Special Educational Needs and Children’s Mental Health Services

Steve Brine Excerpts

Wednesday 9th February 2022 Westminster Hall

[Steve Brine (Winchester) (Con)]

It is an honour to follow my hon. Friend the Member for Bury North (James Daly).

In a few months, I will have been in this place for 12 years, but we are still having the same debate and saying the same things, so I want to give voice to a few constituents who have been in touch with me. One wrote that

“my son (6 in April) is diagnosed autistic…I had to fight to get an appointment with a paediatrician…I cannot express to you how stressful this was and for two years we didn’t get any support…We did find some support once he started school but…I am now paying for this privately…at £70ph…There is no one place to work out what support is out there. It is all piece meal. I’ve learnt far more from speaking to other parents of autistic children about available support than through official channels…if support was given beforehand, so many of these mental health difficulties could be prevented. The majority of parents I know of autistic children are burnt out and stressed—even when they have money to provide private help”.

Another constituent wrote:

“It was apparent at pre-school that he was experiencing difficulties, he was seen briefly by a speech therapist…He transitioned into primary school, where I still remember that fateful day where he just crumbled. Due to a lack of external help we sought the advice of a child psychiatrist…This cost us thousands. Eventually we received, with primary school SENCO help, admittance onto the CAMHS pathway for autism assessment. After many years of waiting we were discharged…We were then dropped from any further care and given a leaflet with web links for information…Any request for help that we have made has been firmly shut down…to navigate the system requires an MSc level of education, legal knowledge, money (we are on benefits!) and time. All at an emotional cost to one’s self.”

Another constituent wrote:

“We only get one childhood and it is proven that it has an impact on the rest of a person's life. I hear so many times of people being turned away from CAMHS and struggling to get support, even when their child is suicidal”,

and another said:

“SEN parents are really stretched to the limit. I cannot begin to tell you what a battle it is and how a more global approach would be of benefit...rather than the fragmented system of try the school, try the GP, try CAMHS etc.”

Another constituent wrote:

“Our experience of CAMHS? Well there isn’t much as we haven’t been able access any treatment for him!…My husband and I referred our son on the CAMHS online referral form in November last year. I wrote on the form that he was using the palm of his hand to slap his forehead out of frustration to get the compulsive thoughts out of his head…We didn’t hear anything so I sent an email asking them to confirm that they had received our referral form. The confirming email asks parents not to inquire about waiting list times...A member of the School Welfare Team phoned me to say that there is a waiting list of 18 months…As a family we are frazzled and I feel like I’m hanging by a thread. Where do we go from here?”

Another one wrote that

“the situation is abysmal. My family have been ripped apart by my daughter’s mental health and she is just SIX years old.”

Finally, another constituent wrote:

“Last night my nine-year-old son said, ‘I would rather have no life than this life’.”

None of those emails makes for easy reading. I have had so many emails, and the key thread I take from them is that, as many have said, early diagnosis is what is missing. As a result, children fall further down. They are helped later, and the help they need is consequently significantly more acute. Covid has been a disaster for children and young people’s mental health, so let us not compound that now by this constant asymptomatic testing.

“Don’t ask us how long the wait is.” I would love the Minister to explain how that message fits with the physical waiting list on My Planned Care, which was launched this week. Where is the parity? I have been really moved by what I have received this week. My constituents do not care about six people being shuffled around the same jobs in Government. They care about the services that they are paying a lot of money for and are not getting. One constituent said to me:

“Childhood is short but it also lasts a lifetime.”

We cannot have this debate for the next 12 years.

--- Later in debate ---

[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.