The proceedings are
reported in the language in which they were spoken in the
committee. In addition, a transcription of the simultaneous
interpretation is included. Where contributors have supplied
corrections to their evidence, these are noted in the
transcript.
Dechreuodd y cyfarfod am 09:32.
The meeting began at 09:32.
|
Cyflwyniad, Ymddiheuriadau, Dirprwyon a Datgan
Buddiannau
Introductions, Apologies, Substitutions and Declarations of
Interest
|
[1]
Lynne Neagle: Good morning, everyone. Can I welcome you all
to today’s meeting of the Children, Young People and
Education Committee? We’ve received no apologies for absence.
Members will be aware that Dr Dai Lloyd is joining us from the
Health, Social Care and Sport Committee for some of the later items
this morning. Can I just ask if there are any declarations of
interest, please? No. Okay, thank you.
|
Y Bil Anghenion Dysgu
Ychwanegol a’r Tribiwnlys Addysg (Cymru):
Sesiwn Dystiolaeth 10
Additional Learning Needs and Education Tribunal (Wales)
Bill:
Evidence Session 10
|
[2]
Lynne Neagle: Item 2 today is our tenth evidence session on
the Additional Learning Needs and Education Tribunal (Wales) Bill.
I’m very pleased to welcome Joe Baldwin from Bridgend College
and Humie Webbe from the National Training Federation Wales.
Members will be aware that, because of some traffic disruption,
Iestyn Davies from ColegauCymru is not yet able to be with us.
Thank you very much for attending this morning. Are you happy for
us to go straight into questions?
|
[3]
Mr Baldwin: Absolutely.
|
[4]
Lynne Neagle: Okay. If I
can just start with a question, really, about what ColegauCymru
told us, which is that they felt that there was little mention or
consideration at a strategic and ministerial level of further
education and the impact that the Bill and code will have on the
sector. I would just be interested in your views on that, please,
if that’s possible.
|
[5]
Mr Baldwin: Yes, absolutely. So, I think, initially, the comments
were formed on the basis that, if you look at a 0-to-25 framework
and you consider that more than a third of that age category is
going to be post 16, and you think about the impact of the
responsibilities of post-16 education in terms of a young person
who might have an individual development plan, in terms of the
voice of the young person in post-16, and the prevalence that that
has within the Bill, I think that there’s a feeling that
there needs to be some acknowledgement and consideration of some of
the implications and responsibilities that a further education
institution would take as a result of the Bill. So, this is in
terms of how we might cease an IDP, and the conversations that
would have to be had with young people and parents who may feel
that perhaps it is a right to have a 0-to-25 plan, and managing the
conversations and expectations around a 0-to-25 plan. But, it is
also in terms of the workforce and the expectations and the set-up
around responsibilities that would be brand new for an FEI versus a
school. A lot of the Bill at the moment talks heavily around
schools and the way that schools are set up in terms of special
educational needs statements, and school action and school action
plus. But of course, for an FEI, when you’ve got a learning
and skills plan, or a section 140, that’s not a statutory
document, it’s not something that an FEI needs to review
annually; it’s more of a
sort of transitions passport to give us an awareness of the needs
of the young person. Actually, there’s a whole raft of
responsibilities in terms of an ALNCO and in terms of a workforce
that is able to support varying additional learning needs. The Bill
gives quite a clear steer that there would be an aspiration that
more needs of young people with complex needs would be met within
local provision, which I think ColegauCymru welcome, but I think
there’s hesitation and reservations around how that would
work in practice, the funding for that, the structure and the
set-up within an FEI in terms of the delivery of
provision—the fact that most provision isn’t five days,
for example—provision for learners with complex needs and how
we go about meeting those needs in light of the responsibilities
set out in the Bill.
|
[6]
Lynne Neagle: Okay, thank you very much. Julie.
|
[7]
Julie Morgan: The Bill, as you know, proposes to bring in a single
age—0 to 25—system. What are your view on that? What do
you feel are the advantages or disadvantages of having one single
system?
|
[8]
Mr Baldwin: I welcome a 0-25 framework. In terms of meeting the
needs of young people and the parity that 0-25 would bring for
young people, parents and carers is fantastic. I think, for the
first time, it would provide us with an opportunity to really
understand the importance of transition for that young person with
additional learning needs, how we work with schools and how we
engage with local authorities. Whilst for some local authorities
that would be very, very new, I think, for FEIs, it’s an
opportunity for us to understand the needs of those learners and
ensure that the transition into post-16—the provision and the
resource that are required—is there and available for those
young people.
|
[9]
Julie Morgan: So you welcome it?
|
[10]
Mr Baldwin: Absolutely, yes.
|
[11]
Julie Morgan: What about the exclusion of work-based learning from
the system? I don’t know what views you have on that,
Humie?
|
[12]
Ms Webbe: Do you want me to answer specifically the question
first?
|
[13]
Julie Morgan: Yes.
|
[14]
Ms Webbe: In terms of work-based learning, the omission of
work-based learning raises more questions, especially for those
learners who have chosen work-based learning as a career route. We
consider that work-based learning, instead of being considered to
be an alternative route for learners, for some learners it’s
a natural route. Therefore, for those learners who have opted to go
straight from school to a work-based learning environment, there
needs to be more clarity, we feel, in the Bill that looks at how
that transitional support is accessed by those learners who go
straight from school to a work-based learning environment, because,
yes, they are employed but they are continuing to learn. So, some
learners with additional support or needs naturally choose a
vocational route to progress their learning. So, what we feel, as
work-based learning providers, is that the Bill could suggest more
clarity or guidance for those learners who choose that
route.
|
[15]
Julie Morgan: And would you say that a significant proportion of
young people with additional learning needs would choose that
route?
|
[16]
Ms Webbe: We have evidence from the various providers who
specialise in support for learners who have complex barriers, as
well as complex needs, of learners who naturally choose that route.
For them, what they have provided us with is oral evidence that
some learners come without a statement, or some have a statement
but are not willing to share that information. Therefore, it
becomes difficult to apply appropriate support when they initially
gain an apprenticeship vacancy.
|
[17]
Julie Morgan: Right.
|
[18]
Mr Baldwin: Sorry, could I just add that I think it’s also
important to recognise that where we are trying to aspire to the
parity of the system to support learners with additional learning
needs, perhaps, at the moment, there’s an assumption, wrongly
so, that a need may drop away or change as you would move
through a 0-25 span, but, actually, there are some colleges, some
FEIs, that have got training subsidiaries attached to them, so, for
example, Cardiff and Vale College with ACT. And so, what that would
look like for work-based learning and for apprenticeships, where
you may have progressed through a standard FEI route—level 2,
perhaps coming in at level 1—but then may choose a work-based
learning route or an apprenticeship option, whereby, actually, your
IDP would naturally have to cease because, unfortunately, you
wouldn’t be covered—.
|
[19]
Julie Morgan: Right. So, you both feel that work-based
learning should be included.
|
[20]
Mr Baldwin: Strongly.
|
[21]
Ms Webbe: Yes, I strongly agree with that, because, to echo
Joe’s statement, we’re talking about 0 to 25 and
we’re working alongside Welsh Government to progress the aim
of creating parity of esteem between vocational learning and more
academic routes. We feel that parity of esteem should start from 0
to 25, so you’re building that parity of esteem right through
an individual’s learning, and so the omission of work-based
learning looks at where that parity of esteem ends then. Does it
end after they’ve left school? It should continue from 0 to
25, and so it’s building that esteem from 0 to 25, so that
those learners who traditionally or naturally choose a vocational
route feel that it is on par with academia—that they’re
not choosing a less standard route. They’re choosing a route
that is on par with academia. Therefore, the inclusion of
work-based learning, the environment of work-based learning, means
that the learner has that parity of esteem, that they’re not
choosing a route that is not a viable route or considered to be a
less valuable route than that for people who choose academia.
|
[22]
Lynne Neagle: Thank you very much. Llyr.
|
[23]
Llyr Gruffydd: To continue on this subject, just for me to be clear
in my own mind: you mentioned that you were looking for more
clarity in the Bill around work-based learning, but that’s
different to demanding that work-based learning is put on the same
footing, in terms of duties, as further education institutions. So,
are you looking for the duties that are going to be placed on FE to
be actually placed on those involved in work-based learning as
well, or are you looking for something different?
|
[24]
Ms Webbe: What we’re looking for, when I say
‘clarity’—. What exists at the moment—the
National Training Federation has over 100 different organisations
involved in education, training and skills. Some of those
organisations, or some of those consortiums, exist within a
college, and some of those training providers exist outside of
colleges and independent providers. So, therefore, those
institutions or those consortiums that exist within a college are
already starting to make provisions for the Bill—they have
ALNCOs, they have additional learning needs co-ordinators. So,
therefore, those outside of that sort of establishment are
questioning where they are able to access that support. So,
it’s the clarity on the work-based learning environment, as
opposed to having, I suppose, the same responsibilities as
colleges. What we’re looking for is the clarity on the
work-based learning environment as a whole for those learners who
choose work-based learning as an option. Does that answer your
question?
|
[25]
Llyr Gruffydd: It does. So, my next question, then, really, is: how
do you do that? Because if you look to—. I mean, could you
extend the same duties to those other providers who are outside of
FE? Because, you know, there are private businesses who’d be
involved in providing experiences for young people, and is there a
danger that some of those might just walk away?
|
09:45
|
[26]
Ms Webbe: Well, what I wouldn’t want to do is speak on
behalf of providers, but what I would say is: since we’ve
been invited to give evidence, what we found is that providers have
welcomed the opportunity to impart some of their experiences of
employers trying to recruit people with additional needs, including
complex needs. What we have found is, the omission of work-based
learners gives the assumption that it doesn’t apply to
them—you know, the Bill doesn’t apply. At a
recent event that was co-ordinated by Welsh Government, one of the
questions was, ‘What about the settings outside of the
establishment?’, and the omission, sometimes, when
you’re working, trying to get people to have that
transitional support outside of traditional routes, means that some
people feel that it’s nothing to do with them. One of the
things that was clear from that meeting is for providers to have an
understanding of the Bill and what support that we as providers can
put in place to ensure that that independent IDP remains seamless
and also clear. So, from our point of view, what we want to do is
properly understand that so that we can convey this to those
employers who maybe have some resistance, or may have some
resistance to some of the duties they feel that they might have to
put in place. But what we want is just clarity on where work-based
learning lies.
|
[27]
Llyr Gruffydd: Is there a resistance currently, then,
because—?
|
[28]
Ms Webbe: Well, maybe ‘resistance’ is maybe a
strong term. What I would say is that for employers to support
people with additional needs, or complex needs, what employers
require is a simple process so that they know they can put whatever
support in place. What currently exists for people who have
additional needs is, because you’re going from a school
environment to an employed environment in terms of—well, I'm
talking about apprenticeships here—the onus is not on that
individual who applies for that post to actually declare that they
have a disability. So, one of the issues around work-based
learning, or apprenticeships in particular, is until somebody says
that they have additional needs, then that support sometimes is not
put in place right at the beginning. It requires some confidence on
both sides for them to declare that they have additional needs. So,
what we would require is that the individual has the confidence to
declare that they have additional learning needs, so that we can
put the support in place. So, for an individual who is coming into
an employed status, we would prefer for them to have the confidence
to say, ‘I have an individual development plan in place;
I’m getting support from a support agency’, so we can
apply the support as and when it’s needed, but, basically,
right at the beginning as well, so that it’s appropriate
support.
|
[29]
Llyr Gruffydd:
Yes, so the framework is there as
soon as they—
|
[30]
Ms Webbe: So, the framework is there, so that it’s
seamless support.
|
[31]
Llyr Gruffydd:
Okay. And just finally from me, if I
may, Chair: you say in your paper that
|
[32]
‘ALN is not properly funded
under the WBL contract and the process to access a funding for
learners with additional needs are not clear and can be quite
complex.’
|
[33]
There might be a suggestion that,
actually, if the funding was available, then would we need to
incorporate this in the Bill?
|
[34]
Ms Webbe: I think some providers feel that there are some
additional support initiatives out there, like the Work Choice
programme and other things that are in place for the individual,
but in terms of work-based learning, because there is that—.
It’s not that clear as to how to access that support—I
think that’s where they feel that maybe the funding, or the
element of support, could be more clearly defined so that they know
exactly what they can access and what they can’t access,
because, at the moment, what exists is the assessor is the initial
person who identifies the support for the learner and, based on the
skills of that assessor to elicit that information, that is where
the appropriate support is applied. There are transitional sort of
sessions so that we can look at support, as and when people need it
on the apprenticeship journey, but applying that additional support
right at the beginning, I think, is crucial for people in terms of
retaining them on their apprenticeship framework. When you’re
working with parents of people with additional needs—they
like to know what support is in place prior to making that choice
to go into work-based learning. So, that’s what our plea is
for, really: to look at the additional support at the point of when
it’s needed.
|
[35]
Llyr Gruffydd:
Okay, thank you.
|
[36]
Lynne Neagle:
Thank you. I’ve got Oscar
first on this, then Darren.
|
[37]
Mohammad Ashgar:
Thank you very much, Chair. I think
my question will be for Mr Davies now—I think he’s just
catching his breath back. In your evidence to the committee, you
identified that the colleges potentially face challenges. Looking
ahead, in recruiting and retaining specialist staff in terms of
this Bill, what improvements do you feel need to be made to ensure
that students are fully supported and that colleges are fully
equipped to provide specialist provision to those with additional
learning needs?
|
[38]
Mr Davies: Thank you. Apologies, Chair. The bay
link—.
|
[39]
Lynne Neagle: [Inaudible.] We understand.
|
[40]
Mr Davies: I think it’s important to put this very
important and welcome policy departure in context, obviously in
terms of further education. What we’ve seen, in terms of
staffing—the main part we’ve commenced with—is a
17 per cent decrease in staffing across the FE provision due to the
cuts that were obviously imposed on the sector some two to three
years ago. So, turning things around in any policy field in that
context is going to be challenging, not least when we are trying to
identify the human resources, as well as the physical resources,
for learners who have quite complex needs, or indeed those who
simply need additional support to allow them to progress fully
through vocational learning. So, that’s the first point, and
this is bearing in mind the context of FE at the moment.
|
[41]
Secondly, FE is diverse. So, you’re looking to the need to
recruit and support staff from independent living support right
through, possibly, to individuals who are going to be coaching and
supporting ALN learners with degree programmes and everything in
between. So, it’s not, if you like, needing to identify a
workforce for two key stages that exist, or three key stages that
exist, in a school. There’s a very, very diverse provision
that goes on in FE. Of course, FE colleges are also work-based
learning providers in their own right as well. So, I think
that’s why we start in our submission to the committee,
Chair, by saying that we don’t really think perhaps the way
that this has been approached has fully taken on board the
complexity, and, indeed, the context of FE, at the moment.
|
[42]
Mohammad Asghar: Can I come back to Humie?
|
[43]
Lynne Neagle: Go on, then.
|
[44]
Mohammad Asghar: Thank you, Chair. My question to Humie
now—because you’re relating to diversity and the
equalities issue in the Bill, so, basically, my question to you is:
is there enough funding there for ethnic minority children and
others to look after, when they look for a job, especially children
with ALN, for the employer to make sure that they are equally
treated and everything’s available to them on the same level
as others?
|
[45]
Ms Webbe: Without having the sort of information on funding
that currently exists to support children from all walks of life, I
think the issue is not so much about the funding, it’s about
how things marry up and how programmes are aligned so that children
or young people with additional needs or cultural needs can
actually access support. In terms of my role as the work-based
learning equality and diversity champion, what I have found in
terms of the discussions that I’ve had with organisations
outside of work-based learning is that there is very little
information that they actually know about the eligibility of
funding programmes, work assistance programmes, apprenticeship
programmes. So, therefore, those organisations that have funding or
have initiatives to support young people from under-represented
groups—the information is not getting out there. So,
therefore, the ability to access that information and impact on
that learner is not being realised. So, from a work-based learning
perspective, what I’m trying to do, and working with the
work-based learning providers to do, is to have an understanding of
those initiatives, including funding initiatives, that will support
a learner who decides to go into work-based learning
establishments. So, one of the things that we’re doing is
working closely with Remploy, who work with their candidates who
have disabilities—various disabilities on the disability
spectrum—so that we can have an understanding of their
services and their eligibility criteria and, vice versa, they can
have an understanding of apprenticeship criteria, so that when
we’re speaking to candidates who want to go into work-based
learning, they have an idea of the support that’s available.
What we’re doing is trialling similar approaches to those
organisations that work with diverse groups so that the
understanding of where the funding lies and the criteria actually
supports that person into a work-based learning environment.
|
[46]
Lynne Neagle: Thank you. Hefin.
|
[47]
Hefin David: I’d like to move on now to the role of
governing bodies in FE and sections 9 and 10 of the Bill put very
specific demands on the governing bodies: section 9 with regard to
the duty to decide the additional learning needs of the pupil or
student and section 10 regarding the IDPs and preparing and
maintaining plans. Can you just express your views about sections 9
and 10 of the Bill, first of all?
|
[48]
Mr Davies: Thank you for the question, Hefin. I think it is
important obviously that the duty and responsibility rests, if you
like, at the highest part of the organisation, which, obviously,
because of the nature of non-profit institutions serving
households, is the governing body. Members will be aware that we
have helped the sector, in partnership with Welsh Government, to
develop a code of practice for governors. I think one of the things
we would have to do in light of these provisions, let alone when
the Bill becomes law, is make sure that those guiding principles
around governance reflect these duties and responsibilities. When
you look at these relevant sections of the Bill you have to accept
that, ultimately, a governing body is made up of volunteers plus
some staff and the principal. We will need to make sure
there’s adequate resource and training with the governors so
that they understand their responsibilities—the same would be
the case if we were looking at child protection or any other
complex area where they have a legal responsibility—and then
make sure that they have the networks in place to work with the
relevant lead staff and that staff themselves then have enough
capacity across the whole curriculum areas to ensure that the
advice and the guidance that the governing body is being given is
backed up by the professionals, if you like, in the field, in the
classroom and in the workshop. So, I think the Bill has to capture
that and understand that rather than simply put a duty and say,
‘We’ve done that section: thank you very much, move on
to section 10.’
|
[49]
Hefin David: So, do you think further education institutions
feel adequately prepared for that?
|
[50]
Mr Davies: It would probably vary. I think, obviously, as
Joe will outline, there are some colleges that are particular
leaders in this area and, indeed, such as Bridgend, have specialist
provision. Some of our colleges are large multi-million pound
turnover organisations: Coleg Cambria, Cardiff and Vale, Coleg y
Cymoedd, which you’ve visited in your constituency, and then
you have Coleg Ceredigion, for instance, which is a much smaller,
more modest organisation and, indeed, of course, we have Adult
Learning Wales, the former YMCA and WEA organisation that’s
just merged, which has a very different delivery model. The
governors’ procedures and the operation procedures would need
to reflect those very different circumstances, rural and urban.
That’s where the concern is: not in the principles, not in
the responsibilities, but how we do make this happen, because,
whilst a governing body may or may not be prepared for it in terms
of being up to speed with what’s going on and have the
relevant training and skills, there’s no question at all
about the commitment of those bodies towards addressing the needs
of these important learners in our colleges.
|
[51]
Hefin David. Okay. Perhaps I’ll move on to, just
because of time, the next bit. Joe, if you come in, the Bill in
section 9(3) and section 10(2) raises specific circumstances in
which the duties would not fall on the FEIs. Are they clear? Do you
think FEIs will understand those circumstances and how to
operationalise them?
|
[52]
Mr Baldwin: I think, just to echo what Iestyn’s
already said in terms of governing bodies and the way colleges are
currently operating, people are at different stages in terms of
their understanding of the full impact and implications of the Bill
in terms of resource and capacity and understanding. I think, when
you then start to look at local authority relationships, again, I
think that looks very different FEI by FEI depending on provision
available in schools, perhaps, within a locality. And so,
therefore, developing those relationships with local authorities to
then have the confidence to be able to push back if there is a need
presented within a FEI that perhaps is felt can’t be met
within the given resource, or perhaps could be met if there was
some additional resource available in terms of capacity and
training—. There needs to be some clear understanding on how
that relationship would work in terms of responsibilities of
pushing back to a local authority to go back and ask for provision
or resource to ensure that that young person can stay within a
locality and have their needs met within local provision. So, my
view at the moment would be that that needs to be tighter and
clearer in terms of the Bill.
|
[53]
Hefin David: Okay, with that in mind, what’s the
nature of the current relationship between local authorities and
FEIs? Are they fit for purpose for the purposes that this Bill is
requesting them to be, if that makes sense?
|
10:00
|
[54]
Mr Davies: I think more generally we could do a lot of work
with the consortia, the local authorities and FEIs. FEIs, in many
ways, are often looked at like local authorities when it comes to
post-compulsory education provision beyond school. So, for
instance, in the twenty-first century schools and education
programme, when the Government writes out to an LEA or a local
authority, it also writes to the principal of the college. I think
we need to recognise that you’re dealing here with three very
different kinds of organisations—the consortia, the local
authority, and, of course, the college itself. We need to make sure
that there’s a meeting of minds and equals, otherwise we will
get the gaps and the cracks in the pavement that service will fall
through.
|
[55]
Just to note, obviously, the explanatory memorandum sets out a
figure for year 1 of financial support to the FE sector, and it
details £70,000. I don’t know how they arrived at that
figure, whether it was something scientific or something other than
that, but it does seem to me to be a small amount to prepare a
sector that is roughly training some, what, 0.25 million
learners—of all ages, not just up to 25, obviously—in
order to be able to address this quite significant change.
|
[56]
Hefin David: To go back to this specific issue of the
relationship between the local authority and FE, do you think there
needs to be a change in the nature of the relationship, or does
this necessitate a change in the relationship?
|
[57]
Mr Baldwin: I think there are currently some missed
opportunities around some of the innovation funding that’s
been put forward in terms of the priority strands that are set out,
and how that funding is being used across local authorities. So, I
think where some consortia may be engaging with FEIs in pulling
FEIs on board to gain insight in terms of developing an IDP,
developing post-16 links, developing those relationships, in other
areas, and in my experience, I can safely say that that is very
different. So, it feels that there is an opportunity to be working
collaboratively to look at the aspirations of the Bill and how we
work together. But I think there’s no clear steer or
direction, or even impetus, perhaps, to consider how we use the
innovation funding to really move forward in a very different
way.
|
[58]
Hefin David: Okay.
|
[59]
Lynne Neagle: As the Bill currently stands, there’s no
power for local authorities to direct FEIs. Are you satisfied that
that is the correct way to go forward or do you think that’s
likely to lead to more tension and maybe more cases going to the
tribunal?
|
[60]
Mr Davies: I think putting the responsibility on the
governing body of the FEI makes them the body that’s covered
by the Act, and they have a statutory responsibility then,
obviously, to act in accordance with the Bill. I think that’s
consistent with that we are trying to take the FEIs to be
standalone public service bodies with their own governance, with
their own, if you like, legal standing and statutory basis, and I
think trying to subordinate them to another authority would—.
It would create a kind of grandparent relationship between the
institutions and what we want is equity and parity, so that the FEI
can actually act independently if it does.
|
[61]
Just to reiterate the point, when the channelled funding or the
support funding was announced by the Minister, which is to be
welcomed, it was carved up and gobbled up quite quickly by the
local authority. So, as with anything in politics and life,
‘follow the money’ is the argument, isn’t it? So,
the money’s gone in that direction. The amount that’s
been identified specifically for FEIs of £70,000 seems paltry
and insignificant. I think that indicates the kinds of tensions
we’re going to get into. Giving the statutory responsibility
to the LEA to direct I think would just cause more problems. There
will be, I’m sure, buck passing in that kind of relationship.
What we want is equity and parity.
|
[62]
Lynne Neagle: Okay, thank you. John.
|
[63]
John Griffiths: Yes. I’ve got some questions about the
definition of additional learning needs and the new system of IDPs,
and ColegauCymru, in your evidence, you talked about some
difficulties with terminology that’s used, and the need to
establish different categories of need. I wonder if you could just
expand on that a little, as to what you think the issues are and
why that needs to happen.
|
[64]
Mr Baldwin: Sure. So, I think one of the obvious issues
around terminology is, whilst we wouldn’t want to get hung up
on data recording in terms of ALN, that’s an important
element of understanding the needs and the complexities in the
landscape, FEI by FEI. So, I think, if you look at pupil level
annual school census data and the way that an ALN need is recorded
for the purposes of PLASC within a school, clearly, an FEI then
records and reports back to Welsh Government using a totally
different system, whereby the recorded categories of ALN are
different, and then the associated outputs are different.
|
[65]
I think it’s also important to note that disclosure within an
FEI relies on the learner actually choosing, at application stage,
or at enrolment, to disclose an additional learning need, and
whilst we would hope to build relationships with secondary
provision to ensure that the transition from school into college
was smooth, there will be learners who choose, for whatever reason,
not to disclose an additional learning need, or who may not have
reached a threshold to require an IDP, and so, therefore, straight
away, there is disparity in the way that we may record information
and data and therefore be able to channel resource appropriately to
those learners.
|
[66]
John Griffiths: Okay. Could I ask you as well, in terms of
the IDP, whether you would welcome a template, training providers
and colleges? Would a template be sensible? And if so, in terms of
its nature, would you see it as appropriate if there was a standard
format, but also the opportunity to have more personalised
information included?
|
[67]
Mr Baldwin: I think, throughout the Bill, and then the
supporting code, there’s reference in several places to
person-centred approaches and person-centred planning, and I think
it’s important to recognise their person-centred approaches
and person-centred thinking tools in the way we support young
people and parents and carers isn’t about the document;
it’s around the voice of the young person and how we engage
with the young person to understand what their aspirations are and,
therefore, what the outcomes are associated to the provision.
|
[68]
And so, I think, with a template, we would have the opportunity to
fully understand the requirements of the IDP, and where
you’ve got post-16 provision whereby perhaps one FEI is
feeding from three or four local authorities, we would at least
have an opportunity to understand the sections or the template
associated with the IDP. I think if you don’t have a template
and each local authority’s allowed to create its own, you
essentially end up with 22 different documents, and whilst on the
face of it they could look personalised and person-centred,
they’re still going to be within a framework within that
local authority, because, actually, every single young person
within that local authority will have a template. So, I think that,
actually, for a college, we could have three, four or five
different versions of a document with different requirements in
terms of how we convene an annual review, and perhaps what the
annual review template document might look like, and then,
subsequently, what the quality and the consistency of that document
would then be.
|
[69]
Mr Davies: I think it’s important to recognise, Chair,
that the parity of data between what’s referred to as PLASC,
which is the school-based system you’ll be familiar with,
and, obviously, the LLWR—lifelong learning Wales
record—system, which is the FE and work-based learning
system—that’s a wider issue that causes major problems
when we look at transition between, for instance, school and
college around A-levels. So, it’s not just this area. So,
without having some steps to standardise data gathering and
collection and curation of data, I think we’ll just be
compounding the problems we have elsewhere. And, of course,
it’s important to recognise that, particularly in our urban
areas, we are seeing learners now moving between local authority
areas. So, there are 22 local authorities, but, roughly, 13
colleges. In south-east Wales, you know, in and around the Valleys
area, you’d have Coleg Gwent, Coleg y Cymoedd, Cardiff and
Vale, Bridgend, all within striking distance of each other, and the
same would be the case for Swansea. So, standardisation would help
that journey, or that learner pathway, in a way that currently
doesn’t exist, not just in the ALN, but more widely in some
circumstances.
|
[70]
John Griffiths: Okay, and could I ask you as well about
numbers? Do you know how many students have learning difficulties,
disabilities in FE at the moment?
|
[71]
Mr Davies: The question is: how many would have a statement,
and how many have difficulties or have a need? And there’s a
very subtle, important difference, and that does go back to the
issue of collecting data and reaching a threshold. I don’t
have those figures to hand. I mean, I have them, but I can’t
grab them, but we’d certainly be able to provide those data
to you as a committee. Do you have anything further—?
|
[72]
Mr Baldwin: I think just to reference the point that I made
previously in terms of the duty to disclose a learning need,
because the Bill talks around the desire that an IDP may include
school action, school action plus and the learner with an SEN
statement. Traditionally, a learner with an SEN statement might be
the learner who was then transferred on to a learning and skills
plan. So, for us, we would be able to look at those data. Where
that perhaps becomes more complex is when you’re looking at
learners with school action and school action plus, whereby perhaps
that document wasn’t passed through to a college or that
level of recording wasn’t passed through to a college. So, I
think there are difficulties in understanding the clarity of data
to then be able to fully understand the implications of the Bill in
terms of welcoming IDPs and what that would look like.
|
[73]
John Griffiths: Yes, okay. And how confident are colleges
that they would be able to draw up IDPs for all those with
identified needs?
|
[74]
Mr Davies: I think that, with the right resource and
support—. And we have worked with the Welsh Government
already to try to understand what person-centred practice would
look like in an FEI environment. I think there’s been good
commitment on that process, and it’s been well received by
the colleges. So, I’m confident that with the right resource
and the right support, we could get to a situation where we would
be able to deliver what was required by the learner, but that would
come at a cost, obviously.
|
[75]
John Griffiths:
Okay. Perhaps I’ll move on to
transition issues, Chair. Just in terms of that transition between
school and further education, are you confident that colleges would
be able to ensure the necessary smooth transition, and what would
need to happen, really, for that to take place?
|
[76]
Mr Davies: Our consultation response outlines that, actually,
starting that process early—. And, again, there are issues
here more widely about how a school would give access and support
to an FEI to make sure that their learners are aware of all the
transition routes that are available to them, irrespective of their
additional learning needs. So, what we’re saying is that
consideration should be given to sharing resources, sharing best
practice and working together. So, if you have a learner who is
indicating that they want a transition to FE rather than staying on
at school, bear in mind that FEIs can often be the recommencement,
the reboot button for lots of learners who perhaps haven’t
had a positive experience in school. Once that’s been
identified, or, indeed, once that’s been identified as an
option for a learner, to work in partnership between the school and
the college would be the best way for us. How do we do
that—how we get that classroom sharing and how we get that
time sharing between the two institutions I think is the challenge,
and that’s not about resources, that’s about a culture
of colleges and schools seeing themselves as working together for
the needs of the learner. Now, hopefully, we would get it right in
ALN, but I’m not confident that we’d get that right
anyway between the two institutions. So, I think we need to make
sure we don’t fall into that fault line, particularly with
learners who are quite vulnerable.
|
[77]
John Griffiths:
Okay, I wonder if—. Moving on,
obviously, learners’ needs can change and do change, so the
identified needs of a learner coming to a college might change
during the course of their learning with the college. So, how well
placed are colleges to assess needs themselves, and to access
whatever specialist provision might be necessary for that
assessment to be effective and appropriate?
|
[78]
Mr Baldwin: I think it varies from college to college, depending
on the provision and the size of provision that you’ve got
for learners perhaps on discrete pathways or section 14 pathways
with additional learning needs. I think within a school, generally,
you would be given an allocation of, for example, educational
psychology time or speech and language time, of course. For a
college to access that type of provision, we would be required to
commission that or to buy that in. So, I think the skills, perhaps,
within an institution would vary greatly, and I think we would need
to understand just how far we would be taking those specialist
skills in terms of meeting the needs of those young people locally
within a college. Again, there is a resource and a financial
implication attached to a learner who may have a therapy or a
higher level additional learning support need that would require
additional specialist support within the college, and how that
would look in terms of the transition and the resource available
for that to follow through into college—.
|
[79]
Mr Davies: Essentially, you’re looking at the skills of
staff, of the pedagogue. And I think what we identify more widely
is that there needs to be much more investment in the FE workforce.
