outcomes based commissioning and the send reforms · outcomes based commissioning. rba is described...

Outcomes Based Commissioning and the SEND Reforms

BACKGROUND, PROCESS AND IMPACT

As part of the Delivering Better Outcomes

Together (DBOT) contract, funded by the

Department for Education, the Council for

Disabled Children (CDC) has supported

a number of local areas to progress their work

on outcomes based commissioning (OBC).

This document includes:

What is Outcomes Based Commissioning?

Mark Friedman’s Results Based Accountability

How does OBC relate to the SEND Reforms?

What are the anticipated benefits of an OBC

approach?

What does a Strategic Outcomes framework

look like?

How has CDC been supporting the

development of strategic outcomes

frameworks?

What is the impact of CDC’s work with

local areas?

Useful resources

Introduction

2

Outcomes Based Commissioning (OBC) is an

approach that is increasingly being adopted by

Local Authorities and Clinical Commissioning

Groups (CCGs), wherein services come

together to develop a series of commissioning

arrangements that are underpinned by the

measurement of progress towards a set of

shared outcomes.

Central to this process is the identification

and co-production of a set of shared outcomes

that are underpinned by robust quantitative

and qualitative data, which allow commissioners

and service leaders to continually evaluate

the performance of their services and inform

the local area’s approaches to commissioning

services for children and young people

with SEND.

A local area’s journey towards outcomes based

commissioning typically progresses through the

following five stages. Working in co-production

with families and professionals, senior leaders

from the local area:

1 Invite children, young people and parent

carers to share their experiences of the SEND

reforms. In co-production, the local area then

updates its local SEND strategy and agrees a

new strategic vision.

2 Bring together strategic leads, professionals,

children, young people and families to agree a

meaningful set of core outcomes.

3 Identify how these outcomes will be

measured across the whole system using

relevant indicators to identify progress

towards achieving the outcomes.

4 Consider how the workforce and digital

technology can support the delivery of this

framework.

5 Develop an outcomes based contracting

model to promote collaborative working

between multiple providers and achieving the

holistic outcomes.

e.g. through Alliance based Contracting

For more detail, please see CDC’s Joint

Commissioning Bulletin #3.

What is Outcomes Based Commissioning?

3

Fig.1: A typical approach to outcomes based

commissioning, in five stages

Build trust and

establish a new

strategic

partnership.

Through

co-production agree

a strategic vision.

Agree a set

of outcomes that

are meaningful

for patients, carers

and clinicians

within a defined

population group.

Agree a model

of care that

will achieve the

outcomes and how

the outcomes will

be measured.

Identify

implications

for the workforce

and how digital

technology

can support the

delivery of the

model

Undertake financial

modelling and

agree outcome

based contracting

model

https://councilfordisabledchildren.org.uk/sites/default/files/field/attachemnt/Case%20study%20Camden%202018.pdf

https://councilfordisabledchildren.org.uk/sites/default/files/field/attachemnt/Joint%20commissioning%20bulletin%203.pdf

https://councilfordisabledchildren.org.uk/sites/default/files/field/attachemnt/Joint%20commissioning%20bulletin%203.pdf

Mark Friedman’s Results-Based Accountability

Mark Friedman’s Results Based Accountability

(RBA) model acts as an enabler for this work,

and can support a local area’s approach to

outcomes based commissioning. RBA is

described as follows:

“a disciplined way of thinking and taking action that communities can use to improve the lives of children, youth, families, adults and the community as a whole… a data-driven, decision-making process to help communities and organizations get beyond talking about problems to taking action to solve problems.”

Friedman’s approach shifts the focus from

outputs (‘what did we do?’) to outcomes

(‘what did we achieve?’), by asking three key

questions:

• How much did we do?

• How well did we do it?

• Is anybody better off?

For example:

Friedman’s model already supports existing

NHS England & Improvement approaches to

commissioning for outcomes, focusing less

on their treatment and more on how well

patients feel after treatment, and helping them

to stay well.

