Education, Health and Care plans for children and young people with

Education, Health and Care plans for children and young people with Special Educational Needs and disability (SEND) A guide to the new process This guide should be viewed in Slide show mode. Links to external resources will only work if viewed on a computer with internet access. Press Return, PgDn, → or ↓ to move to the next page. Press PgUp, ↑ or ← to return to the previous page. Click on a tab to move to a different section. Press Home to return to this page.

Introduction The Children and Families Act introduces a new approach to securing the care needed by children and young people with special educational needs. This guide to the process is intended for any professional who supports children or young people, taking them through the steps in the EHC plan process, with links to important resources and information. The legislative framework 1. Special educational needs 2. Joint commissioning 3. Education, health and care planning 4. The EHC plan

The legislative framework - 1. Part 3 of the Children and Families Act 2014 introduces new arrangements for children and young people with SEN. A local authority in England and its partner commissioning bodies must make joint commissioning arrangements for the education, health and care provision to be secured for: • children and young people for whom the authority is responsible who have special educational needs, and; • children and young people in the authority’s area who have a disability. The partner commissioning body is the responsible commissioner of health services for the child (usually a clinical commissioning group, although NHS England will have commissioning responsibility for some children under section 3B of the National Health Service Act 2006). 1. Special educational needs 2. Joint commissioning 3. Education, health and care planning 4. The EHC plan

The legislative framework - 2. Joint commissioning arrangements must include arrangements for considering and agreeing the education, health and care provision reasonably required by children with SEN, including: • what education, health and care provision is to be secured and by whom; • what advice and information is to be provided about education, health and care provision, and how; • how complaints about education, health and care provision may be made and are to be dealt with; • procedures for ensuring that disputes between the parties to the joint commissioning arrangements are resolved quickly. The arrangements must in particular include arrangements for— . • securing EHC needs assessments; • securing the education, health and care provision specified in EHC plans; • agreeing personal budgets. 1. Special educational needs 2. Joint commissioning 3. Education, health and care planning 4. The EHC plan

1. Special educational needs 2. Joint commissioning 3. Education, health and care planning 4. The EHC plan

1. SEND SEN and disability A child or young person has SEND if he or she has a learning difficulty or disability which calls for special educational provision to be made for him or her. A child of compulsory school age or a young person has a learning difficulty or disability if he or she — - has a significantly greater difficulty in learning than the majority of others of the same age, or - has a disability which prevents or hinders him or her from making use of facilities of a kind generally provided for others of the same age in mainstream schools or mainstream post-16 institutions. A child under compulsory school age has a learning difficulty or disability if he or she is likely to be within the above categories (or would be likely to be if no special educational provision were made). 3. EHC planning 4. The EHC plan 2. Joint commissioning

1. SEND Prevalence of SEN and disability It is estimated that in 2010/11, around 6 per cent of children aged 0-15 were disabled - this is around 600,000 children in England. (Source: Family Resources Survey, DWP) In January 2012, around 66,200 children in all schools (around 1%) were identified as having a Special Educational Need due to Autistic Spectrum Disorder. (Source: Children with special educational needs: an analysis - 2012, DfE) Other estimates agree that the estimated prevalence of autism spectrum conditions are between 1-2% of the child population, which includes previously undiagnosed cases. (Source: Prevalence of autism-spectrum conditions: UK school-based population study – Baron-Cohen, Scott, Allison et al., 2009 3. EHC planning 4. The EHC plan 2. Joint commissioning

1. SEND Prevalence of SEN and disability – local information The Child and Maternal Health Intelligence Network – part of Public Health England - provides tools to help understand local needs. http://www.chimat.org.uk/disability Service Snapshot - Disability provides a summary of demand, provision and outcomes for services in a particular area. It combines data from ChiMat and the Children’s Services Mapping programme. Needs Assessment Report - Children and young people with disabilities provides evidence-based information on prevalence, incidence and risk factors affecting children’s health and the provision of healthcare services, for: - Child and adolescent mental health (CAMHS) for local authorities and CCGs updated - Children and young people with disabilities for local authorities - Speech and language impairment for local authorities 3. EHC planning 4. The EHC plan 2. Joint commissioning