We know the FE workforce is slightly older or, shall we say, more
mature than the general education workforce, according to data
supplied to us by the Education Workforce Council because of the
management of registration now. And we’ve said previously, I
think, to the committee that we’re concerned about initial
teacher education, and we need to make sure that people coming
into, if you like, the vocational FE learning environment, and,
indeed, those transitioning from general education to FE to maybe
do general education, are aware that there can be a full and varied
career, and they can specialise maybe in additional learning needs
in a vocational setting. Those training pathways for them are
opened up very early on in their career. So, we can deal with
this—I’m not quite sure if it’s upstream or
downstream, but you get my drift—we deal with that when
we’re actually recruiting our workforce, so they see this is
an option, and that it’s actually something that vocational
education training has to address, as well as the need to be
totally compliant with what’s going on in your industry
sector.
|
[80]
So, I think it goes down to the long-term
planning for the workforce and for the institution within the
sector to make sure they have all the same resources, human and
physical, and in terms of capital as well, that are currently
within schools.
|
[81]
John Griffiths:
Okay. And just quickly to follow up on
that—where there are severe or complex additional learning
needs, so the support required is more intensive, it will be local
authorities that will have had the post-16 responsibility, rather
than Welsh Government Ministers, to make the arrangements and
secure the support. So, how would you see that relationship working
between colleges and local authorities, and, again, would colleges
know how to access the support necessary?
|
10:15
|
[82]
Mr Davies: It’s probably worth reflecting on what
currently happens in specialist centres, such as Weston House.
|
[83]
Mr Baldwin: So, generally for specialist provision at the
moment, we would apply directly to Welsh Government and, of course,
with the proposal for that funding to move to a local authority,
again there is an assumption that local authorities, for whatever
reason, understand post-16 provision and the way that post-16
operates. And I think there is work to be done in terms of
supporting local authorities to really understand the provision and
the make-up of post-16 and of FE to ensure that they are well
informed around how we can best support learners’ needs, and
the additional support that may be required if you’re looking
at a learner with complex needs, whereby the case would be held
with a local authority. I think that a mutual relationship would be
needed to really understand what is possible in terms of joint
creative commissioning to support that learner to be in a local
authority area in mainstream provision.
|
[84]
Lynne Neagle: Thank you. Darren.
|
[85]
Darren Millar: I just wanted to ask two questions. We know
that there have been some pilots across Wales in terms of this new
approach to additional learning needs. Were FE colleges involved in
any of those pilots?
|
[86]
Mr Baldwin: I asked the same question last week on the Welsh
Government’s initial rounds of updates. I think Coleg Gwent
have been involved to an extent, and I don’t know the full
detail of their involvement. But, again, I think there needs to be
caution used when applying that to all FE colleges in Wales, and
the reason why I say that is that there are some colleges whereby
the majority of secondary schools within the locality have got
sixth-form provision, for example. So, the way that schools may
engage with one college versus another college could look very
different in terms of post-16 provision and the provider of choice
in terms of FE. So, I think when you’re looking at pilots,
you’re looking at IDPs and you’re looking at
transition, you can’t just look at one provider for the
answers and for the nuances around what needs to work and how that
would work. In my experience, some of the local authorities and
some of the consortia are engaging very differently with their FEIs
from one locality to another, so I think there needs to be some
caution around looking to one gold standard benchmark in terms of
how people are then using that to inform how we move through.
|
[87]
Darren Millar: I also understand that there have been some
pilots in places like Ynys Môn and Gwynedd. We’ve been
shown copies of templates of some sessions from those areas. So,
what about Grŵp Llandrillo Menai? Have they not been involved
in anything in that sort of neck of the woods, or—?
|
[88]
Mr Davies: They’ve been involved in the exploration of
person-centred practice that we have run as ColegauCymru, but
I’m not aware whether they were—
|
[89]
Darren Millar: Not as a formal part of the pilot.
|
[90]
Mr Davies: Of course, the point that Joe is making is that
Grŵp Llandrillo Menai is a multisite campus with urban/rural
areas and coastal areas. It’s very different to Ceredigion.
It would be very different to the model employed by Coleg y
Cymoedd, for instance, which is very different to the model in
Gwent. So, this is the whole point. It’s not like,
‘That’s a sixth form; they look very much like
cookie-cutter sixth forms elsewhere.’ These are very
different and diverse organisations.
|
[91]
Darren Millar: I’m alarmed to hear that there
hasn’t been more engagement with the pilots. Can I just ask
as well: in terms of the responses you were giving earlier on about
needing to identify additional learning needs, one of the big
differences, it strikes me, between the FE sector and schools is
that young people are very often in a school for a number of years,
whereas they could be having a short-burst intensive course in an
FE college or a one-year course, and if you’re not able to
get the appropriate support in place very, very quickly, then that
could have a huge detrimental impact on the ability of the learner
to achieve what they need to achieve while they’re in
college. So, you’ve mentioned the need to encourage
disclosure from the learner. We’ve talked about transitional
arrangements between the schools and perhaps needing to facilitate
some disclosure there. What about disclosure from the health
service if a need might arise while they’re in the college,
or en route to the college, if you see what I mean?
|
[92]
Mr Davies: I think, again, that’s a very complex
scenario, which is made even more complex by the fact that
we’re extending the age to 25. So, imagine a scenario where
somebody leaves school at 16, which they’re able to do, and
eight and a half years later, aged 24, they decide, ‘I want
to actually go into an FE college to make good, or to be able to
raise my educational achievement.’ At 25 years of age
you’re talking about an adult—you know, somebody who
has the right to be able to determine what they want from the
system. I think we have to be able to balance the importance of
disclosure, the rights and the privacy of the individual to deal
with their learning needs in a way that they feel that’s fit,
and also to cope with the interruption in the learning journey
along the way. So, again, I’m just coming back to this point
time and time again that it might be appropriate for health
disclosure to take place at 16 to 17 or 18, for that natural
progression into an FE, but we need to have a system that works
also for the 25-year-old as well.
|
[93]
Darren Millar: So, what happens at the moment for those who
are on a short course, who may have an additional learning need
that’s not been identified?
|
[94]
Ms Webbe: Well, what happens from a work-based learning
point of view is that on an apprenticeship, for instance, because
you're in an employed status, they have to offer at least 12 months
placement. But, there are various review points in an
apprenticeship’s journey and it’s reliant, I suppose,
on the skills of the assessor to identify the learning needs of
that person. So, where the specialisms do not lie with the
assessor, they call upon other organisations to provide that
support. So, if it's a person who has emotional behaviour disorders
or autism, then we call on other people to help to—
|
[95]
Darren Millar: Sorry to interrupt, but in terms of a short
course in a college campus, what happens if it's a six-week
course—
|
[96]
Lynne Neagle: Darren—
|
[97]
Darren Millar: Well, this is important. Do you think it's
appropriate to have a duty—? Let me ask you this question: do
you think it's appropriate to have a duty to assess on an FE
institution if someone was in your building for six weeks doing an
evening course, for example? Or should there be some structure in
there?
|
[98]
Mr Davies: I think it has to be proportionate. Any
assessment of need that could be educational—. Learners
currently entering into an FE environment are required, whatever
their level of entry, to undertake what’s known as the WEST
test. So, that's a basic assessment in numeracy and literacy. And
what we’re seeing, of course, is the more burden, the more
barriers you put in someone's way—perceived or real—the
more likely you are to inhibit that individual from re-entering
back into learning. So, whilst the response within duties is
appropriate in some instances, it has to be proportionate and
commensurate, I think, to what we’re trying to deal with
here. And, surely, that's what person-centred practice is all
about: that we allow the individual to lead on that, despite
recognising the statutory response we as an institution have at the
same time.
|
[99]
Lynne Neagle: Thank you very much. Well, we are out of time.
Can I thank you all for attending and for answering our questions
this morning? You will be sent a transcript to check for accuracy
in due course, but thank you very much for coming. The committee
will take a very short break.
|
Gohiriwyd y cyfarfod rhwng 10:23 a
10:31. The meeting adjourned between 10:23 and
10:31.
|
Y Bil Anghenion Dysgu
Ychwanegol a’r Tribiwnlys Addysg (Cymru):
Sesiwn Dystiolaeth 11
Additional Learning Needs and Education Tribunal (Wales)
Bill: Evidence Session
11
|
[100]
Lynne Neagle: Welcome back, everybody, to our eleventh evidence
session on the ALN Bill. I welcome this morning Eleri Griffiths
from Mudiad Meithrin; Claire Protheroe from the Professional
Association for Childcare and Early Years; Jane O’Kane from
the all-Wales health visitor forum; Jayne Morris, who is a lead
health visitor for children with disabilities; and Andrea Wright
from the Wales Pre-school Providers Association. Thank you all very
much for coming this morning. If you are happy, we will go straight
into questions. Thank you. Michelle.
|
[101]
Michelle Brown:
Thank you, Chair. Morning, everybody.
Right now, how are additional learning needs and special
educational needs identified in very young children? Which are the
main ways in which these needs are identified and
assessed?
|
[102]
Ms O’Kane:
Who did you want to pick up on
that?
|
[103]
Michelle Brown:
Whoever.
|
[104]
Ms Wright: From our pre-school providers’ point of view,
it is either a provider—so that’s a play group or day
nursery, or a childminder or a mudiad—. So, if a child
is taken there and they present at that point, a group will say,
‘Oh, there’s something not quite right.’ They
will talk to parents, and then there will be a process of trying to
engage with parents. But, every authority has a different process
from that point on. So, I could tell you about examples of
authorities, but I couldn’t tell you, across the board, that
that would happen everywhere.
|
[105]
Michelle Brown:
So, what would roughly happen? When an
additional learning need is identified in a pre-school child, what
would happen then? Once it has been identified, what is the
process? I appreciate that each authority is going to be different,
but in general, what would happen?
|
[106]
Ms Wright: The provider would speak to the parent, engage with
them, share their concerns about the child, talk to them about
whether they have seen their health visitor, and encourage them to
go and do that, or encourage the health visitor to come and visit
within the setting. If there is a scheme in place within the local
authority, they could refer into a scheme by which they could apply
for funding for one-to-one support. Some schemes will also kick off
into a panel where that child would then be discussed—a
multi-agency panel—and the work done at the providers will be
agreed between parents and other professionals. But, every
authority is so different. Some have that in place, and some
don’t. In Newport, for example, there is a learning needs
co-ordinator that co-ordinates that scheme. That’s a really
good model that we would say works very well. But, unfortunately,
that’s not across Wales.
|
[107]
Ms
Griffiths: Hoffwn siarad yn y Gymraeg, os oes rhai ohonoch angen
clustffonau. A gaf i ategu’r hyn a ddywedodd Andrea? Mae gan
Mudiad Meithrin brofiad helaeth o redeg cynlluniau cyfeirio fel
hyn. Mae’r rhai yr ydym wedi cael cyfrifoldeb amdanynt yn
cael eu galw’n gynlluniau law yn llaw, ac mae cynlluniau
o’r fath yn dal i redeg mewn rhai awdurdodau lleol. Rydym
wedi’u colli nhw mewn rhai awdurdodau ar draws Cymru,
ond mae
dal i fod rhai, ac maen nhw yn enghreifftiau o gydweithio o
safbwynt sawl partner, sy’n reit effeithiol. Mi fydd y
plentyn, gyda chytundeb y teulu, yn amlwg, fel y dywedodd Andrea,
yn cael ei gyfeirio at y cynllun cyfeirio ac wedyn mi fydd panel
aml-asiantaeth, yn aml gyda’r bobl broffesiynol fel
seicolegwyr addysg yn eistedd ar y panel yna ac yn gwneud
penderfyniad ynglŷn â pha fath o gefnogaeth sy’n
addas i ganiatáu i’r plentyn fedru mynychu’r
cylch meithrin neu’r grŵp PPA neu gael pa bynnag fath o
ofal plant sy’n addas i’r teulu. Beth rydym yn ffeindio
o’r hyn o wybodaeth sydd gyda ni ar draws Cymru—un
o’r gofidiau o bosib, oherwydd bod yna wahaniaethau rhwng pob
awdurdod lleol, yw bod yna wahaniaeth mawr yn y gefnogaeth mae
plant wedyn yn ei chael er mwyn gallu mynd i gylch meithrin neu
ofal plant. Felly, efallai mewn rhai awdurdodau mi fydd yna blentyn
yn gallu cael chwe awr o help un-i-un mewn cylch, ac efallai mewn
awdurdod arall bydd e’n 10 awr o help un-i-un mewn cylch neu
mewn lleoliad. Felly, mae’r gwahaniaethau yma yn golygu bod
yna wahaniaethau mawr i brofiadau plant ar draws Cymru.
|
Ms Griffiths: I
would like to speak in Welsh, if you would like to use the
headphones. Could I agree with what Andrea said? Mudiad Meithrin do
have extensive experience of running schemes such as these referral
schemes. The ones we are responsible for are called ‘law
yn llaw’, and these types of schemes are still running in
some local authorities. We have lost them in some local authorities
across Wales, but some are still
in existence and they are examples of collaboration amongst many
partners, which is quite effective. The child, with the agreement
of the family, clearly, as Andrea said, will be referred to a
referral scheme and then a multi-agency panel, often with
professionals such as educational psychologists on that panel,
making decisions in relation to what sort of support is suitable to
allow the child to be able to go to the cylch meithrin or
the PPA group or to whatever type of childcare that’s
suitable for the family. What we do find from the information that
we have from across Wales—one of the possible concerns is,
because there are differences between every local authority,
there’s a big difference in the support that children then
are able to have to go to cylch meithrin or to childcare.
So, in some authorities there will be a child who’s able to
have six hours of one-to-one assistance in a cylch and
perhaps in another authority it will be 10 hours of one-to-one in a
cylch or setting. So, these differences mean there are huge
differences in children’s experiences across
Wales.
|
[108] Michelle
Brown: Do you think the Bill will improve matters? Will it
improve the identification of additional learning needs in
preschool children?
|
[109] Ms
O’Kane: From our point of view, I feel it will really,
really strengthen the recognition of the expertise that the
childcare sector has to bring to this. I think it’s about
increasing the professionalism of the sector and having evidence
there that the work that they’re doing is respected by all
that are working with children and young people. What’s
really important is that at the moment you can have issues where a
need is identified potentially through observation and assessments
of very young children, and trying to get the parents sometimes on
board with your concerns and getting them to recognise those
concerns can be quite difficult. So, by strengthening and bringing
the childcare elements into the Bill I feel that then strengthens
the duty and responsibilities on the provider. It gives a much
clearer process then for following through, for you then to say to
parents very clearly around the duties and
responsibilities—to try and bring them along on that journey
with you as well.
|
[110] Lynne
Neagle: Shall we take some more questions? Julie.
Sorry—
|
[111] Ms
O’Kane: It might be useful just for you to know, in terms
of health visiting, how additional needs are identified, if
that’s okay. So, we’ve got the Healthy Child Wales
programme that was implemented in Wales in October. For every child
there’s a minimum set of nine contacts from birth on up until
the age of four. At six, 15 and 27 months there’s an
assessment of their development and a range of different
developmental assessment tools that are used. From that, if there
are concerns identified, then a referral is generally made to a
community paediatrician who’ll then undertake an
assessment—a Griffiths assessment—which may or may not
determine a diagnosis. Then, Jane, would you like to talk about how
the disability health visiting team might be involved already?
|
[112] Ms
Morris: Yes. Sometimes, we’re involved from birth if
there’s a diagnosis at birth. But if there are any emerging
needs then we work closely with the community paediatricians and we
work with therapists. There are teams in our areas that work
together to assess children together. So, if they’re
identified as having an additional learning need then we will
support them alongside the generic staff then—supporting the
parents—because it is an issue for us as well that parents
are finding it hard, it’s a journey, it’s something new
for them to take on board that their child has got some
difficulties. So, we all work quite closely together then, once we
know what the problem is.
|
[113] Lynne
Neagle: Darren.
|
[114] Darren
Millar: Can I just ask a follow-up question? You mentioned
these developmental milestones, and if those aren’t met then
you may make a referral as health visitors. What about parents who
don’t perhaps engage with health visitors—those who are
outside that net in terms of being able to make a referral and
identify those needs?
|
[115] Ms
O’Kane: To be honest, very few families opt out of health
visiting. In Swansea, for example, I think they had 10,000
under-fives and last year we didn’t have anybody who
disengaged. I think that’s pretty much the experience across
Wales. We do have a very small cohort of families who opt out, but
often, I think it’s fair to say—not often, more than
often—it is fairly standard—. I think most families
don’t realise they can say ‘no’ as well. They
think they have to have health visitors, so maybe it’s a bit
about that, but, actually, we have really good engagement. We do
occasionally have some families who are perhaps in denial, and that
is a challenge, and unfortunately sometimes we have to involve our
colleagues in social services, but that is unusual. But we will
follow that process through, and sometimes, though, it is about
working with families to come to terms with an emerging diagnosis,
and there is work across Wales to provide different levels of
support, because it is about families sometimes having almost a
bereavement-type support or counselling. But, yes—there is a
small cohort of those.
|
[116] Darren
Millar: And just with child development as well, these things
are obviously very difficult to identify at a very early age, but I
assume some things can come on quite rapidly, can they?
|
[117] Ms
O’Kane: As Jayne said, some disabilities are clear from
birth. In terms of neurodevelopmental disorders, it can take a
little while, but often at two, two and a half, there are some
clear issues. There are communication issues, and some social
issues, so we’ve usually got a good indication even if we
don’t have a clear diagnosis. We can usually tell that
there’s something not right there and that there’s
going to be additional support needed.
|
[118] Ms
Morris: I think the importance of joint working with all other
colleagues involved, really. It’s so important to see the
child in different settings and to get a complete picture, so it
sometimes can take a little bit longer. It’s a bit of a
longer process because we want to gather all the evidence we need.
So, we work with the nurseries and the schools to get everything
that we need.
|
[119] Darren
Millar: Thanks.
|
[120]
Lynne Neagle: Thank you. Julie.
|
[121]
Julie Morgan: Thank you. I’m just carrying on with the health
professionals for a moment. Under section 57 of the Bill, health
professionals have a duty, where they believe a child might have
ALN, to notify the parents, and then a discretionary power to bring
it to the attention of the local authority. So, do you think that
health bodies should always tell the local authority that this has
been identified?
|
[122]
Ms Morris: Locally within Neath Port Talbot, we work as a
multi-agency team and all referrals come into one point, with one
point of access for referrals, and at the referral meeting is a
member of the local authority, so we would all
discuss—
|
[123]
Julie Morgan: So, they always know.
|
[124]
Ms Morris: Yes. We’re piloting it in Neath Port Talbot at
the moment and we have very good links with our other colleagues
across the trust, so it’s something that we’re quite
used to—having those discussions with the local authority.
That’s not unusual.
|
[125]
Julie Morgan: Right.
|
[126]
Ms O’Kane:
And I think that happens in a number of
authorities—that integrated approach.
|
[127]
Julie Morgan: Yes, but in fact, in the Bill, it’s a
discretionary power, isn’t it? But you
believe—
|
[128]
Ms O’Kane:
It’s almost essential, though,
because in terms of having a co-ordinated, robust approach to
providing a range of services, then it’s impossible without
sharing that, almost.
|
[129]
Julie Morgan: Yes, yes. And do you know what happens in other parts
of Wales at all?
|
[130]
Ms O’Kane:
My understanding is that some of the
health boards have got very similar processes. So, I believe Hywel
Dda have an integrated approach. I believe in parts of Betsi there
are very good models as well. I think the integrated approach is
working at different levels, though, so, for some there’s a
more formal approach—perhaps the local authority take the
lead for multi-agency teams—and in others, perhaps,
it’s less defined. I know there’s a whole range of
different approaches, but with that same intention to
share.
|
[131]
Julie Morgan: Yes, and do you think it’s absolutely
essential, the multidisciplinary approach?
|
[132]
Ms O’Kane:
Yes, and I think one of the questions was
‘Will this Bill improve things?’ I think we do think
that it’s a positive and that it should, in terms of raising
the profile, but what is absolutely critical is that co-ordinated
approach and that integrated approach. If we don’t have that,
then this will just touch the edges.
|
[133]
Julie Morgan: Right.
|
[134] Ms Morris: When
parents are referred in—or the children are referred
in—to our team in Neath, they’re aware of who is at the
meeting, so they know there’s going to be a social worker
there. And I think it has helped to break down some barriers, about
the relationships of parents with social workers, because sometimes
they only feel they’re there to take their children away, and
it has given us a little bit more—. Well, it has been a bit
easier, really, to introduce them later on, because we can say,
‘Well, you know, they were part of the assessment process and
you might have met them in the assessment.’ Because sometimes
they come into the assessment as well, with the child, just to be
there, to make that assessment with everybody. So, it is helping to build those
relationships and break down those barriers.
|
10:45
|
[135] Julie
Morgan: Thank you. And then, to turn to the early years
providers, do you think the Bill should place a duty on early years
providers to refer a child to the local authority for assessment,
if they believe there might be additional learning needs?
|
[136] Ms
Wright: Yes, I think there should be a process by which they
can reach. At the moment, that doesn’t exist in all counties
unless there’s an additional needs referral scheme. Within
the regulations for providers, CSSIW doesn’t have that within
its regulations for providers to do that, but providers will always
do that if they come across a child that needs additional support
and they feel that there is a route that needs to be taken. That is
not within their regulatory—
|
[137] Julie
Morgan: So, there’s no clear route.
|
[138] Ms
Wright: No. Hopefully, this Bill, if you have—. I think
we need to clarify what the route would be for a day nursery, for
example, or a child minder, and what is going to be their route to
referral into this process. Because health visitors do their
development checks, but a child can present differently in a group
setting than they would do in a home or clinic setting, and
different issues become apparent. So, it’s important that we
catch all and we have a referral process for that as well.
|
[139] Julie Morgan: Yes, and at the moment,
it’s all different ways that—
|
[140] Ms
Wright: It is all different ways, yes. Funding is available in
most local authorities for early years support in terms of one to
one, but how that is managed and how that looks is very, very
different across Wales. There are some very, very good schemes out
there, but over the last few years some of those have been diluted
down and down. Lots of them have additional needs co-ordinators
running them, and that works really well, but that is the first
post that’s taken out when the funding goes. Actually, we
believe that that would be the most important part of it.
|
[141] Julie
Morgan: So, a number of those posts have been lost.
|
[142] Ms
Wright: Absolutely.
|
[143] Julie
Morgan: Right.
|
[144] Ms
Protheroe: Again, just to echo what’s been said
already—and, obviously, I’d agree with everything
that’s been said—I think it’s about strengthening
that process, both within the Bill and within the code, to make it
very clear that it’s not open to that local interpretation
that we know can occur. I would see it and, as an organisation, our
view would be that if you think about the safeguarding process and
that being very clearly defined, with processes and routes through
that, and if you think about the additional learning needs being a
similar route in a similar process, if it gets embedded in the Bill
and within a code, it would be clear then: when it comes to
training, you would have that consistency of approach, and it means
that, when it comes to the writing and review of policies and
procedures that are relating to it, there would be very, very clear
guidance that could inform the direction of those as well.
|
[145] Julie
Morgan: Eleri?
|
[146]
Ms Griffiths:
O’n safbwynt ni hefyd, mae yna
gymaint o fudd, ac y mae rhai o’r gwasanaethau iechyd i blant
bach, yn enwedig o dan dair oed, mor hanfodol i ganiatáu
iddyn nhw i ddatblygu ac i gael eu haddysgu. Mae’n hollbwysig
bod y cydweithredu a’r gwaith partneriaeth yn digwydd mewn
ffordd drefnus ac yn caniatáu cydweithio rhwng lleoliadau
gofal plant a’r asiantaethau arbenigol sydd allan yno,
a’r bobl broffesiynol arbenigol sydd yn gallu dod a rhoi
cyngor ar bethau fel ffisiotherapi, pethau fel iaith a llafaredd,
pethau sydd angen eu hintegreiddio o ddydd i ddydd o fewn y
lleoliad gofal dydd neu gylch meithrin.
|
Ms
Griffiths: From our point of view as well, there is so much
benefit, and some of the health services for young children,
especially under three, are so vital to allow them to develop and
to be taught. It’s vital that the collaboration and
partnership working happen in an organised manner and allow
collaboration between placements and the specialist agencies that
are out there, and the professional workers—the
experts—that can give advice on issues such as physiotherapy,
speech and language, and the things that do need to be integrated
on a daily basis within the day-care placement or cylch
meithrin.
|
[147] Lynne
Neagle: Thank you. Before we move on to Hefin, can I just press
Jane and Jayne on this issue of the discretion to notify, because
that does seem to be a weakening? Although you can say,
‘Well, that happens anyway’, do you not think that
there is a risk that, if it remains a discretion, we could see a
backpedalling on some of these notifications going forward, and
wouldn’t you prefer to have that tightened up?
|
[148] Ms
O’Kane: Yes, I think. I guess, if there’s any
opportunity for local interpretation, then that does create
weakness, doesn’t it? So, yes, essentially, I would agree
with you, that that probably—. If it’s left
discretionary, then there’s always that risk. Whether
it’s resources or other issues that impact on that decision,
then I suppose, potentially, it creates that risk, yes.
|
[149] Lynne
Neagle: Okay. Thank you.
|
[150] Ms
Morris: Yes, and I think that if it’s a process for all
of the children, then that’s more equitable, isn’t it,
as well?
|
[151] Lynne
Neagle: Okay. Thank you.
|
[152] Ms
Morris: If that’s the way it’s done; and I think
parents would accept that as well. It’s a process for all
children, not only yours.
|
[153] Lynne
Neagle: Yes. Okay. Thank you. Hefin.
|
[154] Hefin
David: What are your views on the definition of additional
learning needs that’s contained in section 2 of the Bill? Are
you happy with the definition?
|
[155] Ms
O’Kane: From health visiting we were comfortable with
that. From an all-Wales perspective it seemed to make sense.
|
[156] Hefin
David: Okay.
|
[157]
Ms Griffiths:
Rydw i’n gwybod ein bod ni wedi
ymateb ar y pwynt yma. Rydym ni yn weddol hapus gyda’r
diffiniad ond ei fod e ddim yn ddiffiniad sydd yn ein clymu ni i
sut mae’r plentyn yn mynd i berfformio yn dair oed, achos
roedd geiriad y Bil, fel yr oeddem ni yn ei ddarllen, yn sôn
bod plentyn yn cael ei bennu i fod ag anghenion dysgu ychwanegol os
oeddent yn annhebygol o ffynnu o fewn ysgol pan oeddent yn cyrraedd
oed ysgol. Y pwynt roeddem yn teimlo’n gryf yn ei gylch ym
Mudiad Meithrin oedd bod y diffiniad ehangach yma o ddysgu yn
cydnabod bod dysgu yn y blynyddoedd cynnar o ddim i dair oed yn
llawer ehangach na chyd-destun addysgiadol a sut y byddem yn mesur
addysg ffurfiol. Felly, rydw i’n meddwl byddai gweld ychydig
o ehangu ar hynny—o safbwynt eich bod wedi sôn am
ehangu’r diffiniad i fod yn aspects of learning o
bosib—yn cyd-fynd gyda’n bod ni yn ceisio sicrhau bod y
diffiniad mor eang â phosib.
|
Ms Griffiths: I know that
we’ve responded on this particular point. We are quite happy
with the definition as long as it is not a definition that ties us
to how the child will perform at three years of age, because the
wording of the Bill, as we read it, suggested that a child would be
designated as having additional learning needs if they were
unlikely to thrive within a school when they reached school age.
