Outcomes Based Commissioning and the SEND Reforms BACKGROUND, PROCESS AND IMPACT
Outcomes Based Commissioning and the SEND Reforms
BACKGROUND, PROCESS AND IMPACT
As part of the Delivering Better Outcomes
Together (DBOT) contract, funded by the
Department for Education, the Council for
Disabled Children (CDC) has supported
a number of local areas to progress their work
on outcomes based commissioning (OBC).
This document includes:
What is Outcomes Based Commissioning?
Mark Friedman’s Results Based Accountability
How does OBC relate to the SEND Reforms?
What are the anticipated benefits of an OBC
approach?
What does a Strategic Outcomes framework
look like?
How has CDC been supporting the
development of strategic outcomes
frameworks?
What is the impact of CDC’s work with
local areas?
Useful resources
Introduction
2
Outcomes Based Commissioning (OBC) is an
approach that is increasingly being adopted by
Local Authorities and Clinical Commissioning
Groups (CCGs), wherein services come
together to develop a series of commissioning
arrangements that are underpinned by the
measurement of progress towards a set of
shared outcomes.
Central to this process is the identification
and co-production of a set of shared outcomes
that are underpinned by robust quantitative
and qualitative data, which allow commissioners
and service leaders to continually evaluate
the performance of their services and inform
the local area’s approaches to commissioning
services for children and young people
with SEND.
A local area’s journey towards outcomes based
commissioning typically progresses through the
following five stages. Working in co-production
with families and professionals, senior leaders
from the local area:
1 Invite children, young people and parent
carers to share their experiences of the SEND
reforms. In co-production, the local area then
updates its local SEND strategy and agrees a
new strategic vision.
2 Bring together strategic leads, professionals,
children, young people and families to agree a
meaningful set of core outcomes.
3 Identify how these outcomes will be
measured across the whole system using
relevant indicators to identify progress
towards achieving the outcomes.
4 Consider how the workforce and digital
technology can support the delivery of this
framework.
5 Develop an outcomes based contracting
model to promote collaborative working
between multiple providers and achieving the
holistic outcomes.
e.g. through Alliance based Contracting
For more detail, please see CDC’s Joint
Commissioning Bulletin #3.
What is Outcomes Based Commissioning?
3
Fig.1: A typical approach to outcomes based
commissioning, in five stages
Build trust and
establish a new
strategic
partnership.
Through
co-production agree
a strategic vision.
Agree a set
of outcomes that
are meaningful
for patients, carers
and clinicians
within a defined
population group.
Agree a model
of care that
will achieve the
outcomes and how
the outcomes will
be measured.
Identify
implications
for the workforce
and how digital
technology
can support the
delivery of the
model
Undertake financial
modelling and
agree outcome
based contracting
model
Mark Friedman’s Results-Based Accountability
Mark Friedman’s Results Based Accountability
(RBA) model acts as an enabler for this work,
and can support a local area’s approach to
outcomes based commissioning. RBA is
described as follows:
“a disciplined way of thinking and taking action that communities can use to improve the lives of children, youth, families, adults and the community as a whole… a data-driven, decision-making process to help communities and organizations get beyond talking about problems to taking action to solve problems.”
Friedman’s approach shifts the focus from
outputs (‘what did we do?’) to outcomes
(‘what did we achieve?’), by asking three key
questions:
• How much did we do?
• How well did we do it?
• Is anybody better off?
For example:
Friedman’s model already supports existing
NHS England & Improvement approaches to
commissioning for outcomes, focusing less
on their treatment and more on how well
patients feel after treatment, and helping them
to stay well.
How does OBC relate to the SEND Reforms (Children and Families Act 2014)?
The SEND Code of Practice refers to shared
outcomes as a legal ‘should’; i.e. not
mandatory in the same way as a ‘must’, but
nevertheless highly recommended:
“Local partners should identify the outcomes that matter to children and young people with SEN or disabilities to inform the planning and delivery of services and the monitoring of how well services have secured those outcomes.”
