There are many ways that a child or young person can be identified as having additional needs and disabilities. Diagnosis can take place at various points in life, through a range of circumstances. Any health practitioner in a specialist field can make a diagnosis, or referrals made to specialist consultants to assess suspected medical needs.
Diagnosis can occur during pregnancy or at birth, during infancy and early childhood, and later. Sometimes additional needs and disabilities occur as a result of trauma resulting in cognitive or physical injury. We hope to have captured these possible pathways on this page to help you understand the role of each health service in identifying additional needs and disability.
The information on this page outlines available health services to children and young adults with special educational needs and/or a disability (SEND), including those without education, health and care plans (EHCPs).
Accessibility of services/adapting practice
All services are required to make 'reasonable adjustments' to meet the needs of their patients. This can include allowing home visits, meeting outside of normal working hours, making adjustments to the facilities to accommodate equipment or sensory needs, and much more.
If you have a specific need that should be considered when making an appointment or arranging a visit, you should always disclose and discuss this as soon as you're able. Practitioners are more able to accommodate needs if they have time to prepare for them effectively.
Although every effort should be made to accommodate need, sometimes it's not practicable to do so. If this is the case you're encouraged to share your concerns with the practitioner so that they can try to improve the experience you have when attending their service.
Feedback about good experiences is always helpful so that we can share it with colleagues to encourage consideration of need for families.
For more advice on access-to-health services, please take a look at the MENCAP FAQs.
Annual health checks
From the age of 14, all young people with an identified learning disability are entitled to an annual health check with their GP. This annual health check is important as it provides an opportunity to identify new medical concerns, monitor existing conditions, and develop a relationship with your GP.
Bee-U emotional health and wellbeing service
If you are concerned that a child or young person is showing signs of emotional or mental ill health, BeeU provides helpful information, advice and can point you in the direction of several useful early help and support services.
These services includes;
- The Children’s Society (known as BEAM) - you'll be able to access this service as a family, a parent carer or sibling, or as a child / young person (aged under 25). No appointment is needed for their drop-ins, which will provide low level strategies.
- Kooth - Free, safe and anonymous online support for young people. One to one and group support via a social platform for children and young people aged 11-25.
- Healios - A specialist online provider of mental health and neuro-developmental services with a mission to bring exceptional healthcare to anyone, anytime, anywhere.
If at any point a child / young person or a family demonstrate a need for further help and support that can't be met by these service providers, these services are able to refer on to the next level of help.
Child development centres and multi-disciplinary assessment
At the child development centres in Shropshire and Telford and Wrekin we provide assessments of children with additional needs who are under five years old. Children attend for assessment, diagnosis, intervention and advice for the following impairments and disabilities:
- Behavioural problems
- Communication and interaction problems
- Delay in their development
- Impaired vision or hearing
- Physical disability
- Severe co-ordination problems
For further information please visit the Child Development Centres website.
Children’s continuing care and personal health budgets
Some children and young people may have very complex health needs which may be so complex that they can't be met by the services which are routinely available from GP surgeries, hospitals or community services. These children and young people may need a package of additional health support to meet their needs, and this can be assessed using the National Framework for Children and Young People’s Continuing Care.
Once these children and young people are assessed by the children’s nurse assessor from Shropshire CCG, a multi-disciplinary decision is made on eligibility for children’s continuing care funding. All children and young people who meet the eligibility criteria for additional funding are then offered suitable care to meet their complex health needs – this can be through an agency with suitably trained carers or with funding made available for a personal health budget.
A personal health budget is offered to all children and young people who are eligible for children’s continuing care, and this offers families and carers some flexibility to arrange their own care to suit their individual needs and circumstances – for instance through employing their own personal assistant. Referrals to the Shropshire CCG Complex Care Team to arrange an assessment for children’s continuing care can be made by any healthcare professional or social worker.
Tel: 01743 277531
Clinical Commissioning Group (CCG)
The Shropshire Clinical Commissioning Group is led by family doctors in Shropshire’s 44 GP practices, and is responsible for buying a wide range of health services for patients. It's committed to involving the people of Shropshire in all major decisions about developing healthcare in the county. On their site is a dedicated page detailing how they support special educational needs and disabilities as part of the local offer.
The SEND Code of Practice 2014 states that the local offer should be used:
"To make provision more responsive to local needs and aspirations by directly involving disabled children, young people and those with SEN and their parents and service providers in its development and review."
Together with partners we intend to use the local offer to map gaps in service provision, and identify areas of need for children and young people with SEND, and their families. To do this as effectively as possible we need your feedback.
Community health services
The Shropshire Community Health NHS Trust provides a range of specialist services for babies, children and families, including specialist child and adolescent mental health services (CAMHS), a specialist service called the Family Nurse Partnership (FNP) for young mothers across the Shropshire area, and specialist wheelchair services.
