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.
For more information, please see the NHS England and MENCAP ‘Don’t Miss Out’ Guide.
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)
NHS Shropshire Clinical Commissioning Group (CCG) is responsible for the planning and commissioning (buying) of health and care services from a range of providers for the people of Shropshire. It also has a duty to monitor these services to ensure they provide a high level of care and are value for money. It is a clinically led organisation with 40 GP Practices and it provides healthcare services for patients across the County registered with a local GP. 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 Children's Nursing team
Find out about the Community Children's Nursing team in your area.
Community health services
The Shropshire Community Health NHS Trust provides a range of specialist services and outpatient clinics for babies, children and families across Shropshire. Outpatient clinics are held at health centres in towns and villages across Shropshire which are held at convenient locations so that families don't have to travel further than necessary to attend medical appointments.
Some specialist services and clinics need to be held at bigger facilities, such as community hospitals or main hospitals. These are based in our main towns - Shrewsbury, Ludlow, Whitchurch, Oswestry, Telford and Bridgnorth.
Find out about SEND specialist dentistry services in your area at Shropshire Community Health.
Designated medical officer (DMO)/designated clinical officer (DCO)
Each Clinical Commissioning Group (CCG) must provide a designated medical officer (DMO) or designated clinical officer (DCO). The DCO plays a key part in implementing the SEND reforms and in supporting joined up working between health services and local authorities.
Who is your Designated Clinical Officer for SEND?
My name is Catherine Smith and I am the Designated Clinical Officer for Special Educational Needs and Disability (SEND) for Telford and Wrekin CCG (DCO)
The role is to support health colleagues here at the CCG and Shropshire Community Health Trust, Shrewsbury and Telford Hospitals and Bee U to ensure children and young people 0-25 with SEND have the right health support to achieve the best they possibly can.
It is a varied role and includes:
- attending Education, Health and Care Panels to discuss which children go forwards for assessments and then if required have a formal plan (EHCP)
- supporting health professionals with the information required within the assessments and education colleagues to access the correct information and support
- supporting the SEND team at the local authority with questions and queries on information
- signposting education professionals to health services and professionals for advice
- sign off and assure the quality of the advice and plans
- working alongside the commissioners and stakeholders including parents, children and young people, to identify and raise any commissioning gaps some of which may require joint commissioning to resolve
- ensuring we can evidence a good local offer of health services and clear health journeys for those age 0-25 with SEND
- participate in processes to ensure we consider requests for those with highly complex needs including continuing care
- supporting the commissioners and senior leadership team with regards meeting and assuring the SEND health requirements
Health, Education and Social care Professionals, PODs and IASS can contact Catherine Smith to discuss queries from families.
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.Flu Heroes - Nasal spray for kids'
Watch the video here.
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 well-being. 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. Find out more about what NHS England does regarding learning disabilities here.
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.
The children's Paediatric Psychology Service (PPS), delivers specialist treatment for children and young people with serious, life-threatening or significant physical health problems and their families, aimed at helping them to cope with, and adjust to their conditions.
The targeted areas currently include:
- Oncology and haematology
- Children with palliative care needs
- Cystic fibrosis
- Muscular dystrophy or other neuromuscular conditions
- Children with an allocated Community Children’s Nurse (CCN)
- Children seen by the nurse-led chronic constipation service (Telford only)
- (By negotiation) children requiring preparation for a planned invasive procedure if this has been agreed with the treating doctor.
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 between 9-12 months, 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.
Young People’s Community Eating Disorders Service (YP-CEDS)
Young People’s Community Eating Disorders Service (YP-CEDS) provides specialist outpatient assessment and treatment for young people suffering from an eating disorder.
The main eating disorders that it supports are
- Anorexia and Bulimia Nervosa
- Atypical Anorexia/Bulimia Nervosa
They do not currently offer a service to people that are presenting with symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID) or binge eating disorder.
The team helps young people restore physical health whilst helping them to improve their emotional health and wellbeing through therapy and guidance, focusing on positive and effective ways to manage eating difficulties.
The service uses the THRIVE model of
- Getting advice
- Getting help
- Getting more help
- Risk support
Different approaches are used in each part of the model.
Scope of the service The service hours of operation are Mon-Fri 9am -5pm. The age group is 8-18yrs The service covers Shropshire and Telford & Wrekin.
Who is part of the Young People’s Community Eating Disorders Service?
The multidisciplinary team includes a psychiatrist, family therapists, a specialist dietician, and Clinical Nurse Specialists. They work alongside paediatric colleagues in the acute sector.
What does the service offer?
