Setting

Area SEND inspection of Suffolk Local Area Partnership

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Inspection dates: 13 to 17 November 2023 Date of previous inspection: 21 to 23 January 2019

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Inspection outcome

There are widespread and/or systemic failings leading to significant concerns about the experiences and outcomes of children and young people with special educational needs and/or disabilities (SEND), which the local area partnership must address urgently.

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Inspection outcome

A monitoring inspection will be carried out within approximately 18 months. The next full reinspection will be within approximately three years.

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Inspection outcome

As a result of this inspection, His Majesty’s Chief Inspector requires the local area partnership to prepare and submit a priority action plan (area SEND) to address the identified areas for priority action.

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Information about the local area partnership

Suffolk County Council, the NHS Suffolk and North East Essex Integrated Care Board (ICB) and NHS Norfolk and Waveney ICB are responsible for planning and commissioning services to meet the needs of children and young people with SEND in Suffolk, as part of the Suffolk Local Area Partnership (LAP). The Suffolk LAP oversees the commissioning of local education, social care and health provision for children and young people with SEND.

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Information about the local area partnership

There have been recent changes to some leadership posts at Suffolk County Council. These include the appointment of an interim executive director for children’s services on 22 August 2023. The interim director for children and families commenced in their role on 23 October 2023.

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Information about the local area partnership

The commissioning of health services changed across England in 2022. On 1 July 2022, the responsibility for health services in Suffolk passed from the NHS Ipswich and East Suffolk Clinical Commissioning Group (CCG), the NHS Norfolk and Waveney CCG and the NHS West Suffolk CCG to the NHS Suffolk and North East Essex ICB and NHS Norfolk and Waveney ICB. 13 to 17 November 2023

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The Suffolk LAP commissions a range of alternative provision (AP). AP provides education for children or young people, including those who cannot attend schools due to social, emotional and mental health and medical needs, or for those who have been or are at risk of being permanently excluded from school.

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What is it like to be a child or young person with SEND in this area?

Children and young people face a system that has not worked well for a long time. They and their families have not seen the improvements they should from the area’s leadership. Their needs are not identified quickly or accurately enough. Assessments for support take too long. When the right help is put in place, it is often only at the point of crisis. As a result, children with education, health and care (EHC) plans in Suffolk achieve less well in school than similar pupils elsewhere, and are much more likely to be excluded and to find themselves not in education, employment or training (NEET).

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What is it like to be a child or young person with SEND in this area?

Needs are not identified early or well. There are many individual practitioners who build up a careful picture of children and young people’s needs. For instance, early help services provide prompt assessment and support. However, significant delays in the processes for EHC plans and annual reviews mean that, frequently, needs are identified too late. Families experience long waiting times for services, such as for autism assessment and diagnosis. Often, children’s needs are not clearly identified or articulated in their plan. This leads to some parents and carers being left not knowing how best to help their children. Unidentified and unmet needs sometimes manifest in behaviours which too frequently result in many not accessing mainstream settings, because of exclusion or absence. That said, pupils who need provision in AP and special schools often get the positive support that they previously lacked.

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What is it like to be a child or young person with SEND in this area?

Many children and young people receive helpful support at the point of crisis. Teams for mental health crisis support, such as the Coordinated Help and Risk Intervention Service and the peripatetic support offer, can have a vital, positive impact. If children and young people meet thresholds, they get very strong social care support, particularly from the disabled children’s team. This means vulnerable children and young people, for example those at risk of coming into care and at risk of exploitation, access the help they need in a timely way. There are effective programmes to help pupils with low attendance or at risk of exclusion.

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What is it like to be a child or young person with SEND in this area?

