Agenda item

In accordance with the statutory duties and powers given to the Health and Wellbeing Board by the Health and Social Care Act 2012, the Board’s terms of reference in Hammersmith & Fulham’s constitution this report provides oversight of the development and use of the Joint Strategic Needs Assessment (JSNA) by the Council and the H&F Clinical Commissioning Group (CCG).

Jo Baty presented the report on behalf of Mandy Lawson, Assistant Director of SEND. The JNSA (Joint Strategic Needs Assessment) was formulated and published in 2017, just as the Council left the shared services arrangement.    It was reported that the outline data was broadly the same with 16% of the population with special educational needs (SEN). It was difficult to capture data due to missing information and difficulties in drawing comparisons due to the differences in cohorts. 

In terms of speech, language and communication needs it was important to note that the way in which schools captured SEN data was based on presented need. For example, a child with SEN may be autistic, with mental health issues and physical disabilities, so the data was one-dimensional.  62%* of EHC (educational health care plans) were conducted in 2018, with only 8 not carried out.  The data was significant and one that the service was very proud of.  This was highlighted in the inspection report and indicated a huge improvement. 

ACTION: *Exact data about ECH plans to be circulated.

It was explained that the relationship with the CCG was not as well embedded as it could have been at the time, but the inspection report identified a strong working relationship with the CCG and parents, so this was also welcome news.  There was also an improved local offer accessible on the Council website for 0-25-years SEND.  A young person had just been appointed to lead work on co-production to co-produce a SEND pathway.  There was a large transition team in place, appointed in line with the transition report recommendations.  This had been in place for one year but there was considerable progress to be made.  In terms of post 16 pathways, it was reported that they were working with West London College to develop these in more detail. 

There was a focus on early intervention and prevention, mental health wellbeing and joint working with CCG colleagues.  They were also considering how to fund mental health pathways and how this work could properly support young people at risk.  The speech and language SEND team was well established and further information about this was available. There were some excellent special schools in the Borough, and it would be interesting to identify if SEND arose within the local cohort or was imported, with many those with SEND moving into the area attracted by the local offer. On transitioning to a sovereign service, Jo Baty highlighted the need for more data and research, and they were fortunate to now have in place a team that offered a high standard of business intelligence. 

Keith Mallinson asked how it would be possible to identify those with SEND in main stream schools as it was difficult to do this.  Jo Baty explained that they worked with teachers and the wider education service.  It was anticipated that a child may not meet the EHC threshold but may still have SEND requirements.  It was confirmed that they were working to develop this further and welcomed the fact that experienced and committed staff had been attracted to working in the borough because of the innovative transitions and SEND collective approach to services.

It was noted that continuity of care for a child with SEN was essential. Some parents did not see the value of coming to a GP practice with provision was made in a special school (if the child was enrolled in one).  It was important that the child was able to see the same GP or medical professional at the same practice so that they are familiar with both professionals and the surrounding environment. 

Jo Baty reported that a transitions conference was being organised by Parents Active. Alison Markwell had made a huge impact both pre and post inspection and this had helped refine the way the service worked.  Vanessa Andreae acknowledged that there remained difficulties in ensuring continuity of care, for example, ensuring long enough appointment time slots that could accommodate unintended late attendance.

The CCG had undertaken many workshops on how to deliver care to vulnerable patients and had worked with SEND colleagues to refine this.  Councillor Richardson highlighted that training should be made available to GP to help them communicate with vulnerable patients as this would help encourage take up at surgeries. Vanessa Andreae confirmed that this was not generally monitored but there had been a trajectory of improvement which she had noted through her work with five strong practices. 

With reference to data on page 5 of the report, clarification was sought about the number of those seeking an EHC plan and how many in the Borough already had one in place, highlighting the concern that parents may not be aware that their child might require an EHC plan.  Lisa Redfern assured the Board that take up within the Borough was high.  The Council worked closely with organisations such as Parents Active, undertook advocacy and support work and had received significant, positive feedback as a result. 

Jo Baty confirmed that the data on page 5 referred to children aged 3 and 4, and acknowledged that this was low, but the Borough had a significantly high number of children with EHC plans. The statutory time frame in which an EHC was required to be completed was a critical element, as was the number of children who were eligible.  This could potentially be cross referenced with the data held by GP practices.

Sue Spiller recounted how a vulnerable Somalian child within the criminal justice system had been targeted by gangs. The children were initially befriended (“mate” crime) and the family had struggled with trying to persuade police that the child had been a victim and not the perpetrator.

 Lisa Redfern commented that in terms of renegotiating the new CLCH contract, it was important that performance on Learning disability Health checks was improved to above 90% completed.

It was confirmed by Anita Parkin that the next expected update for the JNSA was within five years.  It would be helpful to consider specific pieces of work and plan priorities so that they corresponded to expected outcomes.  It was also necessary to demonstrate how this would inform policy and it would be helpful for the Board to understand how this was done. A six-month update would be provided to the Board and it was agreed that CLCH would be invited to contribute to further discussions about this and learning-disabled health checks. Vanessa Andreae pointed out that learning disabled health checks were primarily conducted by primary care so there was an issue around access to patient records because of the lack of integration between information technology systems. 

In welcoming this encouraging report and drawing the discussion to a close, Councillor Coleman supported Councillor Richardson’s view that it was often difficult for a young person to access GP care and that it was important that barriers to accessing care be carefully explored and identified.  There was a similar point about the difficulties for children with SEN in accessing main stream schools.  Councillor Coleman recognised that this required further work to understand how the Council could be more effective and asked that this also be explored in the six-month report.

ACTION: JNSA update report to be provided in six months (May/June 2020), to include input from CLCH who would be invited to participate.

ACTION: Details about the conference on autism to be circulated to Board members