as the Management Board. 

A number of groups report into the Management Board:

• CYPLT which oversees the SEND Programme Board
• Schools Forum which oversees the High Needs Funding Sub Group

The SEND Strategy Implementation Group, the Capital Board and Delivering Better Value all report into the SEND Programme Board and the High Needs Funding Sub Group.

Integrated Care Systems (ICSs)

Integrated Care Systems are new partnerships between the organisations that meet health and care needs across an area, to coordinate services and to plan in a way that improves population health and reduces inequalities between different groups.

North Yorkshire has two Integrated Care Systems: West Yorkshire for Craven and Humber and North Yorkshire for the remainder of the council area - there will be an Integrated Care Board for each system. The Integrated Care Boards (ICB) went live from 1 July 2022. North Yorkshire Council is represented within both integrated systems. Each partnership has a clear commitment to delivering SEND improvements.

In March 2023, the SEND and alternative provision improvement plan was published. The Joint Commissioning Group has reviewed the plan and is considering its priorities based on changes to and new duties stipulated within the plan.

• 15% of children recorded as SEN reaching the required level for reading, writing and Maths at Key Stage 2 (national is 18%)
• pupils with recorded as SEN in Key Stage 4 achieved an average attainment 8 score of 14.7 (national is 14.3)
• Education, Heath and Care plans funded by North Yorkshire have increased by 153% (from 1,728 to 4,374 at the start of 2023)
• 16% (1,975) of the children with SEN in primary and secondary schools in North Yorkshire are recorded as having an Education, Health and are plan
• 84% (10,248) of the children with SEN in primary and secondary schools in North Yorkshire have SEN support
• the January 2023 school census shows that 62% of children with a North Yorkshire Education, Health and Care plan are educated in a primary or secondary school
• the January 2023 school census shows that 37% of children with a North Yorkshire Education, Health and Care plan are educated in a special school
• children with SEN support in mainstream schools are most likely to have a primary need of specific learning difficulties (22%) or speech, language and communication needs (20%)
• as of January 2023, 38% of children with a North Yorkshire Education, Health and Care plan had a primary need of Autistic Spectrum Disorder (ASD)
• 19% of children with a North Yorkshire Education, Health and Cate plan had a primary need of SEMH
• 2.2% of post 16 EHCP young people were NEET as of April 2023

The work of the group will align with the commitment made within the North Yorkshire Co-Production Pledge and adopt the partnership values and pledge.

Our partnership values

Partnership working is a family centred way of involving people in the design, planning and delivery of services across North Yorkshire. Our partnership values are:

• together - services work best when we work in partnership
• respect - understand and listen to all points of view
• care - support each other and the work we do
• responsible - hold each other to account
• open - approachable and honest
• understand - clear in our approach and take ideas on board
• communication - listen, share, inform, reflect

The voice of children, young people and families has influenced the content of the plan throughout.

Working with children, young people and families is a key partnership priority. Listening, hearing and learning is delivered through a variety of mechanisms.

In North Yorkshire we have a parent and young person’s group and the partnership has regular dialogue with them.

Parent Carer Voice

This is the recognised Parent Carer Forum for North Yorkshire supporting families with children and young people (0 to 25 years old) with SEND. Their vision is to inform, empower and represent the collective voice of families with SEND in the region and are a community, connecting families through shared information, experiences and mutual support.

Flying High Flying High

This group is for young people aged 11 to 25 who identify as having special educational needs and/or disabilities. They meet each week to use their
voice to make positive changes to services that affect them. They also socialise and are empowered to lead and champion their own campaigns across North Yorkshire.

Parent feedback

• promotion of strength based attitudes towards children and young people with SEND
• transparency of decision making
• clear accessible information
• shift from reactive diagnosis and threshold led services to pro-active needs led services
• families are supported consistently 
• joined up co-ordinated working
• consistent availability across the county
• more social opportunities for children and young people with SEND

Young people's feedback

• they reported a range of experiences around whether people around them understand the support they need, and whether or not they receive that support
• they hugely value the opportunities they are given to engage in activities, groups and social events
• employment and career opportunities were highlighted as a particularly challenging area for young people with SEND
• improvement around access to information, including the Local Offer website, was identified as a priority
• young people with SEND have a huge range of goals and priorities for the future and they want support to achieve them

Specific quotes from young people:

• "if I get a new career they understand because they are briefed beforehand"
• " I didn't know where to start, so I stopped looking"
• "the job interview itself is a barrier for people with SEND. I can't drive and public transport is bad in rural areas. People assume because I have SEND I won't be any good at the job"

Single agency - not jointly commissioned

Delivered by the local authority:

• Young People's Voice
• mediation
• specialist equipment VI and HI
• transport
• short breaks
• speech and language
• occupational therapy

Delivered by the NHS:

• individual placements
• Child and Adolescent Mental Health Service (CAMHS)
• Community Therapies Speech and Language Therapist (SALT), physiotherapy, occupational therapy
• children's community nursing
• special school nursing

Joint planning and strategy

Delivered jointly:

• SEND partnership
• Joint Commissioning Group
• SEND Joint Strategic Needs Assessment (JSNA)
• autism strategy
• Social Emotional and Mental Health (SEMH)
• exceptional placement panel
• mental health support teams
• Anna Freud 

Joint investment

Delivered jointly:

• Parent Carer Voice
• emotional wellbeing service
• SEND information advice and support service
• sleep service and training - NYCIBC area
• the Go-To website

Local area engagement and communication strategy

Engagement and co-production with children, young people and families is an essential cornerstone for SEND joint commissioning.

