Review of Hertfordshire’s Educational Support for Medical ... · To generate the circulation list...
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1 Review of Hertfordshire’s Educational Support for Medical Absence (ESMA) Service January 2019 L. Massey Performance Improvement Team Family Services Commissioning
Transcript of Review of Hertfordshire’s Educational Support for Medical ... · To generate the circulation list...
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Review of Hertfordshire’s Educational Support for
Medical Absence (ESMA) Service
January 2019
L. Massey
Performance Improvement Team
Family Services Commissioning
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Contents
1. Executive Summary ....................................................................................................... 4
2. Background and Context ............................................................................................... 6
2.1 Scope of Review ...................................................................................................................... 6
2.2 Statutory Requirements of Local Authority ............................................................................ 7
3. Educational Support for Medical Absence (ESMA) Service .............................................. 9
3.1 Service Overview ..................................................................................................................... 9
3.2 Accessing ESMA .................................................................................................................... 10
3.3 Referral Pathway ................................................................................................................... 11
3.4 Forest House Education Centre ............................................................................................ 13
3.5 Key Findings .......................................................................................................................... 15
4. ESMA Structure ........................................................................................................... 17
4.1 Staff Roles ............................................................................................................................. 18
4.2 Staff Qualifications and Training ........................................................................................... 20
4.3 Supervision and Quality Assurance ....................................................................................... 22
4.4 Financial Information ............................................................................................................ 25
4.5 Key Findings .......................................................................................................................... 26
5. Service Data ................................................................................................................ 28
5.1 Gender/Age ........................................................................................................................... 28
5.2 Medical Reason/Length of Support ...................................................................................... 29
5.3 Medical Reason by Year Group ............................................................................................. 30
5.4 Annual Comparisons in Caseloads ........................................................................................ 31
5.5 Average Hours of Weekly Teaching ...................................................................................... 32
5.6 Emerging Challenges and Caseloads ..................................................................................... 34
5.7 Additional Teaching Options ................................................................................................. 35
5.8 Key Findings .......................................................................................................................... 38
6. Delivering positive outcomes for families, schools and settings .................................... 40
6.1 Key Performance Indicators .................................................................................................. 40
6.2 Additional Impact Measures ................................................................................................. 43
6.2 Key Findings .......................................................................................................................... 44
7. Working with partner support services ........................................................................ 45
7.1 Key Findings .......................................................................................................................... 47
8. Survey......................................................................................................................... 49
9. Recommendations ...................................................................................................... 50
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10. Concluding Comments ................................................................................................. 54
11. Appendices ................................................................................................................. 55
Appendix A - Examples of reintegration ....................................................................................... 55
Appendix B – ESMA’s Outcome Bees ............................................................................................ 57
Appendix C – Examples of partnership working ........................................................................... 58
Appendix D - Survey responses ..................................................................................................... 62
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1. Executive Summary In September 2018 a review was commissioned of Hertfordshire’s Education Support for Medical
Absence (ESMA) seeking to ensure that the service is:
- Fit for purpose and delivering positive outcomes for families,
- Demonstrating effective working with partner support services, and
- Delivering value for money.
The review was undertaken between 4 October 2018 and 26 December 2018 and involved a number
of key activities including:
• Review of provision in other LA areas to identify best practice models.
• Provision and needs analysis to map provision against statutory guidance and identify gaps in
service.
• Shadowing of staff members to gain insight into role and tasks of ESMA staff, including referral
panels, review meetings, team meetings and teaching interventions.
• Discussions and interviews with various stakeholders about their experiences of ESMA and
interrelationships with service areas.
• Data gathering in relation to service structure and delivery, including finance and staff
resourcing in order to gain an overview of the current service and its structure.
• Creation and thematic analysis of surveys designed to capture experiences of: Parents/Carers;
Pupils; Schools/Settings; ESMA staff; Partner Agencies/Service areas.
Whilst this was a broad review of a complex service six significant findings were identified and are
outlined below. Additional findings can be found in the body of this report whilst recommendations are
contained within section 10.
1. The service works effectively with partner agencies. There was much evidence provided by the
service exemplifying ways in which they work with partner agencies as well as internal services,
including joint staff training sessions, delivery of workshops and multi-agency review and
planning meetings. However, there is a need to review the level of partnership working to
ensure that it is having the desired impact and using ESMA resources effectively.
2. Clear understanding of the needs of the cohort. Whilst there is a need for clarity as to who the
service should be supporting, as per the previous point, the service has a clear understanding of
their current cohort as well as emerging need. The service has taken steps to ensure that staff
are knowledgeable in a range of medical conditions, particularly mental health, but also Autism
Spectrum Disorder (ASD). The service should continue to ensure that staff have quality training
to enable them to provide support to children and young people with a diverse range of
conditions.
3. Service capacity to meet demand. According to the data provided by the service at this time,
across the whole service, the average number of weekly ESMA support hours provided is 3.66,
including MyTutor and reintegration. Whilst statutory guidance does not specifically specify
the number of hours that should be provided by local authorities, given that full time
education is usually 25 hours a week, acknowledging that 1:1 teaching is considered three
times more intensive than classroom teaching and recognising that pupils are able to engage
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with some independent study, the service is currently delivering below the 5-6 hours a week
outlined as possible when the service has capacity.
The service has also seen a steady increase in the number of pupils being referred for mental
health conditions, with 44% of the cohort at the time of writing, being due to mental health
anxiety need. These pupils do not always meet the thresholds of services such as Child and
Adolescent Mental Health Services (CAMHS) or Positive behaviour, Autism, Learning disability
and Mental health Service (PALMS) and therefore often require extended periods of support,
including both educational teaching as well as the building of emotional resilience and coping
strategies. Furthermore, for some reintegration is not always possible, therefore an increase in
cases of this kind has put a strain on the service’s capacity to deliver as many hours of teaching
that some pupils are able to access.
4. Limitations within data systems and variances in recording standards. The current system used
by the service, Integrated Education System (IES), does not allow the succinct recording of all
information or offer the functionality to extract concise service data at a given point in time.
Furthermore, there is variable compliance amongst staff in updating case records/notes which
impacts on the validity of data.
Whilst the service has introduced separate spreadsheets to help capture missing data fields
there is a need for a more consolidated, comprehensive database which allows the service to
capture the full extent of their activity and evidence outcomes. The service also needs to embed
robust quality assurance checks to ensure that records are updated in a timely manner.
5. Evidencing service impact through outcome measurement. The service currently uses a variety
of baseline measurements against which they monitor progress however there is no one
consistent approach in place to quantitatively evidence the service’s outcomes in a clear format
and indeed the IES does not allow simple capture and extraction of such information.
There is a need for the service to consider a robust universal outcome measurement tool which
can be used for individual cases on regular intervals to provide a picture of progression in a more
tangible format that complements the current qualitative progress reports captured following
teaching inputs and at review meetings.
6. Need for clarity and awareness of ESMA. There is a need for the service to publicly clarify its offer
to ensure that key stakeholders, including those internal to Hertfordshire County Council, and
service users understand what the service offers, to whom and how it can be accessed.
Feedback from a range of stakeholders and service users during this review stated it is not clear,
particularly following the last restructure, what the service is able to offer and to whom.
This report seeks to provide an overview of the service, outline findings and presents some key
recommendations for consideration.
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2. Background and Context 2.1 Scope of Review
During this review a range of stakeholders were consulted in order to gather feedback on experiences
of the ESMA service, particularly in relation to the delivery of positive outcomes for families,
schools/settings and how the service works effectively with other partner support services.
Opportunities to meet face to face meetings were undertaken with the following:
Jennie Newman Interim Head of Integrated Services for Learning (ISL)
Richard Woodard ISL Area Manager, Access & Inclusion
David Canning ISL Area Manager, County Lead for Specialist Advice and Support
Tony Fitzpatrick ISL Senior Support Officer, Barnwell School Headteacher
Silvia Hundal ISL Area Lead 0-25 and County Specialist for Quality Assurance and Performance
Sue Bramley Education Support for Medical Absence (ESMA) Lead Practitioner and Coordinator
ESMA Staff All Specialist Advisory Teachers (SATs) and Variable Hours teachers (VH) for St Albans &
Dacorum and Watford, Three Rivers & Hertsmere
Carol Kelsey Coordinator and Director of Hertfordshire Parent Carer Involvement Forum (HPCI)
Sally Glossop Interim ISL Area Manager, Strategic Lead Special Educational Needs or Disabilities (SEND)
Breda O’Neill Child and Adolescent Mental Health Services (CAMHS) Schools Link Manager
Kate Barker East Herts and North Herts Clinical Commissioning Group (EH & NH CCG)
Stephen Hoult-Allen Executive Headteacher of The Collett School and St Luke’s, incorporating Forest House
Education Centre
Sara Lalis Headteacher, Dacorum Education Support Centre
Ashlyns School Deputy Headteacher
Tring School Assistant Headteacher, Head of House and Inclusion Room Coordinator
Shadowing
In addition, two days of shadowing were undertaken with two ESMA Specialist Advisory Teachers for
North Herts and Stevenage, as well as St Albans and Dacorum through which there was the
opportunity to speak to parents and young people about their experiences of ESMA support, as well
as some Integrated Service for Learning (ISL) Lead Practitioners.
E-Survey
An e-survey was developed and circulated to: parents/carers and young people who are currently in
receipt, or have recently received, ESMA support; schools and settings; ESMA staff; and partner
agencies (this included a mixture of external healthcare/medical professionals as well as internal
Hertfordshire County Council services such as YC Herts and Families First who work alongside ESMA).
To generate the circulation list ESMA staff were asked to provide the details of partners they have
worked with as well as families and schools/settings who had expressed a wish to participate in the
survey. It was also accessible on ESMA’s Hertfordshire Local Offer webpage. Furthermore,
Hertfordshire’s Parent Carer Involvement Forum kindly circulated the survey link to its network.
The survey was open from 3 December to 26 December 2018 and was designed to gain insight into
experiences and gather feedback from which common themes could be identified and used to inform
this review. Findings have been distributed across the report. More detailed summaries of the survey
can be found in Appendix D.
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2.2 Statutory Requirements of Local Authority
Local authorities have several statutory duties in relation to children and young people with medical
needs.
The Department for Education’s (DfE’s) 2013 Statutory guidance, ‘Ensuring a good education for
children who cannot attend school because of health needs’ outlines the role and responsibilities of
local authorities in accordance with relevant legislation. Namely, local authorities are responsible1 for
arranging suitable2 full-time3 education, or otherwise than at school, for children who cannot attend
school because of illness or other reasons and who therefore would not receive suitable education
without such provision. This applies whether or not the child is on the roll of a school and whatever
the type of school they attend. It applies to children who are pupils in academies, free schools, special
schools and independent schools as well as those in maintained schools.
This guidance also recognises that there is a wide range of circumstances where a child has a health
need but will receive suitable education that meets their needs without the intervention of the local
authority therefore, where this is the case there is no expectation of the local authority becoming
involved unless there is reason to think the education being provided is not suitable.
Whilst the guidance does not define full-time education, children with health needs should have
provision which is equivalent to the education they would receive in school, usually 25 hours a week.
However, it is not for local authorities to match the number of hours of education a pupil has missed,
but to consider what education the child can take given the medical condition and educational needs.
If pupils are receiving one-to-one tuition, the hours of face-to-face provision could be fewer as the
provision is more concentrated.4
Where full-time education would not be in the best interests of a particular child because of reasons
relating to their physical or mental health, local authorities should provide part-time education on a
basis they consider to be in the child's best interests. Full and part-time education should still aim to
achieve good academic attainment, particularly in the core subjects of English, Maths and Science.
The guidance drives the importance of working across organisational boundaries to ensure that
provisions made are suitably tailored, maintaining academic progression and attainment whilst also
allowing the child to prosper and thrive within the school community.
The Department for Education’s 2015 Statutory Guidance, ‘Supporting pupils at school with medical
conditions’, reinforces the need for governing bodies to ensure ‘that arrangements are in place to
support pupils with medical conditions. In doing so it should ensure that such children can access and
enjoy the same opportunities at school as any other child.’ This supports the ongoing involvement of
1 Section 19 of the Education Act 1996. This guidance was due a review in September 2014 but to date it seems this has not taken place. 2 Section 7 Education Act 1996 - ‘suitable’ means to the child’s age, ability and aptitude, and any special educational needs he or she may have. 3 Section 3 Children Schools and Families Act 2010 - ‘full-time’ unless the local authority considers that a pupil’s condition means that full-time provision would not be in his or her best interests. 4 Hertfordshire works on the notion that one-to-one tuition is around three times more concentrated than that of the classroom environment.
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the school with individual children even when they are absent from school due to medical illness as
the hope should always be that reintegration will be achieved.
Local authorities must also ensure compliance with the Equality Act 2010. Some complex and/or long-
term health issues may be considered disabilities under equality legislation. Therefore, local
authorities must not discriminate against disabled children and are under a duty to eliminate
discrimination, foster equality of opportunity for disabled children and foster good relations between
disabled and non-disabled children. They should also make reasonable adjustments to alleviate
disadvantage faced by disabled children, and plan to increase disabled children’s access to premises
and the curriculum.
It is important to note that Section 100 of the Children and Families Act 2014 places duties upon the
governing bodies of maintained schools, academies and pupil referral units to make arrangements to
support pupils at their school with medical conditions. The arrangements should provide parents and
pupils with confidence in the school’s ability to provide effective support for medical conditions in
school. They should show an understanding of how medical conditions impact on a child’s ability to
learn, as well as increase confidence and promote self-care.