The point that we felt strongly about in Mudiad Meithrin was that
this wider definition of learning acknowledged the fact that
learning in the early years between nought and three is far wider
than an educational context and how we’d measure formal
education. So, I think seeing that expanded a little—in that
you have mentioned expanding the definition to be aspects of
leaning possibly—would fit in with our idea of trying to
ensure that the definition is as wide as possible.
|
[158] Hefin
David: That was section 2, sub-section 2(a) where a learner
|
[159] ‘has a
significantly greater difficulty in learning than the majority of
others’.
|
[160] Estyn propose a
changed that would be:
|
[161] ‘aspects
of learning than the majority of others’.
|
[162] You support that
is what—
|
[163]
Ms Griffiths:
O safbwynt Mudiad Meithrin, rydw
i’n meddwl bod hynny’n iawn. Mae’n ddiddorol mai
Estyn sydd yn gofyn am hynny achos, wrth gwrs, rheoleiddwyr addysg
ydyn nhw. Ond o safbwynt edrych ar y peth i’r blynyddoedd
ifanc, o sero i dri hefyd, sydd ddim yn dod o dan arolygiaeth
Estyn, rydw i’n meddwl bod ehangu’r diffiniad a
chadw’r diffiniad mor eang â phosib yn bwysig, achos
mae pob math o bethau yn mynd i effeithio ar sut mae’r
plentyn yn gallu datblygu a dysgu a sut mae babanod yn caffael
symudiad. Mi fydd y pethau yma’n cael impact arnyn nhw drwy
eu hoes. Y mwyaf cynnar y mae ymyrraeth yn digwydd, y lleiaf,
gobeithio, fydd eu gofynion nhw wrth iddyn nhw dyfu wedyn,
ontefe?
|
Ms
Griffiths: From Mudiad Meithrin’s perspective, I think
that’s true. It’s interesting that it’s Estyn
asking for that because, of course, they are education regulators.
But in relation to looking at it in the younger years, from zero to
three, which don’t come under Estyn inspections, I think
broadening the definition and keeping the definition as broad as
possible is important, because many different things are going to
affect how a child is able to develop and learn and how babies
acquire motor skills. These things will have an impact on them
throughout their lives. The earlier the intervention happens, the
less their needs will be, hopefully, as they move
forward.
|
[164] Hefin
David: Is that change sufficient to address that?
|
[165]
Ms Griffiths:
Nid wyf yn siŵr. Rydw i’n
methu cofio. Nid wyf yn meddwl ein bod ni wedi gwneud cynnig am
eiriad amgen. Mae’n rhywbeth y byddem ni o bosib yn gallu
rhoi mwy o ystyriaeth iddo a dod yn ôl i’r pwyllgor ar
ôl heddiw i weld. Ond, yn sicr, rydw i’n meddwl ei fod
yn welliant i edrych ar wahanol agweddau o ddysgu. Mae’n
bosib y gallem ni fynd gam ymhellach.
|
Ms
Griffiths: I’m not sure. I can’t remember. I
don’t think we suggested an alternative wording. Maybe
it’s something we could possibly consider more widely and
come back to the committee on that after today to see. But,
certainly, I think it’s an improvement looking at these
different aspects of learning. Possibly, we could take a step
further on that.
|
[166] Hefin
David: Am I to take it from the evidence you’ve given as
well that you’d like to see the greatest focus on healthcare
and medical needs?
|
[167]
Ms Griffiths:
Rydw i’n meddwl ein bod ni
siŵr o fod wedi delio gyda’r prif bwynt y byddwn
i’n hoffi ei bwysleisio, sef pwysigrwydd gweithio mewn
partneriaeth a phwysigrwydd yr holl gefnogaeth amrywiol sydd ei
hangen ar blentyn gan gynnwys yn bendant rhai o’r
gwasanaethau iechyd hollbwysig yma yn y blynyddoedd cynnar, fel yr
wyf wedi sôn yn barod.
|
Ms
Griffiths: I think we probably have dealt with the main point
that I’d like to emphasise, which is the importance of
working in partnership and the importance of all the various
support that a child needs being in place, including definitely
some of these health services that are critical in the early years,
as I’ve mentioned already.
|
[168]
Lynne Neagle: Any other comments?
|
[169]
Ms Protheroe: Can I just add one point quickly? It’s not
really so much around the actual definition of the additional
learning needs itself, but the additional learning needs
provision—
|
[170]
Hefin David: In section 3.
|
[171]
Ms Protheroe: —in section 3. It talks in section 3 about it
being education suitable for a child under the age of three. So, to
us it would be more about care than an education.
|
[172]
Hefin David: Yes; I was referring to sections 2 and 3, just to
clarify.
|
[173]
Lynne Neagle: Have either of the health visitor representatives got
a view on what Hefin just asked about medical needs being
included?
|
[174]
Ms O’Kane:
I suppose I quite like the broadness in
some respects, because I guess being broad keeps it less defined,
really. I think for us, really, it’s more the interpretation.
We’ve got other issues and queries around the
designated education clinical lead officer role, and other things that are a little bit more
concerning, I suppose, from a health perspective. We felt the
definition was broad, but actually there could be some benefit in
that.
|
[175]
Lynne Neagle: Thank you. John, you have questions on the
IDPs.
|
[176]
John Griffiths:
Yes, on IDPs, Chair. I wonder if you
could tell the committee whether you think childcare and early
years providers have enough detail from the Bill and the
draft code, in terms of the IDPs and the role of childcare and
early years providers in preparing and also maintaining those IDPs.
Is there enough detail in the Bill and the draft code?
|
[177] Ms
Wright: Simply put, no. No, there isn’t. If the
expectation is for early years and childcare to take part in and be
part of producing and understanding, then there needs to be a whole
raft of training opportunities to go alongside that. There
can’t be a presumption that they would automatically
understand or know. The expertise is there, but this is a whole new
thing that they would have to do. You also have to consider that
these are mostly private businesses or third sector businesses and
they have no local authority funding within them, and that
you’re asking to do work on behalf of the local authority
that is over and above what they would normally do for a child
attending a setting, so, yes, you would have to—. There would
be an expectation from the sector that you would put in some
ring-fenced funding for them so that they can access training and
be able to use the things appropriately and successfully.
|
[178] Ms
Protheroe: I think for us, from an organisational point of
view, it’s about strengthening the role and clearer
responsibilities within the Bill, and I think that comes out of the
process that we’ve talked about as well. It’s around
chapter 11, in particular. I feel that that needs to be
strengthened to ensure that the role is clear. We’re
all—I think we’re all here; all of us have talked about
the integrated approach and the need to ensure that you’re
working in partnership, which is really, really important, but if
you don’t have those roles and responsibilities more clearly
defined, it’s going to lead to local interpretations of that,
I think.
|
[179] John
Griffiths: So, there’s not enough detail at the moment,
but what role would you see the childcare and early years providers
playing in the preparing and the maintaining of those IDPs?
|
[180] Ms
Protheroe: It’s about having that evidence to be able to
bring to the table, creating opportunities to work together with
health professionals or the local authority to ensure that you can
set up opportunities to engage and discuss and to share
observations and assessments you may have produced. So, it’s
just that joined-up approach, and what that actually is and what
the shape of that is. Like we’ve said, a lot of work needs to
come out of that, and there will be a lot of training needs around
that to ensure that the sector is prepared and ready for the
changes, to ensure that we make the most out of the professionals
we’ve got there, and, again, we’re recognising the role
that they have to play.
|
[181] Ms
Griffiths: O’n safbwynt ni, rydw i’n meddwl,
mae’r wybodaeth sydd ar gael ar hyn o bryd yn y Bil ac yn y
cod yn dal i fod braidd yn rhy annelwig i fedru ateb eich
cwestiynau chi yn glir. O fy narlleniad i, rydw i’n gweld bod
yna ddisgwyliad fod y darpariaethau nas gynhelir sydd yn cael eu
hariannu i wneud addysg tair oed yn dilyn y cod ymarfer statudol
newydd, tra bod yna ddisgwyliad bod lleoliadau eraill, fel
meithrinfeydd, sydd ddim yn derbyn yr arian addysg yma, yn gorfod
rhoi sylw priodol i’r cod ymarfer—due regard.
Felly, mae yna wahaniaeth yna’n barod.
|
Ms
Griffiths: From our
point of view, I think that the information that’s available
at the moment in the Bill and in the code is too ambiguous for us
to respond to your questions clearly. From my reading, I see that
there is an expectation that the non-maintained provision
that’s funded for education at three years old adheres to the
new statutory code of practice, while there is an expectation that
other settings, such as nurseries, which don’t receive this
funding, have to give due regard to this code of practice. So,
there’s a difference there already.
|
[182]
Nawr, yn ein profiad ni, yn aml iawn
yr un plant fyddan nhw yn ddwy oed yn y lleoliadau neu
feithrinfeydd neu gylchoedd meithrin sydd wedyn yn troi’n
dair, ac yn sydyn mae yna wahaniaeth yn beth yw’r disgwyliad
o beth maen nhw’n fod i wneud o dan y cod ymarfer fel ag y
mae e. Felly, rydw i’n meddwl bod yna le gyda ni nawr, ac
rydw i’n gwybod bod y Llywodraeth yn bwriadu trefnu mwy o
gyfleodd pellach, i drafod manylder y cod yma a sut yn union allwn
ni sicrhau cysondeb i’r plant o fewn yr un lleoliad yn aml,
yn lle bod y gwahaniaethau yma.
|
Now, in our
experience, very often it’s the same children who are two
years old in the settings or the nurseries or the cylch
meithrin who turn three, and suddenly there’s a
difference in the expectation of what they’re meant to do
under this code of practice as it stands. So, I think there is room
for us now, and I know that the Government intends to arrange
further opportunities, to discuss the detail of this code and how
exactly we can ensure consistency for the children within the same
setting, very often, rather than these differences being there.
|
[183]
Mae lot o brofiad gyda chylchoedd
meithrin a darpariaethau gofal plant mewn sicrhau eu bod
nhw’n addasu addysg ac yn cefnogi plant ag anghenion dysgu
ychwanegol, ac wrth gwrs mi fydd hynny yn hynod bwysig wrth gymryd
rhan mewn llunio cynlluniau dysgu unigol, ond ein dealltwriaeth ni
yw mi fydd y cynlluniau yma yn dal i fod o dan ofal a chyfrifoldeb
yr awdurdod lleol. Felly, mae lot o waith i wneud i edrych ar beth
fydd siâp ein cyfraniad ni fel sector gofal plant yn y broses
yma.
|
The
cylchoedd meithrin and the other childcare providers have a
great deal of experience in ensuring that they adapt their
education to support children with additional learning needs, and
of course that will be vitally important in taking part in putting
together the individual development plans, but our understanding is
that those plans will still be under the auspices and
responsibility of the local authority. So, there is a great deal of
work to do to look at what the format of our contribution, as the
childcare sector, will be in this process.
|
[184] Lynne
Neagle: Have the health visitors got any comments on the
IDPs?
|
11:00
|
[185] Ms
O’Kane: Well, I think that the proposal as it is
creates—or presents as being more equitable than the current
model, generally. I guess, for us, there is a greater emphasis on
health, or there’s more accountability for health services,
as against as it was with the statementing process. At the moment,
we’re not quite clear how that process will be managed, but
also whether there’ll be any sanctions for health boards.
Obviously, there are real pressures around delivering therapy
services, particularly. Speech and language therapy and
occupational therapy always come to mind, and those are always
pressure points. I suppose, in the current climate within the NHS,
it’s how that’s actually going to feel—how it can
feel any different, I suppose. So, whilst, in theory, in terms of
the process, it looks much better, the challenge—. The other
bit, though, I guess, is around—and I’m maybe moving on
a bit, but it connects—the fact that there’s a
suggestion that there’ll be a change—or, more than a
suggestion, a proposal that, in terms of resolution, for families
where they have issues around health, which will mostly be OT and
speech and language, they’ll follow through the health
board’s complaints processes. Whilst, in some respects,
that’s good, because there’s clear governance around
those—or there should be already—I suppose the worry is
for us is that, potentially, families could be going through two
processes. So, they could be taking health boards through the
complaints process for therapies, particularly, and education. We
have had quite a lot of experience of focus groups with families
with children—preschool children particularly, and older
children—and it is usually issues around education provision,
OT and SLT. So, that is our only concern that, whilst we accept,
for health, it means they’ve got greater responsibility and
accountability, it’s how that will feel both for families,
but—. So, I guess, probably for us, it feels like there needs
to be some more clearly defined operational processes that perhaps
can’t be locally interpreted.
|
[186] Lynne
Neagle: Thank you. Michelle.
|
[187] Michelle
Brown: Thank you, Chair. What sort of resource and staffing
implications will the new framework have for—? We’ll
take health visitors, first, and go with you.
|
[188] Ms
O’Kane: The designated education clinical lead officer
role is obviously an issue, in some respects, of concern in that I
understand it’s a role that is expected to be part of an
existing post holder, that there is no funding. So, I suppose the
first thing that comes to mind is how achievable that will be, but
one of the ladies here mentioned safeguarding, and that’s the
sort of thing we were thinking that, if you had it within the
health board, sitting at—it needs to be, obviously, at a
senior level, maybe an exec level, and a process not dissimilar to
safeguarding. But it’s achievability, I suppose. That’s
the anxiety. It will give children with disabilities, though, much
greater focus and visibility in health boards, and I think
it’s fair to say that that isn’t the case often,
because of other pressures. So, it is a positive. But, in terms of
resources, I guess that the DECLO is something—. We do wonder
how somebody’s going to be able to deliver on this agenda
really meaningfully without delegating an awful lot of stuff,
although I appreciate that if it’s more around the governance
and quality assurance then they will have to draw information from
others. Then I suppose it will raise, I guess, the profile even
more so, potentially, of speech and language therapy and OT service
provision. So, I suppose there’s a bit around expectations of
families as well—[Inaudible.]
|
[189] Michelle
Brown: Do you think the DECLO should be a dedicated role
or—?
|
[190] Ms
O’Kane: I think we would—. Yes. If money was no
object, we would certainly say that that should be, or at least a
dedicated allocated piece of work. If it’s going to have the
authority, it needs to be at a probably very senior level in the
organisation; but, knowing what people’s portfolios are like,
I do have anxieties that that will be a real challenge for them.
Because they are so removed from the operational, there’ll
need to be a range of systems in place for them to be able to do
anything meaningful.
|
[191] Michelle
Brown: What are the implications in terms of staffing and
resources for childcare providers and others?
|
[192] Ms
Wright: I think the issue that we will have is that we would
feel that you’d need an ALNCO for early years, dedicated in a
local authority, to co-ordinate all the work that we do within our
provisions. As I say, some schemes run very well with that person
already there, but there are a lot of schemes that run without that
co-ordinated approach, and, unless you have that person
that’s co-ordinating the referrals in and co-ordinating the
responses that are needed—. And, at this age, families are
needing a huge amount of input as well, and there needs to be a lot
of work done with them, quite often. It’s the in-denial phase
for parents. It’s a whole new journey for them they
weren’t expecting to take, and it does need someone
co-ordinating the whole approach to their child at this emerging
diagnosis stage. Those children that are very early identified,
that’s a much simpler process, but those that are in the two
to three age group particularly are more difficult. You’ve
got the ASD pathways for those, so they’re not going to get a
diagnosis for some time, but they are going to have a need and
those parents are going to need a lot of support. But there needs
to be a lot of multi-agency working for that family, and you are
going to need a dedicated person who understands the childcare
sector and that age group, and I think we would be very anxious
that it wasn’t sucked into the educational element of it at
this stage. It does need a different approach, although it does
need joined-up thinking towards transitioning to education. Again,
that’s another big piece of work that needs really to be
looked at in terms of the link, and maybe being responsible for
transition from childcare provision into education, because they
are different.
|
[193] Ms
Protheroe: I think, for us, it’s about that proactive
approach to ensure that the sector are prepared and have the
confidence, as well as the skills, to be able to support children
with additional needs, so that, when they are identified, rather
than being reactive and then trying to upskill staff once
you’ve had a need identified, you’re embedding a
certain level right across the sector from the very beginning.
|
[194] Again, if you
think of that safeguarding training model, that’s the way it
works with safeguarding, that you will have your staff that are
trained to ensure that that’s the ethos across the whole
setting. If a similar sort of model was followed for safeguarding
training as for additional learning needs, you can ensure then that
you’re embedding that, preparing, upskilling, as well as
giving the confidence, so that people don’t feel scared to
take on children with additional needs in settings.
|
[195]
Ms Griffiths:
Rwy’n cytuno gyda hynny’n
llwyr. Rydym ni’n gwybod bod anghenion ein gweithlu
ni—anghenion hyfforddiant ein gweithlu ni—yn dangos yn
rheolaidd bod cefnogi plant ag anghenion dysgu ychwanegol yn raglen
hyfforddiant sydd angen ei gwneud yn gyson, ac mae’r darlun o
ran sut mae hynny’n digwydd ar draws Cymru yn amrywiol.
Felly, yn sicr, bydd hyfforddi’r gweithlu—dim jest
gweithlu o fewn lleoliadau gofal plant, serch hynny. Mae yna
oblygiadau i edrych ar anghenion a sgiliau y gweithlu ehangach ar
draws y maes iechyd a thu fewn i’n hawdurdodau lleol ni, ac
fe soniai ychydig mwy am hynny efallai pan edrychwn ni ar y
dimensiwn ieithyddol hefyd o ran medru darparu gwasanaethau yn yr
ieithoedd priodol.
|
Ms
Griffiths: I agree with that entirely. We know that the
training needs of our workforce do show regularly that supporting
children with ALN is a programme of training that needs to be
undertaken regularly, and the picture of how that happens across
Wales is variable. So, certainly, workforce training will
be—not only the workforce within childcare settings, of
course. There are implications in looking at the skills of the
wider workforce across health and within our local authorities, and
perhaps I’ll mention that in more detail later when we look
at the linguistic aspect in relation to providing services in the
appropriate languages.
|
[196]
O edrych ar y Bil a’r
dadansoddiad ariannol sydd wedi dod gyda fe, nid oes
modd—wel, rydw i wedi methu â dehongli o’r
wybodaeth sydd ar gael faint o’r gwariant sydd yn mynd ar y
blynyddoedd cynnar ar hyn o bryd. Felly, wedyn mae’n anodd
iawn i wneud sylwadau ynglŷn â faint o wariant y bydd
angen edrych ar ei gynyddu er mwyn gallu gweithredu systemau newydd
yn y blynyddoedd cynnar. A hefyd, fel rydym ni wedi ei ddweud,
oherwydd bod y systemau a’r disgwyliadau yn dal braidd yn
annelwig, mae’n anodd i roi ateb cwbl precise ar hyn
tan bod y manylion yna i’w gweld.
|
In looking at
the Bill and the financial analysis that accompanies it, there
isn’t—well, I haven’t been able to garner from
that information how much of the spending is going on early years
at the moment. So, it’s very difficult to give comments on
the potential spend that will need to be increased in order to be
able to operate new systems within the early years. And also, as
we’ve said, because those systems and the expectations are a
little ambiguous, it’s rather difficult to give an answer on
that that is very precise until we have those details.
|
[197] Ms
Protheroe: I think the options paper looks at some of the
issues and starts to talk about the training implications and the
funding that may be available, but it doesn’t specify enough
what comes into the early years’ side of things there, in
particular those settings that are non-education settings.
|
[198]
Lynne Neagle: Okay, thank you. Oscar.
|
[199]
Mohammad Asghar:
Thank you very much, Chair, and I’m
thankful to the panel here. My question is directly to Andrea here.
You mention that there is solid evidence to support good working
practice in terms of collaboration and multi-agency working. In
particular, you focused on a model currently employed in Newport,
which is highly respected throughout the industry. What steps, in
light of these resources and training implications, can you take in
this Bill to ensure that the best practice model can be employed or
deployed across all Welsh local authorities to ensure a unilateral
basic standard of support?
|
[200]
Ms Wright: The way that it works for us in Newport is that the
local authority tenders out a contract to supply that service, and
that can be done across Wales. Local authorities across Wales put
that process in place. But we as Wales PPA have a standard pack, as
do Mudiad, over how we would deliver that. So, as far as I’m
concerned, we are ready to go in any authority that we can tender
for that package, and, as I say, Mudiad have got exactly the
same—well, it’s not the same, but—. But, if we
had that consistency across local authorities—. So, every
local authority has funding for early years at the moment, but they
all spend it in a completely different way, and if we had every
local authority spending it in the same way, then you would have
that consistency across the board, you would have very
high-quality, well-delivered schemes, and you’d have the
collaboration that we are all looking for. So, we, as early years
providers, are already on board with it in that sense; it’s
the local authorities that you have to get on board with it, and
you have to ensure that what funding they put in is done
appropriately and done across the board. I mean, other schemes run,
but they don’t have an additional needs co-ordinator in; they
just fund a one-to-one within the group, but there’s no
additional needs co-ordinator actually bringing all the agencies
together in a panel to discuss the child and taking the responses
forward. And that is not good enough, really, at all. You
can’t just give one-to-one for a child; that is just not the
response that we would be wanting to see. We want to see a
multi-agency response, working together with the families and the
transition into education from those provisions. I think health
visitors have a real key role within that as well. So, we do have
the means to do it. What we don’t have is the uniformity
across Wales to do it.
|
[201]
Mohammad Asghar:
Thank you.
|
[202]
Lynne Neagle: Thank you. Llyr.
|
[203]
Llyr
Gruffydd: Ie, diolch yn fawr. Gwnaf i ddod at yr elfen ieithyddol,
felly, a gafodd ei chrybwyll yn gynharach, a dau drywydd, mewn
gwirionedd, un yn edrych ar argaeledd y gwasanaethau sydd ar gael,
neu’r diffyg argaeledd, efallai, ac yn ail, wedyn, y
dyletswyddau penodol sydd yn y Bil o safbwynt darpariaeth drwy
gyfrwng y Gymraeg.
|
Llyr Gruffydd: Yes, thank you very much. I’ll turn to the
linguistic dimension, then, as it has already been mentioned, and
two particular issues, one of them the availability of services, or
perhaps the lack of availability of services, and then the other,
the specific duties in the Bill with regard to Welsh-medium
provision.
|
[204]
Fy nghanfyddiad i
yw bod yna brinder eithriadol o ddarpariaeth mewn rhai meysydd, sef
seicolegwyr addysgol, OTs efallai, y therapyddion lleferydd ac yn y
blaen trwy gyfrwng y Gymraeg. Yn sicr, rwyf wedi delio ag un neu
ddau o achosion ar ran fy etholwyr yn y maes yma. Ond ai’r
sefyllfa yw bod yna bocedi lle mae yna ddarpariaeth reit dda a bod
yna ardaloedd eraill lle nad oes yna ddim, neu a ydy’r
ddarpariaeth yn gyffredinol yn denau iawn ar draws Cymru
gyfan?
|
My perception
is that there is a severe lack of provision in some areas, namely
educational psychologists, OTs perhaps, speech and language
therapists and so on through the medium of Welsh. Certainly,
I’ve dealt with one or two cases on behalf of constituents in
this area. But is it the situation that there are pockets of good
provision and other areas where there is none, or is the provision
generally very patchy across Wales?
|
[205] Ms
Morris: Yes, definitely, there’s a shortage of
Welsh-speaking therapists, and the other thing that we’ve
noticed is that if a child is identified as having additional needs
and they come from a Welsh-speaking home, there isn’t, with
us and within ABM, there isn’t a Welsh school provision for
that child. So, we have to rely on the special school and,
hopefully, some one-to-one support within the school for that
child, where there is somebody who can speak Welsh. So,
that’s another aspect of it, isn’t it? But, yes,
we’re very short. We’re very fortunate in our team: out
of eight of us, five of us speak Welsh. So, I think we’re a
little bit rare.
|
[206]
Llyr Gruffydd:
Ond mae yna gwestiwn, felly,
ynglŷn â chynllunio’r gweithlu a faint o waith
sydd wedi cael ei wneud i sicrhau bod siaradwyr Cymraeg yn dod
trwy’r system. A ydych chi’n gweld arwyddion bod digon
yn cael ei wneud ar hyn o bryd?
|
Llyr Gruffydd: But there is, therefore, a question about workforce
planning and how much work has been done to ensure that Welsh
speakers come through the system. Are you seeing signs that there
is enough being done at the moment?
|
[207]
Ms Morris: Na, dim really.
|
Ms
Morris: No, not really.
|
[208]
Ms Griffiths:
Rwy’n meddwl bod y darlun, o
beth rwy’n ei ddeall o hynny o wybodaeth sydd gyda ni, yn
amrywiol. Rwy’n gwybod bod Comisiynydd y Gymraeg a’r
comisiynydd plant wedi edrych ar hyn a’u bod yn derbyn
cwynion, yn anffodus, yn gyson ynglŷn â gwasanaethau
trwy gyfrwng y Gymraeg i blant, a’u canfyddiadau nhw,
rwy’n meddwl, ydy bod yna rai llefydd lle mae’n bosibl
bod yna weithwyr proffesiynol—er enghraifft, y seicolegydd
addysg—yn medru gwneud asesiadau, ond rydym ni’n dal yn
brin o rai o’r tŵls sydd eu hangen ar y bobl i wneud y
swyddi yn iawn, ac mae yna brinder o bethau fel asesiadau safonol
trwy gyfrwng y Gymraeg.
|
Ms Griffiths: I think that the picture, as I understand it in
relation to the information that we have, is a varied one. I know
that the Welsh Language Commissioner and the children’s
commissioner have looked at this and they do receive complaints,
unfortunately, quite frequently in relation to Welsh language
services for children, and I think that their perception is that
there are some areas where there may be Welsh language
professionals—the
educational psychologists, for example—who can undertake
assessments in Welsh, but we’re still lacking some of the
tools that people need to do their jobs properly, and there is a
lack of things like standard assessments through the medium of
Welsh.
|
11:15
|
|
[209]
Felly, hyd yn oed lle mae yna
weithiwr sydd yn medru siarad y Gymraeg, nid ydynt bob amser yn
gallu defnyddio’r offer sydd eu hangen yn eu swyddi nhw achos
nid ydynt ar gael yn Gymraeg. Rydym wedi gweld enghreifftiau o hyn
o fewn Mudiad Meithrin pan mae yna asesiadau amrywiol yn cael eu
gwneud gan asiantaethau gwahanol— bod yna issue nad yw
rhai o’r rheini ar gael trwy gyfrwng y Gymraeg ar gyfer plant
sydd eu hangen nhw yn Gymraeg.
|
So, even where there is a worker who can speak
Welsh, they’re not always able to use the tools they
need for their job because they’re not available in Welsh. We
have seen examples of this in Mudiad Meithrin where various
assessments are undertaken by different agencies—that there
is an issue that some of them are not available through the medium
of Welsh for children who need them in Welsh.
|
[210]
Hefyd, o’r hyn rwy’n ei
ddeall, er mwyn i’r Bil fod mor gryf ag y medriff e i gefnogi
plant a theuluoedd i gael y gwasanaethau y maen nhw eu hangen yn yr
iaith briodol, mae angen i’r atebolrwydd yna fod yr un mor
gryf o safbwynt y ddwy iaith i’r gwasanaethau. Yn y cod, maen
nhw’n tynnu sylw at ddisgwyliadau o dan Mesur y Gymraeg
(Cymru) 2011. Ond, nid yw Mesur y Gymraeg o reidrwydd yn mynd i fod
yn ddigonol i sicrhau y bydd pobl yn medru herio’r
gwasanaethau ac y bydd y cyrff yn atebol am beidio â darparu
gwasanaethau yn y Gymraeg.
|
Also, as I
understand it, in order for the Bill to be as strong as possible to
support children and families to have the services they need in the
appropriate language, that accountability needs to be as strong in
both languages in relation to the services. In the code, attention
is drawn to the expectations under the Welsh Language (Wales)
Measure 2011. But, the Welsh language Measure isn’t
necessarily going to be sufficient to ensure that people are able
to challenge these services and that these bodies will be
accountable for not providing Welsh services.
|
[211]
Mae yna enghreifftiau penodol. Er
enghraifft, nid yw Mesur y Gymraeg, mae’n debyg, yn
cyfeirio’n benodol at ddarparu cymorth dysgu ychwanegol, er
gwaetha’r ffaith bod y Bil yn dweud ein bod ni’n
dibynnu ar Fesur y Gymraeg fel y tŵl. Felly, mae o bosibl
angen edrych ar y pethau yma eto. Hefyd, nid yw’r safonau o dan Mesur y Gymraeg ddim eto
wedi cael eu gosod ar fyrddau iechyd. Felly, ni allwn ni ddibynnu
ar y safonau yna fel modd o yrru’r newid sydd angen cael ei
weld.
|
There are
specific examples. For example, the Welsh language Measure,
apparently, does not refer specifically to the provision of
additional learning support, even though it says in the Bill that
we do depend on the Welsh language Measure as the tool. So, perhaps
these issues need to be looked at again. Also, the standards under
the Welsh language Measure haven’t yet been set for health
boards. So, we can’t depend on those standards as a way of
driving the change that we need to see.
|
[212]
Ond, i fod yn obeithiol, hynny yw,
lle mae’r awydd a’r gyfraith yna, mae yna newidiadau yn
gallu digwydd. Mater o gynllunio gweithlu’r dyfodol yw e,
ontefe?
|
But, from an
optimistic point of view, I think where the law and the desire is
there, changes can happen. It’s just a matter of planning the
workforce for the future, isn’t it?
|
[213]
Llyr
Gruffydd: Y cwestiwn, felly, i ddod at y dyletswyddau yn y Bil ei hun,
yw: a yw’r dyletswyddau’n ddigon cryf? Hynny yw, yn
amlwg, mae yna wrthdaro’n mynd i fod. Os nad yw’r
ddarpariaeth ar gael a bod rhywun yn creu dyletswydd, wel, nid oes
posibl cyflawni’r ddyletswydd honno. Ond, heb fod yna
ddyletswydd gryfach, ble mae’r imperative i sicrhau
bod y ddarpariaeth ar gael? Oherwydd un o’r pethau cyntaf
ddywedodd y comisiynydd iaith yn ei thystiolaeth i ni yn ddiweddar
oedd, ‘Wel, mae wedi bod yn broblem ers 10 i 20
mlynedd.’
|
Llyr Gruffydd: The question, therefore, to come to the duties in the
Bill itself, is: are those duties sufficiently robust? Of course,
there’s obviously going to be conflict. If provision
isn’t available and somebody creates a duty, then it’s
impossible to fulfil that duty. But, without there being a stronger
duty, where is the imperative to ensure that provision is
available? Because one of the first things the language
commissioner said in her evidence to us recently was,
‘It’s been a problem for 10 or 20
years.’
|
[214]
Y perygl yw, oni
bai bod y dyletswyddau yn ddigon cryf yn fan hyn, ac wedi’u
cefnogi gan gynllun datblygu’r gweithlu, fe fyddwn ni
nôl mewn 10 mlynedd arall yn gwneud yr un gŵyn. Felly, a
oes gennych chi farn? Er enghraifft, rwyf jest yn meddwl am y
byrddau iechyd i gymryd pob cam rhesymol i sicrhau bod y
ddarpariaeth ar gael drwy gyfrwng y Gymraeg. A ydy hynny’n
ddigon cryf?
|
The danger is
that, unless the duties are sufficiently robust here, and supported
by the workforce development plan, we’ll be back here in
another 10 years making the same complaint. So, do you have an
opinion? For example, I’m just thinking about the health
boards taking every reasonable step to ensure that provision is
available through the medium of Welsh. Is that sufficiently
robust?
|
[215] Ms
O’Kane: I suppose it’s about reasonability,
isn’t it, and how meaningful it is? Because, as you’ve
said, it’s been a challenge for a long time. It’s the
right thing to do, to have it built into the measure and to be
specific. But I suppose it’s about the achievability and the
means to do that. I hear what you’re saying, it’s that
dilemma I guess—
|
[216]
Llyr
Gruffydd: Un awgrym posibl, efallai, yw ein bod ni yn caniatáu yn
y Bil—ein bod ni’n sticio gyda chymryd pob cam
rhesymol, ond erbyn rhyw ddyddiad, ymhen 10 mlynedd neu beth
bynnag, fod yna ddisgwyliad bod yn rhaid darparu. A ydych
chi’n meddwl y byddai rhyw fath o drefniant dau phase,
mewn gwirionedd, yn help?
|
Llyr Gruffydd: One possible suggestion, perhaps, is that we allow in
the Bill—we stick with taking every reasonable step, but by a
specific date, within 10 years or whatever, there is an expectation
that provision must be made. Do you think that that kind of
dual-phase arrangement would help?
|
[217]
Ms
Griffiths: Fe allaf i weld rhywfaint o werth yn yr awgrym hwnnw ac, o
bosibl, nid yn unig fod yna darged amser lle mae disgwyl y bydd y
gweithlu yna i gefnogi, ond hefyd bod yna dystiolaeth sydd yn sail
i’r camau rhesymol sy’n cael eu sôn
amdanynt.
|
Ms Griffiths: I
can see some value in that suggestion and perhaps not only to have
a specific time target with an expectation as to when the workforce
will be in place to provide support, but also that we should have
evidence as a basis to these reasonable steps that are
mentioned.
|
[218]
Hynny yw, nid cam
rhesymol yw jest cael chat amdano mewn ystafell a dweud,
‘Mae’n anodd i wneud hyn, o wel, fedrwn ni ddim.’