Also included are outpatient clinics held at health centres in towns and villages across Shropshire. Some clinics, such as paediatric appointments, can be held at convenient locations so that families don't have to travel further than necessary to attend medical appointments. Some clinics or specialist services need to be held at bigger facilities, such as community hospitals or main hospitals. These are based in our main towns - Shrewsbury, Ludlow and Bridgnorth.
Designated medical officer (DMO)/designated clinical officer (DCO)
Who/what is a DMO/DCO?
The SEND code of practice is clear that a designated medical officer (DMO) and/or a designated clinical officer (DCO) should be in post to support CCGs in meeting their statutory responsibilities for children and young people with SEN and disabilities. (SEND Code of Practice 2014).
A DMO/DCO needs appropriate expertise, and links with other professionals to enable them to exercise it, in dealing with children and young adults with EHC plans from the age of 0 to 25 in a wide range of educational institutions. (SEND Code of Practice 2014).
In Shropshire we have a designated clinical officer who is supported by the designated nurse for safeguarding children and the commissioner for children's services. The DCO is an active member of the EHC panel and also meets regularly with professional health care providers and the local authority around SEND. This includes, but is not limited to: paediatricians, social workers, headteachers, nurses, dieticians, physiotherapists, speech therapists, GPs and the SEN Team.
What does a DMO/DCO do?
The DMO/DCO provides the point of contact and expertise for local authorities, schools and colleges seeking health advice on children and young people who may have SEN or disabilities, and provides a contact for CCGs and health providers, so that appropriate notification, support and treatment can be commissioned and co-production across agencies can be agreed strategically across Shropshire for children and their families who have a SEN or disability.
The DMO can support schools with their duties under the ‘Supporting Pupils with Medical Conditions’ guidance.
The DMO/DCO wouldn't routinely be involved in assessments or planning for individuals, except in the course of their usual clinical practice, but would be responsible for ensuring that assessment, planning and health support is carried out. (SEND Code of Practice 2014).
For concerns around assessments or planning of EHCPs in the first instance the original health care provider should be contacted, and if these issues aren't resolved they can then be escalated to the CCG for resolution.
The NHS is working to increase uptake of the flu vaccination for people with learning disabilities and those who care for them this winter.
- People with learning disabilities and those who care for them are entitled to a free flu vaccination
- People with learning disabilities are more likely to become seriously ill or die if they get the flu
Importantly, paid carers who are employed by a registered care provider are eligible for a free flu vaccination this year, as well as primary family carers. If carers have the vaccination this improves protection for the people they care for.
An easy read information sheet (aimed at people with learning disabilities and their carers) has been developed with the National Development Team for Inclusion explaining this.
It is hoped this will give people the information they need to get their vaccination at either their GP surgery or pharmacy, and overcome any barriers to that happening. It is not yet well known enough that this group, and their carers, are eligible. An easy read leaflet, suitable for GP surgeries, is available to order from PHE.
There is also published guidance about flu vaccinations for people with learning disabilities aimed largely at health and social care professionals.
A recording of a webinar recently held about flu immunisations and people with learning disabilities is available to view online.
A list of Shropshire CCG GPs can be viewed on the CCG GP practices page.
The NHS Choices website allows you to search for local GPs via your postcode.
Health passports are offered to all looked-after children (LAC) aged 16-17. This will be completed by the LAC team with the young person, and involves a summary of all their health records. It will help young people and their carers keep track of their medical history and health needs, giving them easy access to information that could make a difference to their health and wellbeing. It will empower young people to continue to obtain health advice and services and how to do so.
Hope House Children’s Hospice
To ensure that children affected by conditions so serious that they’re not expected to live longer than early adulthood enjoy together with their families the best possible quality of life - with access to specialist care and bereavement support, when and where they need it.
As a charity committed to supporting children, young people and their families in Cheshire, Shropshire, North and Mid Wales, we’re here to help them to be as comfortable, happy and fulfilled as they can be by providing:
- Specialist nursing and palliative care at home, in the community and at Hope House
- Emotional and practical help to parents and other family members
- We’re also here to provide bereavement support and specialist counselling to any family after the death of their child - whether or not we’ve previously cared for them
We always aim to:
- Put the needs of children and their family at the heart of everything we do
- Provide fair and equitable access to our services for everyone - regardless of their ethnicity, social or economic circumstances
- Deliver effective services as responsively as we can
- Raise sufficient funds and use them carefully to benefit the children and families we care for
- Value and recognise the contribution of all who work with us to improve the quality of life for children and their families - our employees, volunteers, supporters and partners
- Be open and transparent in our business and activities, while protecting the rights of children and families to privacy at all times.