Furthermore, schools should have policy in place for supporting pupils with medical conditions that is
reviewed regularly, readily accessible to parents and school staff and identifies a named individual
with overall responsibility for implementation.
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3. Educational Support for Medical Absence (ESMA) Service 3.1 Service Overview
Educational Support for Medical Absence (ESMA) is provided by specialist teachers who work with
young people aged 5-16, whose attendance has been significantly affected by a medical condition,
this includes both physical illness/injury as well as mental illness.
For those young people temporarily5 unable to attend school for medical reasons the ESMA service
seeks to support schools and work towards getting the pupil back into school life as soon as possible.
Information about the ESMA service can be found on the Hertfordshire Grid for Learning,
Hertfordshire’s SEND Local Offer and an information leaflet.
Support on offer includes:
• Guidance about the impact of medical conditions on school access, including the best ways to
support re-integration
• Advice to schools so they can develop strategies to manage pupils with health needs
• Anxiety courses for parents and pupils
• Teaching support for pupils whose medical condition is preventing them from accessing
school
• Advice to governing bodies in respect of their statutory duties for these pupils.
Unlike other services within Integrated Services for Learning (ISL) ESMA is unique in that it provides
out of school support and curriculum teaching, all others provide in-school support strategies only
and do not offer curriculum teaching.
5 The first three weeks (15days) of absence, consecutive or cumulative, remains the school’s responsibility through use of in-house support procedures and policies.
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3.2 Accessing ESMA
The ESMA eligibility criteria is outlined in ‘Access to education for children and young people unable to
attend school for medical reasons,’ available to access on both Hertfordshire Grid for Learning and
Hertfordshire’s Local Offer.
It broadly outlines the following criterions:
- Pupils of statutory school age who are resident in Hertfordshire;
- Referrals must come from the school on whom whose roll the child is;
- Referrals must be supported by medical advice, such as a letter, from a medical practitioner, e.g.
Consultant Paediatrician or member of a CAMHS team, who is actively involved with the young
person;
- The first three weeks of absence remains school’s responsibility from their in-house support
procedures.
Whilst there is no statutory guidance that states that medical evidence must be provided to access
support, Hertfordshire, as do many other local authorities’6 equivalent services, request medical
advice in order to ensure that any interventions in terms of teaching and planning in terms of
reintegration, is not to the detriment of the young person. It also provides assurances that
appropriate support from healthcare professionals is in place to address the physical or mental health
needs alongside the educational support ESMA is offering.
Where medical evidence is missing or incomplete, ESMA liaise with schools to help obtain such detail,
this is often undertaken by ISL Support Staff.
The table below shows the average number of times a month the service receives referrals without
any supporting medical evidence or has to request additional evidence as the original is unclear about
the impact of the medical issue on school attendance.
ISL Area Average referrals/month
lacking medical evidence
Average referrals/month
with unclear medical
evidence7
St Albans & Dacorum 2 3
East Herts, Broxbourne, Welwyn & Hatfield 2 2
North Herts & Stevenage 1 1
Watford, Three Rivers & Hertsmere 1 3
Such evidence should indicate the impact of the medical condition has on the pupil’s ability to access
education in school and help inform planning and provision of education support and longer-term
reintegration to ensure that any intervention is not detrimental to the child’s health or well-being.
6 Central Beds stipulate an enhanced criteria for referrals, namely that they should have active therapeutic input prior to teaching based on the premise that if someone is unwell, particularly with mental health issues, they need to get support for those needs before they are in the right frame of mind to engage with teaching. 7 Letters are sent to the school from the ESMA Lead Coordinator giving advice to the school. The case will remain ‘pending’ for 4 weeks to see if further information is forthcoming.
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3.3 Referral Pathway
Whilst pre-referral advice and guidance for ESMA related support is provided by the ESMA Lead
Coordinator, the single point of access for referrals is shown below8:
8 This process is still being embedded with Lead Practitioners following changes introduced in 2017 when ESMA moved into
Integrated Services for Learning’s Special Educational Needs and Disabilities Information Advice and Support Service (ISL
SEND SASS)
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The programmes of ESMA support currently available are:
A Advice service – Specialist Advisory Teacher (SAT) role.
B
Teaching – A designated SAT will hold the case and undertake all relevant meetings to plan and
review provision. The SAT will arrange teaching inputs from Variable Hour (VH) teacher/s, but the
SAT can also provide additional teaching capacity if required.
C Reintegration support - SAT led
D Complex specialist provision e.g. HERT (at Forest House)
The referral process for ESMA is the same for all Integrated Services for Learning (ISL) departments,
through a Service Request Form and submission to the appropriate ISL Area.
Referrals are reviewed weekly allowing all referrals to be assessed within a week of receipt. If
approved for support the case will be allocated to a SAT. There is then an expectation that the initial
meeting should be arranged within a week, depending on the support package agreed.
The initial meeting is used to determine what is currently on offer from school and why it is not
accessible/appropriate - in some instances it may be the case that ESMA supports the school in
adjusting the offer.
A delay in allocating the case will only occur when a referral has been received but further
information or medical advice is required and therefore it is recorded as ‘pending’ on the relevant
centralised Special Educational Needs and Disabilities Information Advice and Support Service (SEND
SASS) spreadsheet.
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3.4 Forest House Education Centre
Whilst Forest House Education Centre (FHEC) sits outside the scope of this review, a summary of the
provision and its links with ESMA are outlined below.
FHEC is a hospital school for 13-18 year old students, attached to the Forest House Adolescent Unit, a
Tier 4 CAMHS in-patient facility on the Kingsley Green hospital site. The Centre provides education for
the patients occupying the Adolescent Unit's sixteen beds, while additionally being the sole educator
for a small number of 'day pupils' who are referred by ESMA.
All students have issues affecting their mental health, therefore supporting them towards better
mental health functioning within education (cultivating good communication skills, working to
overcome barriers presented by illness, increasing motivation, encouraging hope for the future) is
central to the work of FHEC.
Students up to GCSE level are taught the 'core' subjects of maths, English and science in small classes.
All students also follow an 'enrichment' curriculum which combines art, PE, drama, work-related
learning, citizenship, general studies and humanities. FHEC is also an examination centre, so are able
to meet the accreditation needs of day students, and provide a venue for hospital patients whose
exams need to be transferred for medical reasons.
Prior to ESMA’s restructure in 2017 a group teaching provision was provided by ESMA staff onsite, but
this has since ceased. The current relationship between FHEC and ESMA involves:
• 1:1 ESMA Tuition – classroom on-site
• HERT Programme
1:1 ESMA Tuition – classroom on site
ESMA have an on-site classroom which is used to work with a range of students that meet the ESMA
criteria. These students have a medical/mental health illness as their primary need but also have
additional need as outlined in the criteria column below.
Criteria Description Process Impact
All age pupils
struggling to attend
tuition on site at
school (over 1 term)
Clear recommendation
from CAMHS
Short-term respite
intervention and pupil
moved back onto
school site as defined
by health
recommendations
½ termly review with
transition steps
identified as part of
discussion
Back on school site
and reintegration
making progress
All age pupils without a
school place
Their support period
can take longer as the
school place needs to
be identified before a
reintegration package
can start
½ termly review with
transition steps
identified as part of
discussion
New school identified
so reintegration can
commence
Criteria Description Process Impact
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All age SEND pupils
whose placement has
broken down
Their support period
can take longer as the
new school place
needs to be identified
before a reintegration
package can start
½ termly review with
transition steps
identified as part of
discussion
New school identified
so reintegration can
commence
KS4 students who are
moving onto the HERT
scheme
CAMHS makes
recommendation on
mental health grounds
Have failed
reintegration attempt
over 2 terms
A graded transition
from ESMA 1-1
teaching on site at
FHEC and onto the
HERT Programme is
carefully managed
with the FHEC staff
introducing
themselves to the CYP
and ESMA staff linking
in with break time
arrangements to
develop exposure
work. The handover
usually takes ½ a term
and once on the HERT
scheme completely,
the case will transfer
to County Lead for
monitoring and
Quality Assurance
while FHEC staff
provide all the
teaching.
This is a holistic
provision so preparing
the young person for
post 16/life skills and
social skills
incorporated
This has a cost saving
impact for ESMA as
the AWPU transfers
from school to FHEC –
joint registration
This frees ESMA
teachers to take on
other cases
HERT Programme
The HERT Programme is for KS4 students only, with students in Year 10 continuing to work towards
reintegration and remaining solely on the roll of the home school and students in Year 11 focusing on
exam entries. Year 11 students are dual registered with the home school with the AWPU being
transferred to FHEC, and Teaching Assistants are part-funded by ESMA. Teaching within the
Programme is provided by FHEC who run the timetable.
Once the student has started on the Programme half-termly review meetings are called by FHEC and
involve the: Head of Participation FHEC; Inclusion and Community FHEC; The Specialist Advisory
Teachers from ESMA (Yr10); County Lead Practitioner (CLP) from ESMA (Yr11); The TA at FHEC, who
co-ordinates meeting and minutes; and the student’s home school.
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3.5 Key Findings 3.5.1 There are some inconsistencies within the information outlining the ESMA offer. Whilst there is
information about the service available on Hertfordshire Grid for Learning, Hertfordshire’s
SEND Local Offer and an information leaflet the information is not consistent and during the
review some external stakeholders reported it lacks clarity.
The ‘Access to education for children and young people unable to attend school for medical
reasons’ document, available on the Local Offer, is currently under review and awaiting final
consideration by the ISL Area Manager & County Lead for Specialist Advice and Support in
January 2019. Once approved the service plan to disseminate the updated document via
various networks such as the SENCO Forum and Herts for Learning (HfL).
3.5.2 Lack of clarity about the role of ESMA and who the service supports. A number of internal staff
and external stakeholders, expressed a view that it is unclear what role and type of cohort
ESMA now supports following the 2017 restructure where it has been repositioned within
SEND SASS.
It is felt that there are some blurred lines in terms of the cohort and type of need the service
is providing support to. Stakeholders consulted, as well as some internal staff, including senior
managers, expressed a belief that the service would sit better within Access and Inclusion
given the role of the service in supporting those with attendance issues due to medical illness.
This would perhaps remove any confusion about the service’s inclusion within SEND SASS.
3.5.3 No support offer for pupils post-16 up to the age of 18. Statutory guidance does not outline
that local authorities need to support beyond 16 however, this topic was raised by both
internal staff and schools during the review. Whilst the Department for Education have not
released statutory guidance to this effect, given that the government increased the age to
which all young people in England are required to continue in education or training, this
potential future development should be considered by the service.
3.5.4 The requirement for medical advice has been highlighted as a point of contention for schools
and parents. Within the service there is a feeling that General Practitioners too readily
provide general medical advice particularly for mental health illnesses such as anxiety,
without detailing what other medical/therapeutic interventions they are providing or
referring to, although the service was not able to provide specific details about the number of
occasions for which this has been an issue.
Furthermore, some of those spoken to during the review, both staff and schools expressed
that the obtaining of relevant medical advice for mental health illness is often significantly
impacted by the length of time families are waiting to access the Child Adolescent Mental
Health Service (CAMHS). There was no firm evidence available to triangulate this claim in
Hertfordshire, although a green paper on CAMHS launched by the government in December
2017 set out a reduction in waiting times for specialist CAMHS as one of its three main
proposals suggesting this is not an issue unique to Hertfordshire.
Following submission of a bid to pilot a Mental Health Support Team (MHST), in light of the
aforementioned green paper on CAMHS, Hertfordshire has been successfully selected. The
teams will deliver evidence-based interventions in or close to schools and colleges for those
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with moderate to mild mental health issues; help children and young people with more
severe needs access the right support; work with and within schools and colleges, providing a
link to NHS services; and build on and increase support already in place.
3.5.5 Barriers to accessing other ISL services. Currently, should it emerge that a child or young
person requires support from another service within ISL during, or more frequently post-
ESMA support (identified as part of the closure meeting) there is currently a requirement for
the school to complete a separate Service Request Form. This creates duplication and can
cause delays in accessing appropriate support for the child or young person.
3.5.6 Progress with the development of a tiered approach. As ESMA now sits within ISL’s Special
Educational Needs and Disability Specialist Advice and Support Service (SEND SASS) who
operate within a tiered approach, ESMA are currently developing their own four-tiered
approach in order to provide clarity to schools what the ESMA offer is against the learner
profile. From January 2019 ESMA will be identifying relevant tiers for all current cases in order
to gain a better understanding of those being supported.
3.5.7 Caseloads do not appear to be actively managed. There is no defined caseload limit for SATs.
When new referrals are being allocated the existing caseload of individual SATs, including
travelling distances, does not seem to be considered which can impact on the capacity of
SATs to deliver teaching hours. It can also have an impact on the opportunity to liaise with
support services and keep on top of record-keeping.9
3.5.8 Advisory programme of support currently undertaken by ESMA Lead Coordinator. Due to
capacity of the service the Lead Coordinator is currently providing advice to schools/settings
however this should be part of the SAT role. Whilst it is recognised that this programme of
support is vital and can act as an early intervention preventing future need for the service, the
Lead Coordinator’s post should be more focused on the service’s strategic direction and
therefore time spent providing schools with advice is not a cost-effective use of service
resources.