0-25 SEND Code of Practice
An OBC approach enables a local area to
approach this systematically and rigorously.
However, a strategic outcomes framework
does not need to be SEND specific as the
outcomes resonate with all children and
young people. Some local areas supported by
CDC started out with a SEND focus, with the
intention to expand to universal once good
progress has been made with operationalising
the outcomes in a SEND context. Others
have begun with the intention of developing
universal outcomes from the start.
4
What are the anticipated benefits of using an OBC approach?
There are many benefits to an OBC approach
for all stakeholders:
CYP’s and families’ wishes are kept front
and centre.
Good co-production of the outcomes gives
parent carers and CYP a meaningful role
in strategic processes, and their views are
established at the heart of commissioning
decisions.
Improves trust between families, professionals
and strategic leads.
The process of developing a strategic outcomes
framework is an excellent opportunity to bring
partners together and focus on improving lives
for children and young people.
Promotes holistic view of the child
The focus is on supporting families to live
fulfilling lives rather than focusing on specific
conditions or disabilities.
Clear, shared vision for professionals
Professionals across the piece see their role as
part of the bigger picture in children’s lives and
are motivated by this. Communication and joint
working is also likely to improve.
Focus on lived experience rather than delivery
of services
Monitoring extends from ‘what did we do?’ to
‘is anybody better off?’.
Promotes evidence-based commissioning
Montoring takes into account which services/
interventions are most effective and make
the greatest difference in families’ lives, which
promotes learning and sharing. Less
effective services can also be identified and
re- or de-commissioned. This promotes efficacy
and efficiency.
What does a Strategic Outcomes framework look like?
There is no ‘correct’ model for an outcomes
framework and different local areas' frameworks
look very different. Local ownership is one of
their key strengths, encouraging buy in across
the area. That said, they do have similarities,
and overall paint a picture of what a fulfilling,
meaningful life looks like for a child or young
person.
Here are some examples:
• Hertfordshire’s Outcomes Bees
• Leeds’ Obsessions
• Essex’s Children and Young People’s Plan
5
CDC has developed a programme of support
for OBC based on these principles, emphasising
that successful joint commissioning is defined
by a local area putting the improvement of
outcomes for children and young people at
the centre of its commissioning approach.
We deliver workshops which bring together
strategic leaders, parent carer representatives,
multi-agency professionals and (on occasion)
children and young people to develop and
implement strategic outcomes frameworks.
In summary, the approach is as follows:
1. Work with local leaders to identify any
existing frameworks in the local area which
may act as a springboard.
2. Deliver a full day workshop with multi-
agency attendees (including parent carer
representatives) to:
a. Provide an overview of OBC.
b. Share examples of existing good practice
from other areas.
c. Develop draft outcomes statements for the
local area OR adapt existing frameworks as
necessary.
d. Identify opportunities and action plan
for further consultation on the draft
statements, including with children and
young people.
e. Begin thinking about indicators and impact
data measurement by identifying existing
data sources and known data gaps.
f. Action planning for next steps.
3. (Optional) Deliver a half day follow-up
workshop to:
a. Confirm the draft outcomes statements.
b. Progress the data and impact measurement
work.
c. Identify actions for operationalising the
outcomes statements, for example in
contracting/ tendering and the EHC process.
Areas that we have supported or are continuing
to support with this approach include:
• Stockport
• Southend
• East Sussex
• Oldham
• Kent
• London Borough of Sutton
• London Boroughs of Kingston and Richmond
A more in-depth explanation of this journey,
along with a case study from Stockport, can
be found in our DBOT Webinar #2: Overview
and learning, with a focus on Outcomes Based
Commissioning.
There is also a write up of the Stockport case
study available here.
6
How has CDC been supporting the development
of Strategic Outcomes frameworks?
7
Leaders value the holistic nature of the
outcomes frameworks:
“These are commitments that everyone in Southend can sign up to; it needs to be a campaign and not a policy. We need to see it in schools, GPs and services so that wherever people go, we know what we want to achieve for children.”