- Assessment, diagnosis and interventions on a range of suspected and confirmed eating disorders
- Evidence-based treatments including Family Therapy, Cognitive Behaviour Therapy, Psychotherapy
- Intensive support for those children and young people whose eating disorder is causing significant concern
- A comprehensive transition support package to those young people who are approaching their 18th birthday and may need continuing support as adults
It also offers training, consultation, support and advice to frontline staff working in other CAMHS services for children and young people in special circumstances including:
- Children’s Services
- Child Health and Primary Care services
- Paediatric Services
- Adult Mental Health Services
SEND team training and liaison is provided by a designated clinical officer for SEND.
How does the service support improved physical health outcomes?
The team conducts multi-disciplinary assessments on a weekly basis and routinely offers physical health monitoring to all young people including regular blood tests, ECGs, weight, height and blood pressure monitoring.
How does this service support improved mental and emotional health outcome? The service improves the emotional health and wellbeing of young people through therapy and guidance.
The service offers a variety of structured and goal-oriented evidence based treatments. Guided self-help may also be offered, as appropriate.
Does the service support improved education outcomes?
Liaison with school/college/school nurse/tutor is undertaken as appropriate.
When a young person’s physical health is compromised it may recommend that they remain off school until treatment and weight restoration is at a point where physical health risks have lowered (typically between 80-85% weight for height).
When returning to school, liaison and planning with school nurse/teachers on how to support a young person’s continued recovery and progress is often done jointly with family and young person.
School nurses can liaise directly with the team for a consultation.
How can a child or young person access the service?
You need a referral from a health, care or education professional. If the referral is accepted, you will be contacted to arrange an assessment.
You will have to wait 5 days or 15 days depending on how poorly you are.
You do not need an EHCP to access the service.
Our professionals work alongside the local council to inform education and health care assessments and plans but do not make recommendations for the issuing of plans.
A referral screening tool is used to assess each referral to ascertain eligibility and risk.
Eating disorders that the service provides treatment for are classified as Anorexia Nervosa, Bulimia Nervosa and variants of these.
In anorexia and bulimia, there is an overwhelming preoccupation with weight and shape with attempts to lose weight.
In anorexia there is restriction of food with consequent significant weight loss whilst in bulimia nervosa frequent episodes of bingeing occur followed by attempts to get rid of the food or calories consumed, e.g. by vomiting or using laxatives. Eating disorders such as anorexia and bulimia are relatively uncommon in younger children but often start in adolescence.
Dissatisfaction with weight and shape is very common and young people will often try and diet or may skip meals to try to lose weight or prevent weight gain. If they are not losing weight and the behaviours are only of a few days or weeks duration, it is unlikely that they have an eating disorder but they may benefit from advice on regular healthy eating and the behaviours monitored to ensure they are not worsening.
Young people who need a referral to the service will have clinically significant symptoms and behaviours. For those whose eating disorder is of the anorexia nervosa type, there will be a significant reduction of food intake over a period of weeks or more with consequent weight loss. There will also be effects on their physical health and mental health. There may be thinning of the hair and skin dryness. The young person may look pale and they may appear tired and fatigued (although this may be masked in some who over-exercise); they may appear low in mood, more anxious or may lack concentration. They may miss school lunch or eat very little. The young person may complain of feeling dizzy or faint; girls may report their periods have become less frequent or have stopped altogether. Medical examination by the GP or school nurse may show effects on the heart rate and blood pressure. Some young people may neglect their general hygiene.
Bulimia nervosa is often harder to identify as it can remain hidden for months or years. The young person may disclose that they are overeating (bingeing) several times per week, with consequent attempts to get rid of the food by purging, e.g. by vomiting or using laxatives, or excessively exercising.
The service does not have absolute criteria for referring as young people often do not have the full set of symptoms and behaviours, so if you have concerns that a young person may be developing an eating disorder but are not sure, please call to discuss your concerns and advice will be given.
Consent of a person with parental responsibility is required for a referral of a young person under 16 years or the young person if they are 16 or older; if you cannot obtain consent but remain worried the service can offer advice.
A guide to the referral process
All referrals from a health, care or education professional are screened by a team called ACCESS. They use a referral screening tool that includes assessing risk and urgency.
If they do not accept the referral, they will give advice to the person completing the referral about where to get guidance.
If the referral is accepted, it is sent to the Young People’s Community Eating Disorders Service, who will contact you to make an appointment.
Involvement in decision making These are obtained through assessment and care planning and meetings with young people and their parents as appropriate.
Parents are an integral part of the treatment program and decisions are made collaboratively and in the best interests of the young person throughout care.
A service leaflet is provided in a pack prior to initial assessment.
A number of Eating Disorder psycho education leaflets are made available as appropriate.
Families are also informed of a number of available resources as required.
Feedback Young people and families can feedback and input into care throughout treatment and feedback on service delivery - CEDS regularly seek this to monitor and improve service delivery.
If difficulties are encountered in treatment or as required - meetings will be coordinated to explore options and take on any concerns and feedback progress to families.
Complaints Details of how to complain, express concern or give a compliment can be found at: www.mpft.nhs.uk/