Update 29 September 2023: Supplementary clarifications on the research specification have been provided following an online Q&A session held on held on 21 September 2023. These can be found in Appendix B & C
|Deadline for Stage 1 applications||24 October 2023, 1pm|
|Notification of outcome of Stage 1 application||09 January 2024|
|Project start||March 2024|
|Project duration||12 - 18 months|
Due to the urgency of this research call, applications will be assessed through a fast-track single stage committee assessment process, based on information provided in the outline stage 1 application form. Successful applicants will be invited to respond to committee feedback in an expanded form and on approval will proceed to contracting and project start-up.
The National Institute for Health and Care Research (NIHR) Policy Research Programme (PRP) invites applications for a single research project to investigate the demand for and supply of therapies for children and young people (CYP) with Special Educational Needs and Disabilities (SEND).
The overall aim of this research is to help us understand the gaps between the supply of therapies and the demand for therapy in children and young people with SEND with a focus on occupational therapy (OT), speech and language therapy (SaLT) and physiotherapy to inform planning about the supply of therapists. Outputs should include models which can provide estimates of demand for therapies against workforce supply to meet this demand.
The research should consider:
- demand for therapeutic engagement amongst CYP with SEND including the number of children referred and in therapeutic interventions, the identification and diagnosis of SEND needs, and the duration and delivery of assessments and interventions
- numbers of therapists in employment and the number who are in training, with detail of those who are working or can work with children with SEND, and the attrition rates of therapists into and out of services, including public and independent (i.e. supply);
- how demand maps to supply, quantifying any workforce shortfalls.
Resulting evidence will support policy makers in the Department of Health and Social Care (DHSC), Department for Education (DfE) and NHS England (NHSE) to undertake workforce planning and assess policy options to ensure CYP with SEND needs are met. Such evidence will inform future decisions on where and what growth in the workforce may be required to ensure all CYP with SEND who need access to therapies have access to them locally, and at the right time.
Children and young people (CYP) with Special Educational Needs and Disabilities (SEND) consistently have worse outcomes than their peers on every measure, including health and education, and often have fewer opportunities in later life (SEND Review). The SEND Review was commissioned in 2019 in response to widespread recognition that the system is failing to deliver improved outcomes despite spiralling costs, due to a cycle of late intervention and inefficient allocation of resources.
Access to therapies – including speech and language therapy and occupational therapy – is a crucial part of this picture and is regularly cited as a reason for less-than-optimal outcomes for CYP with SEND [1,2]. Moreover, the pandemic has exacerbated these issues. The February 2021 Family Fund survey of 2,960 families with disabled or seriously ill children in England revealed that at least half of parents reported loss of access to speech and language therapy, occupational therapy, educational psychologists, and Child and Adolescent Mental Health Services (CAMHS) since the start of the pandemic.
We have some evidence that these issues are due to lower supply of therapists working with CYP than can meet the current demand, with growing waiting lists preventing early intervention and pulling specialist support towards statutory rather than preventative work. NHS data from June 2023 suggest that the longest waiting list for therapies for CYP (and any children’s community services overall) is for speech and language therapy with 72,800 patients waiting, followed by occupational therapy (19,500 patients waiting) and physiotherapy (15,000 patients waiting). In September 2022, a survey by the Royal College of Occupational Therapists (OTs) found that 85% of children’s OTs reported increased demand since July 2021, and 69% of OTs said their teams were not fully staffed. Additionally, many therapists were redeployed elsewhere during the pandemic amongst other issues (Royal College of Occupational Therapy and Royal College of Speech and Language Therapist reports).
The current available data is not comprehensive enough to convey levels of unmet need and demand, specifically data is lacking on the size of the demand for therapies commissioned by local authorities or provided in schools. Data on waiting lists presents just one aspect of the demand on therapists’ resources – it is important to recognise that, as well as providing specific interventions, therapists play a crucial role in early identification, diagnosis and collaboration with other professionals supporting CYP with SEND. Annual data is published by the Department for Education (DfE) with the number of CYP with SEN support and with Education, Health and Care Plans (EHCPs), but we do not have a clear sense of how this translates to unmet need and demand for therapies. Some need types, e.g., speech, language and communication difficulties, are easier to translate into the corresponding demand (speech and language therapies) than others.
