Agenda item

The Cabinet Member for Children and Families, the Lead Commissioner – Early Health, and the Children’s Clinical Service Manager, Worcestershire Health and Care NHS Trust (WHCT) had been invited to the meeting to update the Board on the assessment and diagnostic pathway for children and young people who may be on the autistic spectrum (the Umbrella Pathway).

By way of introduction the Board received a presentation, during which the following main points were raised:

·       The Board had previously been updated in February 2018.  Since then a local area inspection of services for children and young people with Special Educational Needs and Disabilities (SEND) had taken place.  This highlighted the need for partnership working and whole system leadership.

·       In December 2018 Worcestershire’s Joint Strategic Needs Assessment (JSNA) Profile had been published.  This estimated that there were 1235 children with autism in Worcestershire, 1111 of whom were of school age.  The Umbrella Pathway currently received between 900 and 1000 referrals per year.  Analysis of referrals showed a higher than expected level of demand.

·       The NHS long term plan recognised this as a national issue.  Members were reminded that NICE guidelines recommended a period of watchful waiting.

·       The average time taken for the assessment process had risen slightly.  As the team worked through the backlog, it was expected that the average time would reduce.

·       This should be seen alongside developments in the whole system offer and improvements to the SEND local offer.

·       Further work was needed to embed use of the graduated response which schools were encouraged to use when responding to emerging SEN.  The service was developing school level inclusion profiles which would inform this work.

·       Additional health funding was available for the Umbrella Pathway and mental health and emotional wellbeing services.

·       Early help and support for parents had received a positive response.

·       An audit of referrals and subsequent action would be undertaken to ensure referrals were appropriate.

Members were given the opportunity to ask questions and the following main points were raised:

·       The Chairman of the Children and Families Overview and Scrutiny Panel reported that she had received emails from parents concerned about the length of time taken for assessment.  She expressed concern that the average time on the pathway in 2018 was more than a year and commented that this was unacceptable.  If children were diagnosed early enough they would be able to access specialist nursery provision and concern was expressed that children could be missing out due to delays in diagnosis.  She asked what level of investment would be needed to ensure parents received an acceptable level of service.

·       The Lead Commissioner agreed that current timescales were too long and reminded the Board that the aspiration was to have a maximum assessment time of 6 months.  Officers were currently working with the WHCT to put together a business case to achieve this, with an immediate investment of £100k available.  The business case, including figures for what extra investment might be needed, would be available in approximately 3 months.

·       It was suggested that some children whose first language was not English may be mistakenly suspected of being on the autistic spectrum as they did not have the language skills to cope in the classroom.  They may be suspected of exhibiting autistic behaviours which in reality were as a result of social isolation.

·       Members were informed that a child would not need a diagnosis of autism in order to obtain an Education, Health and Care Plan (EHCP).  The EHCP was an assessment of what support the child needed.

·       Members were reminded that when there were concerns about pre-school children, they were often referred to Child Development Centres.  Advice was often to watch and wait and the age of two was very early to make a diagnosis.

·       It was suggested that it would be helpful to produce countywide advice for teachers to encourage correct and accurate referrals.  The Lead Commissioner agreed to follow up this suggestion with colleagues.  Members were reminded that information for schools was provided by Babcock Prime who also offered school and setting-specific training.  There was sometimes a mismatch between the views of the school and parents, and it was confirmed that parental consent was required in order to take forward a referral.  The referral process included a questionnaire for the school and parents.

·       Concern was expressed that, when compared with the figures for one year ago, the average time taken to complete the pathway was going in the wrong direction.  It was suggested that the average figures concealed longer waiting times for some children.  The Lead Commissioner acknowledged the concern.  She confirmed that for children who completed the pathway in 2018 the shortest time taken was 8 days, whereas the longest was 673 days.  Action was being taken to speed this up, such as including the parental questionnaire as part of the referral which as well as speeding up the pathway, also demonstrated the family’s level of engagement.  It was agreed that future reports to the Board should include the range of figures as well as the average.

·       The Chairman of the Board expressed his frustration that the update was not more positive.  He had witnessed the huge impact on the families involved and it was unacceptable that they had to wait this long.  He asked that the business case be brought to the Board or the Children and Families O&S Panel as soon as it was ready.  He also asked for clarification on what needed to be done in order to see immediate improvement.

·       Members were reminded that the specific business case related to the staffing and investment in the Umbrella Pathway.  This should also be seen as part of a whole system issue and symptomatic of the whole SEND agenda.

·       The Chairman asked for ideas as to how the Board could support the service to achieve bigger and quicker progress.

·       Members were reminded that lots of children who started on the pathway would not be diagnosed with autism but would need help and support for other reasons.  The Chairman commented that it was important to ensure appropriate help for all children.

It was agreed that:

• Officers would follow up on what was currently provided to schools in regard to NICE guidelines to ensure accurate referrals and look into providing further written guidance if necessary.
• The business case for the Umbrella Pathway would be brought to Children and Families O&S Panel as soon as it was available.

·       A further update would be brought to OSPB in 12 months’ time.