3.5.9 Timeliness of arranging initial meeting. Whilst it was anecdotally reported by ESMA staff that
following referral approval contact is made with schools and families to arrange an initial
meeting within a week, there is insufficient data to support this as it is not being routinely
recorded on IES.
9 More detail about caseloads can be found in Section 5
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4. ESMA Structure The ESMA service has been structured in several ways over the years. In September 2015 it was
transferred from Education Support Centre (ESC) management back to the local authority where it sat
within Behaviour and Attendance, now known as Access and Inclusion.
In 2017 the service was restructured and became part of ISL’s Special Educational Needs and
Disability Specialist Advice and Support Service (SEND SASS). This was in part due to the increasing
number of ESMA pupils who also have difficulties relating to or associated with SEND, but also to
bring distinct yet overlapping services together into a single strategic 0-25 multi-disciplinary SEND SAS
Service with a unified vision, core team, shared processes and a clear model of universal, targeted and
specialist support, thus contributing to a strengthened local provision.
ESMA staff are now based within ISL 0-25 teams across four quadrants which cover:
1. East Herts, Broxbourne, Welwyn and Hatfield
2. North Herts and Stevenage
3. St Albans and Dacorum
4. Watford, Three Rivers and Hertsmere
Across ISL there is currently one ESMA Lead Coordinator, 9 ESMA Specialist Advisory Teachers (SATs)
and 22 Variable Hours (VH) Teachers.
ESMA staff are currently located within the wider ISL service and whilst ad hoc training and ‘Welcome
Back’ meetings are held after the summer break, there are no formal frequent ESMA team meetings
in place, instead ESMA staff attend separate multi-professional ISL team meetings within their
quadrant.
All staff are equipped with mobile phones which provide access to emails whilst out and about, as
well as personal issue laptops which can be used remotely using WIFI only.
18
4.1 Staff Roles
ESMA Lead Coordinator (Lead Practitioner)
The purpose of the Lead Coordinator post is to ‘deliver quality teaching ensuring a partnership
approach with the family/child at the centre; ensure the relevant partner agencies are engaged at an
early stage to meet the needs of children with medical conditions to achieve their full potential;
ensure that education and developmental progress of children who require support for medical
absence are met in line with Hertfordshire’s SEND Strategy and strategic objectives; ensure the ESMA
service meets Department for Education (DfE) statutory guidance and local authority responsibilities;
and ensure service delivery is co-ordinated within an inclusive 0-25 SEND service.’10
All staff are allocated to an ISL area, whilst the Coordinator’s role is more flexible covering the county.
Specialist Advisory Teacher (SAT)
SATs have a range of key responsibilities including; ‘managing a case load that is planned, assessed
and reviewed within specific timeframes; providing teaching that has a positive impact on the
outcomes for children/young people; providing special assessment and advice to parents/carers and
settings; developing, overseeing and supporting teaching in setting and schools to provide
appropriate interventions in collaboration with the school, setting and family’.11 This is not an
exhaustive list.
There is no dedicated ESMA provision for hospitals in Hertfordshire as they are not often used to look
after children for lengthy stays. However, should there be a need for teaching in one of the
Hertfordshire hospitals12 an ESMA SAT from the relevant area would provide this service.
Variable Hours (VH) Teacher
The working hours of VH teachers are variable according to their availability and the demands of the
service. The core role of a VH teacher is to deliver curriculum teaching, although they may also be
involved in review meetings on occasion.
VH teachers, whilst assigned to a quadrant, can be utilised across other ISL areas, agreement to do so
is at the discretion of the VH teacher. Over the last academic term ten VH teachers have worked
across areas to provide the service with additional capacity.
Use of VHs across alternative areas sees the service incur additional travel costs which are not
payable when based in their assigned quadrant as they are included as standard in the rate of pay.
10 Purpose lifted from Lead Practitioner Job Outline 11 Lifted from Specialist Teacher Job Outline 12 Hospital stay above 5days
19
The below table shows the current staff resourcing levels (excluding the ESMA Coordinator – 1 FTE
post) across the service against the caseload as at 18 December 2018:
ISL Area Staff Numbers Caseload as at 18
December 2018*
St Albans and Dacorum 2 SATs – 2 FTE
6 VH
51
East Herts, Broxbourne, Welwyn and Hatfield 3 SATs – 2.2 FTE
6 VH
45
North Herts and Stevenage 2 SATs – 1.8 FTE
5 VH
37
Watford, Three Rivers and Hertsmere 2 SATs – 1.8 FTE
5 VH
21
*Caseloads are only held by SATs
Some members of staff reported that the split into quadrants has allowed them to be able to build
improved relationships with schools as well as reducing the amount of time spent driving.
It was not possible to obtain specific details about the amount of travel time and associated expenses
claimed for the purposes of this review.13
13 Should the service wish to obtain a clear and accurate picture of travel time and associated expenses they could ask staff to complete diary sheets for a defined period to gain insight.
20
4.2 Staff Qualifications and Training Previously, there were no mandatory qualifications for ESMA teachers as their specialism was
curriculum teaching, as such ESMA staff have a mixture of skills across the core curriculum subjects of
Maths, English and Science across both primary and secondary.
The below table shows the breakdown of core subject coverage per ISL Area and across Key Stages.
ISL Area Teacher Type Core Subject Key Stage
East
Her
ts, B
roxb
ou
rne,
Wel
wyn
& H
atfi
eld
SAT Art - supports with reintegration14 nil
SAT Science 3/4
SAT Maths 3/4
VH English 3/4
VH English 3/4
VH English 3/4
VH Maths 3/4
VH All core primary plus English and Maths at KS3 1/2 and 3
No
rth
Her
ts &
Ste
ven
age
SAT Science and Maths 3/4
SAT All core primary plus Science and Maths at KS3/4 1/2 and 3/4
VH Science 3/4
VH Science 3/4
VH Maths 3/4
VH Maths 3/4
VH English 3/4
VH English 3/4
St A
lban
s &
Dac
oru
m
SAT English KS3/4 3/4
SAT All core primary plus English and Maths at KS3/4 1/2 and 3/4
VH English and Maths 3/4
VH English 3/4
VH English 3/4
VH Science and Maths 3/4
VH All core primary plus English at KS3 1/2 and 3
VH All core primary 1/2
Wat
ford
, Th
ree
Riv
ers
&
Her
tsm
ere
SAT Maths 3/4
SAT Science 3/4
VH Science 3/4
VH Maths 3/4
VH English 3/4
VH English 3/4
VH All core primary 1/2
The service has subject leads in English, Maths and Science, as well as leads in specialisms including
Primary education, Mental Health and Chronic Conditions who share best practice and learning with
the wider team.
14 This staff members’ subject specialism is Art. Their time is used to undertake reintegration support. This staff member was inherited from ESC.
21
Ongoing training has traditionally focused on curriculum updates using various resources such as
Herts for Learning and inputs from ESMA subject leads, as well as medical awareness training
delivered by specialists such as CAMHS, the Chronic Fatigue Team and Paediatricians. In some areas
local schools will hold training as part of their INSET days which they invite ESMA to attend also, this is
reliant on strong relationships with schools. Staff also received Mental Health First Aid and Spot the
Signs Suicide Awareness training in 2017-18.
Following the last restructure which saw changes in the roles undertaken by ESMA, namely the
removal of Senior Teacher and Lead Teacher posts which are now filled by Specialist Advisory Teacher
posts, the past year has been used to deliver training to upskill staff, particularly in Autism given the
high number of Autism Spectrum Disorder (ASD) anxiety referrals the service is receiving. Core
curriculum training remains ongoing for all staff and is delivered by Herts for Learning Advisors.
All SATs and VH teachers have completed Autism Education Trust Level 1 training, with some also
commencing training on the SCERTS15 model, a research-based educational and multidisciplinary
framework that address the core challenges faced by children and persons with ASD and related
disabilities.
All SATs were put on SEN point 216 following the restructure, previously staff were on teaching and
learning responsibility (TLR) payments linked to the level of role. The move to SEN points was based
on the assumption that all ESMA staff will be upskilled in SEN and therefore be able to provide advice
to schools, contribute towards EHCP reports, as well as continue to support the needs of those
children that they provide teaching to.
15 SCERTS Model - http://scerts.com/the-scerts-model/ 16 An additional payment above standard salary to recognise that individuals are teaching pupils with special educational needs (SEN).
22
4.3 Supervision and Quality Assurance Supervision
All staff should have a monthly supervision with their line manager to discuss workloads as well as
training and development needs. In addition, all staff have an annual Performance Appraisal which
includes lesson observations, a review of pupil’s workbooks and gathering feedback from
stakeholders which also feeds in to quality assurance of the service provided.
Lesson observations are currently undertaken using Ofsted-approved framework which has been
tweaked to suit the service.
As mentioned earlier, since the restructure in 2017 ESMA staff now sit within SEND SASS as part of
multi-disciplinary teams. This has meant that line management responsibilities have changed.
The Lead Coordinator is line managed by the Dacorum and St Albans Area Lead 0-25 who is also
Quality Assurance and Performance Lead.
Whilst previously SATs were managed by a Senior Teacher role (a post that no longer exists in current
structure) they are now line managed by the 0-25 Lead Practitioner for their quadrant which is a
move towards matrix management – managing cross functional areas.17 The Lead Practitioners are
primarily specialists in broader SEND areas but have responsibility for reviewing referrals for all
services, which includes ESMA, and making decisions about the support offer and allocating cases.
Overall management of the VH teachers is undertaken by the ESMA Lead Coordinator, this includes
performance appraisals and the processing of pay claims. The ESMA Lead Coordinator is also available
every Thursday morning to VH teachers for telephone consultation.
The day to day management of VH teachers is undertaken by SATs who will allocate VH teachers to
individual cases and collate VH teacher report forms to inform planning and monitoring of progress to
feed into review meetings and such like.
VH teachers are provided with one team twilight supervision session per term which provides the
opportunity for all VH teachers as well as SATS to meet together.18
17 One of the ESMA SATs is a Lead Practitioner for 5-25 in the Watford, Three Rivers and Hertsmere quadrant and is therefore managed by the Area Lead 0-25. 18 These activities have cost implications for the service as VH teachers have to be paid to attend these sessions due to the nature of their contract.
23
Service Evaluations
The service also uses evaluation forms following ESMA support to gather feedback. These are sent to
parents/carers; schools; professionals; and pupils. These forms ask respondents to score the service
from 0-10 (10 being most positive) against specific questions as well as asking some open questions
about how the service could be improved or developed.
The table below summarises how many evaluation forms were sent and received in 2017-18:
PARENTS SCHOOLS PROFESSIONALS PUPILS
sent rec’d sent rec’d sent rec’d sent rec’d
EHBW&H 25 8 20 6 10 3 12 4
NH&S 35 3 39 10 16 3 30 3
STA&D 12 7 14 7 8 2 9 5
WTR&H 18 4 23 18 9 1 18 3
Return rate: 24% 43% 21% 22%
For 2017-18 feedback in the main was positive, particularly from schools. Where concerns were
raised, a more in-depth look at the individual cases was undertaken by the ESMA Coordinator and a
response provided.
Amongst the evaluation form questions, three questions are posed to parents/carers, schools and
professionals which require a score. Out of the 72 forms returned from these audiences the below
scoring was provided.
How accessible was the service? 90% scored 9 or above
How well did the service meet your needs? 89% scored 9 or above
Overall, how would you rate the quality of the service? 90% scored 9 or above
In terms of suggestions for service improvements or development the main themes are around
providing support for longer; offering a post-16 support service; more staffing capacity (linked to
increased hours); and broader coverage of subjects.
General comments included:
‘I am always extremely grateful for the excellent support ESMA offer our students. Thank you!’ - School
‘We are very grateful for the offer of help for our son. He really benefitted from being able to study at
home initially and then at school. We were very concerned that he may not be able to return to full-
time study after being ill with first episode psychosis but with the help provided through ESMA we are
beginning to believe that this will be possible. Thank you!’ – Parent
‘It’s a fantastic service and we wouldn’t be where we are today without it. My son is attending daily
and beginning to go into classes’ - Parent
24
‘Following the support I achieved 2 Grade 7’s in my mocks in English. I really valued my time with my
Support Teacher’ - Pupil
‘The tutors are helpful, knowledgeable and flexible. The service is invaluable as a means to support
students’ - School
‘It is a shame that ESMA (now SEND) has to offer time limited and results driven service, making you
have to focus so much on evidenced medical/psychiatric need since in this situation carrying on your
involvement might have helped towards a breakthrough in pupil’s full return to school - CAMHS
25
4.4 Financial Information19
ESMA is funded from the High Needs block of the Dedicated Schools Grant (DSG) available to the local
authority.
The Forest House20 rent is paid for out of the ESMA budget.
There are also costs resulting from funding the education of children placed by the health service in
private hospitals/clinics (expenditure sometimes referred to as “recoupment”). These costs are based
on incidents of medical need and thus are highly variable.
There is currently no separate budget for expenditure related to education at private hospitals/clinics
and thus in practice this expenditure is met from the ESMA budget, resulting in an overall overspend.
However, the high needs budget proposals for 2019-20 include the creation of a £200k budget for the
costs of education in private hospitals/clinics.