Southend
Some parent carers involved in workshops now
view their own child’s future more positively,
and have increased trust in senior leaders:
“I am never normally allowed to think of my son as being able to be happy and have friends, because I am so bogged down in the fight for the basics. If we can all work towards this I think things will really change.”
East Sussex
Relationships and communication is improved
between different partners:
“The journey is in itself impactful, it has brought us together as partners across education, health and care and with our families to gain this joint shared understanding of what is really important to our families.”
Stockport
Impact of our work with local areas
Case studies:
Hertfordshire’s Outcome Bees
Camden’s Alliance Agreement
Stockport’s Outcomes Based Commissioning Journey
Council for Disabled Children, (2017) Joint commissioning bulletin: applying an outcome based
approach to commissioning
Council for Disabled Children webinars:
DBOT #1: Focus on JSNAs
DBOT #2: Focus on Outcomes Based Commissioning
DBOT #3: Overview of EHC & Outcomes training
Department for Education and Department of Health and Social Care (2015), Special Educational
Needs and Disability Code of Practice: 0 – 25 Years
Friedman, M. (2005) Trying Hard is Not Good Enough: How to Produce Measurable Improvements
for Customers and Communities
What is Results-Based Accountability™?
NHS England (2014) Commissioning for Effective Service Transformation: What we have learned
Useful Resources
8
About the Council for Disabled Children
The Council for Disabled Children (CDC) is the umbrella body for the disabled children's sector with a membership of over 200 voluntary and community organisations and an active network of practitioners and policy-makers that spans education, health and social care. Their aim is to see a fully-inclusive society where disabled children and young people and those with special educational needs can lead full and happy childhoods and rewarding adult lives. They do this by working with the sector to find out what is and isn’t working on the ground and use what they learn to influence policy and improve practice.
CDC hosts the following networks and projects:
Early Years SEND Partnership
IASS Network
Making Ourselves Heard
Special Educational Consortium
The Information, Advice and Support Programme
Transition Information Network
CDC is proud to be part of the National Children’s Bureau (NCB), a leading children’s charity working to build a better childhood for every child.
CDC is also part of the consortium that delivers the Every Disabled Child Matters campaign.
About the Council for Disabled Children
The Council for Disabled Children (CDC) is the umbrella body for the disabled children's sector with a membership of over 200 voluntary and community organisations and an active network of practitioners and policy-makers that spans education, health and social care. Their aim is to see a fully-inclusive society where disabled children and young people and those with special educational needs can lead full and happy childhoods and rewarding adult lives. They do this by working with the sector to find out what is and isn’t working on the ground and use what they learn to influence policy and improve practice.
CDC hosts the following networks and projects: Independent Support IASS Network Making Ourselves Heard Preparing for Adulthood Special Educational Consortium Transition Information Network
CDC is proud to be part of the National Children’s Bureau (NCB), a leading children’s charity working to build a better childhood for every child.
INTEGRATING SERVICES FOR DISABLED CHILDREN 11
Over the past decade, successive governments
have brought in a range of legislation, policies
and programmes in an attempt to deliver on
a vision of coordinated, person-centred care
and better outcomes for children and young
people with SEND. However, despite this visible
drive towards integration, the system around
SEND remains fragmented.
Following consultation with education, health
and care professionals and parent carers
in three local authority areas, this report
considers why the task of integrating the
design and delivery of services around SEND is
proving so challenging. It also identifies the key
factors enabling or hindering progress.
Local authority and NHS commissioners are
compelled to integrate services by a range
of legislation and national programmes. The
desire to address the role of wider, external
factors in determining our health and
wellbeing, has additionally led to efforts to
coordinate across whole ‘population health
systems’ (Alderwick, Ham, & Buck, 2015). This
approach is especially relevant to children and
young people with SEND who are likely, not
only to access a range of services across health,
education and social care in relation to their
SEN or disability, but are also more likely to
belong to other vulnerable groups.
However, we know that in practice the reality of
integrated working between different services
and agencies, such as NHS and local authority
services, children’s and adults’ services and
specialist and universal services, is challenging.