Beth yw’r dystiolaeth bod y corff yna wedyn wedi mynd allan i
wneud trefniadau? A oes modd cydweithio ar draws awdurdodau lleol?
A ydyn nhw wedi edrych ar sgiliau iaith y staff presennol sydd
ganddyn nhw neu gennym ni, lle bynnag ŷm ni?
|
A reasonable
step isn’t just having a chat about it in a room and saying,
‘It’s difficult to do this, oh well, we can’t do
it then.’ What is the evidence that that body has been
looking at making arrangements? Can they collaborate across local
authorities? Have they looked at the language skills of the staff
they have at the moment, or what our staff have, wherever we may
be?
|
[219]
Ac felly bod yna
ofyniad o dystiolaeth o beth yw’r—. Ac efallai yn y
canllawiau sy’n dod gyda’r cod ein bod ni hefyd yn
gallu edrych ar fwy o gyngor ynglŷn â sut rydych yn
dangos tystiolaeth eich bod chi wedi cymryd camau
rhesymol.
|
And so there is
a requirement for evidence of the—. And perhaps in the
guidance that comes with the code we could also look at having more
advice on how you show evidence that you have taken reasonable
steps.
|
[220]
Llyr
Gruffydd: Diolch.
|
Llyr
Gruffydd: Thank you.
|
[221]
Lynne Neagle: Darren.
|
[222]
Darren Millar: Yes, just a very brief question for the childcare
providers’ representatives, really. Obviously, there’s
been a Government commitment to extend the free childcare offer in
Wales, one which has been very, very welcome indeed. But we know
that there’s a lot of pressure on the childcare workforce,
shall we say, and that there’s some concern about places. Is
this Bill potentially going to cause more difficulty for childcare
providers if duties are extended to you? You seem to be suggesting
that you would like some duties and powers to be able to refer, but
isn’t that going to potentially cause you some problems at
the same time as this other stuff going on?
|
[223] Ms Protheroe: I think it’s
important that it goes through and that there’s parity across
the sector. I’m sure we’d all agree that it’s
needed and maybe it’s timely that it ties in with the 30-hour
offer. We know that there’s going to be capacity issues.
We’re obviously working very closely with local authorities
as the childcare pilots start to get implemented now from
September. We know that one of the issues that comes out in
childcare sufficiency assessments is around the availability of
childcare for children with additional learning needs. So, I think
these are things to start to develop and test within the pilots
themselves. I think this is timely and we shouldn’t be
changing it and excluding childcare providers from it. It’s
an opportunity we need to grasp now.
|
[224]
Ms Griffiths:
O’n safbwynt ni, fel mudiad
sydd yn ymrwymedig i hawliau plant, rwy’n meddwl ei bod yn
ddyletswydd arnom ni i gyd. Rwy’n gwybod, o fewn ein
lleoliadau gofal plant ni ar draws y sector cyfan, fod y bobl
sy’n gweithio gyda’r plant eisiau’r gorau er budd
y plant, pwy bynnag ydyn nhw a beth bynnag yw eu sefyllfa nhw.
Felly, mae’n gweithwyr ni yn gwneud y gorau y medran nhw yn
barod. Felly, mae’n rhaid i ni wneud hyn. Nid oes dewis.
Mae’n fater o hawliau dynol i’r plant bach.
|
Ms Griffiths: From our point of view,
as a group that is committed to children’s rights, I think it
is a duty on all of us. I know that, within our childcare settings
across the entire sector, the people who work with the children
want the best for the children, whoever they may be and whatever
their situation is. So, our workforce does the best that it can
already. But, we do have to do it. There is no choice. It’s a
matter of human rights for these children.
|
[225] Ms
Wright: I think we’ve got the will to do it. We do do it.
We work very, very hard within our sector with all children.
Regardless of what the local authority has in place, we will always
do our very best for each individual child there. What we would
like is the recognition that we do that work and that our work is
very valuable and that we can make a big difference. I think that
needs to be built in to all that we do. It’s really the
recognition and the respect that we’re already doing a huge
amount of work. I’d really like to see the local authorities
coming into line with that and providing uniform support across
Wales—that’s what we’d like to see.
|
[226] Darren
Millar: Great. Diolch.
|
[227]
Lynne Neagle: Thank you very much for coming in this morning and
for your evidence. We really appreciate your time and you will be
sent a transcript in due course to check for accuracy. Thank you
again for coming this morning. The committee is going to take a
really short break of about two minutes because we need to just
change over witnesses. Thank you.
|
Gohiriwyd y cyfarfod rhwng 11:22 a 11:26.
The meeting adjourned between 11:22 and 11:26.
|
Y Bil Anghenion Dysgu
Ychwanegol a’r Tribiwnlys Addysg (Cymru):
Sesiwn Dystiolaeth 12
Additional Learning Needs and Education Tribunal (Wales)
Bill:
Evidence Session 12
|
[228] Lynne Neagle: Okay, welcome back, everybody. Can I welcome Dr Dai
Lloyd, Chair of the Health, Social Care and Sport Committee, who is
joining us for some of the sessions today? We're very grateful to
you for your attendance. Can I also welcome Sara Moran from
Diabetes UK, Dr Justin Warner from the RGPCH, Ann
Sivapatham, who is from Epilepsy Action, and Mandy East,
who’s from the Anaphylaxis Campaign? Thank you all for
attending and for the evidence that you’ve provided. If
you're happy we'll go straight—
|
[229]
Darren Millar:
Sorry, Chair, can I just declare an
interest? I'm the vice-president of Epilepsy Action. I think I need
to declare it.
|
[230]
Lynne Neagle:
Okay, thank you. Are you happy for us
to—?
|
[231]
Dr Warner: I'm from the RCPCH, not the RGPCH.
|
[232]
Lynne Neagle:
Oh, sorry.
|
[233]
Dr Warner: It’s the Royal College of Paediatrics and
Child Health.
|
[234]
Lynne Neagle:
Are you happy for us to go straight
into questions? Okay. If I can just start, then, just to try and
get some clarity on what you're actually calling for. Are you
asking for a statutory duty to be included within this Bill to
support all pupils with medical conditions, even where they do not
have an identified ALN as defined under sections 2 and 3, or do you
want the definition of ALN widened so that the needs of children
with medical conditions are taken into account? Who would like to
start?
|
[235] Ms Moran:
I’ll start, if that's okay. Thank you, Chair. I think both
are valid for us, but they don't, perhaps, quite—. There's
more information around both options. So, certainly, having a
long-term medical condition, you could argue that there is a
significant impact on learning and access to education. So, I don't
think, necessarily, it would fall outside of the sections 2 and
3. I know there's been a lot of support around broadening the
definition to include healthcare needs or medical conditions within
healthcare needs, which might impact on learning or disrupt the
school day or require intervention from an adult, and I think
that's probably more accurate for us. I think the use of the
special educational needs system to support medical conditions in
schools in recent years would reflect that more appropriately. I
think it’s less of a jump, if you like. And so, I think
option 2 of what you've just described is probably more suited to
our cause. I don't know if Justin would like to talk just a little
bit around the impact on the school day, really.
|
[236] Dr
Warner: Yes, I'd agree. So, I'm a paediatrician. That's my
training, and I’m a diabetologist. So, that's my exemplar
here, if you like, although I'm covering all chronic medical
conditions, really, with my hat on today. But the impact that
having a medical condition has on the school day—a long-term
condition we’re talking about—is huge and can affect
your ability to learn. So, for diabetes, for instance, if you're
running high or low blood sugars, you don't concentrate,
you’re excluded from sporting activities—all sorts of
things that it will have an impact on. So, I think the widening of
the ALN definition to include medical conditions would be entirely
appropriate.
|
[237] Lynne
Neagle: Thank you. Ann.
|
[238] Ms
Sivapatham: Yes, I agree. With epilepsy, it's very much a
misunderstood condition and it does affect learning. It affects
cognition and memory. It's not just a two-minute seizure; it
affects before and after, and some children can have memory loss
for two, three, four days, or even a week. So, it has a high impact
on learning.
|
[239] Lynne
Neagle: Okay, thank you. Mandy.
|
[240] Ms East:
From the point of view of children who have severe allergies and
potentially are at risk of anaphylaxis, one of the key things that
we’re very concerned about is children not being excluded
from the school day and from the curriculum.
|
11:30
|
[241] So, whilst the
vast majority of these children will not suffer a reaction in the
school day, or even during their school lives, because of the risk,
they’re often excluded from things such as crafts, cooking,
school trips and some sporting activities, because the risk to the
school staff is deemed too high to allow them to take part. For
example, some children aren’t able to choose certain options,
such as food-based subjects, because there’s too much of a
risk. That does impair their learning. So, we’re not
necessarily talking about children that need medical intervention
on a daily basis, but children who are suffering because of their
condition.
|
[242] Lynne
Neagle: Okay, thank you. In terms of this Bill being the right
vehicle for you, why do you think that is the case? Would you, for
instance, be satisfied if the Welsh Government said, ‘Well,
okay, we can’t do it in this Bill, but we’re going to
look at something quickly further down the track’? Would that
work for you, or what do you think the disadvantages of that would
be?
|
[243] Ms Moran:
I think I’d be very surprised if it was elsewhere, given the
reality of the current system. Just to go back some years, even
decades, the SEN funding and staff roles involved have been applied
for medical conditions. So, certainly, if we’re not included
in the ALN Bill, that would pose a threat to it if, in reforming
statements or different types of funding, that would then be
reformed but then not be able to be reallocated to medical
conditions. In practice, what that would mean is that, for a child
today with a statement of SEN for diabetes, if that is removed next
week, the reality would be that I would certainly be confident in
saying that families would not send their child to school. I think
schools would be very much closed-doors and trying to push back
also, understandably, because they can’t guarantee the safety
or access to education for that child.
|
[244] So, in response
to your question, Chair, I think it would be very surprising to do
it elsewhere. Also, I think it’s time critical. I think
we’d all agree on that. The Bill has been around for a number
of years. I’m sure that you’re more aware of that than
I am. Given the proximity of the issues, in terms of legislation,
it’s the same sectors, it’s the same parties,
it’s the same beneficiaries, it’s the same processes
that improve care or, similarly, have a detrimental effect on care,
and, for that reason, the ALN Bill is absolutely appropriate
because of the practice currently used, of the SEN system.
|
[245] Lynne
Neagle: Okay. Anybody—.
|
[246] Dr
Warner: I would say that I think that this would be a missed
opportunity if this is not put into the current Bill. We’re
already behind various other nations—European and
transatlantic nations—in our approach to medical conditions
in school. I know, as I do a lot of work with my Swedish
counterparts, that they started this process in about 2010—a
massive input and policies into schools for diabetes—and
showed a dramatic improvement in their overall care. That has not
only influenced that child’s ability to learn, but it also
has influences on their long-term health. So, it’s a massive
reduction in burden on the family and the child, but also the
burden on the health service and us as taxpayers in the long run.
So, I think it’s actually essential. If we don’t get
this in now, I think it’s a massive missed opportunity.
|
[247] Lynne
Neagle: Okay. Just before I bring Oscar in, you were saying
that healthcare needs don’t fall outside the Bill, as far as
you’re concerned, but you were also saying that definition
needs to be widened.
|
[248] Dr
Warner: Yes.
|
[249] Lynne Neagle: Is that a bit contradictory,
do you think?
|
[250] Ms Moran:
I think—if I could answer, Justin—
|
[251] Dr
Warner: Yes.
|
[252] Ms Moran:
At the moment, I’d argue that it’s too open to
interpretation. It’s not clear enough. So, the danger
is—. You know, we’re coming at it from a medical
conditions position, which is life-threatening, lifelong conditions
that don’t have cures and they’re not going away. We
need to deal with them and treat them appropriately. When you look
at that, I think you can very clearly see the ambiguities involved.
There’s crossover with the Equality Act. I think all of our
conditions are disabilities under the Equality Act. There’s
cross-over in terms of additional learning provision.
|
[253] The types of
support in a school setting are very, very similar for both
parties, and also in the code. The code does mention healthcare
needs, albeit in a very limited and inadequate, I think, capacity.
If you’re leaving it open to interpretation by educational
professionals who don’t have that expertise, that’s
really dangerous. It’s going to increase the variability we
already see, which is a huge issue across all parties involved,
and, ultimately, I think it would end up in the tribunal. I think
you’re going to have to let the tribunal decide. If you put
it in black and white at the start, that removes all the
uncertainty. And, certainly, I know with the England
example—. I know Mandy and I have talked at length about how
much the English model has acted as a dispute avoidance mechanism
in the first place. So, people aren’t having to have these
disputes and ending up having dispute resolution options. I
don’t know, Mandy, if you want to expand on that.
|
[254] Ms East:
Yes, we were a UK-wide charity, and we were very much involved with
the change to the Children and Families Bill in 2014 in England,
and, before that, it was very difficult to help individuals,
because all schools were under a guidance system, which we’re
talking about here. And it was very difficult to be able to give
advice, because we can tell parents what they should expect from
the school, in an ideal world, but there was nowhere for them to
go. Since that became statutory in 2014, we’ve really seen a
massive difference, because we’re able to actually signpost
parents and families towards the right way that things are meant to
be. And it’s also there in black and white for them to
understand. And what we’ve seen since then, because
we’re UK wide, is families in Wales coming to us very much
asking for this to be the same in Wales, because they can see and,
to them, it’s a really straightforward option that, actually,
schools should be completely uniform. Each goal should know what
its responsibilities are. So, it has made a big difference in
England, and I know it’s a different set-up and a different
system, but the general sort of feeling in England is that it has
worked quite well so far.
|
[255] Lynne
Neagle: Okay, thank you. Llyr.
|
[256]
Llyr
Gruffydd: A gaf i jest pigo lan ar ychydig o dystiolaeth gawsom ni yn
ddiweddar gan gynrychiolydd o Gymdeithas Cyfarwyddwyr Addysg Cymru,
a oedd yn dweud, er na fyddech chi efallai yn disgwyl hynny, fod
ariannu addysg anghenion arbennig yn cyfrannu at greu darpariaeth
ar gyfer plant ag anghenion meddygol ar hyn o bryd. Nawr, nid yn
unig, felly, y byddai rhai pobl yn teimlo ei bod yn ddymunol i roi
statws cyfartal yn y Bil yma, ond mae’r perig ydy, o beidio
â gwneud hynny, y bydd yr arian yna a’r gefnogaeth yna
sy’n cael eu defnyddio ar hyn o bryd yn cael eu colli hefyd.
Felly, rwy’n cymryd bod hynny’n risg. Hynny yw, a
ydy’r darlun yna yn un yr ydych chi’n ei adnabod, sef
bod yr arian presennol yn mynd tuag at lawer o’r
ddarpariaeth, a beth ydych chi’n credu yw’r risg o
golli hynny?
|
Llyr Gruffydd: Can I just picked up on some of the evidence we had
recently from the representative from ADEW, who said that, although
you perhaps wouldn't expect it, funding for ALN education does
contribute to the creation of provision for children with medical
needs at the moment. So, not only would some people therefore feel
it would be desirable to give equal status in this Bill, but, also,
the danger is, of course, if you don't do that, the support and
funding that is used at the moment would also be lost. So, I assume
that that's a risk. That is, is that picture one that you
recognise, in which current funding does go towards much of this
provision? And what do you think is the risk of losing
that?
|
[257] Ms Moran:
I think that’s absolutely accurate, Llyr. The conversations I
have with local authorities, with school staff are exactly as
you’ve just described, and, in fact, in many cases, they can
only continue if they apply ALN funding. I mean, I don’t know
what will happen if they can’t do that, and when I made them
aware that that might be the case, you know, we’re just both
sat there, ‘What are we going to do?’ These are
children who have statements of SEN—I know there were issues
around that as well—in the first place, but where funding is
applied, it is, I would say, exclusively through SEN or ALN funding
budgets, because I think it’s the nearest thing in practice,
so that’s what’s being done and has been done since the
1990s in some cases, in some local authorities I’ve spoken
to.
|
[258] The risk is very
real, just to add to that aspect of your question. I would say
it’s almost a certainty, if it’s not clear, and
there’s also the danger, of course, that some people will
just think that, you know, with these reforms, we’re just
moving from SEN and changing the name and they’ll carry on.
So, you’ll have some people carrying on doing what
they’ve always done, some people stopping doing it, and other
people probably ringing us or you, asking for clarification.
That’s really time and resource-heavy. You know, to put it in
black and white, as Mandy has said, on the face of the Bill or on
the face of the code as well, everybody knows where they are. We
don’t want to leave these decisions to hundreds of people in
their professional capacity who are looking at this, thinking,
‘Does it? Do I? Can I do that? I don’t know’, and
then ringing me or you and we’re saying the same thing, and,
like I said, it’ll end up in the tribunal.
|
[259] Dr
Warner: And, as a healthcare professional, it leaves us with no
redress to a system that can help our patients. It’s
difficult enough as it is now, but we would have absolutely nothing
if the medical needs are not included in this Bill, because
we’d be completely powerless to help our patients who we look
after during that school period.
|
[260] Lynne
Neagle: Thank you. Oscar.
|
[261] Mohammad
Asghar: Thank you very much, Chair. Sara, you strongly argued
in your evidence that a statutory duty should be included on the
face of the Bill to support pupils with
medical conditions. What specifically do you identify as the key
issues for students with diabetes, if this continues to be
excluded? And what further work can be undertaken to promote
support for those currently covered in the Bill, alongside having
diabetes also?
|
[262]
Ms Moran: Thank you for your question. I know I’m coming
from Diabetes UK, but, when it is medical conditions in schools,
irrespective of the condition, the issues are always the same.
Primarily, it’s variability of care, and that can be between
local authorities, between schools, even between year groups. And
you won’t know until you speak to a family what care they
receive—you can’t really predict it.
|
[263]
Secondly, I would say it’s high
levels of parental involvement, certainly. So, we do regular annual
surveys, and it’s always around the 50 per cent to 60 per
cent mark where parents have had to leave their job during the
working day to attend the school. Some people have left their jobs
or lost their jobs because of absence. Certainly, it’s very
common to have families with one parent working, and I think
we’d all agree on that; it’s very, very common. So, the
economic impact on the family is massive, aside from all of the
emotional and social aspects.
|
[264]
There’s also the practical side of
things, like school trips, like exams, like anything
extra-curricular, residential trips—children with diabetes
are almost always not allowed to go on residential trips. And even
just taking part in the normal school day; even the school bus, the
school transport. There are issues at every stage, unfortunately.
You know, there are issues around schools’ engagement.
There’s very little we can do if a school refuses to engage
with a child’s medical condition. Even in schools where the
care is what we would consider excellent, there’s still
issues that they don’t know that they’re doing a good
job. There’s no sort of reference that they can look at and
say, ‘We have put this, and this, and this, and this in
place; we’re doing what is expected of us’. Then they
can obviously share that with other parties, and set expectations
all round, which, again, assists with dispute avoidance.
|
[265]
You know, the issues cannot be
understated for families. As I speak, I know families are watching
this session who are at home because they’re probably waiting
for a call from the school to have to go in to attend, to either
provide treatment or provide some sort of monitoring. And I think
that’s the same for all of us, really—none of
it’s a shock, which is awful to say, but I speak to so many
families, and, unfortunately, this is commonplace, and
there’s very little that we can do if a school refuses to
engage.
|
[266]
Lynne Neagle: Okay. Darren.
|
[267]
Darren Millar: I just wanted to follow up. You mentioned some of
these other issues that are not currently referred to in the Bill,
such as home-to-school transport. I know that we’ve spoken
about this issue, but can you just elaborate on the sorts of
problems that a lack of access to appropriate home-to-school
transport can actually mean for young people and their
families?
|
[268]
Ms Moran: Yes, absolutely. Justin’s probably better to
explain the clinical side. Do you want to just say a bit about the
risk of hypo—?
|
[269]
Dr Warner: A child with diabetes, wherever they are—at
home or at school, or on a school bus—are at risk of acute
complications, one of those being low blood sugars. Without urgent
action, it results in that child having a seizure, being taken to
hospital and being excluded then from that school day. And quite
the reverse: if they’ve got high blood sugar, their inability
to concentrate. So, access to proper school transport, where they
are being looked after during that period of time—it may only
be 15 to 20 minutes, but it’s vitally important.
|
[270]
Darren Millar: What sort of other conditions might school transport
complications—?
|
[271]
Dr Warner: Medical conditions?
|
[272]
Darren Millar: Yes.
|
[273]
Dr Warner: Well, epilepsy would be definitely one—if a
child has a seizure on the bus, somebody needs to know how to deal
with that.
|
[274]
Darren Millar: Do you think that home-to-school transport should
feature within these individual development plans—that there
should be a requirement for that to be a consideration?
|
[275]
Dr Warner: Yes.
|
[276] Ms Moran: That
would be massively helpful, definitely. I try and help the parents
by using the learner travel Measure in Wales, and there’s a
very, very brief reference to disability in it, which isn’t
medical conditions management, but that’s the nearest thing.
But it’s inadequate—it doesn’t help me at all in
assisting families. And, certainly, you try and explain that to the
school, and then it’s invariably the local
authority’s responsibility. And so you get back to this sort
of passing the buck culture, unfortunately. I don’t know,
Mandy, if you wanted to jump in as well.
|
11:45
|
[277] Ms East:
It’s the same for anaphylaxis. In fact, we’ve had
parents who’ve had to take their children out of school
because there isn’t adequate home-to-school transport,
because there isn’t anyone trained on that transport to
administer the adrenaline in case of an emergency. And whilst the
risk is low, it relies on the child not eating anything, or not
taking the risk, and you can’t rely on a child, a young
child, to take that level of risk. So, it’s a difficult one
with home-to-school transport. Ideally, it would be fantastic if it
was covered, because even if the school have got it perfectly
right, and the child is perfectly adequately cared for in school,
getting to and from the school can actually be the obstacle that
stops them going to school.
|
[278] Darren
Millar: But some sort of arrangement that allows the tribunal
to direct something in relation to home-to-school transport, and
for it to be considered as part of an individual plan, would be
important, yes?
|
[279] Ms East:
Yes.
|
[280] Lynne
Neagle: Thank you. Michelle.
|
[281] Michelle
Brown: Thank you, Chair. Do you think the Bill goes far
enough to address and resolve the weaknesses in the current system
that you’ve identified?
|
[282] Ms Moran:
I think the code is helpful in addition to the Bill. I think
evidence shows that in almost all scenarios, when there are certain
processes put in place, then care in school does improve. Those
things usually are things like a medical conditions policy, having
a plan—an individualised development or healthcare plan.
Having a positive attitude, certainly from the headteacher and
school governors, helps, and I think those sorts of things can be
put in place as part of what’s described in the code. So, I
think that would be the more practical side of it, but, certainly,
in terms of that framework of having that criteria in place,
evidence shows it does improve care in schools, and those are all
in place whenever you do go to a good school to see what they have
in place. I would say that those are the common denominators,
irrespective of condition. And, similarly, if they’re not in
place, then you will see a direct correlation to the child having
higher absences, having much more trouble at school, perhaps being
bullied, definitely being excluded from day-to-day activities. And,
so, even though we’re talking about the causes of
impairments, I think the effects of the impairments are all very,
very similar, and there are definitely things that Government can
do to put in place to reduce that, and to support children.
|
[283] Dr
Warner: I’m lucky enough to have a specialist nurse
educator for schools, which we got funding for last year. And so
her whole role is going into schools and teaching teachers about
diabetes. She is specifically diabetes related. And that’s
made a massive difference to schoolteachers. They feel far more
confident now. But one of the things it always come back to is the
legal framework. They’re terribly worried that they might do
something wrong and they won’t be protected at all, and so
it’s constant reassurance, and she’s very good at doing
that. But Sara was telling me that over the last year, we’ve
not had a single complaint from a parent in the Cardiff area while
we’ve been doing that. So, it does make a huge difference if
you get it right. The school headteacher is absolutely key to that.
If you don’t get it right with the school headteacher, the
rest of the teachers won’t do it. And it’s not a
criticism of the school system, but that’s how it works. So,
I think it doesn’t currently go far enough in covering the
medical needs. I think that would be vitally important to get that
in there.
|
[284] Lynne
Neagle: Okay. Dai.
|
[285] Dai
Lloyd: Thank you, Chair, and thank you for the privilege
accorded to me to interlope on your committee, and the chance to
learn at the feet of one of the most the distinguished living
chairs. But, anyway, I shall bring that into my other
chairpersonship. I just wanted to go back a little bit in history
and to how we got to this point. I take it that the current SEN
regulations then have tacitly allowed a cross-situation whereby
medical needs were sort of looked after without anybody actually
spelling it out. Whereas now, we’re in danger, under the new
ALN, of actually spelling things out and thereby denuding children
with medical needs of privileges they have, unofficially then, been
privy to. No. 1: would that be a fair assessment? And No. 2: as
you’ve alluded in your answer to Lynne, there needs to
be some resolution of this, so let me put it to you that, if
we’re going to pass any ALN Bill that does not recognise the
sort of issues you’ve been bringing up today, that would be a
big missed opportunity. What sort of legislation would you want to
see in the future then, if it is passed as it is, taking into
account the medical needs? Obviously, being a GP, the medical needs
are paramount, and I fully take on board that we’ve got into
this mixed situation where you cannot separate health and education
in this situation. We’re almost talking, Chair, with your
indulgence, of not behaving in silos and being person centred. This
seems as though we’re going the other way round and
we’re actually creating silos and forgetting about the person
at the centre. Not that I want to feed any answers, but from the
point of view of the health committee here, who have a particular
interest in the health implications of this Bill—which is why
I’m here—I just need to see how you flesh those sort of
issues out.
|
[286] Ms Moran:
Thank you, Dai. So, I think firstly that is a fair assessment of
the system in terms of the SEN system being applied to medical
conditions. I think it’s important to note that, where it has
been applied, it has been positive. It almost invariably always
works—I know there are issues around the battle for
statements. I think it’s important to note that, even though
it is the SEN funding, primarily that has been used for statements.