The data on the size and make-up of the therapist workforce is limited, for example, we do not have comprehensive data that disaggregates who therapists work with (children and/or adults) or which settings they work in (e.g., NHS acute / community, local authority commissioned services, schools). See Appendix A for further details on a scoping exercise looking at current available data.
DHSC committed to building the evidence base on this issue in the SEND and Alternative Provision Green Paper, jointly published by DHSC and DfE in March 2022.
Our primary research aim is:
To review evidence and provide a modelling approach to estimate the gap between the demand for and supply of specialist therapies for CYP with SEND and translate this into inputs for workforce planning.
The Department of Health and Social Care have completed a scoping study looking at the demand for therapies amongst CYP with SEND. Through the scoping study, we were told about a number of pressures that may impact therapy demand, including socioeconomic deprivation and poverty [3,4], comorbidities [5,6,7], and staff training and knowledge. The results from this scoping have informed this specification and can be shared with the successful applicant for this research.
A study has also been carried out by the Health and Social Care Workforce Research Unit (HSCWRU) looking at the current workforce capacity, the limitations and the commissioning of therapies. The results will be ready in Autumn 2023 and can be shared with the successful research applicant. A webinar will also be held to provide further information from the workforce and demand scoping studies.
We envisage that the research will take place in two phases.
Initially, we need to build on existing evidence to generate a clearer picture of demand for therapies from the health therapy workforce and the current supply at national level. This initial phase could consider:
- The factors that impact the demand for therapies, including the significance of their impact and how they impact the demand for therapies nationally and locally.
- The commissioning processes involved in commissioning therapists to fill the demand for the therapies and how they may differ nationally
- The factors that impact the supply of the workforce including the significance of their impact, how they may differ locally and how service design and commissioning process also impact the workforce.
- The identification and diagnosis of SEND needs and how they relate to NHS diagnoses and therapeutic needs
- Quantitative estimates of the size of the impact the factors that affect demand and supply of therapies for CYP with SEND.
In the second phase, the evidence from phase 1 should be used in combination with existing data on SEND and the SEND workforce to build a model to enable better understanding of workforce dynamics, in terms of meeting the need for therapies, and for quantifying unmet need and translating this into an estimate for workforce shortfall. At national level, this could consider:
- The demand for therapeutic engagement amongst CYP with SEND which includes:
- The identification and diagnosis of SEND needs
- The assessments carried out for EHCPs and SEN assessments
- The type and length of interventions carried out
- The supply of therapists to provide therapy to CYP with SEND:
- The number of therapists in employment and training
- Disaggregation of those in the therapy workforce, i.e., those working or who can work with children with SEND, sector of employment (e.g., independent, health, schools) and location of work (i.e., schools, hospitals, community).
- The attrition rates of the therapist workforce, including disaggregation by sector and therapy type.
- How the demand compares to supply, including quantitative estimates in therapist workforce shortfall.
The resulting model should help to inform workforce planning, enabling different scenarios of supply and demand and their consequences to be assessed, including for future demand and supply of therapies. This research should also ideally inform improvements to data collection and provide us with a good understanding of the available data we can build on or where data is missing.
We recognise that these are complex and multifaceted issues, requiring a nuanced understanding of wider workforce and supply/demand issues. We are open to any additional evidence-based qualitative assessment of these issues, e.g., why CYP with SEND cannot access therapies they need and how service provision can be improved, to inform workforce planning, if appropriate and depending on the methodology chosen.
Also of relevance to this work, NHS England are undertaking modelling work across 10 providers in London to determine similar estimates for this area, meaning there is a proof of concept for such work. We want to build on this research where appropriate and we are working with NHS England to receive updates on the work as it progresses. DHSC can help facilitate engagement with the successful research team with NHSE.
We anticipate this research will take place in the two phases outlined above, though these will not necessarily be entirely sequential, with each informing the other.
Given that the need is for quantification of supply, demand and gaps, we envisage a mixed methods approach. We are open to researcher’s suggestions of appropriate methodology to address our research questions, however researchers may wish to include:
For phase 1:
- A literature review of current studies of prevalence for certain conditions covered by SEND and which are identified as needing therapy.
