You could potentially come into contact with someone with SEND (Special Educational Needs and/or Disability) at any time. This could be a patient, service user, family member or someone you work with. This information will help you better support others, such as by making reasonable adjustments or signpost to the Local Offer.

The information is intended to be used as a source of reference, as and when you need it. Further training for health professionals can be accessed through the links provided below.

SEND for children and young people (0-25 years of age) is underpinned by legislation in the Children and Families Act 2014, Chapter 3: Children and Families Act 2014 (legislation.gov.uk). As the age span crosses children’s and adult’s services, this necessitates collaborative practices and effective transition planning to fully support the holistic needs of CYP with SEND and their families.

(1) A child or young person has special educational needs if he or she has a learning difficulty or disability which calls for special educational provision to be made for him or her.

(2) A child of compulsory school age or a young person has a learning difficulty or disability if he or she—

  1. has a significantly greater difficulty in learning than the majority of others of the same age, or
  2. (b) has a disability which prevents or hinders him or her from making use of facilities of a kind generally provided for others of the same age in mainstream schools or mainstream post-16 institutions.

(3) A child under compulsory school age has a learning difficulty or disability if he or she is likely to be within subsection (2) when of compulsory school age (or would be likely if no special educational provision were made).

(4) A child or young person does not have a learning difficulty or disability solely because the language (or form of language) in which he or she is or will be taught is different from a language (or form of language) which is or has been spoken at home.

The Act also:

  • Implemented a new legal framework for SEN Law and reformed legislation relating to children and young people with special educational needs and disabilities (SEND).
  • Placed new duties on local authorities and partner organisations to ensure that children and young people with SEND are supported to achieve the “best possible educational and other outcomes” (Section 19 (d) of the Act).

Of particular note for Clinical Commissioning Groups (CCGs, now Integrated Commissioning Systems) to:

  • Jointly commission services for CYP (up to age 25) with SEND, including those with Education Health and Care (EHC) plans
  • work with the local authority to contribute to the Local Offer of services available
  • ensure practitioners and clinicians work with education to support the integrated EHC needs assessment, and
  • agree Personal Budgets for those with EHC plans

In March 2022 the Government published the SEND Green Paper, 29 March 2022 | Local Government Association, a consultation on the special educational needs and disabilities (SEND) and alternative provision system in England. The review identified 3 key challenges:

  1. Navigating the SEND system and alternative provision is not a positive experience for too many children, young people and their families.
  2. Outcomes for children and young people with SEND or in alternative provision are consistently worse than their peers across every measure.
  3. Despite the continuing and unprecedented investment, the system is not financially sustainable.

The consultation asks for people’s views on the proposed changes to the special educational needs and disabilities (SEND) and the alternative provision system. The consultation ends Friday 22 July 2022 and is available at:

SEND Review: Right support, right place, right time - Department for Education - Citizen Space

Accessible versions are available at: accessible versions of the green paper

The current SEND Code of Practice 2015 outlines how professional must work together to meet the needs of CYP with SEND:

The fundamental principles of the Code, requires professionals to:

  • take into account the views of CYP and families
  • enable CYP and parent/carer to participate in decision-making
  • collaborate with partners in education, health and social care to provide support
  • identify children and young people’s needs
  • provide high quality provision to meet the needs of children and young people
  • focus on inclusive practice and removing barriers to learning
  • help children and young people to prepare for adulthood

CDC (Council for Disabled Children) have created SEND basic awareness e-learning modules to give an overview of SEND, in an accessible and easy to digest format. Level 1 is for anyone working within an organisation, while level 2 is for those who may come into contact with patients/public. The modules are freely available, self-guided e-learning and is intended to improve knowledge and understanding of:

  • the Children and Families Act,
  • the SEND Code of Practice,
  • the Local Offer,
  • the graduated approach and,
  • the EHC needs assessment process and many other topics around SEND.

These can be accessed: Training catalogue | Council for Disabled Children, along with a range of other modules which may be of interest.  

An Education Health and Care Plan (EHCP) is a legal document which is established, through co-production to describe a CYP’s needs, detail the provision that will be provided to meet those needs and outline the outcomes sought to meet the CYP’s aspirations. The plan is required for CYP who require extra support to what the educational setting can provide and will take 20 weeks to create. Health colleagues are required to return health advices within 6 weeks of the request. These need to be specific to the needs of the CYP. The plan is then reviewed every 12 months.

