Far-reaching recommendations to boost SEND transition to adulthood as Ofsted/CQC find systemic “longstanding weakness”

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Supporting young people with disabilities from birth to adulthood was the main goal of the 2014 Children and Families Act. But while the extension of statutory entitlements from age 16 to age 25 was widely welcomed, it has since often seemed like an afterthought. Now, a new joint thematic review from Ofsted and CQC on Preparation for Adulthood has concluded that longstanding “systemic challenges are limiting efforts and some young people face a ‘cliff edge’ in health support once they turn 18.”

This “cliff-edge” was the subject of a recent Lords Think Work First report that found, “Disabled people face continuous barriers to securing long-term employment. This starts from the moment a young disabled person enters nursery school and continues through their preparation for work and their transition from education to employment. We have to start with the presumption that young disabled people are fully capable of thriving in work, as long as they have the appropriate support. Aspiration and ambition have to be at the heart of this support.”

Recommendations for all- except one

The Ofsted thematic report has produced recommendations not just for the Department for Education, but the Department for Health and Social Care (DHSC) the Department for Housing, Communities and Local Government (MHCLG), NHS England and local health bodies, and for schools and colleges. That’s fitting because the transition to adulthood isn’t just about education but moving into adult health and social care services too. It’s a shame it didn’t also look at how the DWP makes life much harder for disabled people than it needs to, especially those who move to higher education who can no longer access universal credit if they cannot work to supplement their income.

But despite some fantastic work being done by the NDTi and specialist colleges, sufficient support for further education, supported internships, and apprenticeships for those with EHCPs has been slow coming. And for those without EHCPs, the report finds “stark disparity in support.”

Main findings

The report splits its findings into employment, independent living, community inclusion, and health.

In employment, careers advice, training and employers, were not set up to meet the needs or aspirations of disabled young people. However, this has prompted some more innovative LA teams to work directly with employers to create work experience opportunities. Careers guidance was typically stronger in specialist settings, but as most young people with SEND are in mainstream, this is clearly an area that needs to be focused on.

Supported internships (SIs), although often unpaid, can provide valuable work experience—both for the young person themselves and as an eye-opener for employers to the benefits to them and their staff. One frustration has been that SIs are only open to those with an EHCP, but last January, the previous government announced plans to widen eligibility so those with SEND but without plans can be included. It was to be tested in a few areas, so if you know how this is going, do let us know.

The widening criteria is just as well, given the way things are going, as LAs seek to strip more young people of their EHCPs at 16.

Independent living has always been a challenge. For those who want to move away from home, there is too little suitable housing, whether that be specialist residential or supported living accommodation. The report found that good support for adulthood starts much earlier, developing and building on independence skills from the early years onwards.

“Community inclusion” is another area where provision gaps were found, particularly in rural areas. Again, the lack of good information sharing of what is available with families was an issue.

Where health is concerned (and often health isn’t in the least bit concerned), the research found that transitions to adult services didn’t happen early enough, or sometimes at all especially for mental health—where a smooth transfer is vital.

“In some cases, they were entirely absent. Local area partnerships should cooperate to improve joint commissioning of services, in line with the SEND code of practice, to make transitions to adulthood smoother. We found that children’s services support can end abruptly when young people with SEND turn 18 and enter adult health services. There can then be a delay before they receive more support. This was highlighted as an area of particular concern for young people who require continued access to mental health services.”
…
“Young people receive limited support during this transition, either because no equivalent service is available or because of capacity issues in adult mental health services…There is a requirement to support children and young people with an EHC plan up to the age of 25. However, some of the support that they rely on, such as mental health services, ends abruptly before that. The goodwill of clinicians means that some young people do receive ongoing care. However, the majority wait for longer than they should before being seen by adult services if they are eligible for support, and therefore do not receive a seamless transition.”
Ofsted/CQC Thematic report

One of the findings highlighted the lack of information available to families about opportunities and services for young people. It’s not always that it isn’t there, but it’s just hard to find, especially on LA local offer websites:

“We often heard that the local offer was ‘not where it should be’ and that there were gaps in provision, especially for 14- to 18-year-olds. Not all parents and carers were aware which activities were most appropriate for their child. We heard from GPs who did not have access to enough information about what was available in the community that would help children and young people with SEND to feel included. The GPs were therefore unable to signpost them to relevant services.”
Ofsted/CQC report

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What good work is being done?

As with education, the report found that what you could access depended on where you live. Pockets of good practice can be found, but what’s needed is for this to be shared, which is the aim of the What Works in SEND website, though this is still at an early stage.