- Using interviews and focus groups with local authorities, health professionals and the Royal Colleges/Chartered Society to get a broader idea of how the various factors involved in SEND demand and provision impact the therapies.
- A literature review of the factors that may impact the likelihood of a child needing SEND support as well as therapeutic support.
- A literature review and focus groups/interviews with therapists and the royal colleges/chartered society to understand which interventions are most effective, the length of specific interventions and the conditions/disorders they are most commonly used to treat.
- Use previous research and data to produce numerical estimates of the size of the impact the identified factors have on the demand and supply of therapies for CYP with SEND.
- Focus groups and interviews with the Royal Colleges/Chartered Society, local authorities and health professionals to gain a better estimate of the number of therapists that work with CYP with SEND.
For phase 2:
- Modelling methodology (e.g., the Balanced System model for SaLT ), to model the level of intervention needed for CYP with SEND and the workforce provision needed for this.
- Consensus seeking methodology, such as the Delphi method, to come up with reasonable assumptions to enable estimates of demand.
- Determining current demand through interviews and focus groups with a representative sample of local authorities to get an understanding of waiting lists and the demand for the different therapies in their area. Using current and historical waiting times data from NHSE, researchers may be able to model future demand.
- Analysis of various data sets, such as workforce data (NHSE workforce data and national registration data), to understand the current and possible staffing levels within the health therapy sector. From interviews and focus groups with the Royal Colleges/Chartered Society, researchers could look into how many of this workforce work with CYP with SEND.
Consideration should be given to the difference in demand and supply regionally in England, including in rural and urban settings and between different therapeutic professions, and in relation to socio-economic factors.
Researchers should also consider any demographic factors which may impact access to therapies and diagnosis of SEND, e.g., culture, ethnicity, gender and age.
Consideration should also be given to the difference in demand between different SEND classifications, i.e., severe learning difficulty and specific learning difficulty, for each therapeutic profession.
Research should also encompass also that not all CYP with SEND who require therapy are known to the NHS as some therapy is received or commissioned through independent therapists. The Royal Colleges/Chartered Society may have estimates of how many therapists work in the independent sector and local authorities can provide further information on commissioning processes.
Engagement with Department of Health and Social Care
We will be happy to have discussions with researchers about any methodological changes as the research progresses, guided by policy requirements.
Results from the scoping studies carried out by DHSC and HSCWRU can be shared with the successful applicant. Further findings from the scoping studies will be shared with interested applicants through a webinar alongside the specification.
DHSC also have access to NHSE data on the current waiting times for therapy services, nationally and regionally. They specify the number of CYP currently on the waiting lists and the length of time they have been waiting. Through the scoping study, we have been cautioned that not all local authorities agree that these figures are representative of their current waiting times situation.
DHSC also have access to the school census data for the numbers of CYP with SEND. Though, through our scoping study, we have been advised to use this with caution, this data can be shared with successful applicants if relevant.
Scope for this programme of work
We are interested in the supply of therapies across all provision, which covers workforce in the NHS, those commissioned by local authorities, independent therapy providers and those working directly in schools.
We are interested in speech and language therapies, occupational therapy and physiotherapy for children with SEND.
We are not considering mental health therapists as part of this request because there are several other programmes of work aiming to address demand for mental health therapies among CYP and supply of mental health workforce.
We are also not including the wider education and care workforce in this study, such as teachers, teaching assistants and support workers, parents and carers.
This project is focused on therapy provision for Children and Young People with SEND. This includes children up to the age of 18. We are focussing on CYP with SEND only, including those that may not be formally diagnosed. Though we are aware that children and young people without SEND do access these therapies, they are not in scope for this study.
To help understand the scope of this research, we have defined some key variables:
Demand - for us, demand is classified as the identification, diagnosis, assessment and intervention for therapies. This includes the duration of assessments and interventions, including number and length of sessions, as well as the number of children referred and waiting for interventions. This also includes the ‘universal’ interventions that local areas may offer as this represents a demand on the workforce time and resources. The research should encompass understanding demand for specialists at universal, targeted and specialist levels of intervention to understand the scope of service provision and demand.
Therapists - this includes the whole therapy workforce, including qualified therapists, therapy assistants, trainees and apprentices to get a true understanding of the available workforce and how they contribute to the supply of therapies.