Recoupment Costs
Recoupment costs 2015-16
Recoupment costs 2016-17
Recoupment costs 2017-18
Recoupment costs 2018-19
(estimated)
£225,000 £257,395 £276,822 £200,000
ESMA Costs 2017-18
ESMA Budget
Specialist Advisory Teachers
Variable Hours Teachers
Forest House rent
Specialist Services21
Total
£1,032,492 7.8 FTE 25 staff
£485,005 £256,764 £53,564 £27,873 £823,206
ESMA Forecast 2018-19
ESMA Budget
Specialist Advisory Teachers
Variable Hours Teachers
Forest House rent
Specialist Services
Total
£1,032,492 9.8 FTE 25 staff
£527,800 £322,088 £53,564 £32,802 £936,253
The budget for 2019-20 has not been approved at the time of writing but is expected to remain of a
similar level.
19 All financial information was provided by Herts Finance service for Education and Services for Children and Young People. 20 FHEC is a hospital school for 13-18 year old students, attached to the Forest House Adolescent Unit, a Tier 4 CAMHS in-patient facility on the Kingsley Green hospital site. 21 This includes specialist staff training, services such as MyTutor and consultancy fees for specialist services.
26
4.5 Key Findings 4.5.1 Perceived impact of restructure process. ESMA staff have expressed a feeling that the
removal of the two previous senior teacher posts, who had responsibility for tasks such as stakeholder manager, liaison with healthcare colleagues, managing meetings, managing case drift and reporting, has reduced the capacity of SATs to provide as much teaching or early intervention work as they are covering wider functions.
It was expressed by a number of staff, and acknowledged by some senior staff spoken to, that communication with staff during the restructure was limited. This has meant that staff were not fully engaged and as a result there is some level of staff dissatisfaction, although there was no evidence witnessed during the review to suggest that staff are letting this impact their day to day role.
4.5.2 Embracing ‘Smart Working’. Whilst ESMA staff have phones on which they can access their emails when out of the office, their laptops lack 3G connectivity and rely on teachers being in locations with access to WIFI to connect to service systems. Furthermore, many laptops are heavy and not conducive to working remotely.
4.5.3 Staff specialisms, ongoing training and development. Having met with a number of ESMA staff during the review it was evident that members of staff have a sound knowledge not only in relation to their curriculum specialism but also in relation to specific medical conditions. It was also apparent that staff have an appetite for continued learning and development, in a wide range of topics in order to expand their knowledge and ability to support the diverse nature of the ESMA cohort. For example, some members of staff have commenced training on the SCERTS model to support their work with pupils with ASD.
4.5.4 Expressed limitations to the introduction of a matrix management approach. Many of the SATs expressed a view that the move to a matrix management approach has meant that supervising staff do not yet have the comprehensive knowledge and understanding of the ESMA cohort’s needs and therefore are not always providing effective advice and guidance through supervision.
Staff expressed that whilst they sit within multi-disciplinary teams and can discuss some relevant cases with these teams, the dispersal of ESMA staff across teams has meant that there is no formal opportunity to discuss cases with ESMA colleagues. It was apparent when hearing about some of the complex cases supported by ESMA that the opportunity to discuss cases in a group supervision forum was highly valued but does not happen formally anymore.
4.5.5 Lack of independent service scrutiny or quality assurance. There is no independent scrutiny undertaken of the service in terms of the quality of teaching. The need for a quality assurance mechanism which monitors outcomes as well as teaching standards was highlighted through several parental responses to the survey. It is understood that a structured lesson observation checklist is currently being developed to assist Lead Practitioners in undertaking lesson observations.
4.5.6 Service evaluation forms from 2017-18 show that the majority of those who responded value and appreciate the ESMA service. It is positive that the service strives to gain feedback from those whom have accessed the service as it also highlights areas for improvement and development. Much of the feedback gathered through the service’s own evaluation forms was also reflected in responses to this review’s survey.
27
4.5.7 Variable Hours teaching staff costs account for a significant level of budgetary spend (24.9% in 2017-18). However, this approach to resourcing offers limited flexibility in terms of availability as the role is often accommodated around other commitments. In addition, contracts have not been reviewed or updated since 2005.
4.5.8 Increased spend forecast for 2018-19. Contributory factors to increased spend in 2017-18 will include the introduction of the MyTutor online learning service which costs £19/hour and the replacement of teaching and learning responsibility (TLR) payments with SEN point 2 payments to SATs.22 However, the forecast accounted for 9.8 FTE SATs whilst there are currently only 8.8 (including the ESMA Coordinator) in post. It was difficult to establish whether the service is offering value for money due to complexities of the service’s finances.
22 See page 21 for detail on replacement of TLR payments with SEN points.
28
5. Service Data23 Exploring ESMA’s data has been challenging not least due to the dynamic nature of the service and
needs of the children and young people receiving support but also due to the systems in place.
To provide some context in relation to the ESMA cohort demographic, caseload data as at 18
December 2018 has been used to highlight key trends as well as provide a picture of the service’s
demands and provision.
Whilst this data is a snapshot in time, it reflects the general cohort and predominant medical reasons
for accessing the service.
The total caseload as at 18 December 2018 was 154.
5.1 Gender/Age Female students account for 60% (93) of the cohort, with the most significant representation evident
between the ages of 14 and 15.
Representation amongst the ESMA caseload is higher from male students up until the age of 14.
When looking at the medical needs of the cohort against the gender split, female students represent
the majority of ‘Mental Health – Anxiety’ primary need cases at 66%.
23 All service data included in this section was provided by the ESMA service.
0
5
10
15
20
25
30
35
40
5 6 7 8 9 10 11 12 13 14 15 16
Tota
l
Current Age
Gender/Age
Female
Male
29
5.2 Medical Reason/Length of Support Whilst there is no defined time limit to ESMA support24 and the length of support can vary based on individual need, out of 154 current cases 64% have been open for 3
months or less, whilst 5% (8) of cases have been open for 12 months or more.25
24 Although during the review ESMA staff expressed a belief that the aspired limit to ESMA support from senior management is one term, which equates to roughly three and a half months. 25 8 cases open for 12months or more = 5 anxiety and 3 oncology.
51
12
140
12
1910
2
18
13
123
12
1
1
2
10
1
3
1
21
11
11
1
1
1
8
1
1
1
1
4
11
11
5
11
1
C H R O N I C F A T I G U E - P O S T V I R A L / G L A N D U L A R F E V E R
C H R O N I C F A T I G U E - P O S T V I R A L / G L A N D U L A R F E V E R , M E N T A L H E A L T H - A S D …
G A S T R O E N T E R O L O G Y - C R O H N ' S D I S E A S E
I N F E C T I O N S - O T H E R
M E N T A L H E A L T H - A N O R E X I A N E R V O S A
M E N T A L H E A L T H - A N O R E X I A N E R V O S A , M E N T A L H E A L T H - A S D & A N X I E T Y
M E N T A L H E A L T H - A N X I E T Y
M E N T A L H E A L T H - A N X I E T Y , C H R O N I C F A T I G U E - P O S T V I R A L / G L A N D U L A R …
M E N T A L H E A L T H - A N X I E T Y , M E N T A L H E A L T H - D E P R E S S I O N
M E N T A L H E A L T H - A N X I E T Y , M E N T A L H E A L T H - O T H E R
M E N T A L H E A L T H - A N X I E T Y , N E U R O L O G I C A L - O T H E R
M E N T A L H E A L T H - A N X I E T Y , O R T H O P A E D I C - O T H E R
M E N T A L H E A L T H - A S D & A N X I E T Y
M E N T A L H E A L T H - D E P R E S S I O N
M E N T A L H E A L T H - O T H E R
N E U R O L O G I C A L - M I G R A I N E
N E U R O L O G I C A L - O T H E R
N O T R E C O R D E D
O N C O L O G Y - B O N E
O N C O L O G Y - L E U K A E M I A
O N C O L O G Y - L E U K A E M I A , O N C O L O G Y - O T H E R
O N C O L O G Y - O R G A N S
O N C O L O G Y - O T H E R
O P E R A T I O N - O T H E R
O P E R A T I O N - O T H E R , O T H E R
O R T H O P A E D I C - O T H E R
O R T H O P A E D I C - S C O L I O S I S
O T H E R
Medical Reason/Length of Support
Under 3 months 3-6 months 6-9 months 9-12 months 12 months+
30
5.3 Medical Reason by Year Group When considering the medical needs of the cohort there is a mixture of physical medical illness/injury as well as
mental health illness listed.
It is evident that ‘Mental Health – Anxiety’ accounts for the most significant level of medical need within the cohort
(44%), particularly for school years 9 to 11.
1
2
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
2
3
1
1
1
2
5
1
2
1
1
10
6
2
3
2
1
2
1
2
1
16
2
3
1
1
3
2
4
1
31
1
1
1
1
1
1
5
3
1
1
1
1
2
1
C H R O N I C F A T I G U E - P O S T V I R A L / G L A N D U L A R F E V E R
C H R O N I C F A T I G U E - P O S T V I R A L / G L A N D U L A R F E V E R , …
G A S T R O E N T E R O L O G Y - C R O H N ' S D I S E A S E
I N F E C T I O N S - O T H E R
M E N T A L H E A L T H - A N O R E X I A N E R V O S A
M E N T A L H E A L T H - A N O R E X I A N E R V O S A , M E N T A L H E A L T H …
M E N T A L H E A L T H - A N X I E T Y
M E N T A L H E A L T H - A N X I E T Y , C H R O N I C F A T I G U E - P O S T …
M E N T A L H E A L T H - A N X I E T Y , M E N T A L H E A L T H - …
M E N T A L H E A L T H - A N X I E T Y , M E N T A L H E A L T H - O T H E R
M E N T A L H E A L T H - A N X I E T Y , N E U R O L O G I C A L - O T H E R
M E N T A L H E A L T H - A N X I E T Y , O R T H O P A E D I C - O T H E R
M E N T A L H E A L T H - A S D & A N X I E T Y
M E N T A L H E A L T H - D E P R E S S I O N
M E N T A L H E A L T H - O T H E R
N E U R O L O G I C A L - M I G R A I N E
N E U R O L O G I C A L - O T H E R
N O T R E C O R D E D
O N C O L O G Y - B O N E
O N C O L O G Y - L E U K A E M I A
O N C O L O G Y - L E U K A E M I A , O N C O L O G Y - O T H E R
O N C O L O G Y - O R G A N S
O N C O L O G Y - O T H E R
O P E R A T I O N - O T H E R
O P E R A T I O N - O T H E R , O T H E R
O R T H O P A E D I C - O T H E R
O R T H O P A E D I C - S C O L I O S I S
O T H E R
Medical Reason by Year Group
Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9 Year 10 Year 11 Year 12
31
5.4 Annual Comparisons in Caseloads
The below charts show annual trends in open and closed cases across the academic year.
Peaks in open cases are commonly seen in April, mid-way through the academic year where exam
pressures often increase.
Whilst it is early in the 2018-19 academic year, this chart shows that the number of open cases is
already higher than previous years.26 Should the trend follow that of previous years there is another
five months before the caseload reaches its peak.
The high number of open cases can, in part, be attributed to a change in process whereby a case is
opened when only advice and guidance is being provided.
26 December data was not included as a full month of data was not available as at 18 December 2018.
155
142
137
0
20
40
60
80
100
120
140
160
180
Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
No
. of
Op
en C
ases
Month
ESMA Open Cases
2016-17 2017-18 2018-19
0
5
10
15
20
25
30
35
40
45
50
Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
No
. of
Clo
sed
Cas
es
Month
ESMA Closed Cases
2016-17 2017-18 2018-19
32
5.5 Average Hours of Weekly Teaching Whilst full-time education usually equates to 25hours/week, guidance recognises that if pupils are receiving one-to-
one tuition, the hours of face-to-face provision could be fewer as the provision is more concentrated. It is not for local
authorities to match the number of hours of education a pupil has missed, but to consider what education the child
can take given the medical conditional and educational needs. To this end there is no defined aspiration as to the
number of hours Hertfordshire will provide although it was stated during the review that on average it equates to 5-
6hours, when service has capacity to do so.
The table below, provided by the service, shows the current number of ESMA support hours being provided per a
week27; total number of hours; caseload total28; and average hours of support, broken down by ISL area as at 31
December 2018.
English Maths Science MyTutor Reintegration Total Support
Hours
Total Current
Caseload
Total Average Hours
Wat
ford
&
Thre
e R
iver
s
8.5 8 8.5 - 5.5 30.5 7 4.4
St A
lban
s &
Dac
oru
m
24.5 16.5 11 6 17 75 24 3.13
No
rth
Her
ts &
Stev
en
age
22.75 27.25 24 11 14 99 22 4.5
EH,
Bro
xbo
urn
e,
Wel
wyn
&
Hat
fiel
d
18.5 13 8.5 - 1 41 14 2.93
TOTAL 74.25 64.75 52 17 37.5 245.5 67 3.66
According to this data the overall service average number of support hours in place is 3.66hrs/week.
27 It is important to note that not all ESMA pupils will require support in all core subjects as they may be accessing lessons on a reduced timetable at their mainstream school. 28 These are live cases receiving ESMA support as at 31 December 2018, other cases are open to ESMA but may only be the provision of advice and guidance rather than formal teaching interventions.
33
The service has provided the below table which presents the current ESMA teaching hours as at 31 December 2018 against staff availability in order to consider service
capacity.