“We visited more than one local area that worked with partners, children, young people and families to co-produce an EHC plan template that has preparation for adulthood as a core theme running throughout. Practitioners told us that this new format helps them to focus on what is important for the child or young person in the future, from the earliest years….
“…one local area placed youth workers in hospital A&E departments. We also heard about children and young people who had moved into supported accommodation sharing their experiences with other children, young people and families at information-sharing events. These were planned well and had a positive impact.”
But once again, the report found good practice was not widespread.
The report is all about collaboration between public services, both national and local. Locally, it found where there was strong partnership, preparation for adulthood was a thread from the first EHCP right through to post-16. The researchers also found that developing “all age” services and having dedicated PfA staff who included the views of young people and what they want to be a sign of strength.

Conversely, areas with weaker partnerships didn’t share information and data to improve provision, didn’t jointly commission or coordinate services effectively, didn’t communicate effectively with parents/carers and were slow to begin transition planning to adult health services.

Recommendations

As mentioned, the recommendations are focused on all areas (except the DWP) that are important for providing a good, collaborative transition.

A new national EHCP template is currently being developed. Ofsted wants it to embed preparation for adulthood across all stages, ensuring earlier planning and support is consistent across the country. (DfE)
It recommends national guidance be developed to include a “transitional period of support” when an EHC plan ceases, to end an abrupt drop off in support (DfE)
Boost supported internships, both in numbers and in opportunities. Not every young person wants to work in retail or a coffee shop. (DfE)
Launch a cross-departmental campaign “to encourage more employers to employ and train young people with SEND” (DfE) Departments working together? Crazee!
Strengthened national transition guidance from children’s to adult health services. “The national guidance should be clear about the adjustments that adult health services should make to support children and young people with SEND. This should also inform adult social care commissioning” (DHSC)
The report wants the two departments to “address conflicting responsibilities and gaps across social care, education and health provision to aid transitions and preparation for adulthood.” (DfE/DHSC)
Create a national standards to ensure “clear roles and responsibilities across education, health and social care regarding transitions to adulthood.” (DfE/DHSC)
Work together to “address the national shortage of high-quality specialist residential and supported living accommodation” (DfE, DHSC and MHCLG):
Cut pre-16 diagnostic waiting times for neurodevelopmental or mental health conditions, so transition planning can start early to get the right adult care (NHS England)
Take a whole-system approach to transition support (All relevant NHS health services)
Improve service joint commissioning to support consistent good support independence, so that they receive consistently good support (local area partnerships)
Include specific health support needed in EHCPs for different stages of a child’s life, particularly after age 14, (LAPs)
Include preparation for adulthood at every annual review (LAs)
Review all transition processes to ensure support for transition works across local agencies (health Integrated care systems)
Ensure service commissioning avoids a “cliff edge” in support during transition. (health Integrated care boards)
Schools and colleges should ensure that careers services also work for SEND learners and are individualised to support their transitions and next steps.

Natspec, the association for specialist colleges has also lobbied hard for better investment and services for Post-16. Ruth Perry, Natspec’s Senior Policy Manager, says,

“Putting preparation for adulthood at the heart of the 2014 SEND reforms was a very welcome move. This Ofsted/CQC thematic review confirms, however, that it’s still very much a work in progress – with some particularly challenging systemic barriers standing in the way.
“We’re pleased to see a recommendation for an explicit PfA section in the revised EHCP template. We’d expect to see the content of this section become increasingly specific as a young person moves from school into further education. The call for transitional support after an EHCP ends is also very welcome. Too often young people experience leaving education as ‘falling off a cliff edge’. Tapering support so there is no sudden cessation would certainly help. The report acknowledges that there is dearth of opportunities for young people as they emerge into ‘the adult world’. We need joined up government and a well-thought through youth disability strategy to ensure that all this preparation can actually lead to a fulfilling adulthood.”
Ruth Perry, Natspec

There are many positive recommendations in this review that are to be welcomed. But we’re not very hopeful, given the number of different agencies, health bodies and government departments involved, that much will be taken forward. Too many competing interests, too little money, and too many priorities elsewhere all mean even if the will is there for one player, the lack of buy-in from another will scupper real improvements.

The report ends with Ofsted and CQC pledging to continue working with the DfE, DHSC, NHS England and the sector “to share their insights and address the issues highlighted in this report”. We say, we wish you the very best of luck with that, and we mean it both sincerely and ironically.

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About
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Tania Tirraoro

Founder, Co-Director at Special Needs Jungle

Founder & co-director of Special Needs Jungle. (She/Her) Autistic parent of two young autistic adults Devoted Grandma. National SEND advisor, journalist & author. Tania also runs a PR, web & social media consultancy, SocialOro Media.
She is a rare disease & chronic pain patient advocate with Ehlers Danlos syndrome.

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