Integrated commissioning future priorities for CYP with SEND
Clinical intervention in schools review
Lincolnshire made a commitment in 2018 to invest £101m to create 527 additional places within 13 of its 17 special educational needs (SEN) schools. Planned school site construction and adaptions are now near completion. A key aim of this project is to enable a wider range of CYP with varying SEND to attend their nearest special school in the area where they live, rather than have to travel to a specialist school for specific needs further across the county or outside the county. high-level aims and objectives include:
- ensure those with complex medical needs, or on long-term ventilation, can attend their local special school in a clinically safe way
- provide a robust health offer to meet the needs of CYP with SEND in Lincolnshire’s ‘all needs’ special schools
- give parents or carers the confidence their local special school can meet their CYP’s health needs
- empower or upskill special school staff to feel confident in meeting these needs within all settings
CYP therapy review
Due to increased demand in the system, an urgent review of Lincolnshire’s SALT service shall take place early 2024 to reshape the service where necessary; to ensure CYP and their families are provided with the right level of support at the right time to meet their speech and language needs. A wider review will then recommend developments to create a more integrated CYP therapy service to provide SALT, occupational therapy (OT) and specialist physiotherapy, for CYP with either complex physical or speech and language and communication needs (SLCN), including the development of advanced clinical practice (ACP) roles to reduce pressure on community paediatrics and transition to adult pathways.
CYP voice and data intelligence
- lived experience intelligence – understanding the lived experience of CYP with SEND and their families in relation to the services they access is already a well embedded approach with LCC’s commissioned suppliers. There is some evidence of CYP engagement and co-production within ICB commissioned providers, however, there is no central place across the system where this learning is shared. An aligned template for collection of feedback from CYP and their families is being developed
- data intelligence – an integrated dashboard for SEND, including health related data, is being developed as a tool to bring statistics relating to EHC in one place. The dashboard will support work taking place across East Midlands in creating a regional dataset to support better understanding of local and regional SEND demand and need. Lincolnshire’s work will identify wider opportunities to improve the quality of intelligence through use of an ICS joined intelligence dataset which is in early stages of development.
Intelligence from both the lived experience and the dashboard will help identify where additional support may be required, or possibly reduced, to ensure our arrangements are making a positive difference for CYP with SEND. Having one joint approach will not only provide greater consistency for families, it will also help the ICB and LCC to identify trends and needs to shape and inform future integrated commissioning plans.
Integration of assessment processes and support for CYP with SEND review
Work of the review shall sit within three sub-categories:
- SEND EHC process-strengthening accountability to drive better outcomes and experiences for CYP with SEND across the EHC process through high quality clinical and medical information and advice with clearly defined specific, measurable, achievable, realistic and timebound (SMART) health outcomes
- independent placements for CYP with SEND- joint decision-making processes and funding arrangements shall be reviewed to ensure the right level of accountability is in place by all partners
- children’s continuing care (CC) review for CYP with SEND - a review of Children’s CC service delivered by both LCC and the ICB. It can be evidenced through national and regional network meetings that CC is delivered differently within each ICB area; this has informed the need for this review
Health inequalities
Priorities continue to be driven by data and intelligence, including an evolving use of population health management information to ensure the work being undertaken addresses and understands health inequalities within our CYP population within Lincolnshire. The NHS England Core20PLUS5 programme outlines key priorities to reduce health inequalities for CYP. The 5 clinical priorities for CYP are, asthma, diabetes, epilepsy, oral health, and mental health. These groups include CYP with SEND. The CYP programme directly aligns to these priorities. New national deliverables are expected relating to the CYP Core20Plus5 programmes, which will support our CYP programme further, for example, improving transition pathways and co-production with CYP and their families in capturing the CYP voice. This work will help us understand if there are particular issues for CYP with SEND in accessing the care they require and addressing any identified gaps. All projects within the ICB work programme 2023-28 shall include a transition workstream.
LYV
LYV have an updated service delivery plan which includes future work around improving accessibility to public transport and an educational programme to address bullying - the outcome of which is intended for use by CYP and professionals.
Recommissioning of an early learning and portage support service
Lincolnshire schools forum have recently agreed to continue supporting the funding of a service for children in their early years with suspected or diagnosed SEND where there is a learning difficulty, developmental delay or physical difficulty impacting on the child’s educational development. The current portage service offer is predominantly a home visiting service delivered across Lincolnshire by eight special school providers. The re-commissioned service will include a single lead provider model, with capacity realigned to geographical areas of demand to ensure an equitable offer for all eligible families. There will be a single point of access for referrals and a strong emphasis on offering coordinated and inclusive evidence-based group and workshop support within children’s centres and community venues, prior to home-based support being provided where there is an identified need.
