Keeping a focus on children and young people: our latest SEND findings

Victoria Watkins, Deputy Chief Inspector of Primary Medical Services and Integrated Care, explores our latest joint report with Ofsted about the experiences of children and young people with SEND.

Today, we have published our joint report with Ofsted into the experiences of children and young people with special educational needs and disabilities (SEND) and their families during the pandemic. This is in the context of the SEND reforms over the last 10 years.

The report looks at SEND from the start of 2020, when the pandemic began. We’ve seen that children and young people with SEND, their families, and those who work with them, have faced significant challenges during this time. Their experiences have also been hugely varied, depending on the extent to which education, health and care providers in different local areas rose to the challenges presented by the pandemic.

We know that the negative experiences of many children and young people with SEND and their families during this time are not new. There are long-standing issues in the SEND system, which the pandemic has highlighted and intensified. It has also deepened the effects that they have on children and young people with SEND.

Evidence from Ofsted and CQC’s SEND inspections suggests that many local areas have struggled to successfully implement the reforms set out in The Children and Families Act 2014. Some of the common weaknesses we found included:

· A lack of joint commissioning

· Little or no involvement of children and young people and their families in making decisions about how their needs could be best met

· Poor-quality education, health and care plans (EHC plans)

· Lack of clarity about who is — or should be — held accountable for services and provision in a local area

· Problems with identifying and assessing the needs of children and young people

Through our visits to local areas in the autumn term 2020, we found that some important health services, such as physiotherapy, had ceased for children and young people with SEND. This left them immobile and sometimes in pain. In some cases, a lack of speech and language therapy, or communication devices being unavailable, left them unable to communicate properly. Social care and health-funded respite provision for families had also not been available in many areas. Parents and carers told us of their frustration, exhaustion and sometimes of their despair — particularly as some children could not attend school because their health or personal care needs could not be met. This disruption to service provision had a serious impact on families, and the wellbeing of the wider family unit, where usual support and respite was not available.

Throughout the pandemic, local areas have had to adapt their ways of working to continue to provide services for children and young people with SEND. We saw that the success with which they adapted appeared to be closely related to the ways they had implemented the 2014 reforms. This included whether they had created the necessary relationships, systems and structures to deliver well as partners. Some areas struggled to adapt, but even where systems seemed to be overwhelmed by the challenges of the pandemic, families expressed appreciation for the support and care given to them by individual professionals.

However, even in areas where the system worked together effectively, it is evident that children and young people with SEND are now even more vulnerable than they were before. Missing out on education as well as support for physical health, communication needs and mental health has had a seriously detrimental, and in some cases potentially permanent, impact. Some children and young people with SEND have also been out of sight of safeguarding professionals.

As recovery from the pandemic begins, we cannot underestimate the importance of good-quality universal services for children and young people with SEND across education, health and wider children’s services, alongside more specialist health or social care support where needed. There is a need for continued focus on improving experiences and outcomes for children and young people with SEND. As the newly established integrated care systems (ICS) evolve and establish, there is an opportunity for every ICS in England to ensure it is meeting the needs of children and young people with SEND and their families well.

I spoke in December about this and the importance of all corners of the health and care system focusing on meeting the needs of children and young people together. This includes for us here at CQC. We have prioritised activity to look at how services and systems work in partnership to provide care for children and young people. Our teams have recently started the fieldwork activity on our next Provider Collaboration Review (PCR), which looks at the experiences of children and young people with existing and emerging mental health needs who have been in contact with mental health services during the pandemic.

Our PCR work so far has received much support from children and young people themselves in terms of sharing their experiences of navigating mental health care and support during the pandemic. So far, we have heard over 2,000 experiences directly from children and young people and we’re looking forward to continuing to work with them and their families to develop our findings. We look forward to sharing these with you in autumn.

We are also working with Ofsted to adapt our SEND inspection framework, with the aim of helping local areas to make the greatest possible difference for children and their families. We will be looking for stakeholders to shape our SEND inspection framework, through a public consultation and a programme of pilots in local areas. We will keep you informed of any updates through our regular bulletins.

Until then, thank you for all the work you do to make sure children, young people and their families are still able to access the vital services they need.

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.