The many services accessed by children
and young people with SEND are subject
to different legislation, funding models and
accountability mechanisms that drive different
organisational priorities. This means that in
reality most initiatives trialling more integrated
systems have focussed on adults where only
health and social care need to be integrated.
Introduction Context: policy and practice
12 INTEGRATING SERVICES FOR DISABLED CHILDREN
Figure 1. The system around Child Health
INTEGRATING SERVICES FOR DISABLED CHILDREN 1312 INTEGRATING SERVICES FOR DISABLED CHILDREN
14 INTEGRATING SERVICES FOR DISABLED CHILDREN
Further details of our methodology are
included in the appendix of the full report.
Our conclusions are based on research into
the organisation and delivery of services for
children and young people with SEND in
three areas in England, each working within a
different geographic and demographic context.
NB: Local areas have been anonymised. This
enabled participants to be frank and open
about their practice.
In total, we engaged with 74 professionals
representative of a range of roles across
health, social care and special educational
needs services, and included parent carer
representatives. Data was analysed using NVivo
Framework Analysis software.
Our findings in these three local areas are
supported by evidence from our work with
local areas across the country and by our
analysis of the Ofsted and CQC inspection
reports into the progress of implementation of
the Children and Families Act 2014 reforms.
Methods
14 INTEGRATING SERVICES FOR DISABLED CHILDREN INTEGRATING SERVICES FOR DISABLED CHILDREN 15
Government policy – a lever and an obstacle
Local areas had been impacted by a number
of change programmes from the Department
for Education and NHS England. Where
national policy provided clear directives and
accountability that aligned to local area’s
priorities this was viewed as a helpful enabler
for organisations to coordinate their activity.
“I think people have seen the benefits…of the EHC plans and have now really bought into the idea that it does improve outcomes and it does help us to focus on the child more, rather than our own services and our agenda.” Area A
However in some cases national directives were
seen as unhelpful, where:
• pressure to implement change within tight
timescales and against a backdrop of stretched
resources risked compromising quality;
• the lack of join up between government
departments and NHS England in developing
and implementing change programmes,
hampered interagency working;
• national operational targets and reporting
requirements placed on different agencies and
services did not align.
In addition participants felt that the outcomes
universal services, especially schools, were
working towards and assessed on did not always
enable them to effectively include disabled
children and young people. This is supported by
data on exclusions from mainstream schools:
pupils with an Education, Health and Care plan
or a statement of special educational needs are
almost six times more likely to receive a fixed
period exclusion than pupils with no identified
SEN (Department for Education, 2017).
Resourcing issues
Increasing demand was a key concern in all
areas. Recent analysis commissioned by CDC
and the True Colours Trust has shown that the
numbers of children and young people with
complex needs or life-limiting conditions in
schools has increased by over 50% between
2004 and 2017. (Pinney, 2017).
Resource constraints were a consistent theme
in discussions with participants.
“…there isn’t enough money in the system to pay for all the care needs, and I'm thinking about children but this also applies in adults as well. And we know, we can see which care companies are going bust or not bidding for local authorities’ contracts because it’s not viable…” Area A
The figures on this are stark: local authorities
have seen a 49% real-terms reduction in
government funding between 2010-2018
(National Audit Office, 2018), whilst CCGs
began 2018/19 with an estimated underlying
deficit of £400-500m (King's Fund, 2018).
Findings of the report
16 INTEGRATING SERVICES FOR DISABLED CHILDREN
Whilst participants acknowledged that
initially austerity had generated creativity and
supported a shift towards integrated working,
as the cuts continued, many felt that the
requirement to carry out further restructures
had undermined these benefits.
A number of participants explained that joint
working and joint commissioning had in
fact become more difficult as each partner
organisation turned their focus to managing
financial pressures. In two cases existing joint
funding arrangements had broken down.