Teaching Hrs allocated/week
SATs availability per subject in hrs
SATs FTE capacity/subject VH Teachers Hours current availability
My Tutor Reintegration Primary Teachers Available
ISL AREA English Maths Science English Maths Science English Maths Science English Maths Science St. Albans & Dacorum 24.50 16.5 11 32.5 16.25 16.25 1 0.5 0.5 6 0 0 6 17 3
Watford, Three Rivers & Hertsmere 8.50 8 8.5 26.0 0.8 7 0 0 0 5.5 1
North Herts & Stevenage 22.75 27.25 24 29.25 29.25 0.8 0.8 6 5 3 11 14 1
EH, Broxbourne, Welwyn & Hatfield 18.50 13 8.5 26.0 32.5 0.8 1 5 1 0 0 1 1
Total 74.25 64.75 52.00 32.50 71.50 104.00 1.00 2.10 3.10 24.00 6.00 3.00 17.00 37.50 6
Surplus/Deficit* -17.8 12.8 55
The availability of SATs in relation to available teaching hours must also take into account the requirement of them to undertake broader activities that sit within their role.
For example, initial meetings for new referrals, review meetings (held every 6weeks), case management of VH teachers, planning and preparation time for lessons (10%), time
to liaise with health to ensure ESMA support is not impacting on pupil’s health and updating of records.
Furthermore, the SATs capacity to teach is further reduced by the hours used to deliver reintegration support including discussions with schools, modelling and exposure
support all delivered to ensure successful reintegration.
Online tutoring, currently provided by MyTutor, is helping to address capacity. In North Herts & Stevenage a new agency, Educ8, is currently being explored to deliver tutoring
following which the cost effectiveness of this resource will be compared against the use of VH teachers to consider the most cost-efficient model.
34
5.6 Emerging Challenges and Caseloads
The service is currently facing several challenges:
• High number of anxiety ASD referrals - 13 pupils (8%) as at 18 December 2018.
• High number of mental health referrals who often require long periods of support – 101
pupils (66%) as at 18 December 2018.
• Having to provide long-term educational support to children for whom reintegration to their
roll school is not going to be viable, but whom need or are going through an Education,
Health and Care Plan (EHCP) assessment.29
In 2017-18 out of the 254 children supported by ESMA, 40 were under an EHC Needs Plan
Assessment, or already had one in place.
The caseload, as at 18 December 2018, shows that currently 39 children are being supported by
ESMA who are either: under an EHC Needs Assessment Plan (18); already have a plan in place (18) or;
have exceptional needs funding (3).
The table below shows the current caseload per quadrant as at 18 December 2018 ranked highest to
lowest:
ESMA Area Current Caseload by
Quadrant30
1. St. Albans & Dacorum 51
2. East Herts, Broxbourne, Welwyn & Hatfield 45
3. North Herts & Stevenage 37
4. Watford, Three Rivers & Hertsmere 21
29 A decision is made within 6 weeks as to whether to carry out the assessment. If the assessment shows a need for an EHC plan, this will be produced within 20 weeks of the request. 30 Not all active cases will require active teaching, they may be receiving another programme of support such as advice and guidance only.
35
5.7 Additional Teaching Options
Alongside 1:1 teaching in English, Maths and Science ESMA also provides access to:
- Online tuition via MyTutor.
- Paired/group teaching at schools or Educational Support Centres (ESCs).
There is an expectation that schools should continue to support students receiving ESMA support
with wider subjects and schemes of work.
Online tuition
In September 2018 ESMA began using MyTutor, an online tutoring service, to provide complementary
teaching input alongside 1:1 teaching and other independent learning activities. The service is staffed
by high achieving undergraduates from top UK universities.
Students can talk to their tutor via live video or instant messaging, the system allows the upload of
documents into the ‘Online Lesson Space’ and students work through problems in collaboration with
their tutor using an interactive whiteboard.
Due to the infancy of this provision there is limited feedback available although, some members of
ESMA staff have reported it provides a useful report which can be used in review meetings and the
service responded to issues raised when requested. There is currently limited feedback available from
pupils.
Small group teaching
Where there is more than one pupil from the same school/setting there are some instances where
small group or paired teaching is being used. Paired teaching is currently underway, or has recently
concluded, in two ISL areas whilst in North Herts and Stevenage there are two small teaching groups
currently active.
This is of particular importance when there is a real likelihood of reintegration as it builds socialisation
skills and confidence, as well as offering a cost-effective use of ESMA resources.
A case study can be found on the following page.
36
Case Study
ESMA have taught pupils in small groups on site at the Stevenage Education Support Centre (ESC)
since November 2017.
Having this provision for group teaching has enabled several pupils with complex mental health needs
access education. These pupils are unable to attend any education support provided on site at their
mainstream schools, a view that is documented by the health professionals working with them too.
The ESMA ESC group allows these pupils learn in an environment in which they feel safe and make
academic progress. Due to this kind of support two pupils were able to take their GCSE exams last
summer and progress to college.
The group offers a bespoke programme delivered to meet the needs of the pupils. For one pupil
during a particularly difficult time provision could be made (following a risk assessment) for her dog to
accompany her to lessons and sit under the table, this made the difference between the young
person being isolated at home and being able to join a group and continue her education.
Pupils are given the opportunity to work alongside peers which in turn develops their social
confidence skills and understanding of others. At the ESC ESMA have access to a Science laboratory so
pupils are able to complete the required GCSE practical Science assessments.
The group provides 2 hours of Maths, 2 hours of English and 1.5 hours of Science teaching input each
week.
The ESMA group at the ESC has provided support for two pupils supported by ESMA while alternative
educational provision has been identified by their Education, Health and Care Plan (EHCP).
Parents of pupils who attend the group similarly value the opportunity to meet one another and build
support networks. The venue has also been used by ESMA to deliver a parent’s workshop, in
conjunction with the local CAMHS team, whilst the young people have been having the lessons in
adjacent classrooms.
The ESMA group provision has allowed the service to maintain support for several pupils who without
this would have been closed to the service and as a result left education with few or no qualifications.
All the pupils who have accessed the ESMA ESC group have made academic and emotional progress.
The feedback from both pupils and families has been that they have really appreciated the
opportunity for support in this way.
37
Mainstream school provision
Schools should maintain involvement and be providing teaching support and resources throughout
ESMA involvement, with ESMA fitting around and adding to that offer.
Some schools have embraced online learning systems such as Google Classroom and Academy21
which can also be used by students whilst they are receiving ESMA support. This allows them to
access actual taught content from their roll school and in some instances collaborate with their peers
on pieces of work, thus supporting eventual reintegration ambitions by maintaining active links to the
school community.
The availability of such resources were reported by ESMA staff to have a positive impact in terms of
minimising the amount of planning and preparation work they have to undertake as they can support
the child in accessing the school’s content.
Schools are expected to provide additional learning content to students whilst they are receiving
support from ESMA whether that be through an online/virtual platform, worksheets and other such
resources.
This can also involve students attending schools on reduced timetables to access other subjects as
appropriate to medical and academic need.
Case study
An example of a mainstream school providing significant and meaningful provision alongside ESMA
was evidenced in the case of a student under oncology treatment.
The student was able to have PowerPoint lesson slides on a laptop screen whilst FaceTiming into the
classroom live using an iPad. This enabled the student not only to access live lessons but to interact
with peers and partake in group work. This allowed the student to continue learning and keep up with
their educational attainment.
38
5.8 Key Findings 5.8.1 IES does not offer timely or comprehensive functionality to extract service data. The current
system does not easily allow for the extraction of service data in order to understand current
resourcing requirements, support programmes in place for children and young people and
progress made. Much of the service’s work is captured on reporting and monitoring forms
which are not live documents within the database. In part these challenges are due to
limitations with IES but it is also due to variable consistency in the accuracy and timely
updating of individual cases by staff.
5.8.2 Clear understanding of the cohort. Throughout the review, through discussions with staff and
wider stakeholders, there was clear and consistent recognition of the needs of the ESMA
cohort, current as well as emerging – mental health issues primarily among females in
secondary education, as well as an increase in the number of ASD high anxiety referrals.
5.8.3 Variable consistency in record-keeping. There is some variation amongst staff in the
consistency and fullness of information when updating case notes. It is understood that the
Quality Assurance Performance Lead is running weekly reports from IES to identify missing
data and following this up with staff members.
5.8.4 Average weekly hours of teaching delivered and service capacity. According to the data
provided by the service at this time whilst one area, is delivering 4.4 hours of support on
average, across the whole service the average number of weekly ESMA support hours
provided is 3.66, including MyTutor. Whilst statutory guidance does not specifically specify
the number of hours that should be provided by local authorities, given that full time
education is usually 25 hours a week, acknowledging that 1:1 teaching is considered three
times more intensive than classroom teaching and recognising that pupils are able to engage
with some independent study, the service is currently delivering below their aspirational 5
hours a week.
When considering this against the service’s capacity amongst staff it is apparent that
currently the service has a deficit in relation to delivery of English teaching. It is also clear that
the range of additional tasks to be completed by SATs further reduces their capacity to deliver
teaching.
5.8.5 The number of referrals for mental health needs has significantly increased. ESMA staff stated
they work closely with CAMHS to ensure children are receiving support for their medical need
although CAMHS have limited resources available so outreach support from CAMHS is lacking.
ESMA staff have been upskilled in mental health awareness training yet recognise that they
are not mental health professionals, instead they are able to signpost schools/setting and
families to NHS approved resources such as Kooth31.
5.8.6 Need for a universal, quality assured online learning platform. Whilst the local authority is
embracing online learning platforms to complement traditional forms of teaching, the
provision is not currently suitable for those children of primary school age and a couple of
31 An online counselling and emotional well-being platform for children and young people.
39
internal staff have raised queries as to how the service was selected and how quality
assurances is monitored.
5.8.7 Positive use of small group/paired teaching. Whilst there are examples of small group teaching
currently in place and being effective, it is not commonplace across all areas yet. Although it
is recognised that the viability of this depends on the nature of the medical need and
individual pupils.
5.8.8 Evidence of innovation. In 2017-18 ESMA piloted the use of iPads as a means of assisting
pupils in maintaining links to their school both socially and academically by allowing pupils to
access live lessons using FaceTime and engage with their peers. Feedback at the time was
positive.
A mentoring pilot is currently being explored and is hoped to commence in January 2019. The
idea is that the mentor will focus more on building self-sufficiency of pupils. Currently
anticipated to be piloted in North Herts and Stevenage with two pupils. The length of support
has not been formally defined at this time but would not be anticipated to go beyond one
term.
40
6. Delivering positive outcomes for families, schools and
settings 6.1 Key Performance Indicators
During the review the service identified two Key Performance Indicators (KPIs):
1. Number of children reintegrated back into school32
2. Progress of child both academically as well as emotionally
Case studies and data for 2017-18 was supplied by the service to provide evidence of performance.
Reintegration
Reintegration is one of the main aims of the service, in order to support this where possible all
teaching takes place within the school setting (this includes a range of environments depending on
what is available).
Where teaching on site is not possible ESMA teachers will endeavour to find a local venue such as a
public library, where the pupil feels relaxed and able to study. Only in exceptional circumstances, and
in the presence of parents will teaching take place at home.
To support this, as mentioned earlier and where opportunity allows, some small group teaching takes
place which positively contributes to reintegration by encouraging socialisation skills.
Case Study
Three pupils in Year 11 from the same school were referred to ESMA at the start of the year due to
extreme anxiety, some ASD, all of whom were not attending school but were receiving support from
CAMHS.
A small group teaching group was established onsite.
A positive impact of this arrangement on the pupils has been visible. All three students have recently
sat most of their mock exams in a small room on school premises and are now interacting better with
each other. It is still possible to ‘see’ symptoms of their anxiety if someone new to them comes into
the room but they are more relaxed with each other and we have also seen improvements in the way
they interact with the teachers.
One of the pupil’s is now partly reintegrated on a reduced timetable and the other pupils are both
staying in school after/before the group to do some independent work on other subjects, although
they still find this hard.
Parents of the pupils are relieved that their children are now happier to attend school and that it is
not a struggle to get them out of bed anymore.
Parents of the pupils also attended a recent session arranged by one of the SATs on parental
emotional well-being.
32 A caveat to this is that there are some occasions in which reintegration or full-time attendance will not be possible for some of the children and young people ESMA support, particularly those with complex MH needs.
41
ESMA has a range of reintegration resources available for staff to use but also to provide to schools.
For ESMA staff these include various worksheets to complete with pupils to help them manage
concerns and track progress against reintegration steps.
For schools there are also various resources available including advice and guidance sheets on
anxiety, well-being and resilience, as well as activity sheets which schools are encouraged to work
through with pupils to build self-esteem and resilience once back in the school environment.
Some pupils are able to access a reduced timetable as part of a phased reintegration, this is
encouraged particularly for core subjects. Schools are encouraged, and indeed sometimes ESMA will
contribute towards teaching support from within the school for a fixed period of time to support the
child during free periods, although it was suggested this is not commonplace.
Some examples of how reintegration of ESMA students has been supported can be found in Appendix
A.
Data provided by the service states that during 2017-18 254 children were supported by ESMA – 112
for physical medical need and 142 for mental health needs. For 66% (168) of these children successful
reintegration was possible.
The below chart shows the alternative pathways for 59 children who did not reintegrate back to their
original school/setting during 2017-18:
The remaining 27 cases only involved ESMA providing advice.
1
3
3
4
5
9
10
11
13
0 2 4 6 8 10 12 14
Chose Elective Home Education
Changed school
Deceased
Moved out of Hertfordshire
Alternative ISL Team
Forest House Day Programme
Alternative Programme e.g. College
Parents declined further support
Too unwell to continue accessing education on advice ofhealth
2017-18 Alternative Pathways
42
Academic Progress
ESMA staff use a range of baseline tools, such as school provided attainment information as well as
the Pupil Attitudes to Self and School (PASS) assessment, to understand the level of academic
knowledge as well as emotional vulnerabilities of individuals on entry to ESMA. This is used to assist in
the planning of work and provide a measure against which progress can be reported through
monitoring and review meetings.