How does OBC relate to the SEND Reforms (Children and Families Act 2014)?

The SEND Code of Practice refers to shared

outcomes as a legal ‘should’; i.e. not

mandatory in the same way as a ‘must’, but

nevertheless highly recommended:

“Local partners should identify the outcomes that matter to children and young people with SEN or disabilities to inform the planning and delivery of services and the monitoring of how well services have secured those outcomes.”

0-25 SEND Code of Practice

An OBC approach enables a local area to

approach this systematically and rigorously.

However, a strategic outcomes framework

does not need to be SEND specific as the

outcomes resonate with all children and

young people. Some local areas supported by

CDC started out with a SEND focus, with the

intention to expand to universal once good

progress has been made with operationalising

the outcomes in a SEND context. Others

have begun with the intention of developing

universal outcomes from the start.

4

What are the anticipated benefits of using an OBC approach?

There are many benefits to an OBC approach

for all stakeholders:

CYP’s and families’ wishes are kept front

and centre.

Good co-production of the outcomes gives

parent carers and CYP a meaningful role

in strategic processes, and their views are

established at the heart of commissioning

decisions.

Improves trust between families, professionals

and strategic leads.

The process of developing a strategic outcomes

framework is an excellent opportunity to bring

partners together and focus on improving lives

for children and young people.

Promotes holistic view of the child

The focus is on supporting families to live

fulfilling lives rather than focusing on specific

conditions or disabilities.

Clear, shared vision for professionals

Professionals across the piece see their role as

part of the bigger picture in children’s lives and

are motivated by this. Communication and joint

working is also likely to improve.

Focus on lived experience rather than delivery

of services

Monitoring extends from ‘what did we do?’ to

‘is anybody better off?’.

Promotes evidence-based commissioning

Montoring takes into account which services/

interventions are most effective and make

the greatest difference in families’ lives, which

promotes learning and sharing. Less

effective services can also be identified and

re- or de-commissioned. This promotes efficacy

and efficiency.

What does a Strategic Outcomes framework look like?

There is no ‘correct’ model for an outcomes

framework and different local areas' frameworks

look very different. Local ownership is one of

their key strengths, encouraging buy in across

the area. That said, they do have similarities,

and overall paint a picture of what a fulfilling,

meaningful life looks like for a child or young

person.

Here are some examples:

• Hertfordshire’s Outcomes Bees

• Leeds’ Obsessions

• Essex’s Children and Young People’s Plan

5

https://councilfordisabledchildren.org.uk/sites/default/files/field/attachemnt/Case%20study%20Hertfordshire%202018.pdf

https://www.leeds.gov.uk/childfriendlyleeds/Documents/CMT18-022%20Childrens%20and%20YP%20Plan%2018-23.pdf

https://assets.ctfassets.net/knkzaf64jx5x/4OOGZ7uXB250hzMXxlpdZy/0f72af8ac07a7616b6420fd8f88dbe5d/YOUNG_PEOPLES_PLAN.pdf

CDC has developed a programme of support

for OBC based on these principles, emphasising

that successful joint commissioning is defined

by a local area putting the improvement of

outcomes for children and young people at

the centre of its commissioning approach.

We deliver workshops which bring together

strategic leaders, parent carer representatives,

multi-agency professionals and (on occasion)

children and young people to develop and

implement strategic outcomes frameworks.

In summary, the approach is as follows:

1. Work with local leaders to identify any

existing frameworks in the local area which

may act as a springboard.

2. Deliver a full day workshop with multi-

agency attendees (including parent carer

representatives) to:

a. Provide an overview of OBC.

b. Share examples of existing good practice

from other areas.

c. Develop draft outcomes statements for the

local area OR adapt existing frameworks as

necessary.

d. Identify opportunities and action plan

for further consultation on the draft

statements, including with children and

young people.

e. Begin thinking about indicators and impact

data measurement by identifying existing

data sources and known data gaps.

f. Action planning for next steps.

