Purpose

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

-     
 
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

Descriptor

Budget

2024/2025 Contract Values

EKHUFT £752,905

KCHFT £1,526,586

 

£2,279,491

Element One

Speech, Language and Communication Needs (DICE)
Service 

 **Inc. Overheads &
oncosts

£1,860,000

Element Two

Occupational Therapy and Moving and Handling
Expertise

£415,431

 
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

Decision

As Cabinet Member
for Education and Skills, I agree to:
 

APPROVE the disaggregation of the
current Occupational Therapy (OT) spend from the current Therapies
spend and the re-investment of this to develop an internally
provided integrated SEND and Social Care OT service.
APPROVE the commissioning and
relevant procurement of a Speech,  
Language and Communication Needs – Delivering Inclusion
within the Curriculum for Education (DICE) Service.
APPROVE the commissioning approach
to procure a five-year contract with an option to extend for a
further 24 months.
DELEGATE authority to the Corporate
Director of Children, Young People and Education, to take relevant
actions, including but not limited to, negotiating and finalising
the terms of, and entering into required contracts or other legal
agreements, as required to implement the decision.