1. SEND Why is reform needed? • Parents have struggled to find the services that should be helping them. • They have to battle to get the help their children need, and have to tell their stories time and again to different people across health, education, social care. • Moving from children’s to adults’ services can be very difficult. • English local authorities spend over £5 billion a year on SEND provision, and yet those with special needs are far more likely to achieve poorly at GCSE, Not be in Education, Employment or Training, or be unemployed. • The 2011 Green Paper Support and aspiration: a new approach to special educational needs and disability proposed a new approach to joint commissioning for children with SEND in 2011. 3. EHC planning 4. The EHC plan 2. Joint commissioning

1. SEND The aim of the reforms We want children and young people with special needs and disabilities to achieve well in their early years, at school and in college;find employment; lead happy and fulfilled lives; and have choice and control over their support. The special needs reforms will implement a new approach which seeks to join up help across education, health and care, from birth to 25. Help will be offered at the earliest possible point, with children and young people with SEND and their parents or carers fully involved in decisions about their support and what they want to achieve. This will help lead to better outcomes and more efficient ways of working. 3. EHC planning 4. The EHC plan 2. Joint commissioning

1. SEND The new approach • New requirement for LAs, health and care services to commission services jointly for SEN and disability; • LAs to publish a clear, transparent ‘local offer’ of services; • More streamlined assessment process, co-ordinated across education, health and care; • New 0-25 Education, Health and Care Plans for those with more complex needs; • New statutory protections for young people aged 16-25 in FE • A new duty on health commissioners to deliver the agreed health elements of EHC plans; • The option of a personal budget for families and young people with an EHC plan. • A phased transition for those already with Statements and Learning Difficulty Assessments, taking place over time. 3. EHC planning 4. The EHC plan 2. Joint commissioning

1. SEND SEND Pathfinders Groups of local authorities (‘Pathfinders’) have been piloting new approaches to joint commissioning for SEN for several years, generating a considerable body of learning for all local authorities on the workforce development and the cultural and organisational change needed to implement the reforms of the Children and Families Act. In 2014, a number of current Pathfinders applied to be SEND Pathfinder Champions, for both regional and national roles). An implementation pack outlines the vision for the reforms and contains useful information for strategic leaders. Further information and case studies, together with details of the Pathfinder Champions available in every region, can be found at www.sendpathfinder.co.uk If you want to contact your regional champion please email Mott MacDonald on: pathfinder@mottmac.com or call 020 7651 0308. 3. EHC planning 4. The EHC plan 2. Joint commissioning

2. Joint commissioning 1. Special educational needs 3. Education, health and care planning 4. The EHC plan

2. Joint commissioning Joint commissioning: the key to improving outcomes Children with complex conditions or disability commonly have to access different agencies, across different sectors, including education and social care, and poor communication and record sharing and disjointed services. This results in parents having to repeat their story to many different professionals, considerable duplication of effort, and the risk of children failing to access all of the services they need. Find a path through such a fragmented system places a severe strain on the resources of the severely ill-child and their family. Section 26 of the Children and Families Act 2014 requires local authorities and partner commissioning bodies to commission services jointly for children and young people with SEN and disabilities, including those without Education Health and Care Plans. 3. EHC planning 4. The EHC plan 1. SEND

2. Joint commissioning From September 2014 CCGs must work with LAs to: • commission services jointly for 0-25 year old children and young people with disabilities and SEN, including those with Education Health and Care(EHC) plans; • ensure that procedures are in place to agree a plan of action to secure provision which meets a child or young person’s reasonable health need in every case; • work with the local authority to contribute to the local offer; • ensure that mechanisms are in place to ensure practitioners and clinicians will support the integrated Education Health and Care Assessment within a 20 week maximum; • agree personal budgets under section 49 of the Children and Families Act. 3. EHC planning 4. The EHC plan 1. SEND