While this is the case, the weaknesses in statutory EHC plan processes lead to widespread and systemic gaps in service provision. The quality of EHC plans is variable. Frequently, crucial information is incorrect or missing, such as in relation to health or social care. At times, intended outcomes are too vague and brief to be helpful. Many plans lack the voice of the child or young person. Likewise, these weaknesses do not get addressed at annual reviews as well as they should. As often as not, annual reviews do not happen. As a result, the information required to support needs successfully is not sufficiently embedded in the process. 13 to 17 November 2023

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Children and young people do not receive good enough help to prepare for adulthood. Some services undertake positive work to support young people’s aspirations. However, some transitions between stages of education are poorly planned and managed, beginning from early years. Key information, for example regarding annual reviews, is not passed on to new settings promptly. Gaps in referrals to adult social care mean young people sometimes become isolated. This poor planning for adulthood leads to too many children and young people with SEND become NEET.

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Since before the pandemic, children and young people with SEND in Suffolk have fared less well in academic outcomes than similar pupils nationally. In the summer of 2023, this improved in some primary school tests and assessments. However, the results in phonics screening checks for children with SEND were well below those for similar pupils nationally. The attainment of pupils with SEND in secondary schools in Suffolk also declined. These outcomes also limit opportunities for children and young people as they prepare for adulthood.

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Families are not aware enough of things to do outside of education, training or work. While in some areas there is access to a wide range of activities, in other parts of the county there are few clubs. Some young people, especially those in rural areas, do not know what options they have for social contact, and experience isolation as a result. Parents praise some aspects of community support, for example Activities Unlimited, short breaks and personal budgets. But many parents are struggling to find the help they and their children need. There are variable levels of provision across the county. Families need more access to some services, such as early intervention for mental health. Following feedback about it being difficult to navigate, the LAP and the parent and carer forum have very recently co-produced a new local offer website to make it easier for families to use and access support. Previously, families too often have not known about

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or understood the available support. This means children and young people do not always get the help they need to develop independence and participate in society.

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These gaps and delays in the system create high levels of dissatisfaction among families of children with SEND. Sometimes, children and young people work productively with the LAP to improve services. Those who do this explain how much they value the chance to make a difference. This is particularly the case in designing health services such as the neurodevelopmental disorder pathway and recent changes to therapies pathways, with a positive impact on waiting times for assessment. But co-production is not embedded through the systems of local planning and support. Too many families are not heard. Communication is poor. Phone calls and emails are often left unanswered. The reality that parents experience is that their children get lost in the system and fall through the cracks. Families resort to making complaints to receive the support they have a right to and need. 13 to 17 November 2023

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What is the area partnership doing that is effective?

▪ In some areas, the LAP has worked successfully to improve services. For example, it has redesigned speech and language therapy and occupational therapy services. This has resulted in reduced waiting times for assessment and intervention. However, many other changes are too recent to measure at the time of our inspection. Examples of these include the new local offer website, and the new portal intended to improve the EHC plan process. ▪ Strong levels of capital investment have increased the availability of special school places. ▪ Initiatives to equip professionals in schools, such as the online tool to support schools, Valuing SEND, or ‘VSEND’, are showing early signs of impact. Providers say the SEND training they receive is helpful. The specialist educational services and the psychology and therapeutic services teams provide helpful early intervention to support schools. In line with good practice, the LAP provides high

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What is the area partnership doing that is effective?

needs funding to schools to support children and young people with SEND without the need for an EHC plan. ▪ Several health teams support families sensitively and successfully. For instance, the neonatal physiotherapy service ensures babies born prematurely with medical and physical needs have well-delivered therapy as they transition out of hospital to home. This means families receive strong support at a very difficult time. ▪ Across the local area, young people identified by the Dynamic Support Register (DSR) as being at risk of admission to specialist mental health hospitals transition well to the adult DSR. Practitioners across both paediatric and adult DSRs identify young people at risk at an early stage and work together to ensure that transition is seamless, thus reducing risk. ▪ Social care teams are effective. Social work assessments and reviews are comprehensive and helpful. In these, children and young people’s views and

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What is the area partnership doing that is effective?

wishes are taken into account, including where they are non-verbal. Social workers advocate proactively and creatively, so that difficult situations get resolved quickly. Personal advisers ensure that care leavers’ needs are considered holistically and that services are coordinated. This means care leavers are well supported. ▪ Many providers, such as schools and colleges, praise their relationship with the LAP. Some say the LAP has enabled their own journey of improvement. Leaders of schools and colleges are keen to be part of the solution to the SEND issues in Suffolk.

