Issue details

Proposed Decision:

A)   To agree to disaggregate current spend between Speech, Language and Communication Needs, Occupational Therapy and Physiotherapy

B)   To procure a Speech Language and Communication needs service required by KCC to access the education curriculum

C)   To agree to the transfer of the Occupational Therapy and Physiotherapy service to further integrate with KCC’s other inhouse provision for a seamless education provision

Reason for the Decision:

-      Savings or expenditure of more than £1m

-      Affects two or more Electoral Divisions

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In March 2024 a Special Educational Needs - Therapy Contracts paper was presented to the Children, Young People and Education Cabinet Committee (Decision 24/00008) to jointly commission a new outcome-focused integrated therapy service with NHS Kent and Medway, which will ensure resources are aligned to activity within the NHS for their 2025 contracts.

KCC has undertaken a review of the Therapy provision which commenced in 2023. The future commissioning intention is to disaggregate the Occupational Therapy and Physiotherapy elements of current service and incorporate with the KCC inhouse service; and commission a Speech, Language and Communication Needs (SLCN) therapy service using the Balanced System® model.

Following the 2023 Therapies review, which was presented as part of the Special Educational Needs – Therapies Contracts at the March 2024 Cabinet Committee, further work has been explored with NHS Kent and Medway and their approach to the re-procurement of their Community Services to commence as an “as is” model with transformation built into the term of the contract no longer aligns from a timing perspective for KCC to commission the new transformed service through the delivery model of the Balanced System®. Therefore, the intention is that there will be a separate KCC procurement with aligned connections with NHS Kent and Medway for unit costs, price increases, the future specification of the transformed NHS service and Key Performance Indicators.

Background:

The Code of Practice for SEND 0-25 requires the development of a Local Offer which is jointly commissioned by health and education partners to meet the needs of all children and young people with special educational needs whether or not they have an Education, Health and Care Plan (EHCP).  NHS Kent and Medway and Kent County Council have committed to working togetherand move towards the delivery of The Balanced System® Service Delivery Model. The model sets out the high level system outcomes across the five strands at universal, targeted and specialist levels.The Balanced System® Service Delivery Model for SLCN will support the priorities set out in Kent SEND Strategy 2025 2028

Therapy provision is often recoded in Section F of an Education, Health and Care Plan (EHCP) because it is considered special educational provision rather than health provision that is noted in section G of a plan. According to the Children and Families Act 2014, any provision that educates or trains a child or young person should be included in Section F of the EHCP. This includes Therapies such as Speech and Language Therapy, Occupational Therapy, and Physiotherapy, which are necessary for the child or young person's education or training.

There is currently a lack of clear pathway for integrated therapy for the SEND cohort, with an  inconsistency of when and why therapies could or should be considered, with confusion exacerbated between what is a health need or an education need, this reinforces the need for a full pathway approach to commissioning.

Commissioning these services will support Framing Kent’s Future by contributing to the commitment to ‘work within the system to ensure a strong focus on preventative community services, building a strong strategic relationship with the social sector in Kent and their role in supporting a system-wide focus on prevention’ and support vulnerable children and young people across the county.

This proposal complies with Spending the Council’s Money requirements:  In accordance with the Cabinet decision to support the recommendations in the paper Securing Kent’s Future on 5 October 2023, the approach set out makes sure that, in line with Objective 2 that any future procurement does not over specify need, ensuring best value for the Local Authority.

What is being proposed?

The commissioning intention is seeking to disaggregate and re-invest current therapies spend into two distinct elements as follows:

Element One: Commission a Speech, Language and Communication Needs – Delivering Inclusion within the Curriculum for Education (DICE) Service, that supports children and young people in mainstream schools and across community settings, such as Family Hubs, during both term time and school holiday periods.  A Link Therapist will hold a key role in supporting those children and young people who are either in mainstream schools and those who, for various reasons, are not attending school regularly (e.g. such as those home educated, non/low-school attendance, living in Refuges, etc.) and have Speech, Language and Communication Needs.

Element Two: The provision of support to children and young people with additional needs is, in this context, advice, support, equipment and aids to promote access to education through Occupational Therapy and or Moving and Handling expertise. 

Financial Implications:

The disaggregated financial implications for both elements of the Therapy Services are as follows:

Element One:

KCC investment in Speech and Language Therapy (SLT) services, represents 20% of the totality of provision. The disaggregated funding available is £1.86m, contracts will need to be costed for additional annual price increases for both NHS Agenda for Change and/or Consumer Price Index or other related increases.

Element Two:

Regarding funding for the Occupational Therapy and Physiotherapy the intention is to utilise the budget which is anticipated to be £415,431 to enhance internal provision within the Social Care -Occupational Therapy and the Physical Disability Specialist Teaching and Learning Service, specifically to work with the education setting, and potentially offer up a budgetary saving through offering a more efficient service model.

                   Total Budget Allocation – Element One and Two

Through implementing The Balanced System® we would look for both elements of Therapies provision to be fully funded from the current £2,279,491 budget. This budget is currently fully funded from the High Needs Block of  Dedicated Schools Grant (a ring-fenced grant from the Department of Education) and the service is expected to be re-commissioned with the current budget envelope without further contributions from either the High Needs Block or the council’s general fund.  

Legal Implications:

Commissioners have determined that these services are now caught by the Provider Selection Regime which came into force on 1 January 2024. As such the procurement of these services will be undertaken in accordance with the requirements of the Provider Selection Regime regulations and statutory guidance. It is envisaged that a competitive procurement exercise will be undertaken. [A further decision paper will be presented in due course once the procurement route is confirmed*]. Officers will engage with Legal Services to obtain advice in relation to the appropriate contract terms and tender documentation to use with the procurement exercise and application of TUPE which is considered likely to be engaged