3. (Optional) Deliver a half day follow-up

workshop to:

a. Confirm the draft outcomes statements.

b. Progress the data and impact measurement

work.

c. Identify actions for operationalising the

outcomes statements, for example in

contracting/ tendering and the EHC process.

Areas that we have supported or are continuing

to support with this approach include:

• Stockport

• Southend

• East Sussex

• Oldham

• Kent

• London Borough of Sutton

• London Boroughs of Kingston and Richmond

A more in-depth explanation of this journey,

along with a case study from Stockport, can

be found in our DBOT Webinar #2: Overview

and learning, with a focus on Outcomes Based

Commissioning.

There is also a write up of the Stockport case

study available here.

6

How has CDC been supporting the development

of Strategic Outcomes frameworks?

https://register.gotowebinar.com/recording/8871209862569839623



https://councilfordisabledchildren.org.uk/sites/default/files/uploads/Case%20study%20Stockport%202020_1.pdf

7

Leaders value the holistic nature of the

outcomes frameworks:

“These are commitments that everyone in Southend can sign up to; it needs to be a campaign and not a policy. We need to see it in schools, GPs and services so that wherever people go, we know what we want to achieve for children.”

Southend

Some parent carers involved in workshops now

view their own child’s future more positively,

and have increased trust in senior leaders:

“I am never normally allowed to think of my son as being able to be happy and have friends, because I am so bogged down in the fight for the basics. If we can all work towards this I think things will really change.”

East Sussex

Relationships and communication is improved

between different partners:

“The journey is in itself impactful, it has brought us together as partners across education, health and care and with our families to gain this joint shared understanding of what is really important to our families.”

Stockport

Impact of our work with local areas

Case studies:

Hertfordshire’s Outcome Bees

Camden’s Alliance Agreement

Stockport’s Outcomes Based Commissioning Journey

Council for Disabled Children, (2017) Joint commissioning bulletin: applying an outcome based

approach to commissioning

Council for Disabled Children webinars:

DBOT #1: Focus on JSNAs

DBOT #2: Focus on Outcomes Based Commissioning

DBOT #3: Overview of EHC & Outcomes training

Department for Education and Department of Health and Social Care (2015), Special Educational

Needs and Disability Code of Practice: 0 – 25 Years

Friedman, M. (2005) Trying Hard is Not Good Enough: How to Produce Measurable Improvements

for Customers and Communities

What is Results-Based Accountability™?

NHS England (2014) Commissioning for Effective Service Transformation: What we have learned

Useful Resources

8

https://councilfordisabledchildren.org.uk/sites/default/files/field/attachemnt/Case%20study%20Hertfordshire%202018.pdf

https://councilfordisabledchildren.org.uk/sites/default/files/field/attachemnt/Case%20study%20Camden%202018.pdf

https://councilfordisabledchildren.org.uk/help-resources/resources/updated-joint-commissioning-bulletins

https://councilfordisabledchildren.org.uk/help-resources/resources/updated-joint-commissioning-bulletins




https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/398815/SEND_Code_of_Practice_January_2015.pdf

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/398815/SEND_Code_of_Practice_January_2015.pdf

https://www.amazon.co.uk/Trying-Hard-Good-Enough-Anniversary/dp/1516971620/ref=sr_1_1?crid=BM95MOJA1Q7O&keywords=trying+hard+is+not+good+enough&qid=1585653345&sprefix=trying+hard%2Caps%2C135&sr=8-1







About the Council for Disabled Children

The Council for Disabled Children (CDC) is the umbrella body for the disabled children's sector with a membership of over 200 voluntary and community organisations and an active network of practitioners and policy-makers that spans education, health and social care. Their aim is to see a fully-inclusive society where disabled children and young people and those with special educational needs can lead full and happy childhoods and rewarding adult lives. They do this by working with the sector to find out what is and isn’t working on the ground and use what they learn to influence policy and improve practice.

