Reflections from Steve Crocker - 24 September 2024

Hello and welcome to my eighth blog as independent chair of the Oxfordshire SEND Strategic Improvement and Assurance Board (SIAB).

The board met once more on 24 September. 

Chair’s remarks

I began the meeting by welcoming everyone back after the summer break. While we haven’t met during August, work has continued. 

I highlighted the significance of horizon scanning in light of recent national political developments and future planning. The past three months have provided insights into policy directions but there remains uncertainty on upcoming national budget considerations. We need to prepare for and adapt to potential changes in policy and budget that could impact our work. 

I shared that the main agenda of the meeting was focused on a deep dive into health provision and NHS updates. Rachael Corser, Chief Nursing Officer, NHS Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (BOB ICB) introduced the item.

Health introduction

Rachael acknowledged that while progress had been made by health services in their improvement journey, she acknowledged that there are areas that still require focus and further work. She highlighted that the ICB SEND board provides a great opportunity to share best practice across Buckinghamshire, Oxfordshire and Berkshire West and work collectively with parent carer forums. Rachael emphasised the importance of not losing focus on the work needed in individual areas while also benefiting from wider system learning and benchmarking. 

Daniel Leveson, BOB ICB Place Director, also provided an overview focusing on the challenges and innovations within the health services related to SEND. He highlighted the increasing demand for services, the efforts to reconfigure and introduce new models of care, and the importance of partnership and co-production with families and other stakeholders. Dan also mentioned the work being done to address long waiting times and the need for a strategic approach and the use of technology to meet the rising needs effectively.

Health update 

Community paediatrics

Sarah Haden, Community Paediatrics Consultant and Clinical Lead at Oxford University Hospitals, provided insights into the role and challenges faced by community pediatricians. She highlighted the extensive work they do in assessing and supporting children with developmental conditions, safeguarding and providing medical advice for education, health and care plans (EHCPs). Sarah also discussed the importance of early recognition of children's needs and the efforts to streamline the assessment process for neurodevelopmental conditions like autism. Additionally, she mentioned the initiative to improve access to healthcare for children with learning disabilities and autism within the hospital setting and the development of a project aimed at enhancing understanding and support for these children in healthcare environments.

Healthy child programme

Mark Chambers, Head of Children’s Community Services at Oxford Health NHS Foundation Trust, led a discussion on children's community services, including the newly created 0-19 healthy child programme and the support offered by school nurses and health visitors. The programme integrates and extends the services provided by health visitors and school nurses, offering a range of preventive and early intervention services. They conduct developmental reviews, support emotional wellbeing, and offer advice on a wide range of health issues.

The programme is delivered through integrated locality teams, ensuring a cohesive approach to child health services across different areas. A significant addition is the universal review at four years, aimed at assessing school readiness and identifying any developmental concerns early.

The programme also offers various support services, including vision screening and the National Child Measurement Programme, alongside targeted interventions for vulnerable families through partnerships with organisations like Home Start.

Children’s community nursing (CCN) and children’s integrated therapies

Mark went on to emphasise the importance of children’s community nursing (CCN) services and children’s integrated therapies in supporting children's health and development across various settings. He highlighted the collaborative partnership efforts to provide comprehensive care tailored to individual needs.

The CCN team operates across four localities in Oxfordshire, providing a range of services including acute needs support, complex disability management and end of life care. The team has initiated the first children's hospital at home service in the southeast, aiming to reduce hospital stays and support children directly from emergency departments. The service also includes special school nurses who work closely with schools to support children with complex needs.

The children's integrated therapies service encompasses occupational therapy, physiotherapy, speech and language therapy, and recently added children's dietetics. Therapies are delivered in homes, educational settings and clinics, tailored to support children's development and wellbeing. The service operates through a targeted, specialist model, offering direct therapy, group sessions and support for educational staff to implement therapeutic programmes.

CAMHS and neurodevelopmental conditions

Kelly Garside, CAMHS Service Manager for Oxford Health, provided an update on the child and adolescent mental health service (CAMHS) and services for neurodevelopmental conditions (NDC). 

Kelly highlighted the ongoing challenges and efforts to manage increasing referral rates and the pressure, demand and capacity within CAMHS and NDC services. She mentioned the implementation of new pilot options and initiatives aimed at improving service delivery and support for families and young people awaiting assessments or treatment.

She detailed various support initiatives available from the point of referral, emphasising that support should not be delayed until after an assessment. This includes the ‘living well with neurodivergence’ offer in collaboration with Autism Oxford, providing a range of support such as webinars, face to face sessions and peer support.

Kelly mentioned the success of a webinar series, facilitated byOxfordshire Parent Carers Forum (OxPCF), that have had high engagement to date. The plan is to continue this series to provide valuable information and support to families. She also touched upon themes and feedback received from families, particularly concerning waiting times for NDC assessments and the confusion around these waits. Kelly reassured that efforts are being made to address these concerns and improve communication with families.

Next on the agenda was Jules Francis-Sinclair, Chair of Oxfordshire Parent Carers Forum (OxPCF).

OxPCF feedback

Jules provided some feedback themes for the partnership that OxPCF had received from families. This included concerns about SEND transport provision and the confusion it caused for families at the start of the September term; issues with the lack of provision funding for alternative provision; confusion and concern over CAMHS and NDC waiting list times, with some families reporting long waits since 2019; challenges with school transitions, particularly for a local authority special school; and ongoing issues with short breaks, summer, and term-time provision, especially the lack of options for children with learning disabilities.

Jules also mentioned upcoming activities, such as the first SEND network event on 18 October and the launch of connect support groups with both online and face to face sessions planned across Oxfordshire. Additionally, Jules highlighted the need for a process to ensure OxPCF is consistently on the agenda for meetings and the importance of addressing the themes raised by families to improve services and support. 

I acknowledged the importance of owning and taking responsibility for ensuring OxPCF is on the agenda every month and the need for quantification of feedback themes mentioned by Jules. 

Wider educational system change

There was a closing discussion on the collective effort and strategic thinking required to address the challenges and opportunities within the local education and SEND system. This included the recognition of a dysfunctional national system but looking at what can be changed locally and leveraging the strengths within our partnership system to make impactful changes. The establishment of the Education Inclusion Partnership will help improve the education system locally. Our strategic vision should not focus solely on SEND but encompass all phases of education across health and education sectors.

As a partnership, we have laid a significant foundation for future improvements and have the potential to make key decisions that will shape the local system for the next three to five years. 

So that’s it from me for now, and I hope, as always, this is useful. We next meet as a board on 23 October 2024.

If you are a parent or carer and have any thoughts or comments, please share with OxPCF by emailing info@oxpcf.org.uk. If you are a partner, please do feedback through your organisation. You can find a list of the LAP member representatives on the board on the SEND improvement webpage. Also don’t forget to sign-up to receive the SEND e-newsletter if you’re not already receiving it. 

Until next time. 

Steve Crocker