Attendance and attainment details for students should pull through to IES from SIMS (a School
Information Management System) however this is not currently available so ESMA staff request this
information from schools.
Service data states that in 2017-18 ESMA supported 44 students during year 11 of which 34 were able
to sit their exams in English, Maths and Science.33
The above chart shows GCSE achievement for pupils supported by ESMA during 2017-18. September 2017 saw
the previous letter gradings being replaced with numerical grades for all subjects. Information of equivalent old
grades can be found here.
For 2017-18 two students were Not in Education, Employment or Training (NEET). Assurances were
made that YC Herts was involved in supporting the two individuals without a post-16 destination.
In relation to emotional progress, no tangible data was available to provide evidence.
33 English includes both English Language and English Literature grades.
5 5
9
6
2
10
8
2
5
4
5
7
4
2
7
11 1
0
2
4
6
8
10
12
English Maths Science
Tota
l
Subject
GCSE Results For Yr11 Pupils Supported By ESMA 2017-18
1 2 3 4 5 6 7 8 9
43
6.2 Additional Impact Measures When asked staff also listed some of the following as ways in which they feel they evidence impact:
• Monitoring forms – completed after every lesson these provide a good dialogue and written
record of effort shown by student and attainment based on current grade, if studying for
GCSEs, or as working at greater depth; working at; working towards expected standard.
• Review meeting forms – these take place every 6 weeks and provide an overview of attendance
and current level of achievement. It also details some targets for the pupil to work towards and
reflect on.
When ESMA staff were asked, as part of the survey, if a formal outcome measurement tool would
help the service provide some tangible quantitative capture of service impact 40% felt it would help.
When asked about what this could look like suggestions included:
• A scaled baseline tool similar to that used by the Educational Psychology Service.
• ISL needs to identify Key Performance Indicators for all ISL teams and create a dashboard
where that information can be recorded and retrieved. This information could be collected on
a termly basis with a final analysis at the end of the summer term leading to next steps and
next target measures.
ESMA is a teaching outreach service so measurements should be of:
- attendance
- attainment and progress
- high quality teaching and impact
- curriculum development and delivery
- reintegration figures/post 16 destinations
44
6.2 Key Findings 6.2.1 The Integrated Education System (IES) used by the service currently does not pull through
school attainment or attendance information. The system used by ESMA does not pull through attainment and attendance data from the School Information Management System (SIMS) so information is manually requested from schools in order to provide student baselines and attendance levels. It is understood that there is currently an ISL workstream underway to explore this issue.
6.2.2 Variable consistency of KPIs. Whilst the service is able to outline their two main KPIs, the Quality Assurance Lead highlighted that there is variation amongst staff as to the consistency in recording KPI information which can impact on the fullness of data available during reporting. This is also in part impacted by the lack of live attendance and attainment information available of IES. Processes have already been developed by the Quality Assurance lead, in conjunction with the Lead Coordinator to drive compliance.
6.2.3 Clear focus on reintegration. All ESMA staff spoken to and wider stakeholders engaged with during the course of the review highlighted reintegration as being a successful outcome of ESMA support. It is apparent that staff work towards this with pupils, appropriate to individual need, in a variety of ways such as small group teaching, support with accessing reduced timetables, exposure work as well as providing advice to schools. The service has a diverse range of resources to support reintegration both for ESMA staff but also resources and tools which provide schools with advice and strategies to support pupil’s transitioning back into their school/setting.
6.2.4 Lack of governance or oversight. There is no overarching governance structure monitoring the service or reviewing performance which could provide transparency to the service and ensure that the service is delivering positive outcomes for families, schools and settings.
Furthermore, whilst the ESMA Lead Coordinator independently undertakes an end of academic year review of the service to identify trends such as high referring schools and highest need, this is only used for her own planning as it is not something that is requested by senior management.
6.2.5 Clear service targets. A ‘Curriculum Policies and Team Plans Evaluation’ document was completed for 2017-18 which provides an overview of how the service has met their Team Plan targets. From reviewing this document there was sufficient information recorded to show progress against such targets.
In 2018-19 there is an ‘ISL Priorities and ESMA Targets’ document in place which outlines six main targets as well as showing how the ESMA plans to deliver their service in line with Hertfordshire’s Outcome Bees - Appendix B.
6.2.6 Recognition of need for consistency in baseline and ongoing measurement. The service recognises the need to have consistency in baseline and ongoing measurement tools in order to be able to quantitatively provide evidence of pupil progress and thus service impact, alongside existing qualitative feedback.
45
7. Working with partner support services The service recognises that an effective package of support and smooth transition back into school for
children and young people recovering from illness is essential. To support this staff liaise and work in
partnership with a range of stakeholders, schools and settings to ensure effective planning and
delivery of support.
The list below outlines some (it is not exhaustive) of the key services ESMA work alongside outside of
schools and settings.
• Attendance Team • Educational Psychologists
• YC Herts • Chronic Fatigue Team
• Families First • Forest House
• Social workers • Crisis Assessment Treatment
• Intensive Family Support Team • Wider SEND departments
• CAMHS • Targeted Youth Support
Day to day conversations between colleagues across specialist services were observed as standard
working practice during this review. These conversations enabled two-way advice and guidance
sharing in relation to individual cases.
Appendix C presents some examples of ESMA’s partnership activities, identified during the course of
the review. This includes examples such as training, working groups and pastoral support groups as
well as joint-working with other local authority departments and healthcare professionals in order to
provide a joined-up approach.
Some examples of challenges and limitations to effective working with partner support services were
highlighted during the review both from face to face meetings as well as the survey.
• ESMA staff highlighted that a change of CAMHS worker can have a negative impact on an
individual however there was no data is available in relation to the frequency of this issue.
Furthermore, some reported that whilst CAMHS are always invited to case planning and
review meetings, there is variable attendance due to their work pressures, not because they
do not want to.
• A lack of consistency in the level of involvement and engagement from schools. It was stated
that in primary schools there is usually one key person with responsibility for the young
person but in secondary settings there seem to be more individuals involved with no clear
one person having ownership and being clear point for liaison. This has meant that ESMA staff
spend additional time building relationships with various staff members and repeating advice
previously given when it could be better managed within the school by a key point of contact.
• Other services and agencies do not always understand that ESMA is a reintegration service
which can sometimes mean they have unrealistic expectations about what support ESMA can
provide.
• Liaison with health colleagues can be difficult due to them being in clinics and appointments
for much of the day and ESMA staff travelling or teaching leaving little time to speak over the
phone or respond to emails. Whilst staff have mobile phones they are not able to take calls
46
whilst driving and the laptops that staff have are in the main not fit for purpose as they are
cumbersome and slow.
• The waiting lists for CAMHS are long which mean that the pupils may not be receiving any
treatment for their medical illness and so progress towards reintegration cannot be made.
Furthermore, a pupil may have their initial CAMHS appointment but next phase of therapy
may have a 4-6month waiting list.
• Staff within schools and settings are not always aware of their statutory responsibilities
around the education of young people with health needs. In addition, classroom teachers can
be difficult to engage with as they feel they are too busy.
Whilst ESMA do not directly refer individuals to agencies/services other than YC Herts, they do
encourage and advise schools to make appropriate referrals.
ESMA staff expressed that they feel they work well with other agencies and contribute to multi-
agency meetings, which is reflected in the survey feedback.
47
7.1 Key Findings 7.1.1 Significant range and scope of partnership working evident. The examples outlined in Appendix
C provide a comprehensive picture of the diverse ways in which the service seeks to engage
and support partners and wider stakeholders with variable aims including early intervention,
building parental resilience as well as simply ensuring that a holistic package of support is
provided for individual children and young people relevant to circumstance and need.
7.1.2 Recording the involvement of other agencies. In discussions with the ISL County Lead for SEND
SASS and the Quality Assurance and Performance Lead it was mentioned that the
involvement of other agencies/services, their role and actions, is not always clearly recorded
by ESMA staff on IES. Furthermore, feedback gathered from partners through the survey
expressed a wish for ESMA staff to inform relevant services of their involvement in cases in
order to seek joined-up working.
7.1.3 CAMHS engagement and capacity. With the increase in mental health related referrals to
ESMA, CAMHS have become a key link and there is much evidence of collaborative working,
particularly with the Schools Link Officer. However, the service continues to experience
variable involvement from wider CAMHS practitioners not for any reason other than capacity
of the service to meet demand which has implications for ESMA in terms of supporting pupils
with mental health illness.
7.1.4 Informal arrangements in place to support collaborative working. When working with partner
support services, for example CAMHS, unless they are formally providing support to an
individual, engagement between the two is in the main based on informal arrangements
across service areas. During the review, in conversations with CAMHS staff and the CCGs, it
was expressed that there is nothing in place to allow information sharing across agencies in
order to help gain an understanding of the scale of need, ensure individuals are known to
CAMHS or indeed be able to inform commissioning decisions.
7.1.5 School awareness and accountability. Staff reported variance among schools in terms of how
proactive and knowledgeable they are with regards to their responsibilities when it comes to
supporting children and young people with health needs, particularly mental health.
The service is already liaising with MH leads from schools with support from individual
Delivering Special Provision Locally (DSPL) networks, as well as engaging with CAMHS School
Link Officer in relation to monitoring whether high referring schools are engaging with MH
First Aid training.
7.1.6 Awareness of the service amongst partner agencies. From conversations and survey feedback
gathered as part of this review it has been highlighted that many services, including other
internal departments, do not fully understand what ESMA offer as a service, to whom and
how it can be accessed.
Furthermore, ESMA have strategies and resources which could be shared with wider internal
service areas such as SEND SATs to share knowledge and support early interventions to avoid
escalation of need and limit future demand on the service.
48
7.1.7 Working with Forest House (FH). Whilst it was agreed that FH was not to be considered as a
formal part of this review it is worth highlighting some comments made concerning the
relationship between ESMA and FH.
During the review ESMA staff reflected on the loss of the small group provision previously in
place at FH. ESMA staff, as well as the Executive Headteacher who has incorporated
responsibility for FH, felt the loss of this service has left a large gap in step-down from
residential provision and has diluted the relationship between ESMA and FH. The previous
group provided pupils with interim educational input and reintegration support which
supported socialisation and confidence building.
Whilst it is important to ensure that any provision at FH is not considered an alternative
provision but short-term period of support to achieve reintegration, it was suggested a
revised collaborative partnership would be worth pursuing in order to deliver a holistic
package of support to children and young people experiencing mental health illness, which
included some training to schools as part of a prevention approach but also to ensure those
pupils reintegrated are effectively supported within the school or setting.
49
8. Survey As part of this review an e-survey was open from 3 December to 26 December 2018 designed to gain
insight into experiences and gather feedback from which common themes could be identified and used
to inform this review.
The survey was circulated to 166 contacts, as well as being accessible on ESMA’s Hertfordshire Local
Offer webpage and circulated by Hertfordshire’s Parent Carer Involvement Forum to their network.
A total of 77 responses were received (46% return rate based on known circulation34) across the
audiences below:
Whilst the surveys were individually tailored to the audience types, there were some common question
themes which ran across all in relation to emerging needs; what successful outcomes look like for
families, pupils, schools/settings and ESMA; and areas for improvement.
More detailed summaries of the survey feedback can be found in Appendix D but for ease key findings
have been distributed throughout the report and included in findings used to inform recommendations.
34 It is not possible the number of people who accessed the survey link via HCPI’s network or on the Local Offer website.
25
4
20
15
13
0
5
10
15
20
25
30
Parent/carer Pupil ESMA staff School or setting Agency/Service Area
Survey Respondents
50
9. Recommendations Thirty-two recommendations are outlined below based on the findings outlined in this report. The
corresponding finding/s are referenced to the right for ease.
It is acknowledged that some of these recommendations are already in progress and as such they
have been highlighted in italics.
1. The platforms and resources used to outline the ESMA offer should be reviewed
and updated to provide consistency. To ensure tone and language of information
sources is clear to service users, the service should co-produce with key
stakeholders, including families and schools.
3.5.1
2. Senior management should clarify the expectations of the service to ensure it is
clear to schools, families, agencies and internal departments what service ESMA
offers, for whom and how it can be accessed.
3.5.2
3. ISL should consider whether ESMA should be repositioned as part of Access and
Inclusion rather than SEND as part of the SEND Transformation. This would likely
remove any confusion in terms of who the service supports and seem a more
natural fit in terms of nature of the service.
3.5.2
4. The service should develop a working group involving the CAMHS Schools Link
team and other key stakeholders, including school representation, to explore an
anxiety support pathway to prevent children from falling through gaps when they
are not attending school, awaiting a CAMHS appointment but unable to access
ESMA due to a lack of medical advice.
3.5.4
5. ESMA should swiftly establish links with the MHSTs to support early intervention
practices in schools for those experiencing mental health issues to prevent
escalation of need and ensure that children and young people have the right
support and treatment enabling them to remain in mainstream education
without a need for ESMA support, or indeed if ESMA support is required, that
children and young people are being dual supported by the MHSTs.
3.5.4 5.8.5 7.1.3
6. Review internal referral process within ISL, original ESMA referral form along with
additional notes should be enough to make a referral to an internal service area
without the need for a referral being required from the school.
