Special Educational Needs and Children’s Mental Health Services

Layla Moran Excerpts

Wednesday 9th February 2022 Westminster Hall

[Layla Moran (Oxford West and Abingdon) (LD)]

It is a pleasure to serve under your chairmanship, Ms Fovargue. I congratulate the hon. Member for Newbury (Laura Farris) on securing this timely debate in Children’s Mental Health Week.

Over the past year—frankly, five years—the number of parents writing to me about their children and the lack of support has grown exponentially. I was a teacher before I was an MP, and I commend the speech made by the hon. Member for Sheffield, Hallam (Olivia Blake), because she is right that this is about allowing young people to be themselves. The word “special” is the right one: just look at the number of Nobel prize winners with neurodiversity in their make-up. When I taught maths and physics, these children were often the brightest, most interesting people in the room. They should never be seen as a burden.

The way the system treats families and children who are neurodiverse makes it so difficult for them that it is understandable how that goes on to affect their mental health. One family contacted me about Poppy—I have changed her name—who is 12. As previously described, there was violent behaviour in the household, and the family was incredibly worried. It took months to even get the GP to refer to CAMHS. The mother said to me:

“Mrs Moran, to be honest, you are my last hope. I am suffering with both my physical and mental health and quite honestly I do not have the energy left to continue fighting the system.”

We are also in a perverse situation where even more professionals are writing to me. I would be curious to know if that is the same for other hon. Members. This is new. GPs are also writing to me, as are educational psychologists, because they all recognise that CAMHS is broken. I had one psychologist write to me saying that he no longer refers to CAMHS. He said that social services and CAMHS are so broken that the only thing he can do is keep children on his books because he worries that if he loses contact with them they will not get anything at all. How is this system not failing our young people? It absolutely is.

My first question to the Minister is on the lack of educational psychologists in this country. My local county council is doing its very best; it is one of the F40 councils and is twelfth-lowest in the country when it comes to the high needs block. I said, “If you had a magic wand and could ask for anything from the Minister, what would it be?” and the council said, “More educational psychologists.” We currently fund only 200 training places in the country. There is only one educational psychologist for every 5,000 young people, which is nowhere near enough. Tackling that issue would go a huge way towards immediately helping to alleviate the backlog.

In the interim, there are amazing third-party groups that are helping. There is Shift, which is an informal parent group in Abingdon, set up by Sally and Andy Foulsham. They run it, provide support and help families navigate the system. There is also The Abingdon Bridge, which is the only wellbeing and mental health charity for young people in Vale of White Horse. It focuses on 18 to 25-year-olds. It is particularly worried about the 16 to 18-year olds that it finds because, if they are referred to CAMHS, the waiting lists are so long that they then drop off that cliff edge. Strangely, the charity cannot access funding from the CCG because of the way that the funding works. Could the Minister help me help The Abingdon Bridge to access more funding?

To conclude where I started, we absolutely must appreciate that these children deserve the best, and deserve more, but the current system is failing them. There is a perverse disincentive in the system, where a school must basically pay the first £6,000 of the funding. We need a national SEND strategy that solves the problem once and for all. Without that, we risk failing our children and our country in the future.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms Fovargue. I thank my hon. Friend the Member for Newbury (Laura Farris) for securing this important debate on special educational needs and children’s mental health services. As we can see by the number of Members who have attended the debate, this is clearly a significant issue across many parts of the country. Unfortunately, the Minister for Care and Mental Health, my hon. Friend the Member for Chichester (Gillian Keegan), is unable to be here today because she is self-isolating, so I will do my best to answer hon. Members’ questions. I am sure we can follow up on anything that I am not able to cover in my remarks.

I thank the hon. Member for Sheffield, Hallam (Olivia Blake) for sharing her personal experience, which illustrates some of the struggles that people face. She outlined the positives and negatives in her remarks. I also thank my hon. Friend the Member for Bury North (James Daly) for sharing his son’s experience, which is unfortunately not uncommon.

My own postbag reflects many of the comments that have been made in the debate. Children are often not getting the help and support they need at the early stages, which often leads to more difficult interventions later that could have been avoided if the support was in place. The collaboration locally between health and education is often not where it should be. I am here not to deny any of the remarks made in debate, but to set out what is being done to address these issues, which have been in place for many years. I agree with my hon. Friend the Member for Bury North that funding is not necessarily the only factor here; it is also about how services are brought together. As my hon. Friend the Member for Newbury said, it is about accountability for how those services are delivered.

In March last year, we published the covid mental health and wellbeing recovery action plan, which includes £31 million to improve autism and learning disability services. There is £42 million to continue funding projects to support young people and families with special educational needs. There are funding pots available, but we are hearing that they are not making it to the families who need them or to the services being provided. In the short time that I have, I hope to be able to set out how we aim to resolve some of those issues.

