The 2014 special educational needs and disabilities (SEND) reforms promised an integrated system across education, health, and social care. A decade on, schools are filling ever-growing gaps in NHS provision. How has it come to this?
Instead of integration, schools face fractured services, diminishing NHS input and, as Schools Week recently highlighted, increasing pressure to provide medical care themselves.
In educational settings, several factors lie behind this, including the absence of a national model for NHS clinical nursing services, delegation missteps and a failure to recognise healthcare activities.
But subtler influences have also played a part. In particular, a lack of clarity and misuse of the SEN and SEND terms have quietly skewed the SEND landscape.
At the time of the reforms, academics raised concerns about how special educational needs (SEN) and disabilities had been brought together, as well as the lack of practical guidance for the new SEND concept.
The Children and Families Act 2014 tightly defines SEN, which is linked to the requirement for special educational provision (SEP). Within SEN, “disability” relates very specifically to the use of facilities, likely to be physical facilities such as classrooms or toilets.
Crucially, health provision can only be deemed SEP in specific and narrow circumstances associated with education, health and care plans (EHCPs) and provision that functions to educate or train. Therefore, health-related needs will only be classed as SEN in limited cases.
Misuse of the SEN and SEND terms have skewed the landscape
The problems arise because the term SEND covers SEN (and SEP-eligible disability within it) as well as disability more widely, defined in line with the Equality Act 2010’s broad definition of disability as an impairment that has a substantial and long-term negative effect on daily activities.
As a result, SEND is associated with SEP but also with disability access, adjustments and services across education, health, and social care. And this conflation of the SEN and SEND terms means they are often used interchangeably to this day.
Examples are easy to find:
Section 69 of the Children and Families Act 2014, labelled ‘SEN information report’, covers SEN and general disability.
In 2019, the National Audit Office presented ‘SEND’ numbers using SEN data.
Just last year, a senior Department for Education official defined ‘SEND’ using the Children and Families Act 2014’s ‘SEN’ definition in parliamentary evidence.
And today, Oxfordshire County Council (and it is not alone) carries a webpage about its SEND local offer which describes ‘SENDCO’ as a statutory post.
This is more than a technicality. Language shapes beliefs and understanding. In turn, this shapes policy and practice. Repeated misuse normalises error.
It’s unsurprising, therefore, that treating SEND as equivalent to SEN has correlated with increased focus on schools and a sidelining of health and social care.
The consequences are considerable: unrealistic expectations, compromised care standards, schools carrying healthcare risks, gaps in NHS-commissioned services hidden and resources diverted from education.
Significantly, following legal concerns, the Equality and Human Rights Commission removed examples of schools providing nursing care as reasonable adjustments from its technical guidance to the 2010 act.
From a social model perspective, societal factors are disabling. And the truth is that current NHS commissioning arrangements are one such factor, because they are creating barriers to children accessing education.
Schools have stepped in to mask the gaps, but even with the best intentions, schools cannot replace the quality and safety of NHS-commissioned clinical services.
As the next phase of SEND reform is drafted, clarity must come first. SEN and SEND must be explicitly distinguished and applied consistently.
Where needs require health provision falling outside SEN/SEP and reasonable adjustments, responsibility should remain with the NHS.
Delivering this will require that compliant NHS services be embedded in educational settings, including an equitable model for NHS-commissioned clinical nursing services in schools.
This is essential not only for SEND but also for wider inclusion and attendance agendas, which rely on pupils being able to access the NHS services they need to stay well and fully participate.
The vision of 2014 was right: integration is the goal. But it cannot be achieved through a confused and inconsistent narrative or misplaced responsibility.
Precision, compliance, and ownership of responsibilities are needed to ensure children receive the services they are entitled to.
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