Eligibility for the NIHR PRP is laid out in our Standard Information for Applicants and applies to all calls unless otherwise stated in the individual research specification.
Ideally, for this research applicants should be based within England to make it easier to access NHSE and Local Authority resources.
Technical requirements / Expertise required
We require the following expertise from the project team:
- Familiarity with the SEND classifications and data.
- Familiarity and expertise with the therapy workforce structure and the interventions, referral and commissioning processes.
- Experience in running rapid mixed method projects.
- Experience in complex modelling projects
- Familiarity with the health and education sectors.
Applicants are asked to consider the timing and nature of deliverables in their proposals. Policymakers will need research evidence to inform key policy decisions and meet timescales, so resource needs to be flexible to meet these needs. A meeting to discuss policy needs with DHSC and DfE officials will be convened as a matter of priority following contracting.
Outputs should include:
- A full project plan, including an initial Gantt chart, at the beginning of the research process to be shared with DHSC and DfE.
- Interim reports every 4 months or as agreed at project scoping, to inform policy planning and decisions.
- A publishable report of interim findings following the end of strand 1, as well as a workshop and slide pack for DHSC and DfE.
- A final publishable report with an executive and lay summary after the end of strand 2, as well as a workshop and slide pack for DHSC and DfE.
- Other summative outputs (such as policy briefings) as required, to disseminate the findings across the range of stakeholders.
Applicants are asked to produce a modelling output from strand 2 of the research. This should ideally estimate the current workforce supply and current demand for therapies amongst CYP with SEND at a national level for overall workforce planning. If possible, an additional regional breakdown would be preferable to help the development of improved data collection and highlight areas of the country which may need targeted policy intervention.
This ideally could also be used to predict possible future SEND demand and workforce supply patterns without policy intervention according to the factors identified in scoping and strand 1 of the study and inform future data collection improvement.
The model should include:
- An estimate of the gap between demand and supply of therapies for CYP with SEND and translate this into an estimate of the therapist workforce gap.
The model could include:
- 3 possible scenarios of future gap - an optimistic, pessimistic and current policy scenario including future numerical estimates for all.
Modelling of various commissioning structures, include optimistic and pessimistic future scenarios.
- Implications from the modelling which could highlight areas of focus for policy intervention.
The model should help indicate areas of concern across the demand for and supply of therapies for CYP with SEND which could be improved through policy intervention.
Budget and duration
Up to £300,000 is available to fund this research.
Costings can include up to 100% full economic costing (FEC) but should exclude output VAT. Applicants are advised that value for money is one of the key criteria that peer reviewers and commissioning panel members will assess applications against.
There is a strong sense of urgency to begin specialist workforce planning for CYP with SEND. Research timelines will be guided by methodological considerations, but we would ask applicants to consider the following in developing their plans:
- We are anticipating that the research will take between 12-18 months to complete but encourage researchers to suggest the shortest feasible time for this work to be completed within budget and resource restrictions.
- Overall, we would like to have research findings in time for them to inform planning and development of options which can be used in Spending Review considerations in 2024/25.
A research advisory group including, but not limited to, representatives of DHSC, DfE, other relevant stakeholders, and the successful applicants for the research should be established. The advisory group will provide guidance, meeting regularly over the lifetime of the research. The successful applicants should be prepared to review research objectives with the advisory group, and to share emerging findings on an ongoing basis. They will be expected to:
- Clarify the roles and responsibilities of the researchers involved to provide clear understanding of each person’s involvement in the project.
- Provide a secretariat to the advisory group, record meeting minutes, maintain an action log and schedule meetings with stakeholders.
- Provide regular feedback on progress (i.e., every 3 weeks)
- Produce timely reports to the advisory group, along with any requested policy input.
- Produce a final report for sign off
Research contractors will be expected to work with nominated officials in DHSC, its partners and the NIHR.
Nominated contacts should be provided to DHSC for day-to-day enquiries.
Key documents including, for example, research protocols, research instruments, reports and publications must be provided to DHSC in draft form allowing sufficient time for review. This time to review should be factored into project timelines at the beginning of the research process. Review timelines are estimated to take a month.