3.5.5
7. Once finalised ESMA’s tiered approach should be shared with all schools/settings,
other relevant service areas and agencies as well as being made available on
Hertfordshire’s Grid for Learning. This information should also be used to inform
the ongoing strategic planning of the service.
3.5.6
8. The service should consider alternative, more cost-effective resourcing models to
deliver the programme of support which involves advising schools/settings on
supporting pupils with medical needs without ESMA teaching intervention.
3.5.8
9. ESMA staff should ensure case notes are updated on IES in a timely manner so
that effective monitoring of measures such as time taken to hold initial meeting
and allocate tuition can be undertaken.
To drive compliance weekly random checks could be conducted by the Lead
Coordinator following which the Quality Assurance Lead would be able to
3.5.9 5.8.3
51
produce a report from which any gaps can be addressed with staff to drive
recording standards.
10. The service should ensure that all staff have appropriate ICT equipment to enable
them to work remotely, without reliance on WIFI, so systems can be accessed and
as such records updated in a timely manner.
4.5.2
11. Pending consideration of recommendation 3, senior management should
undertake work with ESMA staff to ensure they understand the reasons behind
the restructure, the expectations of them in their role within a multi-disciplinary
service and are equipped with the appropriate skills to be able to fulfil their role.
4.5.1 4.5.3
12. Review training given to Lead Practitioners to ensure they are equipped to
understand the complexities of working with children with varying medical needs
in order to provide appropriate support, guidance and supervision to SATs.
4.5.4
13. Explore and develop opportunities for maintaining ESMA links across the service
area. This could include learning from other services the benefits of peer/group
supervision to reflect on complex cases by pooling skills, experience and
knowledge to improve the service provided, as well as providing objective review.
4.5.4
14. Ensure that lesson observations of both SATs and VHs are undertaken by
individuals outside of the service to ensure independence in assessments made
about standards of teaching and introduce a critical friend approach.
4.5.5
15. Explore how other services manage flexible teaching resources. For example, self-
employed teachers, to increase pool of resources but reduce expenditure.
Considerations should include availability requirements, but also the skillset to
support the emerging needs of the cohort. This links to managing the caseload
levels of SATs by providing increased availability of flexible teaching resources.
4.5.7 3.5.7
16. The service should work with Finance to undertake a more detailed cost analysis
of the service, including establishing the average cost of ESMA intervention per
pupil to gain a deeper understanding of the service’s capacity to meet demands,
as well as a cost benefit analysis of the introduction of MyTutor.
4.5.8
17. A consolidated case tracking database is required to enable clear recording of
ESMA interventions from which succinct data can be collated.
Whilst it is understood that a new system called EYES is currently being explored,
it is not yet known when this will be live. ESMA should ensure they are involved in
the development of EYES to make sure that it will enable the service to fully
evidence their impact and record outcomes for families.
5.8.1
18. Work underway by the Quality Assurance and Performance Lead to drive
improvements in recording standards should continue in order to ensure the
timely and robust collection of service data using the current system.
5.8.1 6.2.2 7.1.2
19. The service needs to review and take action to address service capacity and
resources to ensure that the average number of teaching hours increases for
those able to access them.
This should include the increased use of small group/paired teaching, expansion
of current or development of a new online platform, review requirement for
senior teacher roles (may not need to be qualified teachers) or similar being
reinstated in order to increase capacity of SATs to deliver curriculum teaching, as
well as general staff recruitment to fulfil deficits and increase capacity.
5.8.4
52
This is also linked to recommendations 5 and 15 in relation to early intervention
as diversionary measures and the exploration of flexible teaching resource.
20. Hertfordshire should review the due diligence process undertaken when selecting
MyTutor as the chosen online provider. They should also undertake regular
monitoring of MyTutor, including feedback from pupils, to ensure it meets quality
assurance standards.
5.8.6
21. In light of the increasing demands on the service, Hertfordshire should investigate
investing in a quality assured online learning platform which covers all key stage
levels, this could be developed as an in-house virtual classroom/online school
provision. It may be useful to look at Hampshire’s Place2Learn service or
Cambridgeshire’s Red Balloon of the Air.
5.8.6
22. Small group teaching should be arranged wherever possible in order to use ESMA
resources more efficiently (increase capacity and reduce travel time) and due to
the positive benefits this format of teaching has for the students in terms of
socialisation and peer support.
5.8.7
23. Regular monitoring and review points of the mentoring pilot should be agreed
within the first term to ensure that it is having a positive impact and is cost
effective. This should include feedback from the pupil; parent/carer; mentor;
ESMA teacher and school where possible.
5.8.8
24. Where schools are demonstrating good practice in providing additional support
to pupils whilst ESMA are involved, in particular the use of technology, ESMA
should ensure that examples are shared with other schools to highlight successful
strategies and systems which can positively contribute towards the child or young
person’s ongoing progress.
For example, this could be facilitated by an annual workshop/conference type
event, particularly for secondary schools, which provides the opportunity to share
best practice, advice and guidance, clarify the ESMA offer and allow inputs from
other relevant service areas or agencies as part of an early intervention model.
5.8.8
25. The existing ISL workstream should continue to seek solutions to address the
current gap in IES attendance and attainment information.
6.2.1
26. A monitoring function/governance model should be implemented in order to
hold the service to account. The production of an Annual Report, reporting
against service targets, at the end of each academic year would provide an
overview of service activity, thus evidencing impact, value for money, inform
planning for the upcoming year and provide partner agencies with an overview of
the service.
6.2.4 6.2.5
27. A robust outcome measurement tool should be developed which evidences
impact of ESMA support serving as a performance management tool but also to
evidence progress made to support reintegration, both academic and emotional.
Thus, it should capture a baseline and subsequent measurements across the
course of ESMA support.
For example, this could include development of a 10-point scale or some form of
scoring against the 6 Outcome Bees, in any case the selected model would need
to be built into service systems.
6.2.6
53
28. The service should review the amount of time spent on partnership activities to
evaluate the value added as a result. Whilst there are many positive examples of
partnership working it may be that some involvements could be scaled back to
increase service capacity to fulfil core service functions.
7.1.1
29. The service should explore the development of a joint-working procedure which
outlines processes to be followed when other agencies/services are involved in
individual cases to ensure there is common understanding of roles and
responsibilities, to avoid duplication. This should include timely and routine
recording on IES.
7.1.2
30. Formal data sharing agreements should be introduced to ensure that key external
agencies/services have information available to make informed commissioning
decisions based on evidenced need. Furthermore, it enables checks to be
undertaken to ensure that children and young people are known to services and
receiving some level of support appropriate to need.
7.1.4
31. ESMA should continue to maintain links with CAMHS School Link Officer to
monitor whether high referring schools are engaging with MH First Aid training.
7.1.5
32. Develop a short training package, including strategies to use when supporting
school related anxiety refusers, which can be delivered to upskill wider staff
working within schools and settings as part of early intervention approach and
reduce demands on the service for advice.
7.1.6
33. The service should consider reviewing how it works collaboratively with Forest
House to support step-down from residential provision and upskill schools in
successful reintegration support.
7.1.7
54
10. Concluding Comments It is clear from feedback gathered during the course of the review that support and advice from the
ESMA service is well received by the majority of schools, pupils and parents who are currently
accessing or have previously accessed it. Although the reoccurring theme within feedback in relation
to service improvement was focused on the capacity of the service to support pupils for longer
periods of time and provide more hours of teaching.
During the review it was apparent that ESMA staff are committed to the children and young people
they support but, the growing demands on the service has placed additional pressures on the SATs
which, combined with limited availability amongst VH teachers to provide the additional teaching
resource, has meant the service is finding it challenging to deliver a sufficient number of teaching
hours to pupils able to access them.
There is evidence of the service embracing technology and small group/paired teaching to increase
capacity and make efficient use of resources. However, there is room for this type of provision to be
further developed and expanded in order to move away from traditional 1:1 teaching and embrace
more technologically advanced options. It is acknowledged that this also involves schools making
better use of available technology.
If the service considers and takes action in line with the recommendations contained within this
report, it is expected that the service will be able to evidence its impact and the outcomes achieved
for families and schools/settings in a more coherent and comprehensive manner. Furthermore, it is
hoped that by continuing to work closely with the CAMHS Schools Link Officer as well as the new
Mental Health Support Teams, that early intervention pathways can be established in order to
prevent escalation of need, divert children and young people away from requiring ESMA support and
bridge the current gaps, thus enabling pupils to remain within their mainstream school with effective
support in place.
I would like to take this opportunity to thank the ESMA staff for allowing me to shadow their work,
attend meetings and for providing input into the review by way of feedback, data and case studies. I
would also like to thank the parents/carers, pupils, schools/settings and wider services that took the
time to complete the survey the results of which were used to inform this review. Finally, I would like
to thank members of staff from ISL, Finance and HR who provided additional information during the
course of this review.
55
11. Appendices Appendix A - Examples of reintegration
Year
group
Condition Support
commenced
Support
ceased
How was reintegration achieved?
10 MH -
Anxiety
22.05.17 01.03.18 • When ESMA support began for X, her anxiety was extreme and she was unable to leave the house.
• Lessons began initially at home and then with support X was encouraged to access lessons in a local library.
• Following a short period of learning in this neutral venue lessons then moved on site at school.
• Effective communication between X’s ESMA teachers and school teachers ensured X was able to keep up to date with her learning
and, when able, begin a gradual reintegration into her mainstream lessons.
• X’s ESMA teachers supported a stepped exposure to her timetable lessons, providing opportunities for X to challenge her anxiety
and still feel safe.
• ESMA liaised closely with CAMHS throughout who attended all review meetings.
• When support closed for X she was accessing a reduced timetable and the school had an informed and effective network of
support in place to help X following ESMA advice and guidance.
• X attended an ‘Empowering Girls’ activity a joint venture organised by ISL.
8 MH -
Anxiety &
ASD
19.04.18 19.07.18 • When ESMA started working with A he was already working with the Autism team however would not come into school and
attendance was in serious decline.
• ESMA initially met A at home and discussed his issues around attending school. A agreed to try to return to school so a planned
timetable was made – this timetable was from 23/04/18 to 2/07/18. It incorporated targets for both the school day and weekends
with ‘rewards’ along the way.
• The timetable was photocopied so that there was a copy in both parents’ homes.
• A group email was set up between the parents and ESMA so daily tasks could be recorded against the agreed timetable.
• When ESMA felt A was ready to return to school tuition lessons were delivered on school site.
• A managed to get back to school on a very reduced timetable although it became apparent that because of his autism he could not
manage full time mainstream education.
• ESMA worked with school and SEND Team to help A find a new school.
• A is now attending a new school.
5 Oncology
- Bone
23.11.17 17.07.18 • ESMA was able to provide a bespoke/flexible package of support that worked around B’s significant periods in hospital, frequent
appointments and extensive treatment protocol.
• Lessons were provided for B at home, in a local hospital and on site at school, as per his needs.
• Teaching support worked closely with B’s class teacher to ensure the impact of absence from school was minimised.
56
• ESMA liaised regularly with the Community Nurse team, partnership working which ensured the support for B was always
appropriate.
• B has now returned to a full timetable at school.
• ESMA have provided the school with advice and guidance so they feel confident supporting B as he returns.
57
Appendix B – ESMA’s Outcome Bees
58
Appendix C – Examples of partnership working
Activity Anticipated or achieved outcomes Stakeholders
Provide training to parents and schools as part of Delivering Special
Provision Locally (DSPL) initiatives.
A recent example of this was ESMA’s involvement in delivering
’Supporting Anxious Pupils’, a 5-week evening course in Dacorum
(funded by DSPL Area 8) which saw high uptake particularly from
several parents of primary school aged children.
Increased understanding of support strategies for Anxiety
Management and Exam preparation.
For the most recent event, given the high engagement from
primary school parents this was seen as an early intervention
approach.
Participation of service
users –
Parents; schools
Attend professionals meetings regarding CYP who will be going to SEN
Extra Panel to provide input on their experience of the child or young
person to help inform decisions made about additional funding.
Contributing professional experience to inform decision making
about individual cases to ensure that children are receiving the right
level of support according to their need.
SEND service; parents;
pupils
Members of staff attended a Wellbeing Village event in October and
hosted and ESMA information stall.
One of the SATs also gave a presentation as part of a parent workshop.
This event was attended by 316 visitors.
Raise awareness of the support on offer from ESMA, network with
other agencies present, engage with parents/schools to provide
informal advice and guidance.
Representation from a
range of the agencies and
services ESMA works with,
such as CAMHS, Step 2 and
YC Herts.
As well as parents and
school representatives.
Liaise closely with the Attendance team. Aiming to reduce the numbers of pupils out of school with medical
needs.
Parents; schools;
attendance team.
Jointly led on Mental Health working group to develop a whole school
approach self-review tool which supports the achievement of Kite
Mark which recognises good practice.
Upskill schools and drive standards which contribute to improved
capacity for supporting emotional wellbeing within educatoinal
setting.
Attendees:
CAMHS; primary and
secondary school
representatives; ISL
colleagues from
Attendance, EP, SEND SASS;
Public Health
59
Activity Anticipated or achieved outcomes Stakeholders
Joint training with health professionals delivered to ESMA Variable
Hours Teachers; SAT’s/settings.
Improved understanding of work/resources available from different
agencies & improved dialogue between agencies to identify
appropriate support.