The Shrewsbury and Telford Hospital NHS Trust provides a range of acute hospital services for the people of Shropshire, mid Wales and further afield.
Shrewsbury and Telford Hospital - Paediatrics (Children's Services)
The NHS Choices website allows you to search for local health services via your postcode.
NHS A-Z list of conditions
The NHS provides a comprehensive A-Z list of health conditions on their website which includes lots of useful details, eg overview, diagnosis, treatment, advice and support.
NHS England oversees the budget, planning, delivery and day-to-day operation of health services in England. It's responsible for commissioning the more specialist health services, with local clinical commissioning groups and local authorities commissioning health services for their local areas. It also provides further guidance on SEN on their Live Well pages.
Occupational Therapy Service
The Occupational Therapy (OT) service operates an open referral system, and accepts referrals from schools or any other professional, with parents' consent, for children between the ages of 0 to 18. The referral form and guidelines are available in the patient information section of the Shropshire Community Health webpages. A parent can also easily make a self-referral for their child over the phone by calling Coral House on 01743 450800.
Personal health budgets
A personal health budget allows you to manage your healthcare and support such as treatments, equipment and personal care, in a way that suits you. It often improves the quality of a person’s life and sense of wellbeing. A personal health budget is an amount of money to support your health and wellbeing needs which is planned and agreed between you (or someone who represents you), and our commissioning group. It's not new money, but it may mean spending money differently so that you can get the care you need.
Public Health Nursing Service
The Public Health Nursing service consists of health visitors, school nurses, family nurse partnership and skilled practitioners to support the healthy child programme delivery. The aim of the service is to support health outcomes for children and young people, and they are able to offer support, information and signposting on a number of issues, for example healthy eating, physical activity, continence, toilet training, emotional health and wellbeing, relationships, sexual health, accident prevention and oral health, dependent upon each child/ young person’s needs. A public health nurse may provide information or be asked to undertake an assessment as part of the education health and care plan and/or provide support as part of the plans recommendations.
All children are offered a health review once they pass their first birthday, and again at two to two-and-a-half years of age, and if required additional support is provided or a referral made to a specialist service. Further health assessments are being introduced between the ages of five and 14.
This service can also offer support on managing long term conditions such as asthma, allergies, epilepsy and diabetes, as well as providing training to mainstream schools on how to support children and young people with these conditions in the school environment.
The service also provides a specialist community public health nurse (SEND) and healthy child programme practitioner who work in partnership to deliver innovative and evidence-based care to early years, special education settings, travelling families and the home-educated in Shropshire. The team provides specialist leadership and support to the 0-19 Public Health Nursing Team in care planning for children with special educational needs, EHCP and/or long term conditions.
Parents and young people can self-refer into the service using the dedicated single point of access telephone number or by texting (see information below). Referrals are also accepted from other professionals.
The Public Health Nursing Service (PHNS) contact details are:
General Contact Number: 0333 358 3654
Texting Service (available for parents and young people)
- Health Visitor: 07520 635212
- School Nurse: 07507 330346
Follow on Twitter - @ShropPHNurses
For more information, take a look at the PHNS leaflet.
Speech and language therapy (SALT)
The Children's Speech and Language Therapy (SLT) Service in Shropshire provides assessment and treatment of speech, language, communication and/or swallowing difficulties for children and young people from birth to 16 years old (or to 19 years if in full time education).
They operate an open referral system, and accepts referrals from schools or any other professional, with parents' consent, for children between the ages of 0 and 18. The referral form and guidelines are available in the patient information section of the Shropshire Community Health webpages. A parent can also easily make a self-referral for their child over the phone by calling Coral House on 01743 450800.
Shropshire Community Health NHS Trust provides a range of services from specialist nurses, nursing teams or clinicians. These services are for patients who need highly specialised support and care in order to manage an acute health condition or to reduce the possibility of becoming more poorly.
The trust also provides care and support to patients who have to live with long-term conditions, for which patients need specialist advice and support in being able to live a happy and healthy life despite the condition.
Specialist services are delivered from health centres or community hospitals across the county. These services can include:
Wheelchair and posture service
Shropshire Wheelchair and Posture Service is a clinically-led service which meets the posture and mobility needs of people with a long term disability of all ages across the whole of Shropshire.
Shropshire Wheelchair and Posture Service staff include wheelchair therapists, who are occupational therapists and physiotherapists, clinical assistants, rehabilitation engineers, repair engineers, stores specialists and an administrative support team.
Children and young people are assessed for their developmental needs as well as their clinical/physical needs. This may involve meeting the individual’s needs through partnership working. Regular liaison with local professionals working in Children’s Services is established to ensure ongoing developmental needs of children and young people are addressed in a timely manner.