Guidance on Health and Care Inequalities and associate data collection within NIHR PRP Research:
Health and care Inequalities is a high priority area within the Department of Health and Social Care and the NIHR and is often present in a majority of funded projects.We are now assessing all NIHR research proposals in relation to health inequalities. We ask that you please clearly identify in the research plan section of the application whether your application has an inequalities component or theme as well as how this research hopes to impact inequalities or not. Please also detail the core set of inequality breakdown data that will be collected, if applicable. More information on this request can be found in the Standard information for applicants.
References and key documents
-  HM Government. SEND Review: Right support, right place, right time Government consultation on the SEND and alternative provision system in England. 2022; CP624. [Accessed on 20th July 2023]. Available from SEND Review - right support, right place, right time
-  Disabled Children’s Partnership. House of Lords Public Services Committee: the role of public services in addressing child vulnerability. Written evidence from the disabled children’s partnership. 2021; PSC0018. [Accessed on 20th July 2023]. Available from Disabled Children’s Partnership – Written evidence
-  Blackburn CM, Spencer NJ, & Read JM. Prevalence of childhood disability and the characteristics and circumstances of disabled children in the UK: secondary analysis of the Family Resources. BMC Pediatrics. 2010; 10: 21. [Accessed on 22nd August 2023]. Available from: Prevalence of childhood disability and the characteristics and circumstances of disabled children in the UK: secondary analysis of the Family Resources Survey | BMC Pediatrics
- Fleming M, McLay JS, Clark D, King A, Mackay DF, Minnis H, & Pell JP. Educational and health outcomes of schoolchildren in local authority care in Scotland: A retrospective record linkage study. PLOS Medicine. 2021; 18(11): e1003832. [Accessed on 22nd August 2023]. Available from: Educational and health outcomes of schoolchildren in local authority care in Scotland: A retrospective record linkage study | PLOS Medicine
- Perera B, Audi S, Solomou S, Courtenay K, & Ramsay H. Mental and physical health conditions in people with intellectual disabilities: Comparing local and national data. British Journal of Learning Disabilities. 2019; 48(1): 19-27. [Accessed on 22nd August 2023]. Available from: Mental and physical health conditions in people with intellectual disabilities: Comparing local and national data
- Gooch D, Hulme C, Nash HM, & Snowling MJ. Comorbidities in preschool children at family risk of dyslexia. The Journal of Child Psychology and Psychiatry. 2013; 55(3): 237-246. [Accessed on 22nd August 2023]. Available from: Comorbidities in preschool children at family risk of dyslexia - Gooch - 2014 - Journal of Child Psychology and Psychiatry - Wiley Online Library
-  Hughes C, Foley S, White N, & Devine RT. School readiness in children with special educational needs and disabilities: Psychometric findings from a new screening tool, the Brief Early Skills, and Support Index. British Journal of Educational Psychology. 2017; 88(4): 606-627. [Accessed on 22nd August 2023]. Available from: https://doi.org/10.1111/bjep.12206
- Gascoigne M. Supporting children with speech, language and communication needs within integrated children’s services RCSLT Position Paper. RCSLT: London. 2006. Available from: Supporting children with speech, language and communication needs within integrated children’s services
Summary of data from scoping exercise
What do we know?
- The number of children with SEND. This includes both the number with Education, Health and Care Plans (EHCPs) and the number requiring SEN support in schools. The threshold for an EHCP is higher than thresholds for SEN support, and both groups continue to grow significantly. In 2020/21, there were nearly 326,000 (3.7%) pupils with an EHCP and just over 1.08 million (12.2%) with SEN support in school. However, we do not know how the number of CYP with SEND translates to therapy needs and the extent to which this is being met.
- The total number of therapists working in the UK, but not where they are working or whether they work with children and/or adults (including CYP with SEND, specifically). All therapists must register with the Health and Care Professions Council (HCPC), who keep a register of all those who are practising. The HCPC will share data with researchers for research purposes.
- How many FTE therapists are employed directly by the NHS in England from the Electronic Staff Record, but not how many are working as agency/locum staff, in NHS commissioned services, in local authority commissioned services or in schools.
- Some data on referrals and waiting lists from different sources but coverage is either poor, doesn’t match the workforce breakdown regions (i.e., by local authority compared to NHS trust), is not granular enough (i.e., including specific types of therapy) or does not provide detail about whether demand (identified through referrals and waiting lists) is being met. None of these can identify SEND-specific referrals.