“We actually had a fantastic service… we probably had one of the best speech and language therapy services delivered five years ago, because it was, a big chunk of funding came from the city council. I don’t think the council took that decision easily about taking the funding away for speech and language therapy.” Area A
Allocation of funding within health, where
the funding for children’s services is often
tied up in block contracts and all-age service
spending, was also a particular challenge, as
commissioners struggled to direct and even
distinguish spending on children. There was
a sense amongst some participants that as a
result children were often ‘left behind’, and did
not receive a fair share of health funding.
The role of leadership
Strategic leadership emerged throughout our
research as the single most important factor
in enabling or hindering joint working and
integration at local level. This was down to
local leaders’ power to set strategy, influence
organisational culture and support initiatives
that enable integration.
In those areas where they felt supported by
senior leadership, participants:
• had a more positive impression of local area
strategies and how these related to and could
frame their own work;
• were more confident of receiving support
when escalating issues and concerns. “we’ve got a very clear framework …my team plan fits within that ... So for us we’ve got to focus on the quality of education, health and care plan outcomes, looking at the attendance, looking at that, preparation for adulthood and making sure, therefore, that what we do every day is going to make that difference, so that bit for me is quite clear.” Area A
INTEGRATING SERVICES FOR DISABLED CHILDREN 1716 INTEGRATING SERVICES FOR DISABLED CHILDREN
Conversely, in some areas local leaders
were felt to be one of the main barriers to
a more integrated approach. Their lack of
commitment was evidenced by a failure to
agree more formal processes for
working together.
“We’ve been looking at integrating our service with our colleagues in the community… this is a project that’s been ongoing for five years and I find it very difficult to get senior management to focus on any change.… I get the sense that people all think it’s a good idea but we’re not high enough on the priority level for it to be actually actioned. There’s always something else more pressing.” Area B
In the absence of such support and with
no formal arrangements, the majority
of participants referred to good working
relationships and shared cultural values as
the basis on which services and organisations
worked together.
However, this dependence on informal
relationships was recognised as a less
sustainable approach to integration as it could
falter with personnel changes. It also seemed
to lead to significant inefficiencies with
managers spending time agreeing individual
packages of care because an area wide
approach had not been agreed.
Data and information-sharing
Good quality data and effective information
sharing processes should aid integration
at both strategic and individual care level,
supporting areas to look at the ‘big picture’,
respond together as a system and achieve
strategic outcomes. However areas are held
back both by practical challenges and by
the traditional focus on specific services
and cohorts. Leadership has a role to play in
promoting work to overcome these barriers.
Population data was generally perceived as
poor and patchy and of limited usefulness
by participants. This is not only a local but a
national issue (Pinney, 2017).
Even where participants did have access
to good quality population data this did
not necessarily result in needs based
commissioning as it tended to inform a service
or agency rather than a local area approach.
“I think local authority data is very good, actually. So, for example, I was able to show that our percentage of children with the most complex needs, i.e., those with statements and plans, has increased by 50% over the last five years. …[as a result, ours] was the only department in the whole of the council that made a successful growth bid for staff last year.” Area B
Measuring progress against narrow, service-
specific targets was common practice but
felt, by all professionals, to be insufficient
in illustrating the impact public services
were having on families’ lives. All areas were
attempting to develop more effective methods
of measuring impact in a meaningful way.
However even where local areas had defined a
clear set of outcomes tracking their success in
achieving them was a significant challenge.
18 INTEGRATING SERVICES FOR DISABLED CHILDREN
“…it’s hard, isn’t it…how do you measure when you’ve had a positive contribution, that you maybe helped to prevent … something deteriorate, that’s where we always struggle, to start to measure that. ” Area B
Participants were clear that the lack of a
joined up government approach to integration
around data added to the challenge of
measuring progress and outcomes in a
meaningful way.
Individual-level data and information
sharing processes, which enable different
organisations to share information
relating to individual children and young
people, were seen as a key enabling factor
for effective joint working and integrated
care. However, information sharing between
different services and agencies was proving
particularly difficult in all areas due to data
being held in multiple places, incompatible IT
systems and differing governance and security
arrangements between agencies.