It’s also important to note that it’s also used for
different types of support, like one-to-one support. The presence
of having the SENCO there—a lot of people in Wales from
existing school staff volunteer to be the main point of contact for
diabetes in a school, and they put themselves forward, which is
fantastic. But there’s that reach to the SENCO that is really
important. So, it’s not just the funding—it’s
different elements of the SEN system that have been applied, and as
you quite rightly said, that is now under threat.
|
[287] I think, if
it’s not included now, it’s quite sad, really, to note
that all of the benefits that the ALN Bill is going to introduce
would be exactly what we would recommend as going some way in
resolving our issues. Things like having the strategic DECLO role,
having access to a tribunal; I mean, it’s just the stuff of
dreams for us. It really is like a wish list of things that would
really help families.
|
[288] I’m really
hesitant to answer about other legislation, because I don’t
understand why that would be the case when we’ve got this in
front of us right now. I wholeheartedly believe that the benefits
of the ALN Bill will benefit families we represent hugely, and it
really is a case—I can’t say it enough—that it is
either—. We’re at a juncture, and we’re either
going to have the benefits of the reforms or it’s going to
set us backwards. We will go backwards. It’s not a case of,
‘We’re going to stay the same here’. It’s a
case of ‘It’s a threat to us’. Already it’s
such a fragile system, and it’s going to undermine that
further. The difference—I know it’s been discussed at
committee at length—of the battle for the statements:
‘Have you got a statement?’ has been the question that
you always start conversations with, for years. And now, if
you’re outside of the ALN framework, it’s just going to
change to, ‘Have you got ALN?’ ALN will be the gold
standard. The gap will be far wider than it is now. That will be
the thing that families are pushing
for—ALN—unnecessarily early diagnosis of mild learning
difficulties to get in under the framework. I know that’s an
awful thing to think of, but it’s been mentioned to us by NHS
staff. It is a real risk, and it’s so important to get across
that it’s not a case of staying the same. In reforming any
system, you hope that you will improve things for people,
especially for children. The worst-case scenario, I guess, would be
low impact or no impact. You certainly don’t go into it
thinking you’re going to harm some beneficiaries, and the
fact is that the Bill in its current format does not reflect the
current beneficiaries of the SEN system. We’re not starting
from zero, we’re not starting from a point where we can just
draw things out as we want them, we’re starting from a place
where children with medical conditions receive benefits under the
SEN system, and it’s just really—I cannot say it
enough, I don’t know if anyone else wants to jump in, but you
cannot say it enough that it will threaten that.
|
[289]
Lynne Neagle: Okay, I’ve got Julie then Llyr, if that’s
okay, and then I’ll bring—
|
[290]
Julie Morgan: I wanted to ask, really, about the impact on children
in the present system. Because, obviously, we’ve heard a lot
today about what they’re excluded from in many cases, where
they can’t go, and trying to put yourself in the place of
that child. Could you tell us what the present system means to
those children longer term? What are the effects on them if they
lose out in many ways?
|
[291] Ms Sivapatham: Could I just give an
example of one family? The child is seven years old, and
she’s had epilepsy since she was two weeks old—really
complicated, difficult to control epilepsy—but she’s
gone to Great Ormond Street Hospital, and she’s now had three
operations and things have improved. She was sent home last
September from Great Ormond Street with a letter from her
consultant to say, ‘This child needs stability.’ The
child goes to school then in September, and the headteacher tells
the parents, ‘This child’s got to be moved to a
unit.’ So, this parent had to go back to Great Ormond Street,
get the consultant to write another letter, get a consultant in
Cardiff to write, and the epilepsy specialist nurse, and get
everyone involved, and it’s still a bit rocky for that family
and this child. She has epilepsy; she doesn’t have learning
disabilities. She just has epilepsy. She needs stability, the
family have gone through quite a rough patch over the last seven
years, and that could be denied and she might have to go into a
unit, and she’s got a medical condition.
|
[292]
Julie Morgan: And that’s happens under the
existing—that’s what’s happening now under the
existing system.
|
[293] Ms Sivapatham: Yes.
|
[294]
Dr Warner: Thank you for that question, Julie, because we
actually asked one of our psychologists in Wales to review the
literature on this very subject, and the stigma that is put on. So,
irrespective of the medical condition you may have, which
immediately stigmatises you anyway, it was about the stigma
associated with being excluded from doing PE or being excluded from
going on a school trip, and it’s absolutely massive, the
stigma around that. So, it’s not just about having a medical
condition, it’s the association, the knock-on effects, that
having that sort of condition might have. So, it is vitally
important to get it right. The current system’s certainly by
no means perfect, it’s the—. Just coming back to the
SEN system, because I think the variability of that across Wales is
huge, so, there are some parents who are quite forceful, for want
of a better word, who will use the system and get what they want
from it, but there are others who don’t and don’t
succeed to get answers. I think protecting them under a new law
would be hugely beneficial to them, and I would hopefully
see—almost guarantee to see—that you would avoid some
of that stigma associated with the condition itself.
|
[295]
Julie Morgan: I’ve had a number of parents who have come to
me over different incidents over the years, and the last one was
about the child not being able to go on the school trip, which I
had to intervene in, and in the end the parent went with the child,
which—. I suppose that is something that would happen fairly
often.
|
[296]
Dr Warner: But that’s a stigma in itself.
|
[297]
Julie Morgan: Exactly.
|
[298]
Dr Warner: The last thing you want is your parent in the lunch
queue with you. So, the parent turning up at school might be all
right when you’re four, but when you’re eight or nine
you do not want your parent there; it’s a massive
stigma.
|
[299]
Julie Morgan: Yes. And then one last question, if that’s
okay. You mentioned the fact—I think, Mandy, you
did—about examples of how things have improved in England.
Has that been researched, or is that just a general feeling that
things have improved?
|
[300]
Ms East: It’s in the process—. We have a coalition
in England called Health in Schools and it’s a similar
coalition to what we now have in Wales, and there is work being
done on it. It’s quite a slow process, and there’s no
official data yet, but we have a helpline that we monitor and, in
advance of doing this, our helpline calls are—my helpline
colleagues can state that it’s a lot easier dealing with the
calls in England, and they have fewer follow-up calls from the same
families. Whereas we have a number of families in Wales who
we’re working with on an ongoing basis, and the types of
issues that they’re dealing with are—. A lot of the
time children with food allergies are excluded during the lunch
break and they have to sit on their own during lunch, which in
itself doesn’t sound like a massive thing, but over time that
becomes a massive stigma. What we’ve found is it’s not
because the teachers are being cruel, it’s not because the
teachers are being deliberately awkward, it’s just
that they don’t have any understanding of what they could be
doing. As Sara mentioned earlier, they haven’t got any real
models of where it’s good. So, if we have schools where
they’re good, we can say, ‘Well, this is how it should
work’. But, with just guidance, there’s no push for the
teachers to say, ‘Well, actually, I can see now what I should
be doing’. So, the feeling we have, as a UK-wide charity, is
that it’s easier in England for parents to get some type of
recourse, and there will ultimately be some type of data on that.
But I think we’re quite well-placed, dealing with both
England and Wales, to be able to say that it’s definitely
easier.
|
12:00
|
[301] Julie
Morgan: Thank you, Chair.
|
[302] Dr
Warner: And that’s the—
|
[303] Ms Moran:
I do have a bit of data, Julie. Sorry to jump in. I think
we’ve seen a marked increase, just with families with
diabetes. We annually survey around 400 to 500 families, and
we’ve seen a marked increase in the number of medical
conditions policies in schools. That has absolutely shot up by
about 60 per cent. So, those sorts of things—you know,
quantifiable measures. There are early indications that things are
improving. I know that Diabetes UK in England is working with
Ofsted now, who have advised that they’re willing to update
their monitoring, or to certainly look at it to monitor policies
that would help as well. So, just to support Mandy, really, it is
the early evidence. Although any implementation is going to be a
bit challenging, the evidence we do have is certainly showing that
it wasn’t an error, and it has been a good thing.
|
[304] Lynne
Neagle: Okay. Thank you. Llyr.
|
[305] Llyr
Gruffydd: Yes, we heard reference to guidance a moment ago, and
I’m just mindful that we’re discussing the current
situation and concerns about maybe losing services or erosion of
provision; but, of course, we are imminently awaiting revised
guidance from the Government. What hope do you hold that that might
be able to mitigate some of the concerns that we’re
discussing here today?
|
[306] Dr
Warner: I would be extremely concerned, actually, as a medical
practitioner. Guidance is guidance. It’s not statutory duty.
You can write as much guidance as you like, but it doesn’t
protect the child.
|
[307] Ms East:
And, in fact, there are parts of the guidance that are quite
worrying anyway. So, it doesn’t go far enough. Even if it was
absolutely perfect as a guidance document, it wouldn’t be
enough. But the fact is that it’s not fit for purpose, in our
opinion, as it stands, anyway. There are parts of it that allow it
too far open to interpretation and too much of the buck stopping
with the wrong people.
|
[308] Ms Moran:
Definitely. I think one perfect example is that the code actually
refers the reader to the guidance and the guidance fails to
guarantee any support for medical conditions. It’s important
to notice the difference between the healthcare needs generally.
Obviously, we’re representing chronic conditions here that do
impact on learning, et cetera, et cetera. So, the thing that really
worried me was that it says that, in determining whether a child
needs an individual plan, the final decision rests with the
headteacher. I think we all sort of gasped when we read that,
because, as we all know, if a headteacher, as the gatekeeper,
doesn’t want to engage, then the school won’t. So,
certainly, we would want the final say in that to rest with an NHS
staff member. But I completely support Mandy and Justin in what
they’re saying, in that, even if the guidance was fantastic
and of sufficient detail and clarity, it’s not going to
resolve the issues. I can say that with some confidence.
|
[309] Llyr
Gruffydd: Thank you.
|
[310] Lynne
Neagle: Thanks. Darren.
|
[311] Darren
Millar: Just on this issue of guidance, you’ve explained
a little bit about some of the problems that people are already
experiencing. Guidance is guidance—you’re quite
right—and it’s not on a statutory basis, but you
referenced something earlier on, Justin, just about the need for
some opportunity for redress if there’s a problem. Of course,
at the moment, as it stands on the Bill, there is a role for a
tribunal that can require local education authorities and schools
and direct them to deliver certain aspects of support. The NHS is
without that system completely, and it suggests that we should just
follow the NHS redress system that’s there, the Putting
Things Right process, which we all know can be very long and
protracted, not just for children and young people, but for others
as well. Is that one of the reasons why you would like to see
medical conditions within this whole system and framework? I assume
you’d also like to see the redress, in terms of NHS-related
support, and the ability for the tribunal to give direction to the
NHS in terms of being able to access that for learners, yes?
|
[312] Dr
Warner: Yes. I would say. Absolutely, yes. That’s exactly
what we would want. I think it would—. I always spend a lot
of my time writing letters to try and support children and often
get nowhere, but this system would protect consultants as well. It
would protect lots of people on that pathway of trying to provide
that child with the best healthcare they can get. So, absolutely,
yes, I agree with you.
|
[313] Darren
Millar: Just in terms of—you mentioned the time that you
spend often writing letters of support and all the effort. And
you’ve got people who find it difficult to fathom a system of
redress if they’ve never encountered it before. But, bringing
all of that into one place, what sort of efficiencies would that
give you with your time as a busy clinician?
|
[314] Dr
Warner: Yes, it would you time efficiencies, because
you’d have a pathway to point somebody down in order to
address the issues that they have. I think it would protect people
on both sides. It protects the child who’s in the middle,
which is what we’re focusing all around—it brings the
healthcare and the education together in terms of discussing what
the needs are of that child.
|
[315] Darren
Millar: Okay, thanks.
|
[316]
Lynne Neagle: Okay. Are there any other questions from Members? No.
Okay—
|
[317] Darren
Millar: Could I just ask one more? It’s just about
variability of support. I know that one of the issues that we often
encounter, as constituency Assembly Members, is when people move
into an area, and they’ve had a certain level of support in
from a neighbouring local authority, and suddenly it’s not
available to them even though it’s a very similar sort of
school environment. To what extent do you think that the Bill, in
relation to medical conditions, as it stands, will help to address
that?
|
[318] Ms Moran:
As it stands?
|
[319] Darren
Millar: As it stands.
|
[320] Ms Moran:
It’s a threat to—it would just make it worse, as I said
earlier; it would widen the gap. It would—I mean, it’s
hard to quantify the effect. As I said earlier, it will make us go
backwards as a nation, as a system, everything. It would really,
really be a wrecking ball to it. Already when they move schools
around—we worked out that around 60 children with diabetes
have moved schools because of poor care. Ann was saying earlier
that some schools that you come across have never heard of a
healthcare plan. And, you know, when you’re moving from local
authority to local authority that’s even bigger. So
it’s very difficult to quantify, but I’m certain that
it would be very negative.
|
[321] Dr
Warner: Yes, it would certainly be a step backwards.
|
[322] Darren
Millar: Okay, thank you.
|
[323]
Lynne Neagle: I just have one final question before we finish,
then. Would you be satisfied if the code was strengthened in
relation to medical needs, or is it absolutely something on the
face of the Bill that you want—you want the definition
widened clearly on the face of the Bill?
|
[324] Ms Moran:
I think it’s important for clarification. So, I certainly
would expect the code to be updated quite significantly to be a lot
clearer and a lot more definite. And, in terms of the face of the
Bill, I think there is scope to clarify where a medical condition
does impact on learning or there’s a barrier to education in
some form—that should be clear as well. Anything that we can
do to remove the subjectivity is definitely a step forward. I think
it’s dangerous when you get to subjective points, and I know
that’s the difficulty with the Equality Act 2010 and
reasonable adjustments—that’s what they find. So, I
think anything that can be as clear as possible. Being on the face
of the Bill gives it that authority, and you just—that is
exactly what we would call for. So, I would definitely say to err
on the side of as much clarity as possible, please, Chair.
|
[325] Lynne
Neagle: That’s the case for all for all of you, yes?
|
[326] Dr
Warner: Yes.
|
[327] Ms
Sivapatham: Yes.
|
[328] Ms Moran:
Yes.
|
[329] Ms East:
Yes.
|
[330] Lynne
Neagle: Okay, lovely. Well can I thank you for coming this
afternoon? And thank you for your evidence which has been really
useful to the committee. And you will receive a transcript in due
course so you can check it for accuracy. Thank you very much for
your time.
|
12:10
|
Y Bil Anghenion Dysgu Ychwanegol a’r
Tribiwnlys Addysg (Cymru): Sesiwn Dystiolaeth 13
Additional Learning Needs and Education Tribunal (Wales) Bill:
Evidence Session 13
|
[331] Lynne
Neagle: Okay, thank you, everyone. We'll move swiftly on, then,
to our next scrutiny session. Can I welcome Dr Dave Williams from
Aneurin Bevan Local Health Board, Rosemarie Whittle from Cardiff
and Vale University Local Health Board, and Ellis Peters who is
from Powys Teaching Local Health Board? Thank you for coming this
morning. Are you happy for us to go straight into questions?
|
[332] If I can just
start then, if I can tell you that the—. When we had the SEN
tribunal for Wales in recently to give evidence, they told us that
weakness in collaboration between health and local authorities had
plagued the effectiveness of the current SEN system. Can I just ask
you for your views as to how you feel—you know, whether you
recognise that description of the current system, and how things
are working at the moment, and for your general observations on how
you think this Bill will address those problems? I don’t know
who would like to go first.
|
[333] Dr
Williams: I’d recognise those comments but also say
it’s very variable across Wales how well the joint working is
going on, and part of that is historical relationships, but also
how much that sort of joint working is valued. So, we know the way
that organisations are held to account; it doesn’t
necessarily encourage joint working or value it in the same ways.
There’s also a bit about availability of staff, so if you
look across the whole of Wales, for example the availability of
community paediatricians and therapists is hugely difficult, and
prioritising that joint work can be problematic. I think the
direction of the overall Bill is actually really welcomed. I think
when you come to the tribunal end of things, the concern from the
health point of view has been how that tribunal has the necessary
health expertise, if you like, to be a properly joined-up decision
because we’ve had concerns about some independent reports
being put in that don’t necessarily reflect the assessment of
the local services, and that can cause difficulty in expectation
but also delivery.
|
[334] Lynne
Neagle: Okay.
|
[335] Ms
Whittle: Yes, I would completely agree with that. I think the
variety in working together across Wales, as Dave has mentioned, is
definitely right, I think. I would say, in Cardiff and Vale, we
have good working relationships. However, there are times when we
do get into difficulties. So, we’ve had a recent issue with
one of our local authorities saying they don’t feel that the
health board is supporting them enough when they’re actually
challenging tribunals, and when they actually believe that they
need to challenge that. We’ve had a recent meeting and a
recent discussion about that, and that’s because, at the same
time as we’re trying to support our colleagues in education,
we’re also trying to deliver a waiting list against
assessments, and it becomes a case of prioritising what you can and
cannot do.
|
[336]
Lynne Neagle: Okay.
|
[337] Mr
Peters: We would agree with all of those things in addition. We
do have different drivers on us that if a child has been through a
tribunal and they have made a ruling putting a therapy programme in
part 3 but it’s based on an independent therapist
recommendation, it may not be something that we have assessed for,
or a service that we provide, and the local authority would look to
us to provide it, and that causes tension.
|
[338] Lynne
Neagle: Okay, thank you. Dai.
|
12:15
|
[339] Dai
Lloyd: Thank you, Chair. In terms of co-operation between
health and education, which is local government—I’ve
been a GP for a very long time now and one of the frustrations is
whenever I—. At that sort of level, before we get to
tribunals—I’m not talking tribunals, I’m talking
about not getting to a tribunal—if there’s a medical
diagnosis or a health diagnosis, that’s fair enough, I can
refer to a health practitioner in secondary care, but if the
diagnosis is in health but the treatment is in education, we
can’t refer across. It’s a great weakness and we have
to rely on the individuals. So, there’s a big schism between
health and local government from that point of view. Now, I notice
here that we’re going to create a DECLO role, which probably
will be the basis of some later questions, but the fundamental
issue remains that with various forms of learning disability, not
just autism, the diagnosis is medical but the treatment is
educational. But as that child’s GP, I have no locus to refer
to an education specialist to bring things forward now. Some of us
have been looking towards an Act, for a long time, for us to be
able to refer like we can to fellow health professionals. I was
just wondering what your views were on the co-ordination between
health and education.
|
[340] Ms
Whittle: I suspect that that varies, but, certainly, I think
that predominantly, as community child health, which is where I
work, we would be involved with pretty much all of those children,
as a community child health service, who would need support. So, we
have close working relationships at an early stage with early years
committees and conversations about making sure that those children
are highlighted and moved through, but I suspect that the
co-ordination or level of co-ordination varies between different
local authorities and different health boards.
|
[341] Dr
Williams: I think it is about communication going both ways, so
about there being expectation—. Education and health need to
work together so information and expectations get passed on. I
think it’s been accentuated. One of the hopes for this Bill,
but also the other issues that are going on as in teacher training
and in the need, is actually what’s become apparent over the
past 20 years since I’ve been practising is that the baseline
knowledge and understanding of each other’s language has got
further apart, and the understanding of what’s a quirky child
and what’s an illness, and the definition of ‘health
need’ and ‘well-being need’ has become very
blurred and is driven by training and also, possibly, by resource
availability, and we need to get those communications going.
|
[342] I absolutely
think that there should be the opportunity—. The DECLO role
has a couple of roles. There’s the role about making sure the
system works, and in Aneurin Bevan we’ve got five local
authorities who are all slightly different, to try and negotiate
those pathways between, but then there’s the day-to-day
practicality of how you co-ordinate the health input and the
information from health with the delivery of education. Now, in our
health board, we’re thinking the role of the school nurse,
intuitively, is a really helpful place, and could be a conduit
between GP and the education system. They’re going through a
review and there’s an availability of them, but notionally,
there’s a way to use this Bill to improve that sort of
issue.
|
[343] Mr
Peters: In the past, typically, the children would be within
the children’s services. It wouldn’t often be that the
GP would need to take the lead in trying to refer in the child, and
the schools are very good at focusing on what is the child’s
needs. However, whilst the diagnosis shouldn’t be the key to
providing services—it should be based on the child’s
needs. In Powys, three of the high schools have autistic spectrum
disorder units. You can only access those units if you have a
diagnosis, which drives the parents to seek a diagnosis as a label
rather than identifying the child’s needs.
|
[344] Lynne
Neagle: Thank you. A couple of witnesses have expressed concern
that the Bill, the code, doesn’t go far enough in recognising
the other key partner here, which is social services. Is that a
concern that you share?
|
[345] Dr
Williams: Yes. I mean, I think it’s the same
issue—. I’ve just come from a meeting with Caerphilly
social care, and looking at developing various services, it’s
impossible to separate those three things. Increasingly, the
children who we see in CAMHS services, in therapy services, are
more likely to have families that require additional care, and are
more likely to come from education. There’s a big core group
where there’s huge overlap and you can’t isolate the
needs of one from another.
|
[346] Ms
Whittle: Yes, I would definitely agree with that, and I think,
as we’re all trying to look at joined-up plans and
person-centred planning, it’s really important not to have
one sort of person-centred plan for one element and a different
sort for another. We need some clarity around how we do that.
|
[347] Mr
Peters: It’s a huge challenge but we would fully support
the much closer working of the three bodies.
|
[348] Lynne
Neagle: Okay, thank you. Hefin.
|
[349] Hefin
David: In which case, the DECLO is going to have a rather
unmanageable workload, would you say?
|
[350] Dr
Williams: It’s a bigger workload than is anticipated in
the Bill, and when you look at the resource required to deliver the
job—yes. When you look at managing joining the systems, north
Wales have got six local authorities, we’ve got five local
authorities, Hywel Dda have got three. There are lots of linkages
to do, and local authority childcare as well as education has to be
part of that job. So, the resource, and actually how much time, I
think has been underestimated in the supporting papers so far.
|
[351] Ms
Whittle: I agree with that. I know there is work going on
within Welsh Government through the health expert reference group,
and discussions about that role and the job description. And I
think there are definitely two elements: one is just about the
strategic overview, but, in fact, an awful lot of work already
happens on the ground co-ordinating services, and it needs to be
very clear that that doesn’t stop, and suddenly the DECLO
does everything—it needs to be part of a system, because,
otherwise, one individual trying to deliver that role won’t
work.
|
[352] Hefin
David: And you’ve mentioned the collaboration with the
Welsh Government that’s going on to resolve some of those
issues—there are two pilots going on as well that we’ve
been made aware of. Is that right?
|
[353] Lynne
Neagle: There’s one in Aneurin Bevan.
|
[354] Dr
Williams: Yes, well, we’re just establishing the pilot in
Aneurin Bevan because we’re actually looking at separating
out those two strategic roles and delivery roles and things like
that, to looking at how school health nurses might be able to do
the practical—making sure the service works for the child,
and then an overarching role for co-ordinating the local
authorities and social services. But it’s actually
not—it is just starting, literally.
|
[355] Hefin
David: Right. So, it’s just starting—is it the
intention to feed in to give the Minister information
to—?
|
[356] Dr
Williams: Yes, absolutely.
|
[357] Hefin
David: Isn’t that timescale a bit tight there?
|
[358] Dr
Williams: The officials came to me a month ago to start the
system off. So, that’s the time it started. We’re
making people available as soon as, because we think it’s the
right direction to go and it would help in a lot of ways, because
at the moment the system where an individual community
paediatrician has to almost set up a separate assessment, bring
together all the information from the education reviews, is
extremely unwieldly, it doesn’t value the other professionals
from health who are already involved, and we’ve got a massive
shortage of community paediatricians anyway. So, it’s not a
workable system.
|
[359] Hefin
David: When would you be able to produce some evidence-based
outcomes from the pilot?
|
[360] Dr
Williams: Off the top of my head, I wouldn’t be able to
tell you because, literally, we’ve got a meeting on Tuesday,
I think, to start identifying who’s going to be starting
taking that forward.
|
[361] Hefin
David: Okay.
|
[362] Lynne
Neagle: And do you see that being two DECLOs then, or splitting
it?
|
[363] Dr
Williams: We’re splitting the role, so there would be
somebody who’d be doing the strategic overview role, and
somebody who’s making sure that the information is gathered
in a way that allows the individual education plans to be
meaningful and useful for the children.
|
[364] Lynne
Neagle: Okay. Does it concern you at all that’s it in the
Bill when we’re only just starting the pilot?
|
[365] Dr
Willams: Yes.
|
[366] Lynne
Neagle: Okay.
|
[367] Hefin
David: And my final question, which was—from what was
being said, you’re sort of talking about a senior DECLO and a
junior DECLO role. Is that—?
|
[368] Dr
Williams: Well, I don’t think—. Co-ordinating all
the health information for every individual child who needs
co-ordinated care cannot possibly be done by an individual person,
and also making sure, when there is an unidentified health need,
that that is agreed with a health person in the room—which I
think is important as well—again, that can’t be done by
a single person.
|
[369] Hefin
David: Well, it says in the draft code that it shouldn’t
be done by the DECLOs—that they shouldn’t be involved
in every IDP.
|
[370] Dr
Williams: No, they shouldn’t be, but, actually, the code
is slightly unclear where that gap occurs—so where the
process stops and the operational bit starts.
|
[371] Hefin
David: Okay, thank you.
|
[372] Lynne
Neagle: Okay. Michelle.
|
[373] Michelle
Brown: Thank you, Chair. If we could come to the duty on NHS
bodies in section 18. The section actually says that it requires
health bodies to consider whether there is a treatment or service
that might be of benefit. What kind of pressures are likely to be
exerted that might affect whether the NHS considers whether
there’s a treatment that would be beneficial? Are you
concerned that an NHS body’s ability, in a sense, to turn
down offering treatment might be due to non-clinical pressures, and
could that be addressed by amending section 18?
|
[374] Mr
Peters: I’m concerned that parents—. For many
childhood conditions, there is a wide variety of interventions of
varying robustness and parents, desperate for some form of
intervention, will trawl the internet and come up with suggestions
of varying robustness, and the risk could be it raises expectations
for us to provide something for which the evidence base is weak, or
even non-existent. So, I think there’s a potential risk in
that. If it goes to tribunal—sorry to be going back to that
point—if the family have had what they’d call an
independent report, we’d say a private report from a
therapist, they certainly might recommend something that the local
NHS does not provide because we don’t support the evidence
base for it. If it’s in part 3, it raises the dilemma,
‘Well, there’s a legal requirement to provide it, but
where is that going to sit?’
|
[375] Ms
Whittle: I agree. I think the way that it’s worded at the
moment, it says, ‘may be of benefit’. Lots of things
may be of benefit, but is it evidence based and whose decision is
it whether it is of benefit or not? I think it opens up a
conversation that parents may think it’s of benefit, schools
may actually think it’s of benefit, and as a clinician, we
may actually be saying, ‘Well, there is no evidence to
support that.’ So, I think there needs to be some thought
about how that final decision around what is the benefit comes to
an end, really. Because I can see a scenario where, whichever way,
whether it’s tribunals or whether it’s through putting
things right, even if we make a clinical judgement, there is still
a comeback that actually says, ‘We don’t agree with
that,’ or ‘This treatment is happening in America, and
actually, it looks good over there, so why won’t you deliver
that for us?’ So, I think it does put health under pressure
unless we’ve got some more clarity.
|
[376]
Lynne Neagle: Before you come in, it does say ‘likely to be
of benefit,’ so I don’t know if that affects your
answer at all.
|
[377]
Dr Williams: But, again, it’s who considers it likely to be
of benefit? It’s how much understanding of what is benefit
and what knowledge base you have behind that, which is why I think
it’s so important for the health professionals involved in
the decision to say, ‘Actually, we need to explore this
further.’ To take up the end point, it would be totally
unacceptable to not provide a service if there was a clinical
evidence for us and a clinical need. So, you can’t justify it
on lack of resources if there is clinical evidence and need to do
so. But, we already see a system where the expectation of
assessment and, actually, diagnosis—. Education is one of the
few places where telling a child, ‘Actually, there
isn’t a long-term condition here,’ which should be good
news, will lead to an appeal against it, because it disappoints
people that they will no longer therefore be able to obtain the
one-to-one they’d hoped they would get with the diagnosis.
It’s an unusual situation.
|
[378]
Lynne Neagle: Llyr.
|
[379]
Llyr Gruffydd: Just something that has struck me now, really. If the
NHS says that there’s no appropriate treatment, where does
the local authority go next? Is it a dead end?
|
[380]
Dr Williams: Well, it’s about identifying what will work for
the child. So, it should be in collaboration, ‘Actually, what
is the plan?’ But sometimes the plan—. We see it in
therapy sometimes. Good teachers always manage children really,
really well for their mental health problems, for their language,
they’ve done the right things, which has promoted it, but it
hasn’t been, if you like, in a separate box of therapy,
it’s been the way you manage it. There’s that
expectation that if you have a speech and language problem, you
need a speech and language therapist to sit in with you an hour a
week, or two hours a week to do something with you. Sometimes it
is, actually, that the thing that will make this better is time,
and doing the right things more often. So it’s not as if
there isn’t a way forward; it’s just saying it’s
not in a box of therapy, if you like.
|
[381]
Llyr Gruffydd: Yes, okay.
|
[382]
Lynne Neagle: The Bill doesn’t set out any time frame, so
what happens if you decide, say, that a child does need speech and
language therapy, but then they’ve got to wait a year for it.
