The National Institute for Health and Care Excellence has a pivotal role in ensuring new treatments and medicines used in the NHS are effective, but also value for money.
Given the spiralling cost but stagnant outcomes for pupils with additional needs, calls are now growing for an equivalent body for SEND.
Iain Mansfield, a former DfE special adviser, said there had been “minimal efforts to match costs to efficacy – or even to measure efficacy at all” in high-needs spending.
“A NICE for education would allow hard, but necessary, decisions to be made fairly – and for the money we are spending to be used in the way that benefits all children the most.
“Given the scale of the cost, and the impact on the system as a whole, it is not just necessary, but long overdue.”
How could it work?
NICE sets out what good healthcare looks like. This includes quality standards, guidance for frontline health staff and how to assess and treat common conditions.
Mansfield said evaluation of SEND interventions could look at basic academic metrics, alongside wider life outcomes such as employability or enabling independent learning.
The Local Government Association said in a report last year a NICE-type body should produce “standards for mainstream inclusion” and act as a “custodian” for best practice.
David Thomas said an “independent evidence-based arbiter of what support a child should be getting would both raise quality and improve experience.
“Rather than determining support by pitching parents and local authorities against each other, the appropriate support would already be set out,” he said. “NICE creates an external reference point for what good care should look like.”
Guidance could be separated into two tiers: common issues such as struggling to read, and advice for more specific conditions.
For the first tier, guidance could set out “best bets”, and suggest an order to try different treatments.
Read the rest of our special, five-part investigation:
Investigation: How EHCPs are failing our most vulnerable children
Fidget spinners and learning styles: EHCPs’ interventions exposed
Copy and paste: Poor quality EHCPs shortchange schools
Schools pick up the pieces of absent health and social care providers
Comment: SEND provision is the last bastion of unevidenced practice
Mansfield added such as body should also “compare the improvement in outcomes to the cost” – with a value-for-money threshold set. Those falling short should “not be funded”.
While this would be “complex”, it was “no more difficult, and no more sensitive, than the work that NICE does in assessing how conditions such as pain, mobility, use of bodily functions and so on combine to constitute a ‘Quality Adjusted Life Year’.”
Leora Cruddas, CEO of the Confederation of School Trusts, has called for a NICE-equivalent body for SEND.
She added: “We think given the importance of getting provision right for children with the highest needs, alongside the amount of public money spent on the high needs system, that we build a stronger evidence base around the sorts of targeted intervention and specialist provision within the sector.”
What happens in the meantime?
Gary Aubin added the EEF already had the expertise to take on such a role.
While acknowledging “massive gaps” in provision around SEND interventions and approaches, Aubin said it was “not true” that pupils with SEND always needed entirely different things to other pupils.
More work also needed to be done on “how we adapt approaches we know work for all pupils”.
Cassie Young, an inclusion executive officer for a Kent academy trust, agreed it made more sense to focus on adapting mainstream approaches with a strong research base, rather than investing heavily in interventions that lacked evidence.
“While SEND-specific research is lacking, that shouldn’t mean we abandon evidence-based decision-making. We need to be critical about what we adopt, ensuring that whatever we do has a clear purpose and is evaluated for impact, rather than relying on interventions simply because they are popular or feel like ‘the done thing’.”
Chris Paterson, co-CEO of the EEF, said it is “crucial to support schools – and the wider sector – to reject approaches and interventions that have a weak evidence base”.
Evidence suggested support for pupils with special needs in mainstream schools “should start with high quality teaching that is inclusive by design… complemented with more targeted, effective interventions to help overcome the most significant barriers to learning”.
But Andre Imich, the DfE’s former SEND professional adviser, said often on single issues, “not all professionals agree” on how to tackle them.
Teacher and SEND expert Ben Newmark also added it was difficult to learn from best practice “because we don’t have a shared understanding” of “what SEND means”.
“We can’t study something if no one can agree what that thing is…we’re all just talking past each other.”