- The NIHR-funded HOPE Study is aiming to understand SEND provision and the impact of SEND provision on health outcomes using linked education (National Pupil Database) and health (Hospital Episode Statistics) data (the “ECHILD database”). The HOPE Study is expected to complete in August 2024. While this would provide an indication of identification and provision for CYP with SEND, it would not provide insights to the level of individual therapies like speech and language therapy, occupational therapy and physiotherapy. However, it could give an indication of whether CYP are characterised as needing therapies and whether a) they are recorded as needing support for SEND and b) if they get the provision they need. The National Pupil Database does not capture CYP in school or those who have moved between provision so often that they end up in home schooling and falling away from the data.
- DfE recently published Local area special educational needs and disabilities report for Birmingham City Council which highlights statistics on SEND for Birmingham compared to a selected comparison group of All English metropolitan boroughs, including: % of pupils with SEN; % of those with an EHCP; and primary need (e.g., speech, language and communication needs; autistic spectrum disorder; severe leaning difficulty). While this does not address our needs directly, it does provide some proof of concept for local level and granular data in this space.
Special Educational Needs & Disability (SEND) research webinar Q&A 21st September 2023
What are associated timeframes and deadlines for the project?
The deadline for stage 1 applications is the 24th October 2023, at 1pm. Applications will receive notice of the outcome of their bid on the 9th January 2024.
We anticipate the project starting in March 2024, and that the research will take between 12-18 months to complete. However, we encourage applicants to suggest the shortest feasible time for this work to be completed within budget and resource restrictions. Overall, we would like to have research findings in time for them to inform planning and development of options which can be used in future Spending Review considerations.
What is the design / suggested methodology of the study?
We recognise that these are complex and multifaceted issues, requiring a nuanced understanding of wider workforce and supply/demand issues. We are open to applicants’ suggestions of appropriate methodology to address our research questions. However, suggestions on elements applicants may wish to include are set out in detail in the specification.
What technical expertise would be expected for the team?
We require the following expertise from the project team:
- Familiarity with the SEND classifications and data.
- Familiarity and expertise with the therapy workforce structure and the interventions, referral and commissioning processes.
- Experience in running rapid mixed method projects.
- Experience in complex modelling projects
- Familiarity with the health and education sectors.
What is the budget for this research?
The budget for this research is £300,000.
What are the expectations from participants and the time requirement?
Research requirements are as set out in the specification. Demands of participating in research are for applicants to determine and decide what is appropriate.
The commissioning brief is very cross-cutting and ambitious, with a relatively modest budget. What advice can the department share on managing this when applicants are developing their bids?
Unfortunately, we are restricted on budget and timelines due to the nature of the fast-track single stage committee assessment process. This is required due to the urgency of this research call. However, the department would note that we are aware of the ambition set out in the research specification and we are looking to be guided by the applicants on what is achievable within the parameters set.
Would the department consider an adapted approach, for example, with local focus, or a pilot study?
As above, we are looking to be guided by the applicants on what is achievable within the parameters set. Generally speaking, we would advise against a local focus, as the purpose of the research is to inform a national policy programme. However, if the application can demonstrate the value of such an approach, this will be considered by the department.
What can the PRP do to support applicants and facilitate connections?
Once the Committee assessment process is complete, the successful applicant will receive detailed feedback from the commissioning committee and DHSC. At this stage, support will be made available to help research teams to connect, particularly with organisations with national remit and data providers, such as NHSE.
How was the research brief developed?
The research specification was developed by DHSC in light of the findings from the two scoping studies, in conjunction with relevant policy leads and the Department for Education. During the scoping studies, a number of key stakeholders were consulted, including schools, the Royal College of Occupational Therapists, the Royal College of Speech & Language Therapists, physiotherapists, Local Authorities, and regional SEND leads.
The National Bureau of Children was consulted by the Health and Social Care Workforce Research Unit (HSCWRU) during their study looking at the current workforce capacity, the limitations and the commissioning of therapies.
Will the scoping studies be available for sharing, and if so, when?
The findings of the HSCWRU study will be published later this year, however, this will not be in time for the research application deadline. We are not intending to publish the findings of the DHSC study, however, they will be shared with the successful applicant.
