Rethinking health services for disabled children and those with special educational needs

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We can argue about why, but the reality is that we live in a society today where far more children are identified as having a disability or special educational need than ever before.  It should come as no shock then that waits for community health services for children and young people increased by 31.4% between June 2022 and June 2024 to 283,369.  The most common consequence of long waits for community services are delays in a child’s social development, education and communication with disproportionate impacts on vulnerable communities. 

It is vital to remember that children’s brains are incredibly flexible, developing constantly, creating and refining new neural pathways, influenced by experiences.  So, this isn’t just about delay, these are opportunities lost, during the brain’s most fertile period, which can never be recovered.   

If the new Labour government is to deliver on its pledge to break down barriers to opportunity, it needs to look at the health service and how it supports children and young people.  And if it’s going to meet that promise within the prevailing financial constraints, then it will need to think radically.  This isn’t about more of the same – even with an ambitious workforce strategy it would realistically be many years before we could train enough therapists and clinicians to make the current model work.

Children don’t have that time. 

How can we do things differently?  

Children’s health has always been the Cinderella of public services, so commissioners have had to be creative.  People with young children often seek out group activities, and many children are in childcare settings and nearly all are in school settings.

We don’t necessarily have to follow the same referral assessment treatment path as adult services, but we should instead upskill workforces in community settings to deliver low-level interventions, with the support from clinicians. For example, an occupational therapist might visit a school to develop a specific plan for a child for whom the school’s standard approach isn’t working, and then support the school staff to deliver the plan. An educational setting is also more likely to yield an accurate assessment than a clinical environment. 

Placing therapists in drop-in community settings, sometimes with other health professionals, enables fast and easy access to triage for those parents concerned about their children’s development. An upskilled workforce would also be able to identify issues and refer children with more confidence.   

This approach has been tried with speech and language therapy with the staff in community settings who are upskilled to ensure they have a good basic understanding of speech, language and communication, including supportive strategies.  Clinicians are on hand to help, with key staff at settings given the tools and guidance to develop specific knowledge and skills to support children identified with speech, language and communication needs (SLCN). 

This means that in triage parents may be provided with advice and information and referred for universal support  - a local chat, play and read group.  Some children may be identified as needing targeted support and referred to groups run by staff trained within their setting.  Other children are identified as needing specialist support so referred for more in-depth assessment and specialist support, most likely in a clinical setting.   

Through this approach far fewer children are referred for specialist support and local areas that have adopted it have seen waiting times drop significantly.  Because a drop-in service is part of the offer, there is a safety net for parents referred for universal support so if their child doesn’t make progress, they can flag this and request support through targeted or specialist services without a lengthy referral process.   

Unsurprisingly, areas adopting these approaches have seen high levels of parental satisfaction with 99% of parents reporting they found is easy or very easy to get advice, 99% reporting the advice was helpful or very helpful and 99% reporting they understood the next steps for their child.    

Such approaches also enable commissioners to target areas where they have identified that a high proportion of children might have or be vulnerable to developing SLCN.  This is incredibly important in addressing intergenerational disadvantage. 

Is this approach transferable beyond some therapy appointments? 

Allied approaches could also help with other areas of crisis in children’s health services such as autism assessment.  Bradford has had really encouraging results with a school-based assessment for autism spectrum disorders.  Portsmouth is trialling a neurodiversity profiling tool and has put in place a neurodiversity team (0-19) to support education settings. 

The aim is to improve early identification of neurodiversity and offer increased support for families and professionals, so that children and young people may not need to go through the lengthy assessment process to get their needs met.  Again, parental satisfaction with the support available in these areas is high.  Both approaches also have the advantage of offering increasing equity.  In Bradford, all children are screened, not just those that actively seek assessment. 

At the moment, the Department for Education is trying hard to rebalance the SEND system so that more pupils get the support they need earlier.  But to look at doing so only through an education lens feels like tackling the problem with one hand, with the other tied behind your back.

Mandating approaches like those adopted in Lancashire and Portsmouth would give us an Ordinarily Available Provision (OAP) plus approach: schools and early years settings supported to give targeted support to pupils, with a far smaller fraction requiring lengthier assessments. This would mean...  

• Support on hand, not at the end of a long and winding queue; 
• Support that is equitable, and not linked to parental capacity;
• Support on site, that minimises missed learning;
• Support that avoids ‘othering’ children and instead helps them and those around them to understand who they are and how they are best supported.
• Support that break down barriers to opportunity.

I think that’s a world that most parents and children would be happy to live in.