Each local authority can design their own format for an EHCP, but it must include all sections:

  1. My Story’ This is background information and is written by the child and parents / carers, young person and / or parents / carers and should include all the views of the family.  Any input from professionals should be indicated as such.
  2. Special Educational Needs. This section will describe all of the needs under 4 headings: Communication & Interaction, Cognition & Learning, Social, Emotional & Mental Health, Physical and Sensory Needs. The strengths and skills of the child or young person can also be mentioned here.
  3. Health needs. These are based on clinical assessment by NHS professionals. Families can commission private assessments. However, the NHS does not have a duty to provide any private recommended provision.
  4. Social Care needs. The local authority has a duty to identify any unmet need.
  5. Outcomes. These are divided into the same for headings as used in 2 and should include both short-term (within the next 12 months) and long-term (by the end of the next key stage) outcomes.
  6. Special Educational Provision. This section should clearly describe all of the additional support, therapies and resources that have been identified to meet the needs listed in 2. The Code of Practice expects any provision to be specified and quantified so that it is clear what additional support and resources are required to meet needs. Provision could be listed under of headings - Curriculum, Environment and Facilities, Equipment and Resources, and Staffing Arrangements.
  7. Health provision. Health services to meet health need. Although, some provision that is arranged through health professionals (Physiotherapy, Occupational Therapy or Speech and Language Therapy) may be seen as educational and so should be reflected in Section 6.
  8. Social Care provision. This should refer to any social care interventions (e.g., Respite, Direct Payments).
  9. Placement. This is the name of the educational establishment where the special educational provision is to be provided.
  10. Personal Budget. Any provision that is made via a budget, rather than through the educational placement.
  11. Appendices. All of the reports obtained to inform the initial EHCP and Annual Review.

Young people and families have the right of appeal if dissatisfied with the content of needs, provision or placement within the EHCP, which can also include health and social care advices. Mediation is offered as an initial step. However, families have the right of appeal via the SEND Tribunal ‘single route’ of address, where a judge can give non-binding recommendations to health and social care.

In cases where a parent or young person seeks amendments to the EHC plan with respect to health and social care, parents, local authorities, and health and social care commissioners will be required to provide evidence and arguments for the health and social care issues. In these instances, health and social care commissioners will need to let parents and the local authority know what steps they have decided to take or their reasons for any decision not to follow the recommendations.

You can find out more about the scope, benefits, and limitations at Extended Powers SEND Tribunal: Online Toolkit - Mott MacDonald (sendpathfinder.co.uk).

The consultation for the new area SEND inspection framework consultation  is now live and can be accessed from this link: Area SEND consultation. A new approach to area SEND inspections - GOV.UK (www.gov.uk).

The easy read of CYP can be found here CYP version.

Her Majesty’s Chief Inspector Ofsted has also published a strategic commentary to coincide with the launch of the consultation. HMCI commentary: consulting on Ofsted's new area SEND framework - GOV.UK (www.gov.uk)

The consultation closes on 11.45pm 11 September 2022.

Throughout the duration of the consultation period Ofsted and CQC are planning to host webinars and online focus groups for parents, carers and those working in the sector.

Webinar for education, health and social care professionals

Each area is inspected by OFSTED and the Care Quality Commission (CQC) and rated to the effectiveness of meeting the needs of CYP with SEND. Inspections are carried out under section 20 of the Children Act 2004. The local area SEND inspection framework, directs inspectors to look for evidence of how children and young people (from birth to age 25) with SEND are identified, how their needs are assessed and met, and how they are supported to move on to their next stage of education, the world of work and wider preparation for adulthood. Inspectors also look at the way in which local areas meet their duties under the Equality Act 2010.

The resulting report outlines areas of strength and key priorities for improvement. Where inspectors have identified areas that show significant weakness, a Written Statement of Action (WSoA) is required. Local area leaders must set out how they will tackle the areas of significant weakness within 70 days of receiving the pre-publication inspection letter. The Department for Education (DfE), working with the Department of Health and Social Care (DHSC) and NHS England when relevant, will seek to engage closely with the local area. If the inspection outcome does not result in a WSoA, the local area is deemed to be meeting its statutory duties in relation to children and young people with SEND. However, this does not mean that the local area cannot do more. Inspectors outline areas for improvement in the inspection letter.