We will also share a briefing note to summarise the webinar discussion, which will be made available to all.
Do the scoping studies include information on the impact of the demand on therapies to young people, other services, or the future outcomes of the SEND population?
The objective of the scoping studies was to focus on demand and supply. Research applicants may wish to consider the topic of impact; however, primary focus should be on estimating the gap between the demand for and supply of specialist therapies for children and young people with SEND and translate this into inputs for workforce planning
Scoping Study on the Demand and Supply of Therapists for Children and Young People with Special Educational Needs and Disabilities (SEND)
Ian Kessler, Professor of Public and Management.
The recent Government SEND Review - Right Support, Right Place, Right Time noted the limited data and evidence on the precise level and nature of demand for therapy from children and young people (CYP) with SEND and on the capacity of the healthcare workforce to deliver on this demand (2022:46-47). Regrettably, this is not a new issue. The follow-up Improvement Plan reiterated this observation and committed to ‘analysis to better understand demand for support for children and young people with SEND from the health workforce’ (2023:61).
In Spring 2023, and as an initial step towards this analysis, the NIHR Policy Research Unit in Health and Social Care Workforce at King’s College London was asked to undertake a scoping study on the demand and supply of therapists for children with SEND, with a particular focus on speech and language therapy, physiotherapy, and occupational therapy.
Key questions to consider:
- How is SEND defined?o Should the focus be on need or demand?
- In what settings can and are therapies to CYP with SEND delivered?
- What therapies should be and are available to CYP with SEND?
- Who can and does deliver these therapies both in organisational and workforce terms?
Aims of study
The study aimed to explore key aspects of the demand for-supply of therapies for CYP with SEND, with a view to:
- Developing a broad understanding of the size of the workforce delivering therapies to children and young people with SEND.
- Examining the structure and nature of this workforce.
- Exploring the working arrangements for this workforce.
- Highlighting the perceived challenges faced in managing it.
- Considering whether and how this workforce was accessed by service users.
Over Summer 2023, around 40 policymakers and practitioners were interviewed as a means of addressing these issues.
- National and regional SEND and therapy leads (11)
- Representatives from professional bodies and trade unions (6)
- Representatives from service user organisations and commissioners (4)
- Organisational/teams leads for therapy services to children and young people with SEND (17)
- Experts in the field (3)
Interviewees included: national and regional SEND and therapy leads, representatives from professional bodies and trade unions; representatives from service user organisations; organisational leads employing therapists and providing therapy services to children and young people with SEND; and various experts in the field.
The findings from these interviews are being processed and will be written up in a report.
Issues and themes
The study and report findings centre on the following:
Requirements for therapies:
- The distinction between SEND support and additional support, the latter often underpinned by an Education Health Care Plan (EHCP) rooted in certain statutory requirements.
- The need to distinguish between different types of need/demand, its scale and complexity, as well as between when and where this need/demand is presented and addressed: early years/school years/further education.
- Here it is important to recognise the complexity that may be facing any given child.
- The process of CYP with SEND accessing therapy services linked to referral, assessment and the delivery of the intervention.
- The availability of data held by DfE and DHSC on those with SEND needs (including those with EHCP), such as primary needs, school type, gender, ethnicity and waiting times.
- Referral routes – things to consider include who is eligible, who the referrer is, how the referral is made, and when, and then whether the service is able to be provided.
- Primary consideration is the therapy workforce, but must be in context of the wider workforce and wider care workforce – e.g., teachers, teaching assistants, SENCOs, GPs, SALT, social workers
- Issues around skill mix, career pathways, covid redeployment, caseload, more assessment/less therapy delivery, retention rates (move to private practice), training places and supply line
- Available data: number of registered therapists, membership data (CSP, RCOT, RCSLT), each with specialist paediatric networks
Models of workforce planning and current work, noting previous and current attempts to address therapy demand-supply issues for CYP with SEND, including:
- There are models to assist with workforce planning – e.g., generic demand-capacity NHSE models
- Bespoke (Children/SEND) NHSE Regional Therapy Deep Dives
- Bespoke ‘expert’ models for example Balanced System and Care Aims
- Mapping of the CYP SEND workforce in general (NHSE initiative)
- Perhaps most useful - precise and bespoke workforce planning for CYP SEND Therapies (London)