Special Educational Needs and Children’s Mental Health Services

Maria Caulfield Excerpts

Wednesday 9th February 2022 Westminster Hall

[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.

[Steve Brine]

On accountability, can the Minister shed any light on the issue of CAMHS in Hampshire telling parents not to ask how long, or will she take it away? It means that they cannot plan, for instance, decide to sell the car. Those are the choices that people are facing. They cannot plan for what is next. Does that sound right to her, that people have been told not to ask?

[Maria Caulfield]

No, that does not sound right. That is exactly why we want to bring some accountability to local services, so that when such statements are made, we can look at what the problems and the blocks in the system are to try to overcome them.

Local authorities also need to be held to account for how they support schools, because schools do a huge amount of work, going above and beyond in most cases to support children with special educational needs. That is why we continue to work with Ofsted and the Care Quality Commission to develop a new area of SEND inspections, which will look at how services and support are delivered in practice on the ground. That will hold local areas to account, so that there is no gap in oversight before full implementation of any new reforms resulting from the SEND review. It also recognises the importance of inspections in SEND services by highlighting areas of good practice and areas to improve on.

I reassure colleagues across the Chamber that that is an area of high priority. The SEND review will be published shortly, and the Green Paper will follow swiftly on from that. I encourage all colleagues to share their powerful experiences in that process, as they have today, so that we can improve services for the children and their families who at the moment are not getting the service that they deserve.