Each Local Authority (LA) is responsible for developing and sharing their SEND Local Offer on the council website. This ensures CYP and families are aware of the services available to meet their needs. It is health’s responsibility to support the LA with information and contacts of health services and how to access them. Each area’s visual display of the Local Offer will be different. However, the content should be consistent, representing education, health and social care services. In addition, links to voluntary sector organisations are promoted. Professionals need to be aware of what is on offer to better support their CYP and families and be able to navigate them to the appropriate site. In essence, this is a one stop shop of useful resources.

  • Liverpool SEND Local Offer:

SEND Local Offer | Liverpool Family Information & Support Directory

  • Sefton SEND Local Offer:

Local Offer - Special Educational Needs and Disabilities | The Sefton Directory

  • Knowsley SEND Local Offer:

Knowsley Local Offer (SEND) | Knowsley Family Information Service (knowsleyinfo.co.uk)

Co-production is a way of working where children, young people, their parent carers, service providers and users work together towards a collective outcome. This involves participating as fully as possible in decisions about their individual care and being involved in decisions about local provision and strategic planning. In addition, children, young people, parents and carers should be provided with the information and support necessary to enable participation in those decisions.

Watch this co-production video or watch the subtitled version, where forums, local authorities, health providers and commissioners share their experiences of working in co-production and how it helped them improve services.

Forums, local authorities and health partners need to work more closely than ever as the SEND reforms are implemented, with an ambition that all areas work towards effective co-production in their planning and strategic decision making. On this video, forums, local authorities and health providers and commissioners share their experiences of working in co-production and the difference it has and is making in their local areas to improve services for children, young people and families.

An example of good practice is the Liverpool Co-production Charter.

The Designated Clinical Officer (DCO) plays a key part in implementing the SEND reforms and in supporting joined up working between health services and local authorities. The role was developed following the SEND reforms 2014 and is underpinned by the Children and Families Act 2014. Each DCO role will be tailored to local circumstances and priorities. However, all will have common elements covering:

  • Advisory role
  • Strategy and Leadership
  • Governance, Policy and Practice
  • Relationships and Connections

Your DCO can support you with many things in relation to SEND. For example: training i.e., Education Health and Care Plan advices, navigating services and signposting to professionals, addressing commissioning gaps in services and supporting CYP/families.

The DCO for the Liverpool and Sefton CCG’s is Ingrid Bell: Ingrid.bell@merseycare.nhs.uk.

Each local area will have a joint SEND Board, who hold each other to account in regard to the SEND reforms. Work priorities and risks are managed as a multiagency stakeholder group. Although, CCGs are responsible for meeting their duties in regard to the health elements of the SEND reforms. However, CCGs will cease to be in operation from 30 June 2022, being replaced by Integrated Care Systems.  

Each area will have a priority action plan, data dashboard and risk register. More information, pertinent to an area should be available on the area’s Local Offer. This will also include any inspection reports.

Integrated care systems (ICSs) are partnerships of health and care organisations, that come together to plan and deliver joined up services and to improve the health of people who live and work in their area.

They will exist from 1 July 2022 to achieve four aims:

1. improve outcomes in population health and healthcare

2. tackle inequalities in outcomes, experience, and access

3. enhance productivity and value for money

4. help the NHS support broader social and economic development.

Each ICS will have two core components:

  • Integrated Care Boards – addressing the Five-year forward plan
  • Integrated Care Partnership – addressing the Integrated Care Strategy

In regard to SEND The statutory duties which apply to ICBs, as imposed by the Children and Families Act (2014), are explained in the SEND Code of Practice (2015) which is statutory guidance. The guidance will be updated to reflect the change from CCGs to ICBs. Each ICB will set out the accountability structure for its statutory duties. The statutory duties will apply to children and young people up to the age of 25 with SEND.

To ensure that statutory duties in relation to SEND receive sufficient focus in ICBs, NHS England have agreed that their statutory guidance will provide that responsibility for these accountable functions should be delegated to an ICB executive lead.

ICSs will be held to account by the Care Quality Commission (CQC) Integrated Care System inspection framework, which will be used from 2023. The CQC will look broadly across Integrated Care Systems, and in particular at how Integrated Care Boards, local authorities, providers of NHS care, public health and adult social care services are working together to deliver safe, high quality  and integrated care to the public.

ICBs will be held to account by NHS England annual performance assessments, which will assess how well each ICB has discharged its functions.