CDC hosts the following networks and projects:

Early Years SEND Partnership

IASS Network

Making Ourselves Heard

Special Educational Consortium

The Information, Advice and Support Programme

Transition Information Network

CDC is proud to be part of the National Children’s Bureau (NCB), a leading children’s charity working to build a better childhood for every child.

CDC is also part of the consortium that delivers the Every Disabled Child Matters campaign.



CDC hosts the following networks and projects: Independent Support IASS Network Making Ourselves Heard Preparing for Adulthood Special Educational Consortium Transition Information Network


INTEGRATING SERVICES FOR DISABLED CHILDREN 11

Over the past decade, successive governments

have brought in a range of legislation, policies

and programmes in an attempt to deliver on

a vision of coordinated, person-centred care

and better outcomes for children and young

people with SEND. However, despite this visible

drive towards integration, the system around

SEND remains fragmented.

Following consultation with education, health

and care professionals and parent carers

in three local authority areas, this report

considers why the task of integrating the

design and delivery of services around SEND is

proving so challenging. It also identifies the key

factors enabling or hindering progress.

Local authority and NHS commissioners are

compelled to integrate services by a range

of legislation and national programmes. The

desire to address the role of wider, external

factors in determining our health and

wellbeing, has additionally led to efforts to

coordinate across whole ‘population health

systems’ (Alderwick, Ham, & Buck, 2015). This

approach is especially relevant to children and

young people with SEND who are likely, not

only to access a range of services across health,

education and social care in relation to their

SEN or disability, but are also more likely to

belong to other vulnerable groups.

However, we know that in practice the reality of

integrated working between different services

and agencies, such as NHS and local authority

services, children’s and adults’ services and

specialist and universal services, is challenging.

The many services accessed by children

and young people with SEND are subject

to different legislation, funding models and

accountability mechanisms that drive different

organisational priorities. This means that in

reality most initiatives trialling more integrated

systems have focussed on adults where only

health and social care need to be integrated.

Introduction Context: policy and practice

12 INTEGRATING SERVICES FOR DISABLED CHILDREN

Figure 1. The system around Child Health

INTEGRATING SERVICES FOR DISABLED CHILDREN 1312 INTEGRATING SERVICES FOR DISABLED CHILDREN


Further details of our methodology are

included in the appendix of the full report.

Our conclusions are based on research into

the organisation and delivery of services for

children and young people with SEND in

three areas in England, each working within a

different geographic and demographic context.

NB: Local areas have been anonymised. This

enabled participants to be frank and open

about their practice.

In total, we engaged with 74 professionals

representative of a range of roles across

health, social care and special educational

needs services, and included parent carer

representatives. Data was analysed using NVivo

Framework Analysis software.

Our findings in these three local areas are

supported by evidence from our work with

local areas across the country and by our

analysis of the Ofsted and CQC inspection

reports into the progress of implementation of

the Children and Families Act 2014 reforms.

Methods

14 INTEGRATING SERVICES FOR DISABLED CHILDREN INTEGRATING SERVICES FOR DISABLED CHILDREN 15

Government policy – a lever and an obstacle

Local areas had been impacted by a number

of change programmes from the Department

for Education and NHS England. Where

national policy provided clear directives and

accountability that aligned to local area’s

priorities this was viewed as a helpful enabler

for organisations to coordinate their activity.

“I think people have seen the benefits…of the EHC plans and have now really bought into the idea that it does improve outcomes and it does help us to focus on the child more, rather than our own services and our agenda.” Area A

However in some cases national directives were

seen as unhelpful, where:

• pressure to implement change within tight

timescales and against a backdrop of stretched

resources risked compromising quality;

• the lack of join up between government

departments and NHS England in developing

and implementing change programmes,

hampered interagency working;

• national operational targets and reporting

requirements placed on different agencies and

services did not align.

In addition participants felt that the outcomes

universal services, especially schools, were

working towards and assessed on did not always

enable them to effectively include disabled

children and young people. This is supported by

data on exclusions from mainstream schools:

pupils with an Education, Health and Care plan

or a statement of special educational needs are

almost six times more likely to receive a fixed

period exclusion than pupils with no identified

SEN (Department for Education, 2017).