2. Joint commissioning Working together While local authorities will lead the local SEN arrangements, their CCGs are key partners. CCGs will need to ensure they have a strong relationship with their local authorities which can provide a basis for joint working to secure SEN services. The CCG and local authority may will wish to consider formal joint arrangements, and appropriate governance, including accountability to the CCG governing body and executive. Section 75 of The National Health Service Act 2006 supports joint working between local authorities and health bodies. The arrangements cover lead commissioning, joint management of provision and pooled budgets. Any partnership arrangement needs to be covered by a signed agreement between the partners, and partners must undertake consultation with people that would be affected by such arrangements when developing a section 75 agreement. 3. EHC planning 4. The EHC plan 1. SEND

2. Joint commissioning CCG role • CCGs must have: • a designated health officer or officers, who can ensure the CCG exercises its statutory responsibilities in relation to SEN; • designated capacity to participate in the development the local offer, and EHC plan process, and in particular, supporting delivery of EHC assessment processes within the 20 week maxima (which may be drawn from commissioning support); • clear oversight of the participation of their contracted providers in contributing to EHC assessments, and a mechanism for considering commissioning requests for high-cost, interventions; • a mechanism for addressing complaints, including patient liaison, and appropriate integration. 3. EHC planning 4. The EHC plan 1. SEND

2. Joint commissioning Designated medical / clinical officer Each CCG should have a designated medical / clinical officer (usually a community paediatrician, although there is flexibility for the role to be undertaken by nurse or other clinician). The DMO /CO supports the CCG in meeting its statutory responsibilities in relation to SEN. The DMO / CO provides the main point of contact for local authorities, schools and colleges seeking health advice on children and young people who may have SEN, and contact for CCGs or healthcare providers to make appropriate notification to the local authority of children believed to have SEN. Several CCGs may share a DMO / CO. 3. EHC planning 4. The EHC plan 1. SEND

2. Joint commissioning The local offer The local offer is the name given to the range of services which are locally available for a child with special educational needs or disability. It captures the key services which are commissioned across health, social care and education. Each local authority will publish clear, comprehensive and accessible information about these services, including information on how they are accessed, eligibility criteria etc. The local offer is more than just a list or directory of services, as the local authority and its partners, including CCGs, should involve children and young people with SEND, parent carers, and service providers in its development and review. 3. EHC planning 4. The EHC plan 1. SEND

2. Joint commissioning The local offer The JSNA / JHWBS informs the local offer; individual EHC plans draw on the services in the offer. 3. EHC planning 4. The EHC plan 1. SEND

2. Joint commissioning The local offer North Yorkshire County Council has produced an interactive map of the services which comprise the local offer. Click on the image below to explore. 3. EHC planning 4. The EHC plan 1. SEND

2. Joint commissioning Parent Carer Forums In each local authority there is a parent carer forum, whose membership is made up of parents of children with a range of disabilities and complex conditions, working in partnership with strategic leads, service providers and commissioners to improve the services across health, education and social care that their children access. Parent carer forums can also work with commissioners and providers to reach disabled children and young people to make sure their views are heard, and make sure services meet their children’s needs and help commissioners monitor how well these services are being provided. Forresourceson parent participation and contact details for every local parent carer forum, see www.cafamily.org.uk/parentcarerparticipation 3. EHC planning 4. The EHC plan 1. SEND

2. Joint commissioning Code of Practice The Code of Practice is the statutory guide to the EHC process and covers all the legal requirements and important good practice. Click on the title page to link to the full Code 3. EHC planning 4. The EHC plan 1. SEND

3. Education, health and care planning 1. Special educational needs 2. Joint commissioning 4. The EHC plan

3. EHC planning The CCG role in EHC planning Relevant local clinicians, such as community paediatricians, will participate in the development of the child’s or young person’s EHC plan, advising on the child’s needs and the provision appropriate to meet them. CCGs mustensure that commissioned services are mobilised to participate in the development of EHC plans. The CCG as commissioner will often have a limited involvement in the process (as this will be led by clinicians from the services they commission) but they mustensure that there is sufficient oversight to provide assurance that the needs of children with SEN are being met in line with their statutory responsibility. The CCG will have a more direct role in considering the commissioning of a service that does not appear in the Local Offer to meet the complex needs of a specific individual, or in agreeing a Personal Budget. 4. The EHC plan 1. SEND 2. Joint commissioning