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What does the area partnership need to do better?

▪ Since Ofsted and Care Quality Commission (CQC) inspections raised serious concerns in both 2016 and 2019, leaders have not urgently or effectively addressed systemic and significant weaknesses in the SEND provision in Suffolk. Many longstanding issues, particularly the quality and timeliness of EHC plans, parental dissatisfaction, and high proportions of children and young people with SEND being excluded and becoming NEET, have remained unresolved issues over 13 to 17 November 2023

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this time. ▪ The LAP’s SEND strategy has had a limited effect in the areas that matter. Leaders have done a lot, but have focused overly on activity and not enough on impact. Leaders accept their work has not sufficiently improved the experience of children and young people and their families across the local area. ▪ The local area’s oversight and accountability have not been effective. Governance is not as robust as it needs to be. Quality assurance is not rigorous. Leaders are not effective in using information across education, health and social care to inform strategy and commissioning. Leadership has not been joined up. For instance, leaders have not coherently pulled together all aspects of the partnership’s work into areas such as sufficiency planning and support for social, emotional and mental health. Multi-agency approaches are not well-embedded. As a result of this weak oversight and accountability, children and young people

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experience a disjointed set of services which lack cohesiveness and are not effective in supporting them. Too often, the quality of support depends on luck in terms of a particular practitioner who they see or service they receive, rather than the team around them and a system that ensures they get what they need. ▪ Because of the systemic gaps in identifying and meeting needs, there are high numbers of families at crisis point. Rather than pre-empting issues, the local area partnership ends up firefighting. This is having a negative effect on services. For example, while it provides high-quality information, the Special Educational Needs and Disabilities Information Advice and Support Service has concerns about the workload and morale of staff, due to the constant reactive and crisis-management work required. These issues create further barriers to effective support for children and young people with SEND.

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▪ Leaders of the LAP aim to commission services that meet the needs of children and young people. However, families experience an inconsistent quality of services. For example, there is variability in quality and timeliness of the speech and language therapy offered in different parts of the county, despite recent improvements in waiting times for assessment. There is also inequity between ICBs for the transition to the adult neurological team for children and young people with a neuro-disability or diagnosed neurological disorders. There are very long waiting times to access some neurodevelopmental assessments. The LAP has recently co-produced and commissioned a lot of services in health, for instance to support mental health in Waveney. However, it is too soon to assess the impact of this work. ▪ Leaders of APs are not always clear on the LAP’s commissioning aims. Commissioned AP places have been underused. Delays in referrals to APs result in

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needs not being met early. The LAP has put in a new process to address this but the impact of this new structure on decision-making is not yet clear. However, once children and young people are in AP, they are typically well supported. ▪ Leaders do not do enough to work successfully with parents and parent groups that voice concerns, including the Suffolk Parent Carer Forum. Extremely high numbers of families go through mediation, but there is little evidence that families find this helpful or supportive. While relatively few appeals get upheld at tribunal, 13 to 17 November 2023

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a significant number of complaints that are made to the Local Government Ombudsman are upheld. Families feel that legal routes are their only option. Leaders’ own data shows that complaints are increasing. ▪ There is not enough residential special school provision within the local area for disabled young people. The provision that is in place is of a high quality. Most disabled children and young people in residential special school provision are placed out of the county. There is regular oversight of this, and the LAP makes sure it is safe. Leaders’ capital investment, as described above, is helping more children with SEND to remain locally and with their families. ▪ Leaders’ work to improve the statutory EHC process has not been effective, leading to unacceptable delays and gaps in support. The timeliness of completing EHC plans is getting worse. The average wait is twice the statutory deadline. The

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LAP has struggled to recruit sufficient numbers of educational psychologists, and this has exacerbated already long delays for families waiting for an EHC plan. The recent recruitment of several educational psychologists may help with this. This additional resource is, however, too recent to show the much-needed improvements in the timeliness of plans. ▪ There is some improvement in the accuracy and coherence of the newest EHC plans, but even here the quality is patchy. Too many EHC plans do not routinely or sufficiently capture the input of all the professionals involved from education, health and social care. This means practitioners, such as special educational needs coordinators, do not have clear or broad enough guidance to put in place provision that meets a child or young person’s needs successfully.