Where information sharing processes had been
established arrangements were not always
successful once in place. In some cases this
appeared to be due to a failure to involve all
relevant colleagues in the development of the
new system or process, leading to low levels of
commitment to maintaining shared datasets.
A lack of formal processes increases pressure
on parents to coordinate information sharing
between the different professionals involved in
their child’s support.
“To be honest, the best solution I’ve seen so far is that highly motivated proactive parents actually keep all the data on their own iPad and bring it to every appointment.” Area B
INTEGRATING SERVICES FOR DISABLED CHILDREN 1918 INTEGRATING SERVICES FOR DISABLED CHILDREN
Despite the challenges presented by the
system, there are a number of ways in
which local areas are working to overcome
this complexity and enable some level of
integration.
There are various forms and levels of
integration. Care can be integrated around
the individual, across multiple services or
system-wide; it may be low level - introducing
improved referral pathways and information
sharing processes between two teams - or
as high level as formally merging multiple
organisations.
We have come across various initiatives and
arrangements both through this research and
in our work with local areas across England. In
all cases, they appear to work best where they
are supported by senior leadership and a clear
strategic vision.
JOINT COMMISSIONING ARRANGEMENTS:
• Commissioners are increasingly coming
together to jointly commission roles which
support joint working – most notably the
Designated Clinical Officer for SEND role
(DCO).
• Participants felt that formal Section 75
Agreements make integration ‘harder to
walk away from’ and therefore increase
commitment to joint working.
• Commissioners can also support joint
working through committing to an
Outcomes-Based Commissioning (OBA™)
approach where commissioners task multiple
providers with delivering on the same key
outcomes.
• There are a number of innovative
contracting models that can support
outcomes-based commissioning, such as:
- Alliance Agreements, whereby different
providers who already have a contract
with a commissioner are brought together
to work towards shared outcomes for a
specific population. This model encourages
providers and commissioners to work
collaboratively.
- The Accountable Provider Model or
Prime Contractor Model, in which one
provider is commissioned to deliver an
integrated pathway of services designed
to achieve a defined set of outcomes. This
usually involves sub-contracting other
providers to support different elements of
the programme/service. Sub-contractors
are held to achieving the same defined
outcomes.
JOINT WORKING ARRANGEMENTS:
• For participants in this study, co-location
helped teams to understand each other’s
perspectives and develop their work in a
more integrated way.
Making it work
20 INTEGRATING SERVICES FOR DISABLED CHILDREN
• A set of case studies by the Social Care
Institute for Excellence (SCIE) has highlighted
the value of multi-disciplinary teams in
driving integration. SCIE stresses that there are
different ways of doing this, including:
- formal arrangements, where teams are
brought together under a partnership body;
- the introduction of systems and processes
that enable professionals across different
organisations to come together to manage
complex cases.
- the ‘key worker’ system whereby care is
coordinated by a named worker.
• Formal multi-agency decision-making
processes should enable different partners,
for example from the local CCG and local
authority, to navigate the differing referral
processes, threshold criteria, delivery models
and funding mechanisms which apply to
different agencies and services in order to
agree on and deliver an appropriate package
of support for a family. In successful examples,
panel representatives were supported by clear,
multi-agency arrangements and processes
agreed at strategic level.
INVOLVING FAMILIES IN DECISION-MAKING:
• At strategic level, co-production with parent
carers was achieved by involving families
from the earliest stages through workshops,
meetings, consultations and representation
on programme boards. Parent carers were
also involved in day-to-day work through
representation on multi-agency panels or
governance boards.
• At individual level, building dedicated time
and space into support planning processes
for a person-centred conversation with the
child or young person and their family, and
ensuring this conversation informs the rest
of the process and any resulting support
package, can support integration through
uniting agencies around holistic needs,
outcomes and aspirations.
• Involving children and young people at
strategic level was felt to be more challenging
for participants, but all areas were making
efforts to include young people in these
processes too, or to seek their advice through
workshops and engagement groups.