Provides chance to discuss case principles with others and get input
on suggested next steps through reflection and thinking differently
about range of interventions and ways of thinking about child and
family.
CAMHS; Paediatrician;
Consultants.
Leads on a termly, county-wide multi-agency meeting.
For example, in St Albans, Watford and Dacorum ESMA holds a termly
review of ESMA cases involving a Paediatrician, Physiotherapist and
CAMHS worker.
This was previously focused on Chronic Fatigue Syndrome but as a
significant reduction in this level of referrals has been seen, the scope
of this meeting has been broadened out.
Strategic support measures identified aiming to reduce the number
of pupils out of schools with medical needs.
Attendees-
CAMHS; Paediatrician;
Physiotherapy; Public
Health.
Successful in achieving funding for two ‘Feeling Good’ bids. Supported the reintegration process due to increased levels of self-
confidence.
External providers to offer
extra-curricular
opportunities
Lead on a County-wide meeting at the beginning of each academic
year
Increased awareness of support measures available from ESMA & in
schools – and improved multi-agency working for identified pupils.
CAMHS/Step 2
Involvement in working party to develop a website for parents, young
people, schools and other professionals.
This website is now live: Healthy Young Minds in Herts
Acts as a source of resources for ESMA staff but also a useful
signposting tool which ensures consistency in messaging and advice
being given across various agencies.
CAMHS; schools; parents;
professionals
Involvement of SATs and Lead Coordinator at a strategic level within a
number of multi-agency meetings, often designed to provide advice
and guidance to attendees which seek to identify good practice and
early intervention techniques.
Developing multi-agency working practices with stakeholders and
schools
Schools; agencies; public
health; professionals
60
Activity Anticipated or achieved outcomes Stakeholders
For example, in St Albans the ESMA Lead Coordinator attends quarterly
Pastoral Hub meetings attended by a number of stakeholders from
educational settings and agencies such as Youth Talk and Public Health.
Inputs have included: ‘Strategies to help school refusers’ – including
anxiety-related.
Attend Children in Need/core group meetings in identified cases and
links the ESMA review into this process.
Reduced meetings required for families as facilitate joint-meeting
which also improves the understanding of professionals involved so
not working in isolation.
ESMA provide interim reports if required.
Social Care; TYS; Families
First; Wellbeing Team
Involve relevant healthcare professionals in all planning and review
meetings.
Support considers appropriate medical advice but is supplemented
with advice on education and associated strategies – a collaborative
approach which utilises the specialist knowledge of those involved
to support the best possible outcomes for the child or young
person.
Healthcare professionals;
parents; schools; pupils
Delivery of wellbeing workshop for twelve parents of ESMA pupils in
North Herts and Stevenage with support from CAMHS School Link
Officer – a light-touch intervention
Increase parents’ understanding of their own wellbeing in order to
help them understand their child’s wellbeing better.
Opportunity to signpost to resources and for self and online help.
Parents
Strong links with YC Herts developed to discuss cases, particularly re
post-16 pathways with YC Advisors, as well as make referrals for post-
16 support.
Ensure young people have support in place post-16 to support with
their next steps.
Signposting parents to YC Herts for suitable projects that may
complement educational input.
YC: Herts; parents; schools;
pupils
Involved in the development of Hertfordshire’s Emotional Well-being
and Mental Health Strategy through stakeholder workshops.
Contribute specialist knowledge and input to Hertfordshire’s
Strategy designed as early intervention and preventative.
Diverse range of agencies
Liaise with Access and Inclusion team for information on children on
reduced timetables and Electively Home Educated (EHE).
Cross reference information against ESMA caseload to ensure
information is shared across teams.
ISL Access and Inclusion
61
Activity Anticipated or achieved outcomes Stakeholders
Trialling collaborative multi-disciplinary approach with SEN colleagues
to deliver advice and guidance to high referring schools for autism and
anxiety. ESMA angle particularly around providing advice and guidance
on systemic changes in school.
Upskill staff/train them to spot the signs and implement support as
part of early intervention.
Encourage schools to develop a proactive approach rather than
reactive.
Schools; SEND SASS
62
Appendix D - Survey responses
Parents/Carers
25 parent/carers responded to the survey from across secondary (15), primary (5) and sixth form (5)
who are either currently accessing the service or accessed the service in 2017-18.
The predominant cause for their child’s absence was mental health/anxiety related illness.
Reasons detailed in ‘Other’ included:
o Difficulties in getting to the point where ESMA provided support, not due to ESMA but getting
‘pushed from pillar to post by different agencies’.
o Delay in getting ESMA support as first submission of evidence was not accepted.
o School did not want to refer to ESMA.
When asked about their experience of planning and review meetings the majority of feedback was
positive - parent/carers reported that they were/have felt included and fully involved in all meetings
and their child was/is also encouraged to engage but when they do not wish to they are not pushed
to do so. In these instances, respondents stated they were happy to advocate for their child.
When asked whether they are happy that their child is receiving an adequate number of ESMA
teaching hours, appropriate to their medical needs there was an almost equal split with 12 stating
‘yes’ whilst 13 stated ‘no’.
Fourteen parent/carers responded that their child’s mainstream school does/did not provide
complementary support to ESMA’s offer such as email or phone contact with teachers or sending
through schemes of work.
A few respondents noted that they did/do not feel CAMHS are providing effective support alongside
ESMA and that CAMHS have hampered the process and lacked consistency in their support.
Additional comments included:
‘It is vital for those losing out on school education and relieves a great amount of stress for the child
and for the family as a whole.’
‘I would like to thank the ESMA team for all their support and understanding why my child is going
through difficult health issues and school was very challenging due to her illnesses.’
23% 23%
35%31%
19%23%
0%5%
10%15%20%25%30%35%40%
Challenges Experienced During Init ial Referral Stage
63
Pupils
Four pupils completed the survey. Whilst attempts were made to increase this return rate, given the
time of year and the vulnerabilities of the cohort it was unfortunately not possible to increase this
number ahead of the review deadline.
Responses however were split equally between those absent due to physical medical illness and those
experiencing mental health related illness.
Three respondents are currently receiving ESMA support at secondary school, whilst one respondent
received support in 2017-18 during year 11 and has since progressed to Sixth Form.
When asked about their initial concerns at the start of ESMA support answers included worries about
teachers not understanding their illness or disability; getting judged if they did not know the answer
to a question; and being pushed to go back to school. However, all pupils reported that as soon as
they met their teacher they felt supported, and that they were in a safe environment in which they
could ask for help.
All four pupils stated that they have been involved in all ESMA meetings, through which they have
been able to say how they feel and what they would like to do.
When asked what they like most about ESMA’s involvement the main theme across responses
focused on them getting support with missed learning but also accessing what is currently being
taught in their school. Additionally, one pupil mentioned that they had found the sharing of exam
techniques helpful.
One of the questions asked whether there are any alternative ways of teaching or learning that would
be helpful, responses suggested the use of videos in subjects such as Science as well as some use of
interactive computer-based options, whilst one respondent stated a preference for one to one
teaching.
In response to the question ‘What do you hope to achieve at the end of your time with ESMA?’ all four
expressed their goal was to achieve good grades in their GCSEs, with one mentioning improved
attendance.
Additional comments included:
My teacher ‘has been such an amazing help to me just wanted to let you know she is amazing!’
‘I had lovely teachers who always tried to support me through difficult times with my health issues. I
had one teacher who had a passion for science and luckily passed that onto me, unfortunately he left
due to his own health issues. Luckily I had another teacher who helped me develop my passion for
science, and spoke to the school on my behalf to help me do more GCSEs in science. Which I did and
got grade 8 in physics chemistry biology.’
‘Most of my teachers are amazing and very supportive of me and have helped me improve
exponentially’
64
Schools and Settings
Fifteen schools/settings responded to the survey, predominantly from mainstream secondary schools.
86% of respondents agreed that the ESMA service is meeting the current needs of families.
When asked about where and what the gaps might be, responses included:
o A lack of resources and staffing to support children with mental health issues and refusing
school.
o Difficulty in accessing support at different points in the year.
o No coverage of subjects outside core curriculum.
o A lack of long-term provision.
In response to what the emerging and future needs of the cohort requiring ESMA support are, 73%
(11) of respondents stated mental health and anxiety, whilst one respondent suggested a need for
post-reintegration mental health support.
Twelve (80%) schools/settings reported they do not feel equipped to manage and support these
emerging and future needs. When asked to detail what kind of support would be useful the following
were given as some examples:
o Therapeutic outreach service.
o Small group work.
o Access to additional interventions/specialists.
o Advice and support in how to increase pupils’ time in school without it affecting their anxiety.
Additional comments:
‘They remain unflappable and project such positive energy, even when a family is going through the
most difficult of times. They liaise well with schools and health and are very good at keeping in
contact.’
‘The work of ESMA is invaluable in building the confidence and self-esteem of young people who are
facing significant challenges.’
65
ESMA Staff
In depth responses were received from 20 members of ESMA staff. From the extensive feedback it
has been possible to identify some key themes in relation to individual questions.
When asked how they think the ESMA service is meeting the current needs of families, staff
responses fell into two main themes:
1. Tailored Support - ESMA is effective in providing short-term, flexible, tailored support to
children unable to access education due to medical illness through which pupils are able to
maintain a level of education in core subjects, keep up with their peers and then be
supported in planning for and returning to school.
2. Whole Family Approach - Support from ESMA extends to the whole family, it provides some
level of consistency and normality during a difficult period for the family. Staff are able to
provide advice, information and reassurance to parents helping to relieve parental anxiety
about their child’s education.
Five respondents felt that ESMA will not be able to support the future and emerging needs of schools,
children and families. When asked to identify where the gaps are and how these could be filled the
following themes were apparent:
• Capacity of Service - Capacity of the service currently means that whilst there are pupils able
to undertake more learning, increased hours of teaching is not possible as there are not
enough teaching hours available when considering travel, meetings, planning and
reintegration aspects of role too. Furthermore, there is not capacity within the service across
all areas to cover all subjects.
• Cohort - Increasingly the service is supporting pupils that are SEND or without a school place
which is impacting on the capacity of the service to support those children who are unable to
attend school due to medical absence, be it physical illness or mental health.
• Length of Support – For some of the children referred to ESMA, particularly those with
complex mental health needs, the prospect of reintegration within a term is not realistic and
therefore a longer period of support is required.
For some, reintegration will never be a viable option, this means there is occasionally an
expectation that ESMA will provide indefinite education.
• Confidence – Many children accessing ESMA support have lost confidence in their own ability
therefore some of the work ESMA does is around overcoming self-esteem and self-
confidence barriers in order to get to a point where the pupil is able to engage with the
teaching and thrive.
• Mental Health – Schools need to take more of a responsibility in providing support within the
school environment to help pupils manage their mental health and feel able to ask for help.
This extends to training school staff to recognise the signs.
The increase in this cohort of need also means that ESMA staff need to have sufficient
ongoing training to be able to effectively support pupils experiencing a range of mental health
issues, as well as provide signposting, advice and guidance to schools.
In addition, there is a need for health services to be more involved.
• Paired/Group Teaching – In order to help manage to high caseloads and resourcing more
paired or group teaching, particularly for those of the same age group, should be undertaken.
66
Partner Agencies
The survey saw 13 responses from a variety of respondents including: YC Herts; Autism Specialist
Advisory Teachers; the Education Psychology Service (EPS); NHS Paediatrician; Children’s Community
Oncology Nurse; Virtual School; Family Safeguarding and Hertfordshire’s Parent and Carer
Involvement (HPCI) Forum.
62% of respondents agreed that the ESMA service meets the current needs of families. Responses
from those that disagreed commented that they believe the gaps are due to staff capacity and
resourcing of the service. One respondent also disagreed as they felt the eligibility criteria for medical
evidence is too inflexible and information about the service is not up to date or clear.
There was consistency across respondents around the emerging and future needs of the cohort
requiring ESMA support, namely mental health, particularly high anxiety (specifically those within
secondary education and those with an ASD diagnosis).
Additionally, it was commented that ESMA will increasingly be required as an interim service to
support those unable to access their current schools whilst they await a SEND school place following
an EHCP.
Some examples of joint working were provided including joint home visits and meetings, effective
information sharing to ensure that YC Herts were aware of the young person in order to deliver
partnership support around reintegration as well as post-16 pathways.
Responses to ‘What kind of information do you need from ESMA to help shape provision?’ included:
o Clarification of what ESMA are able to offer and the frequency.
o A referral booklet to give families and schools outlining the service and referral process.
o Information about the number of CLA referred, nature of need, level of involvement and
outcomes.
o Trends within cohort and an understanding of the impact of involved agencies.
o Overview of who is accessing the service, types of need, changes in profile.
When asked about how ESMA can work with the responding agencies/services more effectively
suggestions included:
o Offering reintegration support to families of non-attending pupils who are likely to become
electively home educated (EHE) to avoid their becoming EHE.
o Ensure that IES is up to date and it is clear what is being delivered and supported by ESMA in
order for other services to be aware and avoid duplication.
o Awareness raising of the service across departments and share best practice techniques.
o Build capacity and confidence of schools to address mental health needs.
Additional comments included:
‘Joint working has helped my understanding of ESMA and how support works and have been valuable
in sharing good practice and strategies.’
‘They (ESMA) have certainly moved a number of students on to achieve and do well.’
‘I have asked for and received advice on how to support pupils who are experiencing difficulties in
attending school - this has enhanced and improved my knowledge and understanding to the benefit of
the schools, families and pupils I work with.’