3. EHC planning Co-ordinated assessment The co-ordinated assessment and EHC planning process should: • promote a “tell us once” approach to sharing information wherever possible; • put children, families and young people at the centre of the process; • have effective co-ordination between education, health and care services, with joint agreement on key outcomes; • include consideration of a step down process for children/young people who do not have plan following assessment or who do not meet the criteria for an assessment; 4. The EHC plan 1. SEND 2. Joint commissioning

3. EHC planning A speedier process The whole process, from initial request to issuing the final EHC plan, should take no longer than 20 weeks. A more detailed diagram is on the next slide. 16 wks 20 wks 6 wks LA notification that plan will not be issued following assessment Final plan Assessment and planning Initial request for an EHC needs assessment LA response to request Contributors to planning must respond within 6 weeks of request for information 4. The EHC plan 1. SEND 2. Joint commissioning

3. EHC planning 6 wks 16 wks Plan finalised 20 wks

3. EHC planning Who might contribute to the EHC plan ? Community paediatricians, therapists, nurses Schools, or early year settings Parents and family The child or young person and family Designated staff for looked-after children Social workers, care workers Educational psychologists 4. The EHC plan 1. SEND 2. Joint commissioning

3. EHC planning Involving the child and their family • Children, young people and families should experience well co-ordinated assessment and planning leading to timely, well-informed decisions. • Local authorities must consult the child and the child’s parent or the young person throughout the process of assessment and production of an EHC plan, and families should be closely involved in the process, by: • being provided with access to the relevant information in accessible formats; • given time to prepare for discussions and meetings, and • being allowed dedicated time in discussions and meetings to hear their views. • Some young people and their families will receive advocacy support. 4. The EHC plan 1. SEND 2. Joint commissioning

3. EHC planning Co-ordinating the EHC plan process • The process of EHC assessment and planning will be led by the local authority. An effective, co-ordinated assessment will need a clear plan to ensure everyone who needs to contribute can do so. • Logistical issues include: • planning the process to meet the needs of children, parents and young people; • timing meetings to minimise family disruption, and to allow for professional schedules; • keeping the child’s parent or young person informed through a single point of contact wherever possible and; • ensuring relevant professionals have sufficient notice to be able to contribute to the process . Click here to link to Southampton City Council’s EHC process. Click here to link to Cornwall County Council’s Pathway for 16-19 year olds . 4. The EHC plan 1. SEND 2. Joint commissioning

3. EHC planning Health professionals • There is potentially a wide range of professionals who may need to input to the development of an EHC plan for children and young people with SEN, ranging from community paediatricians, to physiotherapists and nurses. • The local authority will need to work with their partners, to make sure they have considered as part of their joint arrangements: • the range of professionals across education, health and care who need to be involved and their availability; • flexibility for professionals to engage in a range of ways and to plan their input as part of forward planning; • providing opportunities for professionals to feed back on the process, and its implementation, to support continuous improvement. 4. The EHC plan 1. SEND 2. Joint commissioning

4. The EHC plan 1. Special educational needs 2. Joint commissioning 3. Education, health and care planning

4. The EHC plan The role of the EHC plan • At the heart of the new arrangements for children with SEN is the EHC plan, which replaces the current Statement. • The plan captures: • the child or young person’s special educational needs and any health and social care needs; • the services which the relevant commissioners intend to secure; • the outcomes which they will aim to deliver, based on the child or young person’s needs and aspirations. • Like a Statement, an EHC is a statutory document: a local authority must secure the specified special educational provision for the child or young person. • If the plan specifies health care provision, the responsible commissioning body – usually a CCG - must arrange the specified health care provision for the child or young person. 1. SEND 3. EHC planning 2. Joint commissioning

4. The EHC plan What the EHC plan should cover EHC plan checklist EHC plans should be: clear, concise, readable and accessible to parents, children, young people and practitioners specific on special educational The format of an EHC plan will be agreed locally. However the plan must contain the sections listed here, identified by their letter. Click on a section to find out more. A. Views, aspirations B. SEN needs C. Health needs D. Social care needs E. Outcomes F. SEN provision G. Health provision H. Social care provision I. Placement J. Personal budget. K. Advice and information 1. SEND 3. EHC planning 2. Joint commissioning