Resourcing issues

Increasing demand was a key concern in all

areas. Recent analysis commissioned by CDC

and the True Colours Trust has shown that the

numbers of children and young people with

complex needs or life-limiting conditions in

schools has increased by over 50% between

2004 and 2017. (Pinney, 2017).

Resource constraints were a consistent theme

in discussions with participants.

“…there isn’t enough money in the system to pay for all the care needs, and I'm thinking about children but this also applies in adults as well. And we know, we can see which care companies are going bust or not bidding for local authorities’ contracts because it’s not viable…” Area A

The figures on this are stark: local authorities

have seen a 49% real-terms reduction in

government funding between 2010-2018

(National Audit Office, 2018), whilst CCGs

began 2018/19 with an estimated underlying

deficit of £400-500m (King's Fund, 2018).

Findings of the report


Whilst participants acknowledged that

initially austerity had generated creativity and

supported a shift towards integrated working,

as the cuts continued, many felt that the

requirement to carry out further restructures

had undermined these benefits.

A number of participants explained that joint

working and joint commissioning had in

fact become more difficult as each partner

organisation turned their focus to managing

financial pressures. In two cases existing joint

funding arrangements had broken down.

“We actually had a fantastic service… we probably had one of the best speech and language therapy services delivered five years ago, because it was, a big chunk of funding came from the city council. I don’t think the council took that decision easily about taking the funding away for speech and language therapy.” Area A

Allocation of funding within health, where

the funding for children’s services is often

tied up in block contracts and all-age service

spending, was also a particular challenge, as

commissioners struggled to direct and even

distinguish spending on children. There was

a sense amongst some participants that as a

result children were often ‘left behind’, and did

not receive a fair share of health funding.

The role of leadership

Strategic leadership emerged throughout our

research as the single most important factor

in enabling or hindering joint working and

integration at local level. This was down to

local leaders’ power to set strategy, influence

organisational culture and support initiatives

that enable integration.

In those areas where they felt supported by

senior leadership, participants:

• had a more positive impression of local area

strategies and how these related to and could

frame their own work;

• were more confident of receiving support

when escalating issues and concerns. “we’ve got a very clear framework …my team plan fits within that ... So for us we’ve got to focus on the quality of education, health and care plan outcomes, looking at the attendance, looking at that, preparation for adulthood and making sure, therefore, that what we do every day is going to make that difference, so that bit for me is quite clear.” Area A


Conversely, in some areas local leaders

were felt to be one of the main barriers to

a more integrated approach. Their lack of

commitment was evidenced by a failure to

agree more formal processes for

working together.

“We’ve been looking at integrating our service with our colleagues in the community… this is a project that’s been ongoing for five years and I find it very difficult to get senior management to focus on any change.… I get the sense that people all think it’s a good idea but we’re not high enough on the priority level for it to be actually actioned. There’s always something else more pressing.” Area B

In the absence of such support and with

no formal arrangements, the majority

of participants referred to good working

relationships and shared cultural values as

the basis on which services and organisations

worked together.

However, this dependence on informal

relationships was recognised as a less

sustainable approach to integration as it could

falter with personnel changes. It also seemed

to lead to significant inefficiencies with

managers spending time agreeing individual

packages of care because an area wide

approach had not been agreed.

Data and information-sharing

Good quality data and effective information

sharing processes should aid integration

at both strategic and individual care level,

supporting areas to look at the ‘big picture’,

respond together as a system and achieve

strategic outcomes. However areas are held

back both by practical challenges and by

the traditional focus on specific services

and cohorts. Leadership has a role to play in

promoting work to overcome these barriers.

Population data was generally perceived as

poor and patchy and of limited usefulness

by participants. This is not only a local but a

national issue (Pinney, 2017).

Even where participants did have access

to good quality population data this did

not necessarily result in needs based

commissioning as it tended to inform a service

or agency rather than a local area approach.

