The health sector must take on “increased accountability” for SEND provision, experts have said, as they warned a national focus on NHS reform “crowds out” local ambition for greater partnership working.
The Parliamentary education committee also heard that cuts to integrated care boards (ICBs), NHS bodies responsible for planning health services in local areas, will have an impact on SEND and are hindering greater collaboration.
MPs heard evidence from experts in speech and language therapy, educational psychology and officials from local and national health organisations.
Here’s what we learned.
1. Health must take more accountability
Alison Stewart, head of SEND at the South West London Integrated Care Board, was asked if it was fair for most of the accountability in the system to sit with local authorities.
“I don’t think it’s fair. I think there does need to be an increased accountability for the local area, the local system, and that should be the local authority and the ICB and the providers within that.
She also said we needed to “move with statute to a position of joint commissioning, where we are looking at how our services are being designed.
“It is about looking at, how do we enable services like speech and language therapy, for example, to have commissioned time, to have the flexibility to work at the universal targeted level, as well as that specialist level.”
Increased accountability would be “really important”.
“With all of this I think it is about, how do we work as a whole system? We have children waiting…for far too long in my own opinion. However, for some of those children, they will be getting support from other bits of the system. And other bits of the system can provide some really excellent support.
“I think sometimes we’re driven into a position that we are splitting education and health, rather than looking at a proper needs-based approach to children offering the right support at the right time.”
2. ICBs ‘turbulence’ will affect SEND…
ICBs replaced clinical commissioning groups in 2022. Ministers recently told boards to find cuts in their running costs of 50 per cent as part of wider NHS reforms that will also see the closure of NHS England.
Asked what impact the changes would have on SEND, Sarah Walter, director of the ICS network at the NHS Confederation, said it was “inevitable…the turbulence that integrated care boards are responding to at the moment, and an environment which has a great degree of instability at the moment, I think will have an impact”.
3. …and cuts hinder greater collaboration
Boards are now working on “what the future model will look like in across England.
“And I think it is likely that we will see change to potentially the number and the shape and size of integrated care boards, so that does create an additional degree of instability within the system.”
She said ICBs had “existed for less than three years, have already had a 30 per cent reduction in their running cost allowance, and now are subject to this 50 per cent cut.
“So I think it’s, unsurprising, perhaps, that that has been a hindrance to some of the attempts to develop greater collaboration and partnership across local government, with schools and other partners.”
4. National priorities ‘crowd out’ local ambition
Walter said many integrated care partnerships had “prioritised children and young people’s support”, but national priorities currently “feel very fixed towards a more short term and more financially driven approach”.
She said there was a “clear need for the NHS to recover services. There are significant financial and performance challenges at the moment.
“But I think some of that then crowds out the ambition locally to have a greater focus in some of these partnership spaces, and for children and young people in particular.”
5. Cuts to EPs prevent early intervention
Lisa O’Connor, vice president of the Association of Educational Psychologists, warned cuts to council budgets and the academies movement had led local authorities to “reduce considerably their EP services, with many of them only employing EPs to carry out statutory duties”.
This has had an effect on early intervention among younger children.
“When we think back, 15 years or so, we would have been working with the Every Child Matters framework, and working with other publicly funded services, health services and education specialist services, and we would be working together collaboratively and promoting inclusive practices.
“That’s one of the areas where there is a considerable difference these days. We are in a position where we haven’t the capacity to do as much early years work as we would like to, and it’s very much missed.”
6. Training clarity call
O’Connor also called for clarity over future funding for EP training, with government support not confirmed beyond 2026.
“We would like to see an increase in the training of educational psychologists each year so that there would be an educational psychologist available for each school. It’s very hit and miss at the moment.”
She said some council EP teams now acted as a “traded model”, with their services bought back by some academies.
“But other schools, we don’t know whether they seek out other EP providers or whether they just go without.”
7. Speech and language caseloads ‘inordinately large’
The committee also heard from Janet Harrison, head of service at Leicestershire Partnership NHS Trust and member of the Royal College of Speech and Language Therapists.
She said most therapists “have got inordinately large caseloads”, having to deal with “extraordinary large numbers”.
This leads to a “dilution of the access, the speed of access, the responsiveness. It leads to dilution of intervention”, and resulting dissatisfaction among families and adverse on therapists’ health and wellbeing.
“I have lots of concerns about the health and wellbeing of staff, and particularly newly qualified therapists who we want to really stimulate to be excited to be part of the profession, leave quite early.
“They really didn’t come into it to deal with those large numbers. And I just want to make a point, even when we are fully staffed…the workforce is still massively insufficient in relation to the demand.”
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