Are the needs of children with SEN being met?

The Audit Commission national report – Out of Authority Placements for Special Educational Needs – concluded that ‘while strategic planning for the educational needs of children with complex needs has improved, opportunities to provide more integrated and cost effective services through joint working between education, social care and health services were not being maximised.’

The report suggested that a ‘lack of integrated local programmes of support for children and families, such as therapies and mental health support’ had led to demand for out-of-authority provision in many areas.

There are currently more than 11,000 pupils with a statement of special educational needs (SEN) who are placed in out-of-authority special schools, and these are most often children with severe behavioural, emotional and social difficulties (BESD) and autistic spectrum disorders (ASD). The Audit Commission report stated: ‘Expenditure on these placements is high and has increased steeply in recent years, however the rate of increase has decreased since 2003-04. While the interests of the child must be the primary focus of a decision about placement, achieving value for money is also an important consideration.’

Criticisms levelled at councils
In particular, while councils have responded to the ‘steeply increasing’ costs of out-of-authority placements by developing in-house provision, they were criticised for the following: failing to base decisions on out-of-authority provision on a fully costed option appraisal; that budgets for out-of-authority provision for SEN were not yet jointly planned or managed; that budgets were rarely based on the full unit cost of forecast need and financial planning did not often extend beyond one year.
Other criticisms levelled at councils included the following:

• Little progress is being made in developing and implementing pooled or aligned budgets with primary care trusts (PCTs), and contributions to the cost of placements by PCTs are not based on long-term assessed need.
• Contracts with out-of-authority providers failing to include details of the expected outcomes for a pupil and not being a satisfactory basis for monitoring or challenge.
• Inconsistent monitoring of the progress of individual pupils by their home councils.
• A lack of joint planning between agencies for the transfer of pupils from residential out-of-authority schools to post school provision, which created uncertainty for young people and parents alike.
• Not being in a position to know whether they and their partners were achieving value for money for their out-of-authority placements because they have not brought together the information needed to assess this.
• Not being aware of the full unit costs of either in house or out-of-authority packages of support and having insufficient understanding of out-of-authority providers’ costs.

The report’s recommendations for councils and their partners
Recommendations for councils and their partners, including health trusts, outlined in the report urged them to:

• review the way they manage delivery of services to children with complex needs to integrate strategic planning, budget planning, commissioning and the management and monitoring of services better
• take a more strategic approach to the joint commissioning of support for pupils with complex needs. This commissioning strategy should take account of the costs and benefits of local and out-of-authority provision and seek to address the shortcomings in respite care, therapies and mental health support identified in this study and others
• align their budgets for children with complex SEN to underpin this joint commissioning process. As a basis for this, forecast likely demands on their out-of-authority placement budgets in education and social care over three years participate fully in the work of regional partnerships to maximise the opportunity to benefit from information sharing and joint working
• develop systems for recording cost-effectiveness of provision for individual pupils with complex needs. This should be done by linking the cross-agency resources used with the progress of individual pupils, wherever they are placed, against outcome-based targets such as their individual education plans (IEPs) or outcomes specified in contracts
• develop their financial information systems to ensure that they have accurate information about all the costs of meeting the needs of individual children and young people with complex special needs, whether in-house or in out-of-authority provision
• ensure that for each child placed in out-of-authority SEN provision there are clear targets and outcomes agreed and included as part of the contract with the provider and that placements are regularly monitored and assessed
• identify a lead professional or key worker for each pupil with severe and complex needs placed out of the authority, who would act as an advocate for his or her needs and monitor progress.

How are local authorities responding?
The message to local authorities, therefore, was quite clear. So, 18 months after the Audit Commission report was published, how are they responding to its findings and recommendations and, moreover, what are the implications for the independent and non-maintained special schools that have traditionally provided out-of-authority placements for children with complex SEN?

Caroline Abrahams, programme director for children and young people at the Local Government Association (LGA), told Special Children: ‘I think the picture here is a developing one – local authorities are working towards integrating their services for disabled children across health, social care and education and inevitably some are doing it faster and more effectively than others, which is always the case given there are 150 local authorities across the country.

‘The fact they are doing so may be partly in response to the Audit Commission report but probably even more so in response to the support of the Aiming High for Disabled Children initiative, which came out of the Comprehensive Spending Review 2007 and which is joint across the Department for Children, Schools and Families and the Department of Health.’

Caroline added: ‘The other issue that needs taking into account here is that the population of children with very complex needs is not static, but known to be growing – a happy consequence of advances in medical science. However, the fact is such children are extremely expensive and difficult to care for and in a small local authority you only need one or two such children to have a very significant impact on the Children’s Services budget. Such children are inevitably hard to plan for.’