Do you think that’s sufficient clarity for delivering for
children?
|
12:30
|
[383] Ms Whittle: The
target waiting times for therapies is actually 14 weeks and, yes,
there are services under tremendous pressure actually trying
to achieve that and also continue with interventions. But, I would
like to think that we aren’t still in the realms of people
having to wait a year for speech and language therapy. It is at
what level you actually provide that. Just as an example,
we’ve done quite a lot of work locally about a graduated
response to therapy and I think we’ve got quite a lot of
clarity that there are levels of input. So, there are levels of
input where the speech and language therapist will advise the
school. There are levels where there may be a written programme
that the school carries out but is overseen by the therapist, right
up to, ‘Actually, this child needs an individual block of
therapy.’ But, there are pressures on the ability to deliver
all of that.
|
[384]
Lynne Neagle: Oscar.
|
[385]
Mohammad Asghar:
Thank you very much, Chair.
|
[386]
Lynne Neagle: Is it on this?
|
[387]
Mohammad Asghar:
Yes. You have stated that there are
concerns across LHBs surrounding the capacity of the current NHS
workforce to adequately deliver the outcome of this legislation. We
heard earlier in the committee meeting from the sector that all
local authorities are working differently, but I hope the health
boards are working in the same direction rather than working
differently for ALN children. Basically, what sort of concerns do
you have to overcome to co-ordinate with each other?
|
[388]
Dr Williams: How we manage to fill the workforce of NHS Wales is a
massive issue. Just as there needs to be partnership working in the
way we train to deliver and support, I think we do need to be
thinking about how we work together as NHS areas, so that if we
can’t provide—. Our health boards are such different
sizes. The range of people and services that Powys can manage will
not be the same as the range of services and people that Betsi
Cadwaladr can employ. So, there has to be some working together and
saying, ‘Well, if this expertise is available, how do we
access that on a more regional basis, rather than just on a health
board by health board basis?’ Those discussions are starting
to take place and are having to take place because the
sustainability of the NHS depends on it.
|
[389]
The other bit is, as was mentioned
earlier, if we get to the point where, repeatedly, certain demands
are coming through the additional learning needs Bill and health
boards are saying, ‘Crikey, we’re struggling to
accommodate’, that has to go into the needs assessment that
the partnership boards are having to do for other education,
because the needs of children maybe haven’t had as loud a
voice in that. I know it’s not part of this committee, but I
think it’s joining all those areas up to say, if we’re
identifying a need here, through ALN, that needs to go into how we
develop those as core services. How we train, the new ways of
working, therapy practitioners, nursing practitioners, and how we
make the most of the workforce we’ve got to deliver the range
of competencies we need.
|
[390]
Lynne Neagle: On this, Llyr.
|
[391]
Llyr Gruffydd: On this, yes. But that sounds a bit like setting
ourselves up to fail, doesn’t it? What we’re saying is,
if we’re creating this demand, and we know that the workforce
isn’t there, then we need to develop alternative strategies.
So, are we convinced that enough is being done in terms of
workforce planning now? Because we know where we are, which
suggests that we’ve failed in the past, in that respect. We
know what’s coming down the line—a huge jump from,
whatever it was, a few tens of thousands to over 100,000 IDPs,
potentially. But, you know, the workforce isn’t there, is
it?
|
[392]
Dr Williams: But, it is coming online.
|
[393]
Llyr Gruffydd: Quickly enough?
|
[394]
Dr Williams: As quickly as it can happen. So, it’s not
starting today. My feeling, having been head of service since 2001,
is all those things where you think, ‘Hang on a minute, we
need more health visitors here, we need more school health
visitors’, actually, the past two or three years, the
training numbers have finally started to be fed in, with proper
collaboration between the health boards to say, ‘Let’s
think about what we need between us.’ It’s doing simple
things like recruiting on a regional basis so that you don’t
have Cwm Taf competing against Cardiff and Vale—all those
sorts of things are now starting to happen. So, yes, they are. On
the basis of a UK and the rest of the world population, we are
doing the right thing.
|
[395]
Llyr Gruffydd: So, would having stronger duties in the Bill actually
help push that along?
|
[396]
Dr Williams: I think stronger duties to identify the gaps and
unmet need may well help, actually.
|
[397]
Llyr Gruffydd: Okay, thanks.
|
[398]
Lynne Neagle: In terms of duties, section 57 imposes a duty on
health bodies to notify parents when they believe a child below
compulsory school age might have ALN, but only a discretionary
power to bring to the attention of local authorities where they are
satisfied this is in the child’s best interests. What’s
your view on that, and when might it not be in the child’s
best interests?
|
[399]
Dr Williams: Firstly, I can’t think of a reason for where it
wouldn’t be in the child’s best interests, unless the
family came up with a particularly interesting personal reason for
why they wouldn’t want the local authority to be referred
to.
|
[400]
Ms Whittle: I would agree. I can’t see a reason
why.
|
[401]
Mr Peters: I would agree, absolutely.
|
[402]
Lynne Neagle: Okay, thank you. John.
|
[403]
John Griffiths:
Yes, in terms of the issues we’ve
just been discussing, the increasing demand for services, the
workforce and financial implications of that, do you have a view on
the regulatory impact assessment that accompanies the Bill as to
whether it’s adequate in those terms or not?
|
[404]
Dr Williams: I haven’t looked in a lot of detail at the
regulatory impact, but the bit I have, it’s about what you
then do with it, because we’re very good at identifying
holes; it’s about how you then take that forward and put it
into the wider system to address those holes. So, it’s not so
much the rigour with which we identify the problems, but the rigour
with which we then do something to address the problems, I suppose,
and being unsure about whose responsibility it is to address the
problems.
|
[405]
Ms Whittle: I think I have some concerns that it’s perhaps
an underestimate. One of the things we haven’t talked about
at the moment is the 16 to 25 element of the Bill. And whilst,
obviously, I’m coming from a community children’s
services background, and we tend to work in a
team-around-the-child/team-around-the-family manner and pull in
those required professionals, but once you move to adult health
services, it tends to be more a specific area or a specific
speciality, which is not that generalist approach. So, I think
there are some concerns, medically, but also through therapies,
about how that transition will take place, how the engagement for
adult colleagues, and also whether there are adult colleagues
available to actually work in the same way that we do in
children’s services. I think it’s important to say
that.
|
[406]
Mr Peters: Well, we welcome the Bill, but, from a health
perspective, it does increase and ramp up the demands placed on the
services in a way that we haven’t had to meet previously, and
it’s unclear how we’re going to grow to meet those
needs. We need to, but, practically, how do we do that?
|
[407]
Lynne Neagle: Thank you.
|
[408]
John Griffiths:
Could I just ask: would you point to any
differences in terms of those challenges in terms of diagnosis,
assessment, and then delivery of the actual services required? Are
there differences there? Is any one of those a bit easier than the
others in terms of the challenges of having enough professionals
and enough resource in place?
|
[409]
Ms Whittle: I think, for me, within health, obviously,
we’re talking about prudent health care, we’re talking
about assessments, we’re talking about providing that
support, so, we tend to be better at that end, but the provision of
ongoing intervention is often not built in to when we’re
doing a piece of work around capacity and demand about therapies
and how much we need to be able to deal with the number of
referrals coming through. We’re focusing on referrals,
assessments and treatment; we’re not necessarily focusing on
ongoing, long-term intervention to deliver an IDP. So, I think
there are challenges at different areas.
|
[410]
Dr Williams: It’s that availability to support the
professional, the educational professionals as well, in addition to
the, ‘Okay, this needs to sit down.’ But, I have to
say, when you get to the adult services, that’s not a way
they’re used to working; it’s very much diagnosis, see,
treat and reliance on that individual to manage themselves and do
their own networking. You see better models in elderly care; you
don’t see it in 16 to 25. So, services for elderly care have
that idea—it’s team around the family for an older
person—but, actually, for 16 to 25, that would be a big step
change for staff who are currently working with that age
group.
|
[411]
Mr Peters: I think you said about whether there are any issues
with waits for diagnosis, if I understood you correctly.
Theoretically, the needs are based on the needs of the child, not
the diagnostic label. So, even from a health perspective, if
we’ve got a child, say, waiting for an assessment of ASD,
even in the meantime, we can be looking at what their needs are,
how they can be met, irrespective of the diagnosis in that
case.
|
[412] I think, too, we
have—and it’s moved forward with the prudent healthcare
agenda—a shift in parental expectation that having therapy
once a week for a block of therapy is not going to, by itself,
resolve the challenges. A key component is the school implementing
it on a daily basis, and the parents implementing it at home, and
to get all of that, everybody, realising that it’s a
long-term challenge for many of these childhood conditions.
It’s not just the NHS therapy intervention that’s got
to sort it out. So, we’ve got a number of challenges that go
above and beyond this Bill, really.
|
[413]
John Griffiths:
Okay. And is there any particular
specialisms that you would point to as being in particularly short
supply?
|
[414]
Ms Whittle: I suppose it depends where you—
|
[415]
Dr Williams: There are different tide lines.
|
[416]
Ms Whittle: Yes.
|
[417]
Dr Williams: So, there are certain health boards—. Community
paediatrics is a real problem. There’s a national problem
with paediatrics. Community paediatrics also has to do some of the
safeguarding work, the fostering and adoptions service—it is
not currently a popular specialty to go to. So, if you’ve got
a national shortage, it’s accentuated. There are one or two
brighter spots, but, actually, several health boards are struggling
with community paediatrics. Therapies and mental health services do
vary. So, it tends to be—south-east and north-east tends to
be a bit easier to recruit to, and the further you go down the
motorway, the harder it becomes, actually. And that’s a bit
about how we work in a more regional approach and support each
other, rather than in a siloed health board area.
|
[418]
John Griffiths:
Okay. And finally from me, Chair, if
that’s okay, just in terms of educational psychologists, the
code places particular emphasis on those professionals, those
services. Do you agree with that, or would you perhaps want other
specialists to also be given that sort of focus in the
code?
|
[419]
Mr Peters: I think we’ve got a challenge there, with a
shortage certainly in Powys, and the challenge of recruiting
educational psychologists. So, if a particular assessment or focus
is purely for that one profession, it will create blockages in the
process for children. But how we get around that is not easy. One
particular challenge is identifying a child with a learning
disability, and the criteria for that and who can do that. With the
proposed ALN Bill, that recedes into the background as the need to
identify it as a learning disability, as a formal diagnosis. But,
when that young person becomes an adult, they can’t access
the adult learning disability service, unless they’ve got
that formal diagnosis. So, it becomes a chicken and egg—the
adult service won’t accept them because they haven’t
been diagnosed during childhood has not been an issue, and the
educational psychologist obviously plays a key role in
that.
|
[420]
Dr Williams: And most educational psychologists are employed by
the education services. So, again, the ability to join up the
system is dependent on how well education services and health
services are working together on local grounds. So, you get that
clinical psychology perspective linked in with the education
psychology perspective.
|
[421]
Ms Whittle: I suppose I would pick up the other services being
speech and language therapy. And I think there are lots of further
discussions to come about where speech and language therapy starts
and stops, in terms of a health need, and in terms of education and
life need, to be able to communicate. And it’s at what point
the speech and language therapists in health start and stop. So, I
think there is a conversation around that too.
|
[422]
Lynne Neagle: Llyr.
|
[423] Llyr Gruffydd: Thank you. I just feel there’s a bit of a
contradiction here, because, on the one hand, you’re telling
us about the problems in terms of recruitment, and the shortages
that are out there, particularly, maybe, in certain disciplines,
and we know, for example, the NHS Confederation in their evidence
have told us that speech and language therapists are estimating
that they’ll have to attend 90 per cent of multidisciplinary
meetings in future, under the Bill, as opposed to 25 per cent at
the moment. So, we’re currently short, there’s going to
be a huge increase in demand, but then, 20 minutes ago, you
were telling us, ‘We think that, maybe, things are getting a
little bit better, things are in place.’ Surely,
there’s a lag there even if things are getting better, and
you’re the ones in the front line who are going to be exposed
to this.
|
12:45
|
[424] Ms
Whittle: I think what we need to understand is whether it will
actually go from the levels that you’ve said. I think,
certainly, a lot of the work that’s happening behind the
scenes is, ‘Actually, will that be the case?’ I think,
as you read it, it looks as if you might need to go to 90 per cent,
but whether that develops into being that many, or not—
|
[425] Llyr
Gruffydd: Yes, but in the same way, we need to understand
whether the workforce planning is actually going to deliver as
well.
|
[426] Ms
Whittle: And that’s the issue, because if it is 90 per
cent, that’s a workforce planning challenge of one magnitude.
If it actually turns out to be 30 per cent, it’s a workforce
planning of another magnitude, and I don’t think we’re
totally clear on that.
|
[427] Dr
Williams: Which is why there needs to be a health person
involved in the identification, because I think the 90 per cent is
if decisions are made in the same way as they are now, which is
somebody saying, ‘I think you need speech and language
therapy’ as opposed to a health professional being involved,
and going ‘Well, these are things you can do. This person
needs to see a speech therapist’. If the second happens,
I’m confident that, whilst there will be a lag, it will not
be a critical lag. If the first thing happens and health
aren’t involved in decisions, and it’s request driven,
then, actually, it would cause a problem.
|
[428] Llyr
Gruffydd: Of course, when you drill that down to individuals,
if there is a shortage, then every lag is critical, isn’t it,
really?
|
[429] Ms
Whittle: Yes, it is.
|
[430] Lynne
Neagle: Okay. Julie.
|
[431] Julie
Morgan: Yes, thank you, Chair. I wanted to ask you about the
definition of additional learning needs and how that relates to
health needs.
|
[432] Dr
Williams: I think it’s hugely problematic, and it’s
how much—. Getting a shared language is vital to how this
will work and how much discord and how much upset and difference in
expectation of the system will occur. We have noticed, or felt, in
health, that the well-being, health and the need for diagnosis has
actually increased over the past 20 years. Some of that might be
due to better identification, but some of that has been because
that’s seen as a key to access better resources and further
resources for all. So, I think managing that is going to be hugely
difficult, and such broad terms—. The problem with diagnosis
itself is an issue, because different people with the same label
have hugely different needs. And actually having that formulation
behind it, so that you drill down to, ‘Yes, I’m very
interested in the diagnosis, but do we agree what the needs are and
how we address that?’ is almost more important than the
diagnosis. So, we need to make sure that the health need and the
additional learning need don’t become dependent on a
quick-fix diagnosis, but actually working out how that will work
out in practice is going to be hugely difficult.
|
[433] Julie
Morgan: Do you feel that the health need should be included in
the Bill, as part of the definition?
|
[434] Dr
Williams: I think, on occasion they are part of the need, but
on occasion they’re not. If you’ve got well-managed
asthma and things like that, then they don’t necessarily need
to be involved. We come back to the child’s individual plan
though, and, actually, you probably need to draw attention to the
fact that this child needs to take Ventolin as well. So, it’s
about what needs to be in the Bill and what is part of good
practice, I suppose.
|
[435] Julie
Morgan: Right. And how do you feel that children with health
needs get on in the system as it is at the moment? We’ve
taken evidence from the voluntary sector, and in particular
diabetes, epilepsy and other groups today, who have expressed the
variable nature of the way these needs are addressed. Could you
tell me how you feel that they’re being addressed in the
system at the moment?
|
[436] Ms
Whittle: I think it is variable, and, as well, does the
definition of ‘additional learning needs’ also include
those medical needs? So, I think there needs to be a clarity around
when health is required in order for a child to be able to access
education, and what that looks like and how that’s delivered
across schools, and, then, what is a definite health need and how
we deliver that is slightly different. So, I think the example in
the federation’s response was around toileting. So, is
toileting a pure health need or not, and I think those are the
things that we still have to work out. And I think there will be
variation in terms of how health needs are managed, also depending
on the setting of the child. So, there is variation between a child
in a mainstream school and how they’re supported and what
health can do to support those, versus a child that may be in a
special school where there’s more actual health provision on
site. So, there is some variability in that.
|
[437] Mr
Peters: I think it’s variable. The special schools and
the provision of services within those compared with mainstream can
be very different. Some medical diagnoses very clearly have a
strong ongoing medical need. As to other conditions, just going
back to autistic spectrum, is it a disorder or is it a medical
condition? It’s a medical label, but the interventions that
are required for that particular condition sit across both health
and education. Then it comes down to how we sort out, to the
child’s best situation, who does what. The example mentioned
was of toileting. That could be dealt with by maybe a number of
different professionals. It doesn’t necessarily sit with just
one professional or just within one agency. So, with a lot of the
childhood conditions, there’s a fuzziness around the edges of
them as to who could help, and it could be a number of people. But
the Bill doesn’t at this stage shed light on that, and it may
give rise to some confusion or confused expectations between the
different agencies on the ground.
|
[438] Dr
Williams: I think that, actually, it’s about the health
literacy of education staff to a certain extent, to be able to
understand. Some of it is about how confidently you manage
diabetes, epilepsy, the exacerbations, availability of medication
and having a school system that is able to recognise and adapt to
that. Obviously, when it becomes more problematic, there are
specific issues. But I think it comes down to how we train staff so
that, for children with some of the common chronic conditions,
there’s an awareness of how to manage that as part of your
day-to-day job, not driving it though additional learning needs in
the same way, I suppose.
|
[439] Julie
Morgan: So, on the whole, you don’t think the call of the
stakeholders to have a statutory basis for health needs—you
don’t support that, really.
|
[440] Ms
Whittle: Unless you can actually really clearly define those
differences, I think it is quite difficult, because a child’s
needs could be so variable. I think that there is a potential
danger that, if you say, ‘That’s a health need;
that’s an education need’, you actually drive a wedge
down the middle—an unintended wedge down the middle, in
fact—because we still go back to saying, ‘Well,
that’s yours’. That’s not a position that we want
to be in, so it does need to be a focus on the child’s entire
needs and how, collaboratively, we’re going to meet those, I
think.
|
[441] Lynne
Neagle: Okay, thank you. Michelle.
|
[442] Michelle
Brown: Thank you, Chair. It’s interesting that
you’ve just left off saying about driving a wedge between the
NHS and other bodies. We’re kind of winding up with two
appeal processes in the Bill, aren’t we? We’ve got the
employment appeal tribunal—. Sorry, the educational tribunal
handles the educational side, and then parents will have to go
through the NHS appeal procedure. Can you see this causing a
problem in actually increasing that division you were talking about
earlier?
|
[443] Ms
Whittle: I think so. I think parents find the system difficult
enough to navigate because, at the end of the day, what
they’re trying to do is fight for the best outcome they can
possibly have for their child. I think if we put in a system that
means that if you don’t accept what education have said in
the plan, you go that way, but, actually, if you get into a
dispute, as we were discussing, about what your intervention is
from speech and language or what your intervention is from
occupational therapy, if you don’t like that, you have to go
through a different route. I think that that potentially
causes more confusion.
|
[444] Michelle
Brown: How easy or difficult is it to separate the education
issues from the medical needs that might come under the duty of the
NHS bodies to provide some of the treatment?
|
[445] Mr
Peters: I think the questions we’ve just been addressing
on the health needs, and when is it a health need, I think that
will make it more of a challenge, because, for a parent who
hasn’t got that specialist knowledge, it’s going to
make it harder for them to know how to navigate to get the best for
their child.
|
[446] Dr
Williams: We already have a situation where people who
aren’t getting the support, they feel, from the school will
ask for second, third and fourth opinions for a diagnosis to unlock
that door. We get, as I said right at the beginning, tribunals
making recommendations from private assessments that maybe
haven’t included all the evidence that we would have
available to us, which drives a wedge not only between us and
education, but also us and the parents and families, where we need
to actually deliver it. At the moment, we have a problem with the
level of health expertise on that tribunal, and I think the
solution is to improve that and not to have two separate
panels.
|
[447] Michelle
Brown: The suggestion has been made that the education tribunal
would be able to direct the NHS bodies. I can see that causing a
problem, because if you get one result under the NHS appeal process
and another result under the education tribunal, then you’ll
have a clash. Is there any other way that you could think of that
could resolve this sort of dual appeal system we’re in danger
of going into now with the Bill?
|
[448] Dr
Williams: I think having independent health people as part of
the tribunal process is the way forward. We started from the point
of view that, actually, the services haven’t worked together
consistently across Wales. We speak a different language. We end up
with gaps. Actually, the more we work together and consider the
child as a whole, the better we’ll do. And that’s got
to be from the bottom of the process right up to when we’ve
got a major problem. At the moment, that’s almost the point
at which we’re separating it, in the current system, and
actually we need to join that together as well. But health
professionals need to have assurance that the basis on which that
assessment is made is that it’s been made by somebody who
understands the health needs.
|
[449] Mr
Peters: Another small anomaly with the current system is that,
obviously, for assessments by the national health service, we must
get parental permission. We have had scenarios where parents go
into tribunal and their solicitors have advised them to refuse
permission for the NHS so the tribunal only has evidence from the
parent-commissioned private therapists. So, they rule on that, and
it goes into part 3, and then health is put in a position of having
to provide something that we’ve had no input into all, and
that seems a most peculiar anomaly.
|
[450]
Lynne Neagle: So, just to clarify, you are saying that you would be
happy for the NHS to be covered by the tribunal, provided we could
find a mechanism that works better than the current system, so that
you were genuine partners?
|
[451]
Ms Whittle: Yes.
|
[452]
Dr Williams: Yes.
|
[453]
Lynne Neagle: Okay, thank you. Is that your questions done,
Michelle?
|
[454]
Michelle Brown:
Yes, thank you.
|
[455]
Lynne Neagle: Okay. Are there any other questions from Members? No.
Well, can I thank you for attending this morning and for answering
all our questions? We very much appreciate your time. You will
receive a transcript to check for accuracy in due course. Thank you
very much.
|
[456]
We’re going to take a really small,
two-minute break again. I’m so generous with these
breaks.
|
Gohiriwyd y cyfarfod rhwng 12:59 ac 13:03.
The meeting adjourned between 12:59 and 13:03.
|
Y Bil Anghenion Dysgu Ychwanegol a’r
Tribiwnlys Addysg (Cymru): Sesiwn Dystiolaeth 14
Additional Learning Needs and Education Tribunal (Wales) Bill:
Evidence Session 14
|
[457] Lynne
Neagle: Welcome back, everyone, to our final evidence session
of the morning. Can I welcome Alison Davies and Lisa Turnbull from
the Royal College of Nursing? We’re very pleased that
you’re here today and thank you for your paper that you
provided in advance. If you’re happy, we’ll go straight
into questions, and the first questions are from Julie Morgan.
|
[458] Julie
Morgan: Good morning. I wanted to ask you, really, whether you
could give us a brief overview of how nurses are currently involved
in the provision for those with special educational needs, as it is
at the moment.
|
[459] Ms
Turnbull: Certainly. As we’ve laid out in our written
evidence, there’s a variety of different types of nursing
role that provide different types of intervention at different
stages, really, of a child’s needs. They’re drawn into
that process in different ways: either as additional to the
educational need to support that, perhaps entirely separately as a
referral, or it might be a number of different ways that those
nurses come into context. And a number of those nursing roles work
strategically to address the health needs of all children and young
people, regardless of the individual circumstances. I’ll just
turn to Alison to perhaps say a little bit more about those
different roles.
|
[460] Ms
Davies: Thank you, and thank you for that question. I think
it’s very worth while considering the wider nursing workforce
for children with special education needs, and children who
potentially have got additional learning needs. If we look at the
scope of potential interventions, we can look at health visitors
and school nurses who work with 0 to 18s from a universal health
perspective, and those nurses are very skilled in assessment,
referral, safeguarding—sort of looking at healthcare more
broadly. If we consider the workforce of children’s nurses
and child and adolescent mental health nurses, they generate more
nursing care intervention for children with medical needs where
there’s an identified condition, and they may provide some
specialist intervention and advice for that child or young person,
the family and the school settings. So, nurses have a role right
across the age spectrum, and from health to ill health.
|
[461]
Julie Morgan: So, you have a universal role as well as the
specialised role.
|
[462]
Ms Davies: And that skill set is particular to different aspects
of nursing.
|
[463]
Ms Turnbull: And in addition to the roles that Alison has
mentioned, we also then will have specialist nurses working in a
particular field, like diabetes, who will have that educational
role generally, and a specific role. So, there are a plethora of
different ways in the health system in which therapists very much
are central to the needs of children and young people, and nursing
then provides these wider support services in different
ways.
|
[464]
Ms Davies: Probably something else to consider is the age range.
We know that, for children and young people, particularly those
with specific health or medical needs, that age of transition is
particularly important, so we then often come into the realms of
adult nursing, district nursing or adult mental health services as
well.
|
[465]
Julie Morgan: And could you tell us, under the present system, are
you under pressure to fulfil those roles? What is the pressure on
the workforce?
|
[466]
Ms Turnbull: I think it’s fair to say that there are so many
different ways in which the nursing provides the
support—there are different ways in which that support is
manifested. But, yes, if we’re talking about down to the
individual child’s needs, we would say the workforce is
currently under pressure. There is an insufficient number of
children’s nurses, for example, in Wales. There are
insufficient numbers, particularly, of children’s nurses in
the community. Now, I have to say on the record, we were extremely
pleased that Welsh Government increased the commissioning numbers
this year, and that is a real step in the right direction, but,
nevertheless, those will take some time, obviously, to come
through.
|
[467]
So, children’s nurses is one area
in particular where we’ve written to the committee with our
concerns before. There are concerns in some of those wider
areas—learning disability nurses particularly, again, and
particularly learning disability nurses who work with very young
children—and we also have some concerns about some of the
wider areas as well, so maintaining numbers of school nurses and
health visitors.
|
[468]
So, generally speaking, one of the things
we want to return to in this is that there is a problem with the
workforce planning process, in that it doesn’t accurately at
the moment, in our view, reflect the need that is out there in the
community. I think that is a real issue that needs to be addressed.
Now, how that’s addressed—there’s a variety of
different options, but that is a key point.
|
[469]
Ms Davies: There’s probably another aspect to that to
consider, I think, and that’s in relation to unmet need. So,
we know there are levels of unmet need currently for children and
young people that nurses, per se, care for, and it’s worth
thinking about, if and as the Bill progresses, what that means in
terms of workforce capacity.
|
[470]
Julie Morgan: And, would you anticipate that the Bill would require
an increase of your involvement?
|
[471]
Ms Daives: I think quite possibly, yes. The Bill is
child-focused, needs-led, which is an excellent focus to have, and
I think points have been mentioned earlier about working in an
integrated way to meet those needs, and that’s an ideal way
to work with children and young people and families, and all of us,
indeed. I think, if the Bill goes forward, then it depends on that
focus on education, education and medical needs, and education and
healthcare needs, as to what that means in terms of capacity, and I
think it’s fairly reasonable to say, yes, it will
increase.
|
[472]
Julie Morgan: Thank you.
|
[473]
Lynne Neagle: Llyr.
|
[474]
Llyr Gruffydd: Yes, thank you. Just to pursue the workforce aspect,
really, and workforce planning—you recommend a new
duty to be put on health
boards to take account of workforce requirements in their area in
terms of ALN. Could you tell us a bit more about that? Are you
aware of any other similar duties or requirements, maybe, in other
legislation or in other sectors?
|
[475] Ms
Turnbull: I think that was an option that we felt was worth
suggesting to the committee. It’s one option and, obviously,
there’ll be other people with expertise to be able to say
whether it’s the best option. The reason we felt it was worth
suggesting is because there have been improvements in the workforce
planning process within Wales, and I think it’s important to
recognise those. In the last sort of five years, there’s been
significant development. We have a situation now where health
boards are producing what are known as IMTPs—these plans for
their services, which should encompass workforce planning. These
should feed in then to the education commissioning process, say, of
nurses and, indeed, other professionals. However, our frustration
has really been the lack of transparency for that process and also
a frustration that it’s not accurately reflecting need. There
needs, obviously, to be a balance between resources available and
need, but if you’re not actually capturing what the ideal
need is, you’re not very clear what you’re working
towards.
|
[476] There have been
a number of decisions in recent years that we feel have not
reflected that. I’ll give you two examples of that. One is:
until recently—until this year—the fact that
children’s nursing figures were static, at quite a low level.
My second example would be the dramatic demise of the district
nurse, which was not a policy decision. It was merely happening,
and it took a great deal of effort for us to point that out, again,
and we now have been rectified [correction: and now we hope it is
beginning to be rectified]. So, the reason for those frustrations,
really—that’s why I think a number of organisations,
including ours, are seeking ways to perhaps use legislation to
ensure that workforce planning properly takes account of need. So,
one example might be, for example, in law, the recognition that
Welsh language need needs to be recognised and, in some way,
evidenced and incorporated into the plans. This was a suggestion
perhaps along those lines: that if you have got a system whereby,
strategically, you have, potentially, this DECLO role that is
strategically preparing these individual plans for children, there
will be an opportunity perhaps at the end of the year to reflect
back and say, ‘Well, you know, this is the need that’s
been coming through. This is what we’ve been able to do to
meet that. This is the gap’. Now, if that data doesn’t
go anywhere, it’s not very useful; but if that analysis is
then fed into the workforce plans and the recommendations, then
that could be very helpful—if people are saying,
‘Actually, do you know what we really need? We need speech
and language therapists’, or ‘Do you know we really
need? We actually need some Welsh-speaking learning disability
nurses’, or whatever the need might arise. That’s the
background to where that came from. Now, there may be other ways of
solving that problem, but that was one suggestion we thought was
worth considering.
|
[477] Llyr Gruffydd: Thank you for that.