Family hubs programme speech and language support pilot
An evaluation of the family hubs start for life offer in Lincolnshire will commence April 2024. This will include evidence-based programmes funded through the family hubs programme from conception through to the age of five years (early years foundation stage). Family hubs stem from clear evidence that identifying risks early and preventing problems escalating, means better long-term outcomes for children and their families. As a system we will review the evidence-based outcomes from the family hubs programme in order to identify the areas that have had the most positive impact for young children and their families, with a key focus on the first 1,001 days in a child’s life, that with sustainable funding investment could continue to improve the outcomes and life chances for Lincolnshire children and their families.
Families first for children pathfinder
The pathfinder is part of the government’s children's social care: stable homes, built on love and is part of phase one of the government’s social care reform programme: laying foundations for whole system reform to design and test key social care reforms and policies in relation to family help and child protection. Lincolnshire has been pre-selected as one of three local authorities to take part in wave one of the pathfinder to implement and test delivery against minimum expectations with a view to influencing the national vision. LCC is working in partnership with ICB, health, education and police colleagues to build upon our existing strengths and identify areas of improvement and development that will help to further improve outcomes for Lincolnshire families and share learning with strategic and national partners.
CYP mental health transformation programme
Together with CYP in Lincolnshire, will transform services in Lincolnshire by 2028 to improve emotional wellbeing and mental health support for CYP and families, enabling them to live independent, safe, well and fulfilled lives in their local communities. We will focus on improving support for CYP and their families through:
- increasing public mental health promotion, prevention, community and early intervention support
- empowering parents, carers and professionals working with CYP to better identify and respond to emotional wellbeing and mental health concerns
- increasing and improving access to community based emotional wellbeing and high-quality, evidence-based and timely mental health assessment and support
- ensuring that CYP with a learning disability or autistic CYP who are also suffering from mental illnesses receive specialist care that is tailored and able to meet their specific needs
- avoiding unnecessary specialist and acute mental health related hospital admissions, particularly for CYP with a learning disability or who are autistic
Autism diagnostic pathway
Despite investment in the autism diagnostic pathway in Lincolnshire and improved waiting times being achieved, post pandemic demand for assessment has increased significantly again. This is also the case nationally. A new and improved pathway has been designed that would allow appropriate clinicians in Lincolnshire to assess and diagnose autism in CYP up to the age of 18. This has been co-developed with the autistic community and specialist clinicians to make it a simpler journey for both CYP and families, as well as for professionals. During 2024 system leaders are working together to agree how to transform the existing autism diagnostic process and how to potentially fund and implement the newly co-produced pathway design. The new pathway would include more focus on offering support to the CYP and family throughout the assessment process, as well as post-diagnostic outcome. This would help us to achieve reduced waiting times, address increasing numbers of referrals for assessment and simplify the process for families.
Sensory processing difficulties (SPD)
SPD can cause issues at home, in education settings or in the community. Partners across the system state many CYP would not require OT intervention, or may need less specialist intervention, if they received focussed support earlier. Unmet needs are escalating and leading to more costly specialist services. Over 2024 the mental health learning disability and autism programme of work shall consider the need for a stepped model; initially requiring ownership by the parents, carer or CYP, moving on to later stages of more tailored, specialist-led support as required.
Neurodevelopmental pathway
Many of these conditions, including autism, are the most common lifelong conditions in our SEND population. However, there is currently no diagnostic pathway for CYP with suspected learning or intellectual disabilities in Lincolnshire, or for CYP with suspected tics or tourettes, and CYP aged 16-17 with suspected autism. Plans are being developed to address these gaps. Initially through strengthened out of area treatment panel integrated commissioning arrangements (as an interim) with longer-term plans to develop Lincolnshire’s existing commissioned services and pathways.
Admission avoidance
Plans are being discussed to develop joint mental health crisis provision in Lincolnshire, including for autistic CYP or those with LD. More resource has also been agreed for CYP mental health crisis liaison across Lincoln and Boston (outreaching to Skegness and Grantham), further supported by making the Lincoln hospital mental health urgent assessment centre (MHUAC) all-age from 4 December 2023. A review of the processes for inclusion or addition of CYP on the DSR, including across health, social care and education partners as well as potential self-referral, is being undertaken. This will also include processes for identifying those at risk on 38 or 52 week placements, as well as reviewing the progress with wider processes for multi-agency monitoring and support and care planning.
CYP keyworking
The keyworking offer is being further strengthened since going live with the full 0-25 offer, by recruiting additional fixed-term band 5 keyworkers. The service will focus on further building relationships with the VCSE sector in Lincolnshire; continue to work with those with lived experience, service users and external stakeholders to co-produce service improvements; and will further improve relationships with social care and education partners, with a continued focus on facilitating system partnership working. Since the service is still relatively new, there is also ongoing work to improve understanding of the CYP keyworker service across other services and professional groups, and to establish relationships with the new virtual autism hub.