4. The EHC plan What the EHC plan should cover A. Views, interests and aspirations of the child or young person, and their parents B. SEN needs B. SEN needs • The child or young person’s aspirations and goals for the future • Play, health, schooling, independence, friendships, further education and future plans including employment (where practical) • How to communicate with the child or young person and engage them in decision-making • The child or young person’s history C. Health needs C. Health needs D. Social care needs D. Social care needs E. Outcomes E. Outcomes F. SEN provision F. SEN provision G. Health provision G. Health provision H. Social care provision I. Placement I. Placement J. Personal budget. J. Personal budget. K. Advice and information. K. Advice and information. 1. SEND 3. EHC planning 2. Joint commissioning

4. The EHC plan What the EHC plan should cover A. Views, aspirations B. The child or young person’s special educational needs (SEN) • All of the child or young person’s identified special educational needs must be specified • SEN may include needs for health and social care provision that are treated as special educational provision because they educate or train the child or young person C. Health needs D. Social care needs E. Outcomes F. SEN provision G. Health provision H. Social care provision I. Placement J. Personal budget. K. Advice and information. 1. SEND 3. EHC planning 2. Joint commissioning

4. The EHC plan What the EHC plan should cover A. Views, aspirations C. The child or young person’s health needs which relate to their SEN B. SEN needs • The EHC plan must specify any health needs identified through the EHC needs assessment which relate to the child or young person’s SEN. Some health care needs, such as routine dental health needs, are unlikely to be related • The CCG may also choose to specify other health care needs which are not related to the child or young person’s SEN (for example, a long-term condition which might need management in a special educational setting). D. Social care needs E. Outcomes F. SEN provision G. Health provision H. Social care provision I. Placement J. Personal budget. K. Advice and information. 1. SEND 3. EHC planning 2. Joint commissioning

4. The EHC plan What the EHC plan should cover A. Views, aspirations D. The child or young person’s social care needs which relate to SEN B. SEN needs • The EHC plan must specify any social care needs identified through the EHC needs assessment which relate to the child or young person’s SEN or which require provision for a child or young person under 18 under section 2 of the Chronically Sick and Disabled Persons Act 1970 C. Health needs E. Outcomes F. SEN provision G. Health provision H. Social care provision I. Placement J. Personal budget. K. Advice and information. 1. SEND 3. EHC planning 2. Joint commissioning

4. The EHC plan What the EHC plan should cover A. Views, aspirations E. The outcomes sought for the child or young person B. SEN needs • A range of outcomes over varying timescales, covering education, health and care as appropriate • Steps towards meeting the outcomes, arrangements for monitoring progress • Forward plans for key changes in a child or young person’s life, such as changing schools, moving from children’s to adult care and/or from paediatric services to adult health, or moving on from further education to adulthood C. Health needs D. Social care needs F. SEN provision G. Health provision H. Social care provision I. Placement J. Personal budget. K. Advice and information. 1. SEND 3. EHC planning 2. Joint commissioning

4. The EHC plan What the EHC plan should cover A. Views, aspirations F. The special educational provision required by the child or young person B. SEN needs • Provision must be detailed, specific and quantified, e.g. the type, hours and frequency of support / level of expertise • Provision must be specified for each and every need specified in section B. It should be clear how the provision will support achievement of the outcomes • Health or social care provision which educates or trains a child or young person must be treated as special educational provision and included in Section F C. Health needs D. Social care needs E. Outcomes G. Health provision H. Social care provision I. Placement J. Personal budget. K. Advice and information. 1. SEND 3. EHC planning 2. Joint commissioning

4. The EHC plan What the EHC plan should cover A. Views, aspirations G. Any health provision required by the child or young person B. SEN needs • Provision should be detailed and specific and should normally be quantified, for example, in terms of the type of support and who will provide it • It should be clear how the provision will support achievement of the outcomes, including the health needs to be met and the outcomes to be achieved through provision secured through a personal (health) budget • For more information on possible health services to be included, click HERE C. Health needs D. Social care needs E. Outcomes F. SEN provision H. Social care provision I. Placement J. Personal budget. K. Advice and information. 1. SEND 3. EHC planning 2. Joint commissioning