- Some local areas have established Young
Commissioners groups to support
commissioning and procurement
activities, undertake research and make
recommendations about services from a
young person’s perspective.
• Crucially, engagement with families must be
meaningful, with a clear, pre-determined
process for feeding any outputs into strategic
planning. This again links to leadership and
strategic-level commitment to change.
• In addition, local areas must be mindful of
not shifting the burden of coordination onto
families: the effective engagement of parents
and carers must be one of a range of strategies
for supporting the integration of care at
individual level, and cannot substitute broader
efforts to join up services.
INTEGRATING SERVICES FOR DISABLED CHILDREN 2120 INTEGRATING SERVICES FOR DISABLED CHILDREN
Leadership
Senior leadership within national
government and NHS England should:
• Review and align key priorities across all
national programmes impacting this group
of children and young people; then align
performance measure across programmes.
• Ensure that when introducing any new
change programmes work is done to align
that programme with all related existing
requirements.
The National Leadership Board for children
and young people with high needs, reporting
to the Minister for Children and Families
should consider what further steps need to
be taken to ensure that leaders in local areas
prioritise integrated commissioning to deliver
integrated services.
Data and information-sharing
National government and NHS England
should review and align reporting
requirements for national programmes in
order to:
• Facilitate a shift towards outcomes-based
data that will help demonstrate the value
of delivery beyond simply activity data and
outputs;
• Reduce the reporting burden on local areas
wherever possible.
We also emphasise the need for national
government and NHS Digital to continue
to support and incentivise data collection on
children and young people with complex needs
to build a clearer picture of the needs and
outcomes of this group, and to develop more
integrated means of gathering and presenting
this information. This reflects the more
detailed recommendations made in our report,
Understanding the needs of disabled children
with complex needs or life-limiting conditions
(Pinney, 2017).
NHS Digital should identify whether or not
it is possible to update their information
sharing resources, to include agencies working
with children, without an amendment to The
Health and Social Care (Safety and Quality) Act
2015 which introduced a legal duty requiring
health and adult social care bodies to share
information where this would facilitate care for
an individual. If possible the resources should
be updated with immediate effect.
If an amendment is required, national
government should seek to amend The Health
and Social Care (Safety and Quality) Act 2015
to extend the legal duty to education, health
and care bodies where this will facilitate care
for a child.
Recommendations
22 INTEGRATING SERVICES FOR DISABLED CHILDREN
Funding structures
National government should review local
government funding for services for children
and young people with SEND as rapidly as
possible in response to the concerns raised both
in this report and wider publications and media
reports.
DHSC should require CCGs to report separately
on their spending on children’s health services.
NHS England should, having set goals for
children’s health services, ensure that they hold
CCGs to account on progress towards those
goals, ensuring that they give sufficient priority
to services for children.
DfE and NIHR should commission a cost
effectiveness study of joint strategic planning
and joint commissioning arrangements in order
to support the case for change.
Universal services
Ofsted should ensure that its review of the
schools inspection framework includes a
greater focus on pupil health and wellbeing
and the outcomes sought for pupils with
SEND, to incentivise schools to meet the needs
of all pupils.
The Government should ensure that
commitments made to ensure that all health
and social care staff have training on learning
disability and autism adequately cover the
children’s workforce and includes education
staff so that all professionals know how to
support children with SEND.
Supporting and involving families in decision-making
CCGs should jointly fund Information Advice
and Support (IAS) Services to ensure that they
can adequately fulfil their statutory duty to
provide advice and support across health as well
as education and care services.
CCGs and local authorities should recognise
and fund local parent carer forums (PCFs) as a
well-established source of expertise, who due to
their own personal experience are ideally placed
to support a holistic approach to supporting
children and young people with SEND.
INTEGRATING SERVICES FOR DISABLED CHILDREN 2322 INTEGRATING SERVICES FOR DISABLED CHILDREN
Alderwick, H., Ham, C., & Buck, D. (2015). ‘Population health systems: going beyond integrated care.’