“I think local authority data is very good, actually. So, for example, I was able to show that our percentage of children with the most complex needs, i.e., those with statements and plans, has increased by 50% over the last five years. …[as a result, ours] was the only department in the whole of the council that made a successful growth bid for staff last year.” Area B

Measuring progress against narrow, service-

specific targets was common practice but

felt, by all professionals, to be insufficient

in illustrating the impact public services

were having on families’ lives. All areas were

attempting to develop more effective methods

of measuring impact in a meaningful way.

However even where local areas had defined a

clear set of outcomes tracking their success in

achieving them was a significant challenge.


“…it’s hard, isn’t it…how do you measure when you’ve had a positive contribution, that you maybe helped to prevent … something deteriorate, that’s where we always struggle, to start to measure that. ” Area B

Participants were clear that the lack of a

joined up government approach to integration

around data added to the challenge of

measuring progress and outcomes in a

meaningful way.

Individual-level data and information

sharing processes, which enable different

organisations to share information

relating to individual children and young

people, were seen as a key enabling factor

for effective joint working and integrated

care. However, information sharing between

different services and agencies was proving

particularly difficult in all areas due to data

being held in multiple places, incompatible IT

systems and differing governance and security

arrangements between agencies.

Where information sharing processes had been

established arrangements were not always

successful once in place. In some cases this

appeared to be due to a failure to involve all

relevant colleagues in the development of the

new system or process, leading to low levels of

commitment to maintaining shared datasets.

A lack of formal processes increases pressure

on parents to coordinate information sharing

between the different professionals involved in

their child’s support.

“To be honest, the best solution I’ve seen so far is that highly motivated proactive parents actually keep all the data on their own iPad and bring it to every appointment.” Area B


Despite the challenges presented by the

system, there are a number of ways in

which local areas are working to overcome

this complexity and enable some level of

integration.

There are various forms and levels of

integration. Care can be integrated around

the individual, across multiple services or

system-wide; it may be low level - introducing

improved referral pathways and information

sharing processes between two teams - or

as high level as formally merging multiple

organisations.

We have come across various initiatives and

arrangements both through this research and

in our work with local areas across England. In

all cases, they appear to work best where they

are supported by senior leadership and a clear

strategic vision.

JOINT COMMISSIONING ARRANGEMENTS:

• Commissioners are increasingly coming

together to jointly commission roles which

support joint working – most notably the

Designated Clinical Officer for SEND role

(DCO).

• Participants felt that formal Section 75

Agreements make integration ‘harder to

walk away from’ and therefore increase

commitment to joint working.

• Commissioners can also support joint

working through committing to an

Outcomes-Based Commissioning (OBA™)

approach where commissioners task multiple

providers with delivering on the same key

outcomes.

• There are a number of innovative

contracting models that can support

outcomes-based commissioning, such as:

- Alliance Agreements, whereby different

providers who already have a contract

with a commissioner are brought together

to work towards shared outcomes for a

specific population. This model encourages

providers and commissioners to work

collaboratively.

- The Accountable Provider Model or

Prime Contractor Model, in which one

provider is commissioned to deliver an

integrated pathway of services designed

to achieve a defined set of outcomes. This

usually involves sub-contracting other

providers to support different elements of

the programme/service. Sub-contractors

are held to achieving the same defined

outcomes.

JOINT WORKING ARRANGEMENTS:

• For participants in this study, co-location

helped teams to understand each other’s

perspectives and develop their work in a

more integrated way.

Making it work


• A set of case studies by the Social Care

Institute for Excellence (SCIE) has highlighted

the value of multi-disciplinary teams in

driving integration. SCIE stresses that there are

different ways of doing this, including:

- formal arrangements, where teams are

brought together under a partnership body;

- the introduction of systems and processes

that enable professionals across different

organisations to come together to manage

complex cases.

- the ‘key worker’ system whereby care is

coordinated by a named worker.