4. The EHC plan What the EHC plan should cover A. Views, aspirations H. Social care provision B. SEN needs • Section H1 of the EHC plan must specify all social care services needed for a disabled child or young person under section 2 of the Chronically Sick and Disabled Person’s Act 1970 , such as practical assistance in the home and non-residential short breaks • Section H2 includes social care services not covered by the CSDP, such as residential short breaks C. Health needs D. Social care needs E. Outcomes F. SEN provision G. Health provision I. Placement J. Personal budget. K. Advice and information. 1. SEND 3. EHC planning 2. Joint commissioning

4. The EHC plan What the EHC plan should cover A. Views, aspirations I. Placement B. SEN needs • The name and type of the school, maintained nursery school, post-16 institution or other institution to be attended by the child or young person and the type of that institution (or, where the name of a school or other institution is not specified in the EHC plan, the type of school or other institution to be attended by the child or young person). C. Health needs D. Social care needs E. Outcomes F. SEN provision G. Health provision H. Social care provision J. Personal budget. K. Advice and information. 1. SEND 3. EHC planning 2. Joint commissioning

4. The EHC plan What the EHC plan should cover A. Views, aspirations J. Personal budget (including arrangements for direct payments) B. SEN needs • This section should provide detailed information on any Personal Budget that will be used to secure provision in the EHC plan • It should set out the arrangements in relation to direct payments as required by education, health and social care regulations • The special educational needs and outcomes that are to be met by any direct payment must be specified C. Health needs D. Social care needs E. Outcomes F. SEN provision G. Health provision H. Social care provision I. Placement K. Advice and information. 1. SEND 3. EHC planning 2. Joint commissioning

4. The EHC plan What the EHC plan should cover A. Views, aspirations K. Advice and information B. SEN needs • The advice and information gathered during the EHC needs assessment must be set out in appendices to the EHC plan. There should be a list of this advice and information. C. Health needs D. Social care needs E. Outcomes F. SEN provision G. Health provision H. Social care provision I. Placement J. Personal budget. 1. SEND 3. EHC planning 2. Joint commissioning

4. The EHC plan Health services in the EHC plan • Health care provision reasonably required may include: • speech and language therapy; • occupational therapy, physiotherapy, arts therapies; • wheelchair services and community equipment; • children’s community nursing; • continence services; • palliative and respite care and other provision for children with complex health needs • other services, such as emergency care provision and habilitation support; • provision for children and young people’s continuing care arrangements; • support for young people when moving from healthcare services for children to healthcare services for adults. To return to section G. Health provision click here 1. SEND 3. EHC planning 2. Joint commissioning

4. The EHC plan EHC plan outcomes An outcome can be defined as the “benefit or difference made to an individual as a result of an intervention”. An outcome is not a description of the service being provided e.g. ‘three hours speech and language therapy’ is not an outcome. The EHC plan should capture not only the range of services which the child or young person will be receiving, but also the specific outcomes which the services will deliver. The plan is only truly person-centred, if it describes what success looks like in terms of the child’s experience and abilities. The child’s aspirations, captured in section A of the plan might provide a context for setting outcomes, but the plan actions should be focused on more immediate deliverables. 1. SEND 3. EHC planning 2. Joint commissioning

4. The EHC plan Examples of EHC plan outcomes Emma will achieve level 1c in reading, writing and maths this year Toby will be able to use the toilet independently by July 2016. Jamie will be able to demonstrate understanding of basic feelings and emotions (i.e. happy, sad, angry, tired, excited, anxious) through body language, facial expression and pictorial representations. Alice will complete a course in computer skills 1. SEND 3. EHC planning 2. Joint commissioning

4. The EHC plan Examples of EHC plans Click on the documents below to explore examples of EHC plans developed by Pathfinders Nottinghamshire and Southampton. 1. SEND 3. EHC planning 2. Joint commissioning

Education, Health and Care plans for children and young people with