Although it is quite shocking, I think, if you take a step back and
listen to what you’ve said in terms of, ‘We need
legislation to make sure that workforce planning takes account of
need’. That’s quite startling, actually, isn’t
it, you know, that it doesn’t happen; that we need to
legislate. I did ask whether you are aware of any similar
legislative duties in other sectors around workforce planning; or
would this, as far as you’re aware, maybe, be the first?
|
[478] Ms
Turnbull: Well, the obvious example would be the nurse staffing
levels legislation. I did refer to the—. There are, in
legislation, certain different requirements on organisations to
consider Welsh language need.
|
[479]
Llyr Gruffydd: Yes; you’re right. Yes.
|
[480] Ms
Turnbull: I think that’s another example. So, I think
there are examples in legislation of requiring it. I suppose,
really fundamentally, it’s down to an organisation to
understand what its responsibilities are and how it fulfils those
responsibilities. Guidance and policy may be clear and effective
ways of achieving that, but I think we’re not the only
organisation perhaps that has sometimes encountered a belief that
guidance, especially if guidance is not on a statutory basis, may
be too weak to achieve that end.
|
[481] Llyr Gruffydd: Yes, which is true in many
contexts.
|
[482] Ms
Davies: If I could add some context just into your query about
workforce planning. We find, particularly with children’s
nursing, that children’s nurses have a very specific level of
knowledge, expertise and skill set that’s in demand across a
range of settings. For example, children’s nurses can work in
neonatology, working right across the spectrum in services of
health and ill health; and often, then, they translate into small
numbers into specialties and don’t always get captured in
workforce planning, particularly if they're working, for example,
outwith of the NHS. So, I think we already have a small workforce
with a relatively solid level of expertise that’s in high
demand. Therefore, their numbers can be quite dilute in certain
areas.
|
13:15
|
[483] Llyr
Gruffydd: And your focus clearly is health here, but wouldn't
such a duty be just as relevant to, you know, education and other
sort of spheres as well, in the context of this Bill?
|
[484] Ms
Turnbull: Yes. The idea was to build in some kind of a
strategic level health board reflection on any potential gaps
between what can be provided and what might need to be
provided.
|
[485] Ms
Davies: And certainly from a professional point of view, the
vast majority of professionals want to provide that excellent
standard of service all of the time. And where systems and
processes can enable that to happen, that can only be a good
thing.
|
[486] Llyr
Gruffydd: Okay, thanks.
|
[487] Lynne
Neagle: Michelle.
|
[488] Michelle
Brown: Thank you, Chair. In what ways do you foresee children's
nurses’ roles changing with the implementation of the new
framework?
|
[489] Ms
Turnbull: That's a really interesting question, actually.
I’ll turn to Alison, my colleague, in a minute to answer it.
I suppose our first answer might be that we want to make sure that
they don't change in an inappropriate way; that we don't end up
putting duties on groups of nurses that, perhaps, are not best
suited for those duties. So, perhaps, a good example of that would
be—again, going back to this whole child-centred
approach—you have to see what the needs of the child are.
It's probably an inappropriate place for legislation to say, for
example, ‘The needs of the child can always be met by this
type of nurse’—because probably not. They may not need
a nurse at all; they might need a therapist or they might need some
other kind of intervention. So, I think we would want to make sure
the legislation recognises the importance of a healthcare
professional assessing the needs of that child and then having the
flexibility to discuss with other professionals what support should
be provided, rather than trying to specify a profession, as such,
on the face of the Bill. So, I think that would be my first
point.
|
[490] In terms of how
else the roles can change, I mean, we would want to see an
opportunity for more, perhaps, of some of—. You know, there
are some really good strategic interventions we've seen, not
just—. Obviously, it's incredibly important to have that
balance between—. We need to not forget the needs of the
individual child and young person, and they need to be supported,
but then we also need that ability to look at the population as a
whole. So, to give an example of a population-level intervention, I
think there’s been the work of the school nurses in recent
years and the role that they, partly, have played in working to
look at very early teen pregnancy rates and how that has come down.
So, there are public health interventions that can be made at that
level. So, Alison, I don't know if you want to say—
|
[491] Ms
Davies: I think language is really important, and descriptors,
because sometimes we can be funnelled in the way that we think
because of some terminology or titles that perhaps have got some
connotation in terms of role, scope and responsibility. So,
speaking about nurses who work with children and young people per
se, it is about making sure that those individuals have the right
knowledge and expertise. But the Bill could potentially provide a
real opportunity for change in service delivery. If you think that
if the Bill succeeds—and it depends on its focus,
essentially—that might open up means of working in
partnership in effective ways with agencies, obviously with the
child and family, that potentially weren’t as enabled before.
Although there are many good examples of individuals working very
well together to bring the best to children and families. So, I
think the Bill provides an opportunity for evolution of service and
professional practice and service delivery, but it also will
provide the challenge if the resource isn’t there to provide
it, to enable those circumstances to be in existence for that
growth to occur. So, it provides many opportunities, but the
challenge is to ensure that it’s furnished with what's needed
to make it work.
|
[492] Michelle
Brown: What sort of resources and tools and things need to be
in place for this Bill to be implemented properly and to be made to
work from your point of view?
|
[493] Ms
Davies: In very basic terms, we need the right number of nurses
with the right knowledge, skills and expertise to undertake
specific assessment and/or interventions as they were needed, and
it depends on that group of children and young people who are,
obviously, subject to the Bill. So, it depends on the scope of the
Bill, essentially. But we would definitely say that preparation of
that registered nursing workforce would be key to open up other
services for children and young people.
|
[494] Michelle
Brown: Thank you.
|
[495] Lynne
Neagle: Okay, thank you. In your written evidence, you’ve
said that the terms ‘healthcare’ and
‘medical’ are distinct but are mistakenly used
interchangeably. Can you expand on that, and what you feel the
consequences of that are, and highlight any issues you think that
we should consider as part of our scrutiny in relation to that?
|
[496] Ms
Turnbull: Yes, thank you. I think that is really quite
important, and it goes back to this important question about what
is the scope of the Bill, what is the clarity of that, and the
potential for mistaken unintended consequences if the definitions
appear to be too restrictive. So, I think, Alison, if you want to
say a few words about the—.
|
[497] Ms
Davies: So, quite straightforwardly really,
‘healthcare’ is an umbrella term, and healthcare is
delivered by health professionals. Health professionals include
nurses, doctors and therapists. So, that care can be provided in a
number of ways to meet a number of different needs. Medical care is
a component of healthcare.
|
[498]
Ms Turnbull: Another definition might be as well—. We need
to think about where children and young people might have
healthcare needs that, as currently in the definition, arise from
an educational need. But they might have healthcare needs
generally, and again, ‘healthcare’ is quite broad. So
when we talk about ‘healthcare’, we could be talking
about a public health type of intervention or advice, whereas if
we’re talking ‘medical’, we might be talking
about something very specific like a child in a community who might
be needing chemotherapy, or a broken leg, or something very
specific. I think the other issue to think about, in terms of the
scope of the Bill, is where health or educational needs arise from
social need. Legislation is fraught with risks for decision makers,
as obviously you well know. I mean, in one sense, if you make the
scope of the Bill too broad, there is a concern about how we have
the resources to effectively meet that need. But on the other hand
if the Bill is too narrow, as you’ve heard from other
organisations, the risk might be children and young people with
needs might feel, in a narrow interpretation, excluded, and that
would be, obviously, a very difficult situation, which we would not
be supportive of.
|
[499]
Lynne Neagle: Thank you. We’ve got current non-statutory
guidance on meeting the healthcare needs of children in schools,
and you’ll be aware that there’s a campaign to have a
statutory duty in the Bill. How satisfied are you with the current
guidance? How confident are you that the guidance that is being
reviewed is going to lead to a stronger set of protections for
children and young people, and would you favour there being a
statutory duty on the face of the Bill to address the healthcare
needs of children in schools?
|
[500]
Ms Turnbull: I think we currently feel that the guidance in the
current situation is not strong enough; it needs to be improved. I
think we have come to that conclusion, and in fact I think
it’s a conclusion that lots of groups within health have,
perhaps, come to almost independently. The Royal College of Nursing
as a UK organisation, for example, is currently working on guidance
to its own members in this field. So, clearly, the current
situation is not satisfactory and needs to be strengthened. I think
one of the things that concerns us, perhaps, is the involvement of
healthcare professionals in strengthening that guidance. So, we are
currently working, for example, with Welsh Government to make sure
that different professions are represented on the groups that are
strengthening that guidance. So, to take the obvious example, a
perspective from learning disability nurses, as well as a
perspective from, say, school nurses—that there’s a
perspective from everybody to strengthen that guidance. So, I think
there is certainly work to be done on that.
|
[501]
As we’ve said in our evidence, we
have not reached a definitive point as to whether this legislation
is the answer to that question or not. It could well be, but as
we’ve said before, there are some dangers in that, and I
suppose our concern was that if it is part of this Bill, that
it’s part of this Bill in a way that enables healthcare
professionals to respond to the needs of the child or young person
with some flexibility, rather than perhaps being so prescriptive
that it actually ends up narrowing down the situation. What we
don’t want, for example, is what I think one of the previous
witnesses alluded to. We don’t want a situation where
it’s so narrow that parents and children and young people, in
order to get the help they need, are sort of boxed into a situation
of saying, ‘We want this diagnosis and we want to medicalise
this issue because that’s how we can gain
support.’ And that’s
not a good situation to be in. We need a situation where the needs
of the child are met in an appropriate way.
|
[502] Ms
Davies: Chair, if I can provide some context there as well, I
think it’s quite difficult to disaggregate health, education
and social needs, because when you’re looking at a child or a
young person in a holistic way, this means that those needs coexist
very often. So, just some simple examples really: if you would
consider a child or young person with dyslexia, who perhaps has got
some emotional distress and trauma, suffering from bullying and
other misaligned emotional conditions because of that nature. If
you consider a child or a young person perhaps with acute anxiety,
that makes it difficult for that child or young person to attend
school, and, even if they can attend school, their circumstances
perhaps are not conducive to them learning. If you consider a child
or a young person who’s a young carer, who perhaps has got
some circumstances at home or some adverse events of childhood that
colour that young person’s perspective, then that
doesn’t always put that young person or child in the right
environment to learn either. So, from a health, education and
social point of view, we know that those things are intricately
entwined, and that is some of the opportunity and challenge
services face, along with children and young people, right now in
managing those needs. So, we would suggest that—. And I think
the guidance has evolved, changed and improved since 2010, and I
would make the argument that health needs are as important as any
other need to be considered if we’re looking to maximise the
potential of our children and young people through education and
other means.
|
[503]
Lynne Neagle: Okay, thank you. And just finally on school nurses,
what kind of role do you think they can play in addressing these
problems in a school setting? We’re waiting for new guidance,
aren’t we, from the Welsh Government on school
nurses?
|
[504] Ms
Turnbull: I think that this is a key issue, and school nurses
are one of the specialities within nursing that have a role to
play. But I think it’s important to recognise that, despite
the title, their actual role is more at a strategic public health
level. So, on some good examples of work we’ve seen done,
I’ve mentioned the teenage pregnancy work, and another
positive example might be around the introduction in the last
decade of vison and hearing screening at a very young age. Those
are the kinds of roles that they are looking at in terms of the
population.
|
[505] They also can
work very effectively in terms of advice for individuals and
referrals, and the co-ordination of support for when they become
aware of a need. And they also can be very useful in terms of
providing support to teaching staff in terms of how to deal with
particular issues—sex and relationship education is obviously
a key example here. So, they play a very important role. But I
think, in terms of what perhaps some of the committee discussions
have been focused around—say, children with chronic
conditions, or children with those kinds of need—then I think
you’re actually looking at a different range of
professionals. You’re talking about the learning disability
nurse, perhaps CAMHS involvement. You may even be talking about
children’s nurses who are working in a community team. You
may be talking about—one example was alluded to by a witness
earlier—a specialist diabetes nurse who was able to provide
education for the broader school environment. So, they do have an
important role to play, but they are certainty not the only nursing
role that provides that support, and they may not even be the
primary nursing role that you are looking for, depending on the
scope of the Bill.
|
[506] Ms
Davies: Chair, if I can provide some context around the school
nursing services as well. For school nurses in Wales, they manage
the health needs—health rather than medical need—of the
school-age population. So, although their title is
‘school’, they work with school-age children rather
than solely within schools, and caseloads—so, the population
that school nurses serve—can vary widely across Wales and are
related to geography and a number of other things. So, it
wouldn’t be unusual for a school nurse to have something like
2,000 plus children on their caseload. So, when we look at the type
of work, the type of detailed care and intervention that children
and young people with additional health needs might need, school
nurses aren’t always best placed to do that. They may be in
individual circumstances, but, as a professional group, they
probably are not best placed. Children’s nurses per se would
be, but it’s all about working in partnership. So, we
wouldn’t look at an individual component of nursing managing
the health and well-being needs of children and young people;
we’d look at it in the round.
|
[507] Lynne
Neagle: Okay, thank you. John.
|
13:30
|
[508] John
Griffiths: Yes, really, continuing with this interface between
education provision and health provision, from what you’ve
said, there’s a lot of overlap, I guess, and a lot of
blurring of borders between the two. Is that becoming increasingly
the case, do you think? How would you characterise the interface in
terms of how smooth and unproblematic it is or otherwise?
|
[509] Ms
Turnbull: Well, I think the answer to that, obviously, has to
be ‘it varies.’ Ultimately, we’re talking about
people at an operational level and working together. I think, in
some ways, the blurring of the boundaries, as my colleague, Alison,
has already said, is natural. If you’re looking at a
child’s needs, are those boundaries possible? So, I think
there has been a lot of overlap and blurring of boundaries, and,
very often, you’ll see professionals working very hard to get
the best result for the child and doing what they can to ensure
that to happen. Of course, what’s always difficult in these
situations generally is when there’s a shortage of resources.
That can be very hard then, because if people don’t have the
time to attend meetings in person, if meetings become phone calls,
if phone calls become an e-mail, you lose the cultural
organisational understanding of different perspectives, you lose
that understanding of people’s perspectives and,
fundamentally, there may be more division about budgets, which
becomes a difficult conversation then where certain people become
perhaps slightly more defensive. All of those things have
an—. The lack of resources generally has an impact on any
kind of cross-organisational working, which is obviously what we
want to foster—the best kind of relationships.
|
[510] Ms
Davies: I’d like to add something there. I think, in any
setting, as here or in any walk of society, when you’re able
to access somebody with the knowledge, expertise and resource that
you need to help you manage a need or a situation, then those
working relationships are going to be far better and easier. So,
it’s about having the right resource in the right place at
the right time for children and families, for schools, for
education settings and, obviously, within health as well. The role
of DECLO may or may not go some way towards putting systems and
processes in place to assist that. It will be interesting to see
the results of the pilots that are being undertaken, and the role
of DECLO would seem to have a number of levels in terms of
strategic and operational perspective.
|
[511] Lynne
Neagle: John, we would like to get on to the DECLO role because
we are short of time, if that’s okay, and I think it’s
important to cover it. Hefin.
|
[512] Hefin
David: You were critical in your evidence of the DECLO role,
saying that there’s a risk the role will divert healthcare
professionals into providing an administrative service. It seems an
appropriate point to ask you for an elaboration.
|
[513] Ms
Turnbull: Well, I think, to be quite honest, we were unclear
really as to what role—the DECLO—was being proposed.
What we were trying to do in our evidence, I guess, was be honest
about that lack of clarity rather than necessarily be critical of
it. We genuinely were unsure what was being proposed. We were
unsure whether we were talking about a role that was doing the
actual assessment, in which case you would need a healthcare
professional to do it, or if we were talking about a role that was
doing the co-ordination that followed on from the assessment, or if
we were talking about a strategic analysis role, in which case
genuinely would you need specifically a healthcare—? I
suppose there’s also an important point, going back to the
issue I alluded to earlier, which is the far more strategic level,
board level role of somebody actually taking a step back and
looking overall at the needs of the population, and that’s a
very senior role. It could appropriately be at medical or nursing
director level. I don’t know if Alison—.
|
[514] Ms
Davies: I think that role is potentially key and I think there
are challenges in terms of getting that right. Where that resource
comes from, I think the Bill identifies that could be from a
medical, nursing or therapy perspective. It probably benefits
greatly from a professional/clinical perspective to that role, but
it’s about being very clear where that added value is
expected to occur. So, is that at board level, is that about
service delivery level, is that about operationally working
together to resolve and manage, is that about forward planning and
integration? Where is the added value meant to be in that role? It
may be across all those settings, and, if that’s the case,
it’s again about having the professional level in that post
that’s going to be able to undertake that and make a
difference for children and families. So, stretching that resource
too thinly or not having it at the right level is not going to be
helpful in the round.
|
[515] Hefin
David: I know we’re not scrutinising the draft code, but
would you permit me to read a paragraph from the draft code?
|
[516] Lynne
Neagle: Yes, if it’s not too long.
|
[517] Hefin
David: Okay, very quickly. The draft code:
|
[518] ‘The role
of the DECLO includes strategic and coordinating functions which
should remain with the DECLO. However, the DECLO should not be
involved in every child’s IDP and, therefore, should delegate
operational functions to an appropriate service in the
HB’.
|
[519] Isn’t that
clear enough or is it not clear enough? Would you like more
clarity?
|
[520] Ms
Turnbull: I think, if the role—. Where the added value is
would be helpful to state and, therefore, it would be helpful to
state exactly what that is, but almost in the reverse of that, in a
positive way. So—
|
[521] Hefin
David: So, that’s not clear enough.
|
[522] Ms
Turnbull: I think we would like—. For example, if
it’s intended to be a very senior role and it’s
intended to do certain things, I think it would be helpful to say
that, as well as what it’s not expected to do. So, yes, we
would like more context, yes.
|
[523] Ms
Davies: I think—
|
[524] Hefin
David: And last—. Sorry, go on.
|
[525] Ms
Davies: Apologies. I think, not to underestimate the role and
potential influence or otherwise of the DECLO, the introduction of
the Bill brings, as I said earlier, many opportunities, but
it’ll bring significant challenge as well. And it’s
about having either a person or persons at several levels to be
able to manage those challenges quickly and appropriately. Some of
those will be strategic, some of those will be operational, some of
those will be individual. Yes, it says not to be involved in an
individual’s health plan there, but what happens when
there’s a dispute? What happens when things are not
straightforward? There will be occasions when things aren’t
straightforward. I think, when you’re working with
whole-population groups, as children and young people are,
particularly up to 25, so there’ll be an involvement of adult
services across the board, then, there are likely to be
complexities.
|
[526] Hefin
David: And the last question: you mentioned the pilots, how
critical are they to getting this role right in relation to the
evidence?
|
[527] Ms
Davies: I suggest pilots generate excellent learning and I
would imagine that the pilots will identify some key issues,
perhaps, that haven’t been considered before, or the
perspective of those will change following the pilot.
|
[528] Hefin
David: Thank you.
|
[529] Lynne
Neagle: Thank you. Michelle.
|
[530] Michelle
Brown: Thank you, Chair. Under the Bill, the education tribunal
doesn’t have the right to direct and make decisions that bind
the NHS bodies. That leaves parents going through the NHS appeal
system in respect of NHS-related matters and the education tribunal
in relation to education-related matters. Can you foresee any
difficulties with that system?
|
[531] Ms
Turnbull: We don’t, as the Royal College of Nursing, have
specific views on the best route for that. I think we would advise
taking evidence, perhaps, from some other experts in the field from
within the NHS and from children and young people themselves, but
what we would say, as a general point, is that there are
difficulties with setting up two separate systems. On the other
hand, there are difficulties, if you are asking for healthcare
professionals to make decisions—whether strategically or
individually, which we think is the right thing to do—there
will always be problems then, if the appeals process is through a
route where that expertise, that knowledge, or that understanding
is coming from a different perspective. So, really, there are
certainly risks on either side, and the solution, perhaps, is not
structural; the solution is better co-ordination. Is there, for
example, a formal link between the two processes? So, we
don’t have a specific view on what the best result should be,
but we do sound a note of caution, I guess, about ensuring that the
people who have the expertise and the ability to understand what
the decision should be—. A second group of those people need
to be involved in any appeals process.
|
[532] Michelle
Brown: It was suggested in the previous session that healthcare
experts be involved in the education tribunal when they’re
hearing a case, so that you have that feed-in between the two. What
would your views be on that?
|
[533] Ms
Davies: Well, I think that the whole perspective of the Bill is
about looking at a child and young person’s needs
holistically. So, that can only be a good thing when you have
professionals who are involved in providing care to children and
young people working and discussing and exploring aspects of that
together. It’s how that would work in operation, I guess,
that would need a little more consideration.
|
[534] Ms
Turnbull: I mean, the reverse could also possibly be
true—making sure there’s an educational perspective to
that particular appeal process in the NHS. If it was connected to
this issue, you could bring people across to provide that context.
So, either way, in a sense, might work.
|
[535] Michelle
Brown: Okay, thank you.
|
[536]
Lynne Neagle: Oscar.
|
[537]
Mohammad Asghar:
Thank you very much, Chair. Thank you,
both. Welcome to you. My question is straight to Lisa, could you
elaborate more on how you envisage, in your own words, the
refreshed school nursing framework supporting any ALN legislation
and provide an indication of how this work would work in
practice?
|
[538]
Ms Turnbull: Yes. Just to start off, what we’ve always
wanted from the school nursing framework, from the first time
around and what we were looking for this time around, is a
framework that reflects the fact that school nurses are working
with the school-age population, that they are working all year
around, that there are sufficient teams there with the sufficient
skills that reflect the local needs of the population, and that
they have the scope to do, as we’ve said, some of the more
ambitious population-level interventions that really provide quite
remarkable results when they’ve worked well. So, that’s
what we’re looking for from that framework. Ideally, we would
like to see similar-level developments in all of the areas
we’ve alluded to, for all of them. I don’t know if
Alison—maybe you’ve got some specific points about the
school nursing framework and what we would like to see in
that.
|
[539]
Ms Davies: I think, in terms of children and young people, that
every child and young person is able to access the school nursing
service—it’s a generic, universal service that’s
there to support health and well-being, essentially. So, we would
expect school nurses to be able to help support the health and
well-being of children and young people in all settings, whether
those children and young people have additional learning needs,
special educational needs, or are in the main body of school-aged
children. So, we would want a refreshed framework to reflect that
scope and have the resources, education and opportunity in there
for school nurses to work in that way, whether that’s for
children and young people in school or outwith the
school.
|
[540]
Mohammad Asghar:
Thank you.
|
[541]
Lynne Neagle: Okay, thank you very much. Well, we’ve come to
the end of our time. Can I thank you both for attending and
answering all our questions? We will send you a transcript to check
for accuracy in due course, but thank you very much for coming. The
committee will now break until 2.40 p.m. Thank you very
much.
|
Gohiriwyd y cyfarfod rhwng 13:42 a 14:42.
The meeting adjourned between 13:42 and 14:42.
|
Y Bil Anghenion Dysgu
Ychwanegol a’r Tribiwnlys Addysg (Cymru):
Sesiwn Dystiolaeth 15 Additional Learning Needs and
Education Tribunal (Wales) Bill:
Evidence Session 15
|
[542]
Lynne Neagle: Okay. Welcome back, everybody, for our final evidence
session today. We’ve got a large panel. Can I welcome Dr
Karina Dancza, who is from the College of Occupational Therapists;
Sarah Lewis-Simms, who is also a member of the College of
Occupational Therapists; Kate Fallon, who is here from the
Association of Educational Psychologists; Mary Greening, from the
Association of Educational Psychologists; Dr Alison Stroud, from
the Royal College of Speech and Language Therapists; and Pippa
Cotterill, who is also from the Royal College of Speech and
Language Therapists? So, welcome to all of you. We’re very
much looking forward to hearing what you’ve got to say. If
you’re happy, we’ll go straight into
questions.
|
[543]
If I could just start, just by asking
each organisation to give a brief overview of your current
involvement in assisting learners with SEN. I don’t know who
would like to start.
|
[544]
Dr Dancza: I can go first.
|
[545]
Lynne Neagle: Go on then, thank you.
|
[546]
Dr Dancza: So, I’m an occupational therapist by background
and, with occupational therapy, we are supporting children and
young people with how they occupy their time—so, the things
that they do, they want to do, they need to do, they’re
expected to do. So, we very much support children in schools, we
support children through the health service, we support children
through social care and voluntary services, and we’re also in
a wide range, and in all of those services, we are trying to
support the children to do the things that they want to do. The
work that occupational therapists are doing with additional
learning needs is very much based around how the children are
learning in the classroom and the things that they are doing, like
outside of the classroom, playing in the playground, having meals,
so, all of those are what we call ‘occupations’. So,
that’s very much where we’re situated, and I think that
gives us quite a unique perspective, because we do span health and
education and social care services.
|
[547]
Lynne Neagle: Okay, thank you. Who would like to go
next?
|
[548]
Ms Fallon: I’m an educational psychologist by background.
For those of you who don’t know, until quite recently,
actually, all educational psychologists were also qualified
teachers. More recently, that has changed to having the three-year
postgraduate doctoral training after doing a first degree in
psychology and spending time working with children, usually in
schools. So, a lot of educational psychologists’ work is in
schools, although they do also work in pre-school settings and,
again, in health and social care settings, and children’s
homes at times.
|
14:45
|
[549] But the majority
of the work is in schools, with nought to 19-year-olds—sorry,
early year settings and schools, and some colleges with nought to
19. And, since 1981—the Education Act 1981—educational
psychologists have actually had a statutory role in the assessments
of children whose special educational needs require them to have a
statement. But, the EP role was usually a very long time before a
child had a statement of special educational need. So, working in
schools, educational psychologists would largely have had some
input, either indirectly through discussion with teachers and
staff, or directly with all children who had special educational
needs. So, you know, if a teacher’s got a worry, they might
discuss it with an educational psychologist, the psychologist would
give advice without necessarily seeing the child, also supporting
the training of teachers, both in schools and in larger groups,
about meeting a wide range of special educational needs.
|
[550] So, educational
psychology is very much involved in what’s the graduated
approach—start at the lowest intervention level as required,
but then give advice as things go on. And then, if a child needed a
statement, the EP would do that. They also work with groups of
children, helping at a sort of whole-school level, if you like, if
there’s a need that a number of children have got, helping
staff. And also working with local authorities and multi-agency
groups, if there needs to be a strategic approach to, say,
supporting the workforce, right across education as well as social
care. But also if there’s new research that’s come up,
that actually should have some influence on the way certain
children’s needs are met, on new ideas, new approaches. So,
they’ll work at all those levels—teachers, individual
children, right through to local authorities, and other
multidisciplinary groups as well.
|
[551]
Lynne Neagle: Thank you. And the royal college.
|
[552]
Dr Stroud: Well, speech and language therapists manage the risk
of harm for children and young people who’ve got
communication, speech, language needs or swallowing needs.
There’s obviously a lot of discussion about the inadequacy of
services, and support from speech and language therapy to children.
And, in 2008, there was a three-year pilot project, funded by Welsh
Government, which helped us co-produce, in prudent healthcare
terms, with other agencies, like local authorities, more of a
graduated level of service so that it wasn’t all at the
specialist end. So, we’ve now in Wales achieved universal
services for all children at risk, via the Flying Start programmes,
particularly. So, we know that 70 per cent of children in socially
deprived areas are going to develop their language slower than
their peers. And then we’ve got targeted services across the
whole of Wales now, where local authorities are funding teacher
training, within schools, for awareness of how to support children
at risk from their speech, language or communication needs. And
then we’ve got the specialist end.
|
[553]
Lynne Neagle: Okay. Thank you very much. Julie.
|
[554]
Julie Morgan: Thank you very much, and good afternoon. You’ve
told us what your role has been, or is at the moment. How do you
see your role under the new legislation?
|
[555]
Ms Fallon: We’re slightly concerned, because at the moment
we have a very clear role. With the current legislation and code of
practice, it’s expected that, before a referral is made to a
local authority to have a statutory assessment, there will have
been an educational psychology involvement, giving advice, as I
say, at those lower levels. Now, under the current proposals,
there’s certainly no mention of educational psychologists on
the face of the Bill. There is mention of educational psychologists
in the draft code of practice, where it says that, if a child is
referred to the local authorities, so that the local authority
would take responsibility for the IDP, then the local authority
must engage with an educational psychologist. Prior to that though,
it says that schools should be encouraged to seek the advice of an
educational psychologist, not that they must do, which is really
what they’re expected to do now. And I think we have concerns
that, actually, then, children might be referred for the local
authority to take over responsibility without the opportunity of
the school having an educational psychologist to help give advice,
which might, in some ways, have prevented the child needing to get
to that level of the local authority taking over. So, we are a bit
concerned about that at the moment, and we’d welcome sort of
further discussion of the code, to perhaps put more onus on
schools to say that they must engage with an educational
psychologist.
|
[556] Julie
Morgan: So, you think that should be changed to
‘must’?
|
[557] Ms
Fallon: Yes, basically. And I think we’re concerned
because it seems as if, actually, you’re reducing the rights
that children and young people have had since 1981, of having that
access to a specialist professional, who has the holistic approach
to looking at children in schools, but bringing in other aspects of
their development as well.
|
[558] Julie
Morgan: Thank you. What about the occupational health?
|
[559] Dr
Dancza: I think that the code has got a lot of opportunities
for us, particularly to work in a very person-centred and
family-centred way. So, I think the intentions of the Bill are
right, and are good. I think there are some concerns about,
sometimes, it seems to be a getting a little bit lost in some of
the translation, particularly into the code—that
person-centred, that planning—and maybe that could be
strengthened. I think there is something about having the
children’s needs—. A lot of the Bill and the code seems
to direct people to supporting the individual child, and while
there are the intentions of that universal, and probably targeted
support, I think perhaps there are opportunities to strengthen
that, because like the educational psychologist, occupational
therapists would also welcome the opportunity to work closer with
schools, on a whole-school basis, in order to be able to support
the needs of children while they’re in the classroom rather
than have to always focus on one individual child for one
therapist, if you like, because, particularly with the increase in
the numbers of plans that is proposed, I’m not sure how
sustainable it will be if we keep on trying to target a one-to-one
model.
|
[560] Julie
Morgan: So, it’s similar—[Inaudible.]
|
[561] Dr
Dancza: Yes.
|
[562] Ms
Cotterill: From a speech and language therapy perspective,
there would continue to be that graduated response, that there will
be work and information that school teachers and learning support
assistants can do to support children with speech and language
communication needs, and then, with the continuing focus, as
we’ve said, on the outcomes for the child, what’s going
to change. So, what can we do as speech and language therapists to
support that change, to meet those outcomes, where there is an area
that we can do that? The person-centred planning focus of that is
going to support that, looking at those outcomes, and we welcome
that. And something that we do in our health work now is focus on
what those outcomes are going to be for the child. So, there will
still be that role looking at what’s being done at a
whole-school and a whole-classroom setting, and then it may be in
some small group work, through the work of the teacher, and if
there are any learning support assistants in that setting, and then
also the specialist role when they would get referred into the
service.
|
[563] Julie
Morgan: Right. So, do you think there should be any changes in
the code, or on the face of the Bill?
|
[564] Ms
Cotterill: I think the focus on the outcomes I think is very,
very important and that comes across in the code. But I think it
could be stronger in the code, and maybe a focus on that in the
Bill as well.
|
[565] Julie
Morgan: Right. Anything anybody else feels should be on the
face of the Bill or in the code that isn’t there?
|
[566] Dr
Dancza: I think I would reinforce the—. In the code, and
in the Bill, it’s talking about your description of
additional learning needs, it’s talking about your
description of the provision, and then it says, ‘Any other
thing’. So, actually, it doesn’t—. It’s not
as clear, I don’t think, about how the provision links to the
outcomes, so it should be the outcomes first with the provision,
rather than just a focus on the provision.
|
[567] Lynne
Neagle: Thank you. Michelle.
|
[568] Michelle
Brown: Thank you, Chair. What is—? To what extent is your
sector, and your professions, currently under pressure to provide
for existing needs, and how do you see that—? Do you see your
workload changing? Do you see the role becoming more complicated,
which will complicate your own workloads? What do you think the
implications of this framework are going to be on you?
|
[569] Dr
Stroud: I think we have some concerns that some of the code may
increase demand on the number of meetings, the number of
person-centred planning meetings—that could be just an extra
layer of bureaucracy. We’ve done some quantification of that,
and it could mean a 7 per cent—. To keep doing all
we’re doing and do other things like that on top, it would
mean another 7 per cent increase in the workforce, which, in terms
of prudent healthcare, is expensive. And we do have to think in
health economics terms—you know, already half the budget is
spent now on health, and what are we going to stop doing if
we’re going to have increased demands for another layer of
work because of an education Bill?
|
[570] We try to work
within prudent healthcare principles, so you have to always
consider within the resource what outcome you’re going to
get, and whether that’s worth the investment. They’re
hard decisions, there’s no doubt—and Dai is nodding.