The children, young people and families must be working in a partnership with professionals and have a clear voice in developing services that meet need. In ensuring the local area partnership has a strategic and operational plan of engagement, in North Yorkshire there are the SEND system Communication, Engagement and Partnership agreements, which denotes how the partnership engages with children, young people and families, along with how they interact with each other.

Additionally, there are Engagement Forum meetings and Parent Carer Forum meetings hosted for the partnership by the local authority and HNY ICB to ensure collaboration and joint partnership working.

Needs led system transformation for Neurodiversity Autism pilot

NHS England funding was secured to deliver a 'Better Pathways' pilot for Scarborough and Selby localities. The aims of the pilot were to:

• test the potential for enhancing the role of schools in the referral and initial assessment of children with suspected autism (currently around 90% of referrals for autism assessment are made by Primary Care)
• roll out the Solihull Approach two day foundation training for staff in two North Yorkshire Council locality SEND Hubs (Selby and  Scarborough) and Unlocking Autism course for school staff

This pilot involved working with schools in the Selby and Scarborough areas on a new pathway for referral and assessment for children and young people aged 5 to 18. The pilot has been positively evaluated.

The next steps are to develop and agree, as a partnership, the feasibility of a new referral pathway where children and young people are supported at point of referral with a focus towards professionals who know the child and family. 

Relaunch of health notification pathway E-Hen

ICB, NHS Trusts, and NHS Foundation Trusts must inform the appropriate local authority if they identify a child under compulsory school age as having, or probably having, a disability or SEN (Section 23 of the Children and Families Act 2014).

A revised health notification pathway (E-Hen) has been introduced to remind health clinicians of their duty to notify local authority of children with possible SEND. Training sessions ran in 2022 for the Healthy Child Service and GPs on early ID and health notifications.

This has meant an increase from 25 notifications in whole of 2021 to 95 in 2022, leading to 60 children receiving swifter access to specialist services.

Emotional health and wellbeing

In 2022 Compass Phoenix was launched, a service jointly commissioned by North Yorkshire Council, Humber NY, ICB and West Yorkshire ICB.

Compass Phoenix supports children and young people aged 9 to 19 (up to 25 for those with special educational needs or disabilities) with mild to moderate emotional wellbeing and mental health issues. There is a dedicated team of Emotional Wellbeing Practitioners who provide time-limited one-to-one or group work sessions (usually around six); these are designed to support children and young people make improvements to their long-term health, resilience, and emotional wellbeing.

In addition, the service provides a training and consultation offer to schools and colleges in North Yorkshire.

Sleep service

A sleep service delivered by Doncaster based ‘Sleep Charity’ has been commissioned to provide non-pharmaceutical sleep support for all children and young people struggling with sleep issues in North Yorkshire. A jointly commissioned sleep support training offer for health, education and early help staff has been an extension of the offer to ensure a consistent approach to sleep hygiene is embedded across North Yorkshire.

SEND health data dashboard

The agreement to extend the reach of health data included in the SEND Joint Strategic Needs Assessment was identified in 2021 as a result of the inability to disaggregate the education, health and care plan population from whole population health trust data.

A working group was formed to oversee progress and the technical mapping of a process, Data Protection Impact Assessment and Data Processing Agreement were completed.

The NHS number as an identifier was confirmed and a list produced from the current education, health and care plan cohort. North of England Commissioning Support have used the list to cross reference health provider data. First draft reports were received and have provided data on A and E and primary care presentations. The next stage of the work is to develop a MH dashboard with the local MH providers.

Our joint commissioning principles are:

• we will always consider sustainability and consistency within North Yorkshire
• the joint commissioning partners will actively seek joint commissioning opportunities
• communication between all stakeholders will be clear, proactive and transparent
• information is simple and accessible to families and the workforce
• joint commissioning will aim to achieve integration
• joint commissioning decisions are made in partnership with children, young people and parent carers (co-production). We will seek out and learn from lived experience both positive and negative
• joint commissioning decisions achieve the best value for families and for North Yorkshire

Our joint commissioning priorities for 2022 to 2025 are:

Priority one - Identifying the needs of children and young people early

We know that identifying the special educational needs and disabilities of children at an early stage improves outcomes and life chances. Across education, health and care services in North Yorkshire improving early identification systems will remain a key focus so that children can access the support they needs as they need it. 