• Formal multi-agency decision-making

processes should enable different partners,

for example from the local CCG and local

authority, to navigate the differing referral

processes, threshold criteria, delivery models

and funding mechanisms which apply to

different agencies and services in order to

agree on and deliver an appropriate package

of support for a family. In successful examples,

panel representatives were supported by clear,

multi-agency arrangements and processes

agreed at strategic level.

INVOLVING FAMILIES IN DECISION-MAKING:

• At strategic level, co-production with parent

carers was achieved by involving families

from the earliest stages through workshops,

meetings, consultations and representation

on programme boards. Parent carers were

also involved in day-to-day work through

representation on multi-agency panels or

governance boards.

• At individual level, building dedicated time

and space into support planning processes

for a person-centred conversation with the

child or young person and their family, and

ensuring this conversation informs the rest

of the process and any resulting support

package, can support integration through

uniting agencies around holistic needs,

outcomes and aspirations.

• Involving children and young people at

strategic level was felt to be more challenging

for participants, but all areas were making

efforts to include young people in these

processes too, or to seek their advice through

workshops and engagement groups.

- Some local areas have established Young

Commissioners groups to support

commissioning and procurement

activities, undertake research and make

recommendations about services from a

young person’s perspective.

• Crucially, engagement with families must be

meaningful, with a clear, pre-determined

process for feeding any outputs into strategic

planning. This again links to leadership and

strategic-level commitment to change.

• In addition, local areas must be mindful of

not shifting the burden of coordination onto

families: the effective engagement of parents

and carers must be one of a range of strategies

for supporting the integration of care at

individual level, and cannot substitute broader

efforts to join up services.


Leadership

Senior leadership within national

government and NHS England should:

• Review and align key priorities across all

national programmes impacting this group

of children and young people; then align

performance measure across programmes.

• Ensure that when introducing any new

change programmes work is done to align

that programme with all related existing

requirements.

The National Leadership Board for children

and young people with high needs, reporting

to the Minister for Children and Families

should consider what further steps need to

be taken to ensure that leaders in local areas

prioritise integrated commissioning to deliver

integrated services.

Data and information-sharing

National government and NHS England

should review and align reporting

requirements for national programmes in

order to:

• Facilitate a shift towards outcomes-based

data that will help demonstrate the value

of delivery beyond simply activity data and

outputs;

• Reduce the reporting burden on local areas

wherever possible.

We also emphasise the need for national

government and NHS Digital to continue

to support and incentivise data collection on

children and young people with complex needs

to build a clearer picture of the needs and

outcomes of this group, and to develop more

integrated means of gathering and presenting

this information. This reflects the more

detailed recommendations made in our report,

Understanding the needs of disabled children

with complex needs or life-limiting conditions

(Pinney, 2017).

NHS Digital should identify whether or not

it is possible to update their information

sharing resources, to include agencies working

with children, without an amendment to The

Health and Social Care (Safety and Quality) Act

2015 which introduced a legal duty requiring

health and adult social care bodies to share

information where this would facilitate care for

an individual. If possible the resources should

be updated with immediate effect.

If an amendment is required, national

government should seek to amend The Health

and Social Care (Safety and Quality) Act 2015

to extend the legal duty to education, health

and care bodies where this will facilitate care

for a child.

Recommendations


Funding structures

National government should review local

government funding for services for children

and young people with SEND as rapidly as

possible in response to the concerns raised both

in this report and wider publications and media

reports.

DHSC should require CCGs to report separately

on their spending on children’s health services.

NHS England should, having set goals for

children’s health services, ensure that they hold

CCGs to account on progress towards those

goals, ensuring that they give sufficient priority

to services for children.

DfE and NIHR should commission a cost

effectiveness study of joint strategic planning

and joint commissioning arrangements in order

to support the case for change.

Universal services

Ofsted should ensure that its review of the

schools inspection framework includes a

greater focus on pupil health and wellbeing

and the outcomes sought for pupils with

SEND, to incentivise schools to meet the needs

of all pupils.