You know, do you spend £35,000 on one cancer treatment for
one person to give them three months’ quality of life, or on
another speech therapist to go to person-centred planning meetings?
There are difficult questions on this, and undoubtedly there is a
risk of unintended consequences here.
|
[571] But we could
think more broadly about workforce planning in others.
There’s a learning support assistant workforce that
we’ve worked very well with for individual children.
We’ve put a lot of effort into training them around the tasks
around children, and then the next term they’ve gone and you
have to train another. So, maybe there’s workforce planning
that’s joint as well around generic workers but that are held
longer rather than being in and out of systems. So, there might be
some solutions there.
|
[572]
Lynne Neagle: Thank you.
|
[573]
Ms Lewis-Simms:
I think that’s key where the IDPs
come in, that we move away from looking at impairments, and look at
what is the outcome. We’ve already talked about that. I think
that’s key, because we won’t cope with the volume that
we’re anticipating. But if we get what the outcome is that we
need to achieve, and all the different people that can help the
child achieve that outcome, I think, then, we’re pooling our
resources more sensibly in order to achieve the outcome that the
child and family want, and getting that right at the beginning when
we start the IDP I think is key.
|
[574]
Lynne Neagle: Thanks. Llyr.
|
[575]
Llyr Gruffydd: But we still need an increase in capacity in terms of
workload, regardless of however clever we are in terms of pooling
resources. We’ve seen an upturn, I believe, in people coming
through, or at least starting their training. Is that sufficient?
Is that level of increase that we’ve seen of late sufficient
to meet this perceived or expected increased demand, or does the
Government, the health boards and others need to go further
still?
|
[576]
Mr Fallon: Our training isn’t anything to do with health;
ours is Welsh Assembly funded. I was going to say—I think, in
the longer term, there’s clearly more work because
you’re taking in a group of young people who are currently
included in the 19 to 25-year-olds. The person-centred planning
certainly will take more time because it’s bringing people
together, but if that actually then improves the quality of outcome
planning and the quality of people working together, and that
actually helps young people to develop better outcomes in the
future, then you are actually investing for the future. So, it may
take more people to do it now, and those meetings—. I mean, I
spend a lot of time in England, and they say that one of the most
successful parts of the implementation of the new legislation there
has actually been people coming together to do that person-centred
planning. It is resource-heavy, but you get greater parental
confidence, and you get the children and young people actually
being more included and knowing what it’s all about. So,
it’s really a sort of, ‘Do you want to invest to save
later on?’, really.
|
[577]
I also think there’s going to be
some shorter-term increase of work, whilst some
professionals—and I would include ours particularly in
that—actually help the implementation of the new approach,
because for the staff on a day-to-day basis, actually, there still
needs to be a culture change there. So, I think there will be a lot
of collaboration required between the professions sitting here in
terms of helping staffing in schools and parents as well understand
that slight shift, but, hopefully, if that’s done well, that
should only be short term. Sorry, I know that
wasn’t—
|
[578]
Llyr Gruffydd: No, that’s okay. The NHS Confederation have
told us in evidence, I think, that speech and language therapists
would need to attend, they estimate, around 90 per cent as opposed
to 25 per cent of meetings that they attend at the moment. Now,
that will have a resource implication, clearly. So, I’m just
trying to fathom how far away we are from where we need to be, and
what we need to do to get there.
|
15:00
|
[579] Dr Stroud: Well, either we keep
doing the same work or we stop doing things. There’s some
evidence from the England reforms that that’s what
happened—that actually it’s shifted work just towards
the children who’ve got an IDP. So, all the others—the
prevention work and things—drop off, which would be a
mistake.
|
[580]
In terms of Wales’s workforce
planning, I don’t believe any—obviously, the
implications of this Bill will be in the doing. We’re not
sure yet. But they wouldn’t have been factored into workforce
planning arrangements yet, and therefore there will be a lag, if
there is a need to increase the workforce, in the numbers being
trained in Wales.
|
[581]
Dr Dancza: It very much depends on what we’re expecting.
So, if we are expecting a similar type of plan like a
statement—if we’re expecting that to be rolled out,
then it’s about that culture shift as well. So, if people are
thinking that they can just take on what’s currently
happening and then replicate that on a larger scale, that’s
not going to work. So, we do need to be looking at different ways
of working and focusing on what’s in the plan, and how much
resource it’s going to take to write those plans. I think
that’s where, if we can focus on outcomes for the family and
put that resource in, then actually we can target the resources
more sensibly rather than try to replicate what we’ve done in
the past.
|
[582] Llyr Gruffydd: One—. Sorry, yes, go
on.
|
[583] Ms Cotterill: I was just
thinking—we’re already trying to work very much in a
co-production way, and it’s continuing that, and everybody
doing that. We’re doing that ourselves in health and trying
to push that forward. It’s making sure that’s wider.
But that is the whole cultural thinking, and it takes time to
do.
|
[584] Llyr Gruffydd: So, we need both, really,
don’t we? We need the cultural shift and we need the
increased resource.
|
[585]
Ms Cotterill: Yes.
|
[586] Llyr Gruffydd: Okay. One practical
suggestion that the Royal College of Nursing has made, and they
made it earlier in the previous session, was that maybe we look to
put a duty on health boards in the Bill to take account of the
workforce requirements for meeting the ALN in their area, when they
draw up their workforce plans that are submitted to the Welsh
Government. Do you think there’d be merit in that? I was just
a bit startled that it doesn’t happen—that we need
legislation to force it to happen.
|
[587] Dr Stroud: Workforce planning processes at
the moment in Wales are professionally informed, so there have been
various situations for how this workforce planning is done.
It’s a bit of a crystal ball job, not a science, really. If
we were sure that we could quantify the amount of extra that was
needed then they would be fed into the workforce plans for the
health boards right now. It’s just because it’s a new
thing I’m not sure whether can truly quantify the workforce
required, because it would take three or four years for them to
come out. So, health boards do plan for workforce training.
|
[588]
Llyr Gruffydd: Yes, although we’re not where we would like to
be at the moment, so planning has not been what it should have
been, maybe. I don’t want us to be here in another 10 years
having the same discussion, because we were here 10 years ago
having this discussion. So, I’m just wondering whether a
stronger duty in legislation would actually force that a bit,
rather than just hope people do it.
|
[589]
Dr Stroud: In my other job I’m head of a speech therapy
service, and I do every year give workforce, education and
development services an estimate of what the speech therapy
workforce should look like. I would always factor in things that
are coming. So, I wouldn’t need legislation to tell me
that—we would be bad workforce planners if we didn’t.
Occupational therapists are a good example, because their workforce
plans go in from the NHS, but there’s also a big workforce in
social care. And the NHS still plans for that social care
workforce. So, it doesn’t need legislation there.
|
[590]
Ms Cotterill: I think one of the other big challenges is how it
actually works out practically. Yes, there could be a significant
number of additional person-centred planning meetings that
we’re invited to, but that doesn’t take into account
how many clashes there are of meetings across different schools.
That’s a little bit unknown. It’s very, very difficult
to predict.
|
[591]
Llyr Gruffydd: Okay, thank you.
|
[592]
Lynne Neagle: In the session we had this morning with the NHS
Confederation, they told us that children and young people who need
access to therapies get those therapies within 14 weeks. Is that
your experience across Wales? Is there any risk that the additional
duties that this Bill will bring, in terms of participation in
planning, will cause more pressure on waiting times?
|
[593] Dr Stroud: Can I take that? There is
always a risk of when the set-up shifts. It has a knock-on effect
somewhere else. Going back to a decade ago, when there was a real
two-year waiting list for speech and language therapy, occupational
therapy et cetera, health put a requirement to have a 14-week wait
for new patient appointments, and there was an increase in
workforce to meet that. That is now the standard that everybody has
to report to. You do have to look at the whole system, how
you’re getting people in and at what point to a specialist
service. The way you keep those waiting times within a standard is
to make sure that the beginning—what happens before in
universal and targeted work—is sound, and what happens after
they leave the specialist service is sound, as well. So, it’s
undoubtedly going to take work if one bit of the system shifts.
|
[594] Ms
Lewis-Simms: I agree with Alison on that. We work incredibly
hard, and I think most services are under the 14-week target. That
is something that is very key to us, that no child and family is
waiting more than 14 weeks. There is a huge pressure on services,
but I think it has made us clearer about what are our outcomes for
the children and families, and having that dialogue at the very
beginning—obviously, that work is helpful now, moving forward
with the ALN Bill. But there will probably be more challenge on
that 14-week—.
|
[595] Lynne
Neagle: Thank you. Hefin.
|
[596] Hefin
David: Can I ask Pippa just to go back to a word you used? You
mentioned graduated response, and you’ve used this in
relation to the multi-agency work in evidence you gave, and
I’ll just read out what you said. You said:
|
[597] ‘In our
view, this approach must be underpinned by integrated pathways
between health and education using graduated response with clear
multiagency roles and responsibilities.’
|
[598] Can you just
elaborate on what you mean by that?
|
[599] Ms
Cotterill: Yes. So, obviously, speech and language are
fundamental. They are part of communication, and communication is
fundamental to education and learning. So, within the scope of
that, there are some things that can be done generally through
learning, and what is in place through a lot of Wales is an
accredited qualification for school staff members to do, which is
about learning—about language, sorry, learning about language
and how to develop language, how language develops and what you can
do to bring things on when there are problems. Some of those
problems are going to be transient in nature, so they can be
solved, let’s say, to a certain extent, by the input
that’s made by a teacher or a learning support assistant
within that education setting. There’s very good evidence
coming out now from Flying Start about some of those—about
the impact that that’s having and reducing the level of
transient difficulties. So, that may be everything that that child
needs, and then they don’t need to come on to a specialist
level. That might be adaptations to the language that the teacher
uses with them or adaptations within the classroom setting.
|
[600] Beyond that, it
may well be that there are some small group settings or small group
work that can be done. In a lot of places in Wales, that’s
carried out within the school setting, and there isn’t any
particular input from a speech and language therapist at that
stage, but they’ve had training about how to deliver it and
continue it. Again, to a certain extent, for some children, that
will be everything that they need and they won’t need that
specialist. For some, they will go on and need that specialist
input, and, as Alison said, having the universal and the targeted
stages right, and, also, when a child is having specialist input
from a speech and language therapist, but also when they come out
of having that. So, that’s what I mean by
‘graduated’. Does that clarify—?
|
[601] Hefin
David: Yes, I think it does. I think you’re talking about
multi-agency working required in relation to the needs of the
student.
|
[602] Ms
Cotterill: Yes, and that universal level is looking at the
whole population, so, who is the whole population that’s
working with that child. For the purposes of this Bill, that would
be talking about the childcare settings, that sort of thing, and
looking at qualifications for them, as well. I think that’s
something that colleagues within speech and language therapy have
been involved in discussions about, as well as the maintained
school setting, which is what we’ve been involved with as a
result of those joint projects in 2008.
|
[603] Hefin
David: A degree of flexibility within the working arrangements,
then.
|
[604] Ms
Cotterill: Yes.
|
[605] Hefin
David: You also state—I’ll move on quickly. You
also state that the role of the DECLO is—you’re
satisfied it’s strategic.
|
[606] Ms
Lewis-Simms: Absolutely, yes, that it would be a strategic role
and that it would be—the explanatory memorandum talks about
it being a senior strategic lead in each health board, very much
that would look at that population needs assessment—to look
at it at that level, rather than at an operational level.
|
[607] Hefin
David: Okay. I’ll open this up a bit, but it’s a
little bit at odds with some of the evidence that we’ve had
from other people today that suggests that there’s a lack of
clarity over what the DECLO role will actually be and whether there
may need to be some operational activity within it. I’ll ask
you to comment and anyone else who wants to comment on the DECLO
role.
|
[608] Ms
Cotterill: There is a level of operational work that needs to
happen, but I don’t believe that that should be done by the
DECLO. I think the DECLO role should be a strategic role, as in the
memorandum, that it is a strategic lead in the health board to have
that overview.
|
[609] Hefin
David: So, why, then, would the DECLO need to have clinical
expertise?
|
[610] Ms
Cotterill: I think it’s as in a knowledge and
understanding of the way that health works in seeing the clinical
needs that can be provided for. So, as Alison said earlier, if
there’s a need that a child has, is that a clinical need, is
it something that somebody from health can do something
about—that it would have that knowledge about that clinical
role.
|
[611] Hefin
David: Okay.
|
[612] Dr
Stroud: Can I just add to that? All local health boards have
got directors who have got clinical backgrounds that advise on
service development with their strategic partners in other
agencies. So, a DECLO could be the director of medicine, the
director of nursing, or the director of therapies, but it would be
a clinical background that would be required.
|
[613] Hefin
David: And you’re convinced that’s necessary.
|
[614] Dr
Stroud: I am, because I think, as the NHS Confederation’s
evidence this morning alluded to, the fact that children are
just—. Their strategic planning is not always at the higher
board level, really, because there are all the winter pressures,
the other big—. There’s all the other—. And to
have a strategic role as a DECLO on that board would fill that
strategic requirement.
|
[615] Hefin
David: Okay. That’s my last question, but does anybody
else want to raise the issue of the DECLO at all?
|
[616] Dr
Dancza: Yes. I guess we would agree that it definitely is going
to be a strategic role. However, I think that’s also the
person that, if there’s excessive complexity within certain
cases, then they might be advising some of the other people around
that, and also they would be looking to see what patterns there are
across services, and so they could perhaps advocate for different
service structures in different areas, because they would have that
strategic overview. They’d also be able to co-ordinate with
other DECLOs to have a Wales-wide perspective, as well. But I think
they do need to have that expertise of understanding the health
systems and all of the differences within that and have the option
of being able to advise in the most complex of cases.
|
[617] Lynne
Neagle: Can I just ask—? What you’ve said, Alison,
is slightly different to what some of us understood by the term
‘DECLO’, because I think we thought that it would be a
dedicated post, albeit a high-level one, but you’re saying
that it could be tagged on to the director of nursing or something
like that. Is that your understanding as well?
|
[618] Dr
Dancza: I think it’s probably—I mean, it’s a
large role, so I can’t see how it will fit within that.
That’s my opinion around that, but I think that they
certainly have to have expertise and experience, and perhaps that
is something that they would’ve had in their past history of
having those roles, and that would come into that role, or whether
there is going to be some kind of sharing arrangements between a
couple of people and doing other things at the same time.
|
[619] Dr
Stroud: I should perhaps clarify that I didn’t mean tag
it on to an already existing role, I just meant that those are the
examples of roles that are similar, clinical.
|
[620] Lynne
Neagle: Right, but you see it as a dedicated post, with them
just dealing with ALN, but at a strategic level.
|
[621] Dr
Stroud: Yes. At a strategic level, yes.
|
[622] Lynne
Neagle: Okay, thank you. Dai.
|
15:15
|
[623] Dai
Lloyd: Thank you, Chair. I’m here today basically as the
Chair of the health committee, so particularly in terms of the
health aspects of this Bill and the many representations
we’ve had as regards the medical needs of children in school,
whether they have an ALN requirement or not. Obviously, we
don’t live in a black and white world—it’s all
shades of grey—and we don’t start with a blank sheet
now, bearing in mind the SEN requirements now and the fact that, as
we’ve heard, certain pupils’ health needs are taken
care of out of the SEN budget, as it were, even though they
don’t qualify on the SEN side. So, with that much of a
background, obviously, people then see an opportunity or a
requirement or a need to actually enshrine that on the face of this
Bill. In other words, that it’s not strictly ‘ALN, end
of’, but it should be expanded to include the medical needs
of that pupil, be they insulin-dependent diabetics, asthmatics,
epileptics—you know, requiring a degree of specialist health
knowledge in the school situation. That is sort of taken care of
unofficially now, but, obviously, if we’re going to have a
strict ALN Bill, that will take the current medical situation out
of it. So, the choices are whether we expand the definition on the
face of this Bill to include medical requirements in the absence of
additional learning needs, or whether some sort of non-statutory
guidance elsewhere later on, which seems to be the Minister’s
preferred choice—correct me if I’m wrong, Chair; I
defer to you, because I’m relatively new in these sorts of
situations. Anyway, I was just wondering, just to explore—.
There are hundreds of people out there who would say that if we
don’t grasp this opportunity of somehow encompassing, say,
diabetes in this—. Because, having a chronic long-term
illness like that does have educational consequences, even in the
absence of additional learning needs. So, I was just wondering what
your view would be in terms of should the extent of this Bill be
rigidly ALN, or ALN plus.
|
[624] Dr
Dancza: I guess the complexity of this is that if we try and
stick to a rigid ALN definition we’ve got a lot of children
that can’t be neatly separated into ‘that’s a
health need, that’s an education need, that’s a social
care need’ and, actually, I think a lot of resources would
then go into arguing, ‘No, it’s not this need,
it’s that need.’ And that’s just—it’s
frustrating for families, it’s a waste of resources. So, in
some ways, if we can—coming back to the idea of
outcomes—focus on what it is that child wants to, needs to,
or is expected to do—. So, if they expect or want to have
lunch with their school friends, if that’s what’s on
the plan then, actually, the service that’s required to help
them have lunch with their school friends should become involved.
That might be that the diabetic nurse needs to be involved in that
part and also the learning support assistant, or the speech and
language therapist, or the occupational therapist. So, if we can
target things around what it is that they want to be able to do,
need to be able to do, or are expected to be able to do, then I
think we don’t go down the road so clearly of,
‘That’s your problem; that’s your problem’,
and waste resources.
|
[625] Ms
Greening: I think I’d agree with that, because a lot of
children who have health difficulties, it also impacts on their
emotional well-being and that can have implications within the
school setting as well. What we should be focusing on is:
what’s in the IDP, what’s needed in the IDP, who should
be providing that support, which professional should be giving
advice, but also, what the outcome should be.
|
[626]
Dai Lloyd: That’s fine.
|
[627]
Lynne Neagle: Okay, no more questions on that.
|
[628]
Dai Lloyd: No, I’ve been completely floored by the
excellence of the replies. [Laughter.]
|
[629]
Lynne Neagle: Okay, thank you. John.
|
[630]
John Griffiths:
Thanks, Chair. There will be a duty on
health bodies to notify parents when they believe a child below the
compulsory schooling age might have additional learning needs, but
there’s only a discretionary power to bring it to the
attention of local authorities if it’s considered in the best
interests of the child. Would you be able to think of any examples
when it might not be in the best interests of the child?
|
[631]
Dr Dancza: There may be, actually. Because, sometimes,
with very young children, families might be wanting a diagnosis
very early on, and it might not be in their best interests—or
whether the resourcing goes into the diagnostic process, and that
might be at the expense of actually providing support from the
relevant health services. So, sometimes, with very young children
we would want to be able to support them within their environment
to enhance their environment and enhance their opportunities, and
if we went down a particular path of trying to get everyone
involved at that point, then actually, it might detract from some
of the services. Also, if parents have got an opposition to it as
well, they might not want to go down that road.
|
[632] Ms
Greening: There can be occasions when parents have difficulty
in accepting that their child has additional needs. If they are at
that stage where they can’t really accept that, it might be
quite difficult for the health professionals to refer on to the
local authority. I think that that would be, on the whole, an
exception. Certainly, if the child has additional learning needs,
which are going to have educational implications, the local
authority would need to know in terms of planning.
|
[633] Ms
Lewis-Simms: I think it’s about involving the parents at
an early stage about what is that information that you want to
share over to the local authority. Obviously, at that very early
stage they’re still grieving. You know, ‘What is it
that my child has? What difficulties have they got?’ I think
it’s how you have that conversation with that parent about
what it is that, actually, you are sharing over to the local
authority, and what is the reason, what’s the outcome again
and why we’re doing it, rather than just putting your name
forward to the local education authority that your child has got an
additional learning need. I think it’s really key.
|
[634] Ms
Cotterill: And it is about talking about when they’re
compulsory school age, and prognoses vary. If we’re talking
about a whole continuum of difficulties here, the prognoses can
vary. So, it may well be that that’s not necessary when it
comes to it, at that time when they are of compulsory school age,
but you might have thought that it might have been at an earlier
age.
|
[635] Lynne
Neagle: Okay. Thank you.
|
[636] John
Griffiths: Perhaps just a follow-up, Chair. There are
arguments. Estyn, for example, believe that you need information
sharing for better planning; and the WLGA was concerned in evidence
that children might slip through the net without the notification
taking place. Do you understand those arguments, which support it
being a duty rather than a power?
|
[637] Dr
Stroud: This is a bit of a personal opinion, but the strategic
planning role would give prevalence and incidence numbers, which
aren’t necessarily at an individual personal level. If a
health board knows it’s got a rising incidence or prevalence
of something, they should have informed, at a strategic level, the
local authority that this might be coming your way in the next
couple of years, so that the planning is a bit more timely.
Otherwise, at an individual level, there is always that
confidentiality of getting the parent ready, or where you
wouldn’t want to—on an individual level—declare
too early. Also, you wouldn’t want to be pushed to diagnose
too early either, because once somebody’s got a diagnostic
label on them, it’s very difficult to get rid of it, even if
it turns out to be incorrect in the future.
|
[638] John
Griffiths: Okay. Thank you very much.
|
[639] Lynne
Neagle: I’ve got Oscar first—Oscar.
|
[640] Mohammad
Asghar: Thank you very much, Chair. My question, actually,
Chair—I had prepared for Kate, and she’s not there. The
next best person, I think, is Karina, to answer my question, as an
educational psychologist. You focused on the need to increase
provision for postgraduate provision for training places in Wales.
What is the extent to which this needs to improve, and can you
elaborate more on uptake of training in other devolved nations,
such as Scotland and Northern Ireland? And what lessons could Wales
learn from different approaches there?
|
[641] Dr
Dancza: Is that in relation to educational psychology?
|
[642] Mohammad
Asghar: Yes.
|
[643] Dr
Dancza: Probably my colleague—[Inaudible.]
|
[644] Dai
Lloyd: Good answer. [Laughter.]
|
[645] Ms
Greening: The situation in other devolved nations is that the
training in Scotland is not funded, and that is causing a lot of
problems in Scotland in terms of shortage of EPs. In England,
there’s been an increase in the training places for
educational psychologists of about 25 per cent, I think; and there
are now plans in England for setting up an additional educational
psychology training course in the east of England. In Wales, we
have the one course, which is in Cardiff. There was a threat to
that course a few years ago, but in fact—. There were 11
trainee EPs in each cohort on that course. But we do have problems
with the supply of educational psychologists in Wales, in that a
lot of our members are under increased pressure in the workplace,
and we do have concerns about how we would meet the needs of the
new additional learning needs Bill, because of what we see as being
differing demands and, perhaps, increasing demands at different
pressure points within the services.
|
[646] Mohammad
Asghar: Do you think that we are missing out on these language
issues in various areas with this sort of professional
qualification?
|
[647] Ms
Greening: You mean the Welsh language.
|
[648]
Mohammad Asghar:
Yes.
|
[649]
Ms Greening: Well, we do have a shortage of educational
psychologists who are sufficiently fluent in Welsh to be able to
offer assessments through the medium of Welsh, but it varies from
area to area. I know that Gwynedd and Ynys Môn have had
problems in the past in recruiting a sufficient number of
Welsh-speaking psychologists, although they have taken steps to
address that issue. But the other problem is that some of the
Welsh-speaking psychologists aren’t working in areas where we
need Welsh-speaking psychologists, so there is that difficulty,
then. But I think that is a difficulty that other services probably
have, of not having enough specialists who can actually work
through the medium of Welsh.
|
[650]
Lynne Neagle: Thank you. Llyr.
|
[651]
Llyr Gruffydd: Thank you. A point that was made by the health boards
earlier on was that we need to improve the health literacy of
education staff as well, and, clearly, they’ll be under more
pressure, one would imagine, to identify, potentially, and
understand what the needs are, really. So, I’m just wondering
what kinds of initiatives there are currently and what more the
Welsh Government could potentially do.
|
[652]
Dr Stroud: I think the pilot projects that I talked about
earlier that were funded by Welsh Government have done a lot in
speech and language literacy, for want of a better term. So, it is
possible. They’re all funded by education, but the accredited
training is now—. It still is not always inspected, though,
so there might be a need to have that level of assurance put in
place.
|
[653]
Dr Dancza: We would certainly welcome the opportunity to do some
pilot work in occupational therapy, as well. I think the challenge,
sometimes, with these kinds of programmes is that people want to
see them working before they get funding, but then they need the
funding in order to see them working. I think that’s where
something within the Bill or within the code to reinforce that
perspective of, ‘Let’s provide some universal
services’ is so vital, and I think the message does get lost
because most of it is about one individual’s—. So, I
can see that we’ve got a lot.
|
[654]
I guess the other thing is that just
telling schools that this is what it is, or training them on
things—that only works to a limited extent. I think we
actually need to have people working together on the ground with
teachers, so they have access to therapists—occupational
therapists and speech and language therapists—in the
classrooms when they need it and to work with them. Because if the
therapist goes in on one day and they see something going on, it
might be different to what’s happening the next day. So, I
think it’s that ongoing relationship, almost like a coaching
or a mentoring within schools; that’s going to have a more
significant impact than just trying to get another programme or
another type of training across.
|
[655]
Ms Lewis-Simms:
I think problem solving together is key
and builds confidence. I think that’s really
important.
|
[656]
Dr Stroud: The workforce structure side—sorry to
interrupt. The workforce structure of these targeted,
increasing-the-health-literacy kind of services are a small amount
of the specialist staff, but with a big tier of generic staff, and
that has had evidence of succeeding.
|
[657]
Ms Greening: It’s building capacity. It’s very much
building capacity within the school system and other systems as
well, to enable teachers and others to meet needs.
|
[658] Dr Dancza: But
we have to be very careful that it’s not shifting
responsibility across, because I think it’s—.
That’s where working together with them and not being seen
as—. I guess one of the challenges is that if we’re
only going to schools on a certain basis, we’re kind of seen
as the experts coming in telling them what to do and then
disappearing again, whereas if we could develop those relationships
with the teachers in a more structured way, actually I think it
would have better long-term effect.
|
[659] Lynne Neagle: Okay. We’ve come
to the end of our time, so thank you very much for your evidence
and for attending today. We very much appreciate it. You will be
sent a transcript to check for accuracy in due course, but thank
you very much for your time.
|
15:30
|
Papurau i’w Nodi
Papers to Note
|
[660]
Lynne Neagle: We will move on then to item 8, which is papers to
note. Paper to note 16 is a letter that we’ve sent to the
Cabinet Secretaries for education and health following up the
session with the chief medical officer. Paper to note 17 is a
letter from us to the Cabinet Secretary for health following up the
issues we were concerned about again in relation to child and
adolescent mental health services and on the school nursing
framework. Paper to note 18 is a letter from the
Minister for Lifelong Learning and Welsh
Language updating us on the supporting learners with healthcare
needs guidance. And paper to note 19 is a copy of the letter the
Finance Committee has received from the Minister for lifelong
learning, specifying how the £20 million for the ALN
implementation is going to be spent. Are Members happy to note
those? Thank you.
|
[661]
Just to remind Members, then, that our
next formal meeting will be on Wednesday 22 March. This will be our
final evidence session on the ALN Bill. We’ll be hearing from
the Third Sector Additional Needs Alliance again, and from the
Minister. We’re also going to have a private session on our
approach to the First 1,000 Days consultation. So, if I can just
thank Members for their time today. I know it’s been a pretty
gruelling set of sessions, but hopefully everybody’s found it
really useful, so thank you very much for attending, and I’ll
close the meeting. Thank you.
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Daeth y cyfarfod i ben am 15:32.
The meeting ended at 15:32.
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