One local authority that is working hard towards the recommendations of the Audit Commission report and the Children’s Services Review is Hertfordshire County Council. At the start of 2008, the Council set up a Complex Care Panel, aiming to develop solutions across services for children with severe and complex special needs.

Sheila Reynolds, a consultant for the Council brought in 18 months ago to help advise on how to improve services, explained: ‘It’s aimed at developing a professional team around the child from the different services and we are looking at the impact of that. The panel meets fortnightly to discuss children’s services – it’s a difficult area to measure but in practice this is quite a good tool. At the end of this year, we will be able to look at the impact on our county budget.

‘We are also beginning to look at using one of our units to provide services for children with complex needs and extremely challenging behaviour – it’s basically about pooling budgets and working together.’

Allison Hope-West is director of special educational needs placements for the Cambian Group, which provides specialist residential education and care for young people with autistic spectrum disorders. Asked about changes in the number of out-of-authority placements since the Audit Commission report, she said: ‘We have definitely seen some significant changes in this area. We certainly have not seen any reduction in the number of students placed with us, although we are asked much more frequently for cost breakdowns indicating what part of the package is education, social care and health – this is not an exact science and the line is grey in terms of what constitutes particularly education and care as there are significant crossovers.’

Regional partnership groups
The Cambian Group has also been involved with regional partnership groups in putting forward pre-qualifying tenders to local authorities for provision. Allison explained: ‘Once again these really do vary a lot from group to group – some have requested reams of information about the schools, policies in place and fees, whereas others really appear to be preferred providers’ lists.

‘There has also been a huge amount of debate regarding the proximity of out-of-county placements and whether providers could offer solutions to authorities nearer to the county,’ she continued. ‘There is no easy answer to this and my guess is that this will be an ongoing debate.’

With regard to the report’s recommendations that councils be aware of targets and planned outcomes for individual children, Allison told Special Children: ‘All of our students have outcome-based targets set and we have also piloted a tiered funding system at one of our schools, based on a detailed breakdown of need and a clear focus on short-, medium- and long-term outcomes. While this is still in its early stages, indications are that this has been well received.’

She concluded: ‘All in all, there would seem to be a response to the Audit Commission and a move to more accountability regarding the cost and quality of out-of-county placements. There has also been significant information sharing and joint working to make this happen.’

How is the report impacting LAs?
Helen Hewitt is chair of the National Association of Independent Schools and Non-Maintained Special Schools, as well as director of education of The Together Trust. The Trust is a charitable organisation operating in the North of England and North Wales and runs three schools: two for children with autistic spectrum disorders and one for children with emotional and behavioural difficulties. Asked about the impact of the Audit Commission report, Helen said: ‘It’s quite difficult to attribute changes specifically to the Audit Commission. Local authorities are looking at developing more flexible provision and value for money is a big focus and a driving force but this had actually already started to happen. These changes, however, may perhaps have been given a forward impetus by the Audit Commission report and have now gathered pace.’

She continued: ‘I think within local authorities there is a reconfiguration of provision. If you look at our schools, we run two schools for autistic children and one for children with emotional and behavioural difficulties. In the 1990s, autistic spectrum disorders were quite a low-incidence condition and so local authorities were not setting things up themselves but buying into available external provision. The situation now is that an increasing number of children are being identified with autistic spectrum disorders – it’s no longer a low-incidence issue and so local authorities are looking a lot at what provision they themselves can make.

‘Children with Asperger’s syndrome, for instance, should be in mainstream schools whereas children with very complex needs still require specialised, external provision.’

According to Helen, the changes taking place in local authority provision for children with complex special educational needs are not having an impact on the number of placements. She said: ‘Rather than a reduction in the number of placements because local authorities are reconfiguring their provision, the change is really in referral patterns. Whereas in the past we had children from Year 1 and 2 being referred to us, it is now an older age group – children from Year 5 and 6, for example, who wouldn’t be able to cope at secondary school or who have fallen out of the system in secondary school.’

She added: ‘I believe the main impact of local authority changes will be that long-distance placements will become increasingly rare – if children cannot be provided for within the local authority, their provision will be within a relatively local area, so special schools that have traditionally had a national remit will begin to see a change in their referrals.’

And in the long term, Helen believes special schools will always have a major role to play within the provision for children with SEN, whether within local authorities or in out-of-authority placements.

She concluded: ‘With local authorities looking to develop more flexible provision, special schools have a lot to offer in their areas of expertise in terms of outreach programmes, training teachers and as consultants to mainstream schools – there’s an awful lot of knowledge and expertise that we can pass on to people.’