Joint commissioning priorities for 2023 to 2025:

• refresh Joint Strategic Needs Assessment 2021-2022 and publish May 2023
• review and use the SEND data dashboard in Joint Strategic Needs Assessment 2023-2024
• review elective home education identification, data and support
• partnership working around early years settings and identification of SEND needs
• review implementation of E-Hen and annual awareness raising

Priority two - Working together: Improving communication, co-production and engagement

Good communication is important so that children and young people, parents and carers feel listened to. Their views inform decisions and transparency and trust develops across all partners. Parents have told us that clear communication is of high importance.

It is important that young people and parents and carers can find information easily, and understand how they can positively contribute to strategic and individual decisions that affect their children and others.

Joint commissioning priorities for 2023 to 2025:

• evidence that the voice of the child is captured, and that service offers reflect the needs communicated
• improved decision making and timeliness of funding from education and health (CCC, 117 and responsible commissioner) across complex and out of area packages
• review use of personal budgets across education, health and care
• partnership review of short breaks
• pathways to health support

Priority three - Improving outcomes for children and young people with SEND

Our ambition is that children and young people with SEND have the best opportunity to live healthy and happy lives and are supported to have high aspirations and achieve their goals. Helping children and young people to achieve outcomes in education, health, employment, relationships and participation in society is central to this vision.

Joint commissioning priorities for 2023 to 2025:

• whole system review of children’s emotional wellbeing and mental health
• review of Learning Disability services – community and VCS offer
• implement Long Term Plan commitment – hearing, sight and dental checks for children and young people in residential schools
• reduce reliance on inpatient – Learning Disability Assessments
• explore opportunities to develop Positive Behaviour Service offer
• improve uptake of health screening, advice and information, annual health checks
• waiting list review including therapies, CAMHS, neurodiversity (including a graduated response, solutions for families waiting to prevent crisis, consider a Dynamic Support Register type model)
• speech and language review to evaluate joint commissioning opportunities
• develop a joint dispute resolution process
• proactive housing planning - emphasis on future housing requirements as part of transitions discussions (work underway to improve joint working between CYPS and HAS, including the Supported Housing team)

Priority four - Preparing young people for adulthood

Developing independence and preparing for adulthood is important to young people and their families. Done well and at the earliest stages it allows children and young people to develop skills that will serve them well throughout their lives.

Through engagement it was clear from feedback that it is important for children and young people to feel they make a valuable contribution in their communities and that their talents and skills are recognised and supported. This in turn develops self-esteem and supports them in maintaining high aspirations.

In order that children and young people can truly fulfil their potential it is important that they have a range of opportunities and experiences that build towards being as independent as they are able and provides routes to employment, positive relationships and good health.

Joint commissioning priorities for 2023 to 2025:

• improve uptake of health screening, advice and information, annual health checks
• embed joint transition protocol including consideration of a case meeting for young people with complex health needs (Sheffield model)
• proactive housing planning - emphasis on future housing requirements as part of transitions discussions (work underway to improve joint working between CYPS and HAS, including the Supported Housing team)
• embed and evolve the preparing for adulthood pathway across children's and adults' services to ensure individual outcomes are met
• maximise collaborative commissioning opportunities to meet the needs of young people in North Yorkshire
• improve access to information, advice and guidance for young people and families around finances and access to benefits when considering future housing requirements
• cross discipline training to improve knowledge and expertise in strength based assessment, Mental Capacity Act, adults CHC framework
• collaborative working with social care providers and regulators to expand offer to young people aged 16 to 25
• improve access to information, advice and guidance for young people around access to work and other employment opportunities

Priority five - Achieving best value

The local authority and the National Health Service have a statutory duty to meet the assessed needs of all children with SEND in North Yorkshire.

Alongside this duty is an expectation that statutory bodies utilise public finances efficiently and effectively. High Needs Block funding is provided to the local authority by the Department for Education to make sure the local authority can support young people with SEND.

It is important that all stakeholders understand what resources are available to meet need and that it is used to best effect for all children. Therefore it is
important that all stakeholders work together to manage these resources by ensuring that services are efficient, appropriate and cost effective and that decision making ensures that assessed needs are met.

Joint commissioning priorities for 2023 to 2025:

• joint commissioning arrangements are in place and are informed by thorough review of strategic needs
• engage with the market to develop support models that will enable providers to support young people with complex needs beyond the age of 18 and through the transition into adulthood
• services are efficient, coordinated and effective in meeting the needs of children and young people
• services will be sustainable

An Annual Delivery Plan will be developed to demonstrate action against the identified priorities and provide a point of review.

The actions may be delivered outside of the Joint Commissioning Group but the group will receive timely updates and, where appropriate, accountability will be held within the SEND Partnership.

The actions have been identified across partners however the principles of joint commissioning have been adopted across the system and other pieces of work will emerge.