The demand for services has increased. There is no doubt that the demand for CAMHS, ADHD assessments, autism assessments and diagnosis has increased over time, but waiting times are also dismally short of where they should be. According to the National Institute for Health and Care Excellence, which provides evidence-based guidance on many of these areas, children and young people who are referred for an autism diagnosis should have a diagnostic assessment within 13 weeks. We have heard from many colleagues, including my hon. Friend the Member for Newbury, that it takes around two years. My hon. Friend the Member for Bracknell (James Sunderland) cited three years. Of course, my hon. Friend the Member for Bury North cited his son’s experience, and the hon. Member for Vauxhall (Florence Eshalomi) also spoke about this issue. We can see that it is a problem across the country.

For ADHD diagnosis, NICE guidelines do not recommend a specific waiting time, but they set out recommendations for how services should support and manage children who need a diagnosis and their families, for how such children should be supported through education, and for general support as well. We want every area of the country to meet NICE guidelines but, sadly, that is not happening in many places. To make sure that we get on top of the situation and reduce the delays, we want to work towards providing an assessment within the recommended 13 weeks in order to deliver a timely diagnosis—not just so that they get a diagnosis, but so that the interventions are there to help and support young people and their families.

There are three key areas where I think we can improve things. The SEND review, which was touched on a couple of times in the debate, is a joint collaboration between the Department for Education and the Department of Health and Social Care. It is in progress, and we expect its findings to be announced fairly soon—I am talking about weeks, rather than months. Following the recommendations from that, a Green Paper will be published. It will follow a 12-week period in which I encourage all Members to take part in the process and to highlight many of the experiences that we have heard today. We have talked about the funding that is being announced, but often that goes to health and does not get into schools. I met representatives from one of my schools only last week, and the joined-up working locally between education and health just is not happening. That reflects the point made by my hon. Friend the Member for Newbury that accountability for who is responsible for doing what, and the joint working, is currently not happening.

[Layla Moran]

Will the Minister comment on access to funding for third-sector organisations, which are often more expert at offering advice and support that families need?

[Maria Caulfield]

Absolutely. Services are commissioned locally. Part of the issue is that there is no accountability for when services are not commissioned. The funding that is put forward needs to look at all service providers, and the third sector is often well placed to provide those services.

To touch on long waits, NHS England is working to ensure that CAMHS have embedded diagnostic pathways for autism and ADHD as a core part of their work. A sum of £13 million is going in to improve those pathways and identify those at risk of crisis; £2.5 million of that funding will test different approaches to diagnostic pathways and ensure that they are backed by research and are evidence-based. In addition, NHS England wants to develop a single point of access to ensure that referrals are triaged, and that individuals do not stay on lengthy waiting lists. We have heard today of the difficulties caused by not having a single point of access. I have met families in my constituency. As the hon. Member for Oxford West and Abingdon (Layla Moran) said, we are the last refuge and point of contact when they cannot get anywhere else.

We know that school settings can provide an invaluable opportunity to identify autistic children early in life. We are investing £600,000 in significantly expanding an autism early diagnosis pilot in Bradford. That will test at least 100 schools over the next three years to assess whether new approaches to achieving a faster diagnosis can be rolled out across the country. The early findings from that pilot are positive. Education staff report that they are better able to identify children and put in place the support they need to thrive in education. Local areas will look to upskill mainstream staff to better identify children’s needs. In Manchester, a project to support early identification and diagnosis in young children involves health visitors identifying those who show signs associated with autism and fast-tracking their assessment, with additional post-diagnostic support for families.

The issue for many years has been the lack of a national strategy, but that is changing. What we want, when pilot studies show good initial results, is to roll them out across the country. In the next year, on top of the £1.5 billion spent in the past two years, we are providing an additional £1 billion of high-needs funding for the education of children with more complex needs. The aim of that funding is to reduce waiting lists and variations in practice, make navigation pathways less complex, and improve the speed and quality of diagnosis.

Those points tackle some of the issues around waiting lists, but accountability was the main thread of the introductory remarks of my hon. Friend the Member for Newbury. At the moment, no one is held accountable locally if services are not commissioned. The integrated care system will be put on a statutory footing from 1 July, if the Health and Care Bill goes through on time, and ICS boards will be the accountable bodies for commissioning services. Their chief executive officer will be the accountable officer for the NHS locally and will be responsible for bringing those services together and will be accountable if that is not happening.

Since November 2019, NHS Digital has reported on waiting times for autism assessments, trying to ensure transparency in how services are delivered and highlighting areas where improvements are needed. It is incredible that, up until now, we have not had the data to hold people’s feet to the fire when services are not provided.