What can schools and ICBs expect from each other? 

“What can schools expect from ICBs, and ICBs from schools?”

In 2022 we posed this question in a roundtable while researching our publication on The evolving role of county authorities in Integrated Care Systems with the County Councils Network.

Both the Children’s Commissioners’ call to arms in October and recent HSJ findings highlight that this question is now more pressing than ever. The HSJ found that “the number of children waiting two years (104 weeks) or more for a community health service more than tripled February and October.” That is now close to 8,000 children and young people – and their families, carers and teachers – waiting more than two years. That’s three class-teacher’s worth of teaching for the child. A positive experience, particularly in a child’s early years is crucial, as it lays the foundation for their cognitive, social and emotional development, fostering a love for learning and building the resilience they need to thrive throughout life. They don’t get the time back.

The drivers are clear – demand for specialist diagnosis and treatment for ADHD or autism, occupational and speech and language therapy are hugely up, and community paediatric services have not been funded to the same degree as adults urgent and emergency and elective care.

This is both a national issue, and an intensely local one – a postcode lottery exists, and this is leading to different outcomes place by place. A huge frustration for local authorities and Directors of Children’s Services s as well as clinical colleagues. As Dame Rachel D’Souza said, “These children face an invisible crisis, in a system that is working against itself by forcing families to jump through multiple hoops in a complex and lengthy process of assessment, diagnosis and intervention.”

So, what can be done and what do systems need to be working on jointly on this most complex of issues?

Viewing parents and cares as key partners

As our Improving parent carer confidence and co-production in High Needs publication highlights, there is lots of good practice taking place within local systems and a key strand has been to build positive relationships with parents and carers, viewing them as partners. The Code of Practice is clear in its assertion that parents and carers are essential partners in the planning and reviewing of support for children with SEND. SEND Coordinators within schools play a key role in working with parents and carers to identify and support children with additional needs. They work with families to explore what is working well at home and how that can be translated into a school setting. Whilst waiting lists are long for formal diagnoses and broader support, it is essential that schools work closely with parents and carers to increase their confidence in supporting their child and making improvements to how the school too can support.

Early intervention, prevention and a single view of the child

There is much that can be done to improve and maximise early intervention and prevention support across places – aligned to the first policy shift from “treatment to prevention”. On an NHS and local authority jointly sponsored programme for a borough in Greater Manchester, we found that following professional review, 62% of reviewers felt that something could have been done differently to prevent, delay or reduce the current level of need for children’s health related to SEND. And in 85% of those cases, the appropriate intervention was available but was not accessed, or was not accessed as early as it might have been.

The lack of a holistic view of the needs of a child at the earliest stage was the critical barrier, which meant that care coordination became an issue. On average six professionals were involved for each child. Places need to prioritise getting this single, personalised view around the child to deliver greater capacity and better outcomes in the systems. The key lies in codifying needs, leveraging tools like IMPOWER’s Valuing SEND approach to establish a shared language among practitioners and ensure that support is planned around the unique needs of each individual child.

Building new models of care for children and young people

The “hospital to community” shift is critical to managing needs earlier. With the focus on capital investments, linked to the New Hospital Programme, and the focus on new neighbourhood models of care that will follow with planning guidance, there needs to be a clear voice for children’s and young people’s care and health needs running as a ‘golden thread’ through all of these changes. Engaging with children’s services, clinical and nursing leaders in paediatrics, and schools is no longer a nice to do, but must sit front and centre in these new models and how they become commissioned or built.

Improving inclusion in mainstream schools

Improving inclusion in schools is a vital step toward supporting families navigating the often lengthy process of securing a diagnosis for their child’s additional needs. By fostering inclusive environments, schools can minimise the disadvantages faced by children and young people with additional needs, enabling them to thrive academically and socially while waiting for formal recognition of their needs. With an increasing number of students requiring additional support, schools must adapt their curriculum and teaching strategies to meet the evolving demands of their communities. This proactive approach not only benefits students but also has the potential to ease pressure on health services, as effective, inclusive practices can address some needs within the school setting without the immediate need for external interventions. This aligns closely with the Department for Education (DfE) and OFSTED’s focus on inclusive mainstream education, highlighting the shared responsibility of schools and broader systems to create a supportive framework for all children.

At IMPOWER we have been supporting places and systems to build resilient and sustainable plans that get change made, and outcomes improved. To learn more about we can help you, please get in touch.

Blog jointly written by James Swaffield and Deborah Crossan