The King's Fund.
https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/population-health-
systems-kingsfund-feb15.pdf [Accessed 25 March 2019]
Department for Education. (2017). ‘Permanent and Fixed Period Exclusions in England: 2015-2016.’
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/
file/645075/SFR35_2017_text.pdf [Accessed 25 March 2019]
Department for Education. (2018) ‘Statements of SEN and EHC Plans: England 2018. Department
for Education.’
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/
file/709590/Statements_of_SEN_and_EHC_plans_England_2018_Main_Text.pdf [Accessed 25
March 2019]
Kelly, E., Lee, T., Sibieta, L., & Waters, T. (2018). ‘Public spending on children in England: 2000-2020.’
https://www.childrenscommissioner.gov.uk/wp-content/uploads/2018/06/Public-Spending-on-
Children-in-England-CCO-JUNE-2018.pdf [Accessed 25 March 2019]
King's Fund. (2018). ‘How is the NHS performing? March 2018 Quarterly Monitoring Report’
https://www.kingsfund.org.uk/publications/how-nhs-performing-december-2018 [Accessed 25
March 20
National Audit Office. (2017). ‘Health and social care integration.’
https://www.nao.org.uk/wp-content/uploads/2017/02/Health-and-social-care-integration.pdf
[Accessed 25 March 2019]
National Audit Office. (2018). ‘Financial sustainability of local authorities.’
https://www.nao.org.uk/wp-content/uploads/2018/03/Financial-sustainabilty-of-local-
authorites-2018.pdf [Accessed 25 March 2019]
References
24 INTEGRATING SERVICES FOR DISABLED CHILDREN
Pinney, A. (2017). ‘Understanding the needs of disabled children with complex needs or life-limiting
conditions: what can we learn from national data? Exploratory analysis commissioned by the
Council for Disabled Children & True Colours Trust’,
http://www.truecolourstrust.org.uk/wp-content/uploads/2017/02/CDC.datareview.final_.revised.pdf
[Accessed 25 March 2019]
Social Care Institute for Excellence. (2018, August 8th). ‘Delivering integrated care: the role of the
multi-disciplinary team’, SCIE Highlights, No.4, July 2018
https://www.scie.org.uk/integrated-health-social-care/measuring-progress/role-multidisciplinary-
team?utm_source=The%20King%
INTEGRATING SERVICES FOR DISABLED CHILDREN 2524 INTEGRATING SERVICES FOR DISABLED CHILDREN
This project was funded by the True Colours Trust
09. 04.2020
About the Council for Disabled Children
The Council for Disabled Children (CDC) is the umbrella body for the disabled children's sector with a membership of over 200 voluntary and community organisations and an active network of practitioners and policy-makers that spans education, health and social care. Their aim is to see a fully-inclusive society where disabled children and young people and those with special educational needs can lead full and happy childhoods and rewarding adult lives. They do this by working with the sector to find out what is and isn’t working on the ground and use what they learn to influence policy and improve practice.
CDC hosts the following networks and projects:
Early Years SEND Partnership
IASS Network
Making Ourselves Heard
Special Educational Consortium
The Information, Advice and Support Programme
Transition Information Network
CDC is proud to be part of the National Children’s Bureau (NCB), a leading children’s charity working to build a better childhood for every child.
More information about CDC can be found at www.councilfordisabledchildren.org.uk
About the True Colours Trust
The True Colours Trust is passionate about making a difference to the lives of disabled children and their families and supporting people with life-limiting and/or life-threatening illnesses. The Trust was established in 2001 and works in the UK and Africa.
True Colours has developed a framework of grant-making which enables it to effect change in the short, medium and long-term. This is done through small grants to local initiatives; multi-year grants to build sustainable organisations and sectors; commissioning research to gather information and identify solutions to complex issues; and, making long-term investments towards advocacy and policy change. The Trust’s framework enables it to make positive change today, tomorrow and in the future. The Trust is proud to be a long-term supporter of the work of the Council for Disabled Children.
More information about the True Colours Trust can be found at www.truecolourstrust.org.uk