Children and families bill: marketisation of SEN provision

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After the spot yesterday on SENDirect I thought this letter in the Weekend's Guardian was very interesting. I might contact the author.

The juxtaposition of David Mitchell's article and the story of Gloria Foster's death is important. Families need support to cope. Trained staff who understand the needs of a child (or adult: autism is a lifelong condition) do not and should not come cheap. Increasingly, families are given "personal budgets" that are inadequate to fund specialist care. The marketisation of care means that the poorest families who cannot "top up" these budgets will have the poorest provision. Care on the cheap carries with it huge risks, and the most vulnerable and those who love them are suffering.
Liza Dresner
Director, Resources for Autism, London NW11

I think, although DPs offer control which LAs don't want to give, this move to 'brokerages' suggests that control may not be left in our hands for very long. I wonder if we will just be told we can have services only if we go through brokerages? Will there be a list of acceptable providers? Will you ge on that list of you start saying a child needs more care than the LA want to offer?

Have these charities thought this through? This in particular worried me from the SENDirect site - one aim is to

"Provide support across sector?s to develop products to meet identified needs and therefore create a sustainable marketplace of provision."

Aim of reform: marketisation of SEN provision? We know how that ends up.

As far as I can see brokerage is supposed to do 2 things:

1. Help parents or young people who need assistance in choosing provision / managing a budget
2. Filling gaps in services.

The local offer should do the job of telling parents what provision exists in the locality.

For 1 the starting point should surely be that the vast majority of parents are competent and capable of finding and arranging provision themselves - in the same way they are trusted to choose a school for their child or a mortgage. Those parents who find it difficult would benefit more from a local advice service / advocacy service which is independent - someone who can sit with them and help with paperwork, not a remote broker.

For 2 it seems to me there is a conflict as LAs have a legal duty to make sure there are sufficient SEN services locally and therefore have to make sure gaps don't arise but giving choice to families may mean they don't choose the service the LA has contracted with. So for eg there is a national shortage of teachers for the deaf. Under their legal obligations LAs have to ensure there are enough. Many (since the cuts) now share teachers. But parents may say I don't want to wait x weeks to see the one teacher shared between 3 LAs and may go and find a private teacher etc which may eventually lead to the one teacher being laid off and the LA unable to provide a service to a family who wants the LA to provide it rather than have DPs.

This unpredictability has happened in social care - so locally Barnardos provide some respite services. They used to know their finances a year in advance due to block contracts etc but since DP for social care only know month to month how many people will choose to use their service. They have lost all ability to predict in advance which has affected their ability to recruit and train staff.

But what difference brokers will make to this problem is beyond me unless they are going to be a sort of inspector and say nationally we need x teachers for the deaf and there are only y so all LAs need to contribute £z to train new teachers.

I am however pleased ambitious about autism is involved as at least there will be some pro ABA arguments (I hope), but I can't see parents getting a free choice. Also wonder how new therapies / emerging therapies would be funded.

If I added up the cost of DS nursery place, his nursery 1:1, his autism outreach teacher, his SALT, the specialist early years team & the cost of various useless meetings and panels to block us getting statutory assessment by convincing us the above hotpotch of crap provision met need - I could have taken that budget and had about £10-15k to spend on ABA. I would not have chosen to have used a single one of these services. I would have sacked every one of them after the first visit as being wholly inadequate to meet DS needs. But what are the chances the LA will let a significant % of parents spend the budget on a home therapy programme and risk having to lay off their own employees?

Very good points Agnes. I still suspect that the creation of a marketplace as part of its brief will have implications for block contract and tendering for services which the brokerage will point you towards.

It will almost certainly lead to a list of approved 'sellers' of services .
Even with AAA involved, it won't help people get ABA as LAs will fight to make sure that doesn't happen and those that do fight to Tribunal for it will undoubtedly have organised their own provision anyway which they will want the LA to fund directly.

yes IE the new duty on health always seemed to me to do the opposite of what personal budgets were for as why put a legal duty on CCGs to provide services if parents can opt out of the services that have been commissioned.

I suspect the autism provision will be limited to whatever the pending NICE guidelines say - and there is already disappointment with how ABA has been dealt with in those.

The putative 'new duty on health' looks like a cover for removal of SLT, physio, OT etc from 'educational' provision.

The requirement on CCGs to commission these services is not very reassuring, as they will only need to supply what the plan said the child needs. And since the healthcare bit of the EHC plans isn't subject to challenge via SENDIST's successor it's unlikely to be very well quantified/specified.

And so-called GP commissioning is a front for the covert privatisation of the NHS. CCGs are gradually becoming a hybrid of local medical insurance co-ops and US-style 'health-maintenance-organisations'. Which is hazardous to our dc, as the higher-spending ones will go bankrupt, and the others are unlikely to want to enrol our families.