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Responsible body Areas for priority action

Suffolk County Council, NHS Suffolk and North East Essex ICB and NHS Norfolk and Waveney area ICB The LAP should work more collaboratively and effectively to improve strategic planning. This needs to deliver systems with measurable impact that will create better experiences and outcomes for children and young people with SEND. In particular they should urgently improve: • the robustness and impact of governance • the rigour of quality assurance approaches, so that these give the information leaders require to address weaknesses effectively • the frequency and quality of multi-agency working • the management of transitions and planning for adulthood for children and young people, starting in the earliest years, and across services in education, health and care , including putting 13 to 17 November 2023

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steps in place to reduce NEET, so that they are better supported to lead fulfilling lives. Suffolk County Council, NHS Suffolk and North East Essex ICB and NHS Norfolk and Waveney ICB Local area partnership leaders should cooperate to take urgent action to improve the timeliness and quality of the statutory EHC plan processes, EHC plan needs assessments, and EHC plans and annual reviews, particularly using annual reviews to amend the quality of existing EHC plans where required. This should ensure that plans meaningfully capture the views and aspirations of children and young people with SEND and their families, so that they get the right support at the right time.

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Areas for improvement

Leaders across the partnership should use performance data and information effectively to inform their evaluation, sufficiency planning and joint commissioning of SEND services. The local area partnership should engage effectively and widely with children and young people and their families, developing effective communications systems, and acting to address parents’ and carers’ concerns at an early stage, to reduce dissatisfaction and reduce the need for parents and carers to have to follow formal routes. Leaders across the local area partnership should ensure that providers of services for children with social and emotional well-being, mental health and neurodiverse conditions work jointly to meet the needs of and improve outcomes in these areas for children with SEND. 13 to 17 November 2023

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Local authority Integrated care board

Name of authority: Suffolk County Council Name of ICB: NHS Suffolk and North East Essex ICB; NHS Norfolk and Waveney ICB Name of lead person: Suzy Joiner, Executive Director for Children and Young People Name of ICB Executive lead for SEND: Dr Ed Garratt (Chief Executive Officer for NHS Suffolk and North East Essex ICB) Tracey Bleakley (Chief Executive Officer for NHS Norfolk and Waveney area ICB) Website: https://www.suffolk.gov.uk/ Website: https://suffolkandnortheastessex.icb.nhs .uk/

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Local authority Integrated care board

https://improvinglivesnw.org.uk/about- us/our-nhs-integrated-care-board-icb/ Address:

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Local authority Integrated care board

Suffolk County Council Endeavour House 8 Russell Rd Ipswich Suffolk IP1 2BX Address:

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Local authority Integrated care board

NHS Suffolk and North East Essex ICB Aspen House Stephenson Road Severalls Business Park Colchester CO4 9QR

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Local authority Integrated care board

NHS Norfolk and Waveney ICB County Hall Martineau Ln Norwich NR1 2DH

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Information about this inspection

This inspection was carried out at the request of the Secretary of State for Education under section 20(1)(a) of the Children Act 2004.

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Information about this inspection

The inspection was led by one of His Majesty’s Inspectors from Ofsted, with a team of inspectors including two of His Majesty’s Inspectors/Ofsted Inspectors from Education and Social Care, a lead Children’s Services Inspector and a team Children’s Services Inspectors from the CQC. 13 to 17 November 2023

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Ofsted Care Quality Commission

Mr Charlie Fordham, Ofsted lead inspector Daniel Carrick, CQC lead inspector

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Ofsted Care Quality Commission

Russel Breyer, Ofsted HMI Andrea Crosby-Josephs, CQC Inspector Dr Keith Tysoe, Ofsted Inspector Lesley Perry, CQC Inspector 13 to 17 November 2023

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