The Government should ensure that

commitments made to ensure that all health

and social care staff have training on learning

disability and autism adequately cover the

children’s workforce and includes education

staff so that all professionals know how to

support children with SEND.

Supporting and involving families in decision-making

CCGs should jointly fund Information Advice

and Support (IAS) Services to ensure that they

can adequately fulfil their statutory duty to

provide advice and support across health as well

as education and care services.

CCGs and local authorities should recognise

and fund local parent carer forums (PCFs) as a

well-established source of expertise, who due to

their own personal experience are ideally placed

to support a holistic approach to supporting

children and young people with SEND.


Alderwick, H., Ham, C., & Buck, D. (2015). ‘Population health systems: going beyond integrated care.’

The King's Fund.

https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/population-health-

systems-kingsfund-feb15.pdf [Accessed 25 March 2019]

Department for Education. (2017). ‘Permanent and Fixed Period Exclusions in England: 2015-2016.’

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/

file/645075/SFR35_2017_text.pdf [Accessed 25 March 2019]

Department for Education. (2018) ‘Statements of SEN and EHC Plans: England 2018. Department

for Education.’

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/

file/709590/Statements_of_SEN_and_EHC_plans_England_2018_Main_Text.pdf [Accessed 25

March 2019]

Kelly, E., Lee, T., Sibieta, L., & Waters, T. (2018). ‘Public spending on children in England: 2000-2020.’

https://www.childrenscommissioner.gov.uk/wp-content/uploads/2018/06/Public-Spending-on-

Children-in-England-CCO-JUNE-2018.pdf [Accessed 25 March 2019]

King's Fund. (2018). ‘How is the NHS performing? March 2018 Quarterly Monitoring Report’

https://www.kingsfund.org.uk/publications/how-nhs-performing-december-2018 [Accessed 25

March 20

National Audit Office. (2017). ‘Health and social care integration.’

https://www.nao.org.uk/wp-content/uploads/2017/02/Health-and-social-care-integration.pdf

[Accessed 25 March 2019]

National Audit Office. (2018). ‘Financial sustainability of local authorities.’

https://www.nao.org.uk/wp-content/uploads/2018/03/Financial-sustainabilty-of-local-

authorites-2018.pdf [Accessed 25 March 2019]

References


Pinney, A. (2017). ‘Understanding the needs of disabled children with complex needs or life-limiting

conditions: what can we learn from national data? Exploratory analysis commissioned by the

Council for Disabled Children & True Colours Trust’,

http://www.truecolourstrust.org.uk/wp-content/uploads/2017/02/CDC.datareview.final_.revised.pdf

[Accessed 25 March 2019]

Social Care Institute for Excellence. (2018, August 8th). ‘Delivering integrated care: the role of the

multi-disciplinary team’, SCIE Highlights, No.4, July 2018

https://www.scie.org.uk/integrated-health-social-care/measuring-progress/role-multidisciplinary-

team?utm_source=The%20King%

This project was funded by the True Colours Trust

09. 04.2020



CDC hosts the following networks and projects:

Early Years SEND Partnership

IASS Network

Making Ourselves Heard

Special Educational Consortium

The Information, Advice and Support Programme

Transition Information Network


More information about CDC can be found at www.councilfordisabledchildren.org.uk

About the True Colours Trust

The True Colours Trust is passionate about making a difference to the lives of disabled children and their families and supporting people with life-limiting and/or life-threatening illnesses. The Trust was established in 2001 and works in the UK and Africa.

True Colours has developed a framework of grant-making which enables it to effect change in the short, medium and long-term. This is done through small grants to local initiatives; multi-year grants to build sustainable organisations and sectors; commissioning research to gather information and identify solutions to complex issues; and, making long-term investments towards advocacy and policy change. The Trust’s framework enables it to make positive change today, tomorrow and in the future. The Trust is proud to be a long-term supporter of the work of the Council for Disabled Children.

More information about the True Colours Trust can be found at www.truecolourstrust.org.uk