Agenda item

The Cabinet Member with Responsibility for Education and Skills and the Director of Education and Early Help had been invited to the meeting to update the Panel on the review of the delivery model for medical education provision ahead of the discussion at Cabinet on 30 January 2020.  The Regional Manager (Babcock Prime) was also in attendance.

By way of introduction, the Cabinet Member referred the Panel to the recommendations included in the Cabinet report and highlighted that this was the start of a more formal process of service redesign.  Over the three years that he had been Cabinet Member there had been ongoing discussions on the need for a review of medical education provision and this work was now ready to be taken forward.

The Director of Education and Early Help acknowledged that this report had been due to come to an earlier Cabinet meeting but had been delayed.  She thanked Members for their patience and informed the Panel that the service was now in a good position to take this forward.  The service was part of a continuum of provision for vulnerable learners, in this case those experiencing health difficulties (both physical and mental).  The past 18 months had seen a period of review and officers were now in a position to formalise the approach to redesign.

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

·       It was noted that pupils would be provided with support as soon as it was clear that they would be away from school for 15 days or more, whether consecutive or cumulative.  The period over which the 15 days would be measured would depend on the individual student and the nature of their illness.  Some schools may choose to make their own arrangements and the service aimed to offer a flexible model.

·       A question was asked about how students in Years 10 and 11 were able to access the appropriate exam board to ensure continuity with their school experience.  Members were informed that the service aimed to work with teachers and schools to ensure continuity, with the aim of not losing sight of a student’s host school.  Improvements in this area were currently being looked at.

·       In response to a Member’s question, it was confirmed that students accessing medical education provision as a result of mental health issues were not given priority for CAMHS.  Members were reminded that schools had seen growing levels of anxiety and self-harm amongst pupils, and it could be difficult for them to provide sufficient support.  The Director of Education and Early Help informed the Panel that she aimed to set up a CAMHS steering group to include the Clinical Commissioning Groups (as commissioners) and the Worcestershire Health and Care NHS Trust (as provider).  The Chairman also reminded Members that a Scrutiny Task Group was being set up to look at CAMHS.  Reference was also made to the recently published Care Quality Commission report into CAMHS which had judged CAMHS in Worcestershire to be outstanding.  Members noted that school was not all about education - the social side was also important.

·       A Member commented that the curriculum for Years 10 and 11 (English, mathematics, science, PHSE and business studies) appeared to be narrow for this age group.  The Panel was reminded that the Medical Education Team was a service as opposed to a school and aimed to ensure that students could transition back to school, where they would be able to access more subjects.

·       It was confirmed that the service considered new referrals on a weekly basis.  Although the referral criteria clearly stated that medical evidence was required at consultant level, sometimes referrals were received from GPs.  The service review offered an opportunity to consider whether consultant level was the correct referral level or whether evidence from GPs could be accepted.  Also, the review might look at whether provision needed to be on site or whether it could be delivered via outreach.

·       It was anticipated that a more joined-up service would ensure that the right children were being referred.

·       Concern was expressed about the co-location of some medical education provision on the same site as pupil referral units (PRUs).  It was suggested that some of the behaviour of pupils at PRUs could be intimidating and it was not appropriate for vulnerable pupils to be educated on the same site.

·       A Member expressed concern at the time taken to get a plan in place to review the service, following the external peer review in the summer of 2018.  In response, the Director of Education and Early Help recognised that the plan had taken a long time to be brought forward but she was confident that all colleagues were now working more closely together.  There had also been system issues in relation to Special Educational Needs and Disabilities (SEND) that had reduced capacity to move this forward.  In terms of a timeline for the work, officers were looking for every quick win.  Children would be placed at the heart of the redesign with careful thought being given to implementation to ensure minimum disruption for children accessing the service.

·       The Cabinet Member with Responsibility for Education and Skills reminded the Panel that the Cabinet report included an indicative timeline for future work.  Further proposals would be reported to Cabinet in June.

·       It was confirmed that the educational provision for children who were inpatients at Birmingham Children’s Hospital was provided by James Brindley Hospital School and the County’s Medical Education Team liaised with the school in relation to Worcestershire children.

·       Concern was expressed about the suggestion in the Peer Review Report that some pupils’ placements were too long, particularly pupils with autism.  Members were reminded that the SEND Written Statement of Action recognised that provision for children with autism was in need of improvement.  It was suggested that a barrier to improvement was the lack of capacity and/or capability of schools to support children.  The service was looking to build capacity allow more opportunity for ‘step down’ to mainstream school from the MET.

·       A Panel Member welcomed the fact that any proposals would include an analysis of travel times and the impact on users of the service.  The Director recognised that current service users and their families were key to this work and would be included as part of the co-production of the new delivery model.

·       Concern was expressed that, although proposals would be considered by Cabinet in June 2020, larger scale proposals may not be implemented until September 2021.

·       It was acknowledged that it was not ideal for medical education provision to be co-located with PRUs.  However, it was important to note that it was not a quick process to find an alternative location.

·       A question was asked about the destinations of pupils post-16 and whether they were able to attain sufficient qualifications to gain access to college courses.  In response, Members were told that this would come down to the individual.  Students would also be helped to access careers advice and guidance in schools.

·       It was suggested that schools also needed to be sympathetic to the experiences of pupils accessing medical education provision.  It was confirmed that schools would be included in the membership of the redesign steering group.  This would be a good tool to engage with schools, looking at where things were working well and where they could be improved.

In conclusion, it was agreed that the redesign proposals and recommendations would be considered by the Panel before they were presented to Cabinet in June 2020.