Agenda item

To provide the Health and Wellbeing Board an update on the outcome of Brent’s recent (January 2025) Local Area SEND Inspection, outlining the key findings, agreed action plan, and progress made against the actions to date.

Councillor Gwen Grahl (in her role as Cabinet Member for Children, Young People and Schools, Brent Council) introduced the report, advising members that the conclusion of the local area SEND inspection that took place in January 2025 was that SEND arrangements in Brent typically led to positive experiences and outcomes for children and young people with SEND. In introducing the report, she highlighted the following key points:

·       She provided national context that local areas were operating in a challenging landscape, with the number of Education, Health and Care Plans (EHCPs) rising approximately 10% per year over the last 10 years. This in turn caused significant financial pressure on the High Needs Block (HNB) and there was shortage of provision in some areas, for example children with an Autistic Spectrum Disorder (ASD).

·       She felt that the inspection conclusion was very positive for Brent and commended those staff in the Inclusion Service, those supporting young people in schools and health colleagues. She thanked health colleagues for providing support with prompt anti-natal checks for learning and development needs, enabling needs to be identified as early as possible.

·       Whilst there was good progress identified, resulting in a good outcome, she highlighted that inspections were also an opportunity to recognise areas for improvement.

·       She felt that Brent as a local area partnership had worked hard to meet targets for progressing initial EHCPs but needed to improve on annual reviews to ensure the right support was in place for each young person. She highlighted challenges in that, as reviews required professional input from many different agencies including schools, parents and health.

·       There was work to be done on cross-organisational working to streamline the EHCP review process.

·       In relation to the timeliness of mental health provision and neurodevelopmental provision, she advised that those challenges were deeper and widespread, and she felt government oversight and spending would be needed to comprehensively address those issues.

Nigel Chapman provided further information by way of introduction, highlighting the following key points:

• He advised that Brent had been on a journey over the last 8 years following the inspection in 2017 concluding that Brent required a written statement of action. That had been dealt with quickly, as evidenced by a revisit in 2019 where Brent and inspectors had been assured that improvements had been made. He felt that the outcome of the 2025 inspection showed that those improvements had been consolidated and built upon.
• In terms of the inspection process, he explained that, nationally, there had been 59 published joint CQC Ofsted inspections of local areas, with a possible grading across 3 numbers. 30 of those published inspections had an average middle grading, 15 had the lowest grading, and 14 had the best outcome, of which Brent was one.
• He felt that, throughout the inspection, Brent had been able to demonstrate that the work being done was mitigating the impact of the challenges in the overall system for SEND that was felt did not work as well as it could. This was achieved through effective partnership working.
• An action plan had been created following the outcome of the inspection which was monitored through both the Brent Children’s Trust (BCT) and Integrated Care Partnership (ICP) Executive to ensure issues were escalated where needed and attention was given to areas requiring improvement, such as mental health waiting times.
• The work and learning would feed into the new SEND Strategy due to be published at the end of the year and a white paper on SEND was expected in Autumn 2025.
• Considering the progress Brent had made on SEND, the DfE had invited Brent to become a sector-led improvement partner for SEND because of the good outcome. That would be considered depending on the requirements and resources needed to fulfil that role.

Robyn Doran provided further information on the SEND inspection and outcome from a health perspective, highlighting the following key points:

• A healthy debate had taken place at the most recent BCT meeting in relation to neurodevelopmental assessments and CAMHS waiting lists. This was due to the fact that 70% of young people referred to CAMHS in Brent were also referred for neurodevelopmental assessments, compared to the national and NWL average of 35%.
• The discussion had focused on the need to think differently in that first stage of addressing children and young people to be assured that professionals were not over-pathologizing. She highlighted that many of the children and young people that had SEND were traumatised because of their life experiences such as poverty, domestic abuse and other community issues, and when they presented challenging behaviours as a result of that trauma they were often automatically seen as having a neurodevelopmental disorder. As such, a joint piece of work with Brent’s communities was being implemented. This would include reviewing what percentage of children referred for an assessment were then diagnosed with a neurodevelopmental disorder.

The Chair thanked the presenters and invited contributions from those present. The following points were made:

·       Jackie Allain advised that CLCH had received approval and funding to deliver an incontinence service for children. CLCH was in the process of recruiting and hoped to have staff in post by the end of September. This would make Brent one of only a few boroughs with an incontinence service for children.

·       It was suggested that the Health and Wellbeing Board received regular updates on the ongoing work across the Integrated Care Board (ICB) system reviewing pathways and CAMHS pressure.

·       The Board highlighted that some of the incomplete actions detailed in the action plan stated that there was ‘no funding available, needs discussion’ and asked where that funding might come from. Robyn Doran explained that there was money in the ICB for children’s mental health, but it was not yet defined how that would be allocated. Brent ICP was doing as much as possible to ensure Brent was one of the boroughs that received an allocation as the most deprived borough with the highest waiting lists. The previous year, some internal CNWL money was moved from another borough to Brent to clear some of the waiting lists, but that had been a one-off and the waiting lists had since increased.

·       The Board asked for further information on the waiting lists, and heard that ADHD and autism assessments were at a 30-month backlog, and further details could be provided on the numbers of people on waiting lists.

·       Nigel Chapman explained that the 45-day target for equipment was not a statutory target, but based on the time taken to complete Child and Family Assessments. The targets were variable across the country on that, but this was an area that sat within children’s services that the service would like to increase focus on.

·       In terms of the impact of long waiting lists, Nigel Chapman advised that Brent had been able to demonstrate that it could mitigate the impact of long waiting times through different strategies using the thrive model and Brent Centre for Young People, where support was provided to families whilst they waited. The importance of understanding what was driving the higher referral rates in Brent compared to other areas was highlighted, and Robyn Doran confirmed that a university wanted to work with Brent on that piece of work.

·       The Board asked why there were recruitment and retention challenges for specific skills. Nigel Chapman advised that the primary difficulty in recruitment was for Occupational Therapists, where there was a national shortage and variability in pay across boroughs. Children’s services was now working closely with colleagues in Adult Social Care to ensure a joined-up approach across children’s and adults regarding Occupational Therapy. Robyn Doran added that there was work going on across the sector in Brent to recruit locally. Work was being undertaken by Lead Occupational Therapists to get people into the profession earlier, such as through apprenticeships, and CNWL had funded some apprenticeship posts in the Trust. 

·       The Board asked for further context as to why Brent had constraints with EHCPs. They were advised that the main reason local authorities nationally were struggling to keep up with the pace was the growth in numbers, with Brent now having almost 4,000 children on EHCPs compared to 2,000 before the pandemic. Whilst Brent had kept pace doing initial EHCP assessments at 70%, which was above the national average, it had not kept pace with review assessments. To mitigate this, Brent had prioritised reviews for those children at transitional points such as those moving from reception into primary school or from primary into secondary school. There were plans in place to improve further, and the number of staff undertaking review assessments had increased. Nigel Chapman advised that he was confident with the plan in place that performance would improve.

·       Considering Brent was one of 8 NWL boroughs, the Board asked whether officers were tracking inspections in other boroughs from a service planning perspective. Nigel Chapman explained that Brent was the third of the 8 boroughs in NWL to be inspected under the current framework along with Hillingdon and Hounslow. Officers in the ICB who worked with Brent on the inspection were well sighted on the issues in the other boroughs and had been helpful in providing that insight for Brent.

In concluding the discussion and noting the update, the Board thanked officers and noted the findings of the recent SEND inspection, proposed action plan and progress made. Additionally, the Board welcomed the news about the incontinence service for children and awaited an update on the work to improve the CAMHS waiting lists.