Health and Care Act (2022) Summary - Babies, Children and Young People

The term transition in regard to young people with health needs has been described as ‘the purposeful, planned process that addresses the medical, psychosocial, educational and vocational needs of adolescents and young adults’ (Blum et al., 1993). Although, transitional care delivery can refer to different developmental periods and require different levels of care. For example, condition specific services such as Diabetes can transition at sixteen, NHS Continuing Care (DHSC, 2016) transition on the young person’s eighteenth birthday, while special education provision does not transition until nineteen years of age. In addition, a diverse range of multiagency professionals could also be responsible for these complex needs across a range of settings, from acute to community services. Young people and families often find this a period of great stress and uncertainty. Services have begun to address this with the implementation of Transition roles. Of note to SEND:

Mersey Care Transition:

The role of the Mersey Care Transition Nurse Specialist is to work on all the areas that will support making transition effective and positive for young people and their families, as they transition into the adult world within the community and relevant acute trusts.

The role’s key responsibilities are to provide knowledge to support transition of young people; ensure young people are kept safe and have a positive experience of health; lead the drive for service improvement for transition of care; support implementation and audit of a clinical pathway that safely receives young people into the adult service and provide professional and clinical leadership across the organisation.

Meriam Ghobrial-Wright is the Transition Nurse Specialist:

Email: Meriam.Ghobrial-Wright@merseycare.nhs.uk

Mobile: 07826 383760

CAMHS to AMHS:

The CAMHS to AMHS Transition Practitioner role, supports Children and young people who are aged 16-18 who access both Mersey Care and Alder Hey Trusts. Merseycare are commissioned to provide all urgent and unplanned care to 16+ and this role supports CYP who access AED when in crisis, ensure effective discharge plans are in place and both organisations are working collaboratively.

The role also coordinates the transition over to Community Adult Mental health services when CYP require on going care from CMHTs. The Transition lead ensures the appropriate transfer of care meetings have taken place and supports practitioners and service users to ensure the transition is smooth as possible.

The role also works alongside other organisations to ensure everyone is working together to support Child and Young people with all aspects of their lives.

Hannah Miller is the CAMHS to AMHS Transition Lead:

Email: Hannah.Miller@merseycare.nhs.uk

Mobile: 07827 835194

Alder Hey Complex Transition:

The Transition lead nurse at Alder Hey Children’s Hospital works with clinical specialist’s nurses, Doctors, Consultants, and allied health professionals.

The role delivers transition training, subject matter expert advice, guidance and support for teams at Alder Hey. This gives the clinical teams the knowledge to plan, develop, and implement good Transition planning and pathways, for all children and young people who access the trust, and who have a long term condition’s (LTC’s). This will ensure all children and young people receive the appropriate support through transition, and a safe and seamless handover of care to adult services.

If there are barriers or challenges to transition in any speciality, the transition lead nurse supports clinical teams to work with adult services, to address any challenges to transition.

To find out more about Alder Hey transition and the 10 Steps Framework: Transition to Adult Services :: Alder Hey Children's Hospital Trust

SENDIASS – The Special Educational Needs and Disabilities Information Advice and Support Services (SENDIASS) offer information, advice and support for parents and carers of children and young people with special educational needs and disabilities (SEND). The service is also offered directly to young people. The service is free, impartial and confidential and is a legal requirement for all local authorities. Some areas joint commission this service with the CCG. More information and how to find your local SENDIASS service is available at: SENDIASS | Home | KIDS. Local SENDIASS contact details will also be available on each area’s Local Offer website.

North West SEND Regional Network – provides support for CYP, families and practitioners. Their monthly newsletter, which shares useful information and events can be requested from Dr Cathy Hamer, NW SEND Regional Network co-ordinator Email: cwh01@hotmail.co.uk. Mob: 0778 357 7284

Kidz to Adultz – is a charity who provide practical solutions supporting disabled CYP and adults. They organised events, seminars and have a magazine, with special features each month. This can be requested from: info@disabledliving.co.uk. The link to their website is: Kidz to Adultz Exhibitions - Free Exhibitions by Disabled Living (kidzexhibitions.co.uk).

Council for Disabled Children (CDC) – is a charity organisation who work in partnership with multiagency stakeholders to drive improvements for CYP with SEND and their families. They sharing learning from various projects and provide updates on guidance and legislation. E-learning modules, covering a number of topics are also available on their website: Council for Disabled Children.

Contact – is a charity who support families with disabled children. They support by providing guidance and advice, influencing policy, campaigning, delivering training and are the national delivery partner supporting parent carer forums. More information is available at: What we do | Contact.