Knowsley Metropolitan Borough Council

An innovative digital solution to improve the quality of EHC Plans for children and young people

Briefly describe the initiative/ project/service; please include your aims and objectives

Launching a new digital solution to tackle the shortcomings in the quality of Education Health and Care Plans for children and young people with Special Educational Needs (SEN) at the height of the pandemic was a big decision. However, Knowsley Council’s co-production of a digital quality assurance solution has seen dramatic and sustained service improvements and a marked cultural shift. 12 months after introducing its online audit tool, the Council has seen an 82% reduction in the number of audited plans graded as inadequate.

The Challenge & Purpose of the Initiative
For a number of years, through peer review, feedback and an inconsistent audit framework, it had been identified that the quality of Education Health and Care Plans (EHC Plans) at Knowsley Council continued to be inconsistent and in need of being addressed at a strategic level. For context, around 20% of school-aged children in Knowsley have been identified as having SEND; this is one of the highest rates of SEND across the country. With over 1700 children on an EHC plan, we needed to respond strategically and efficiently with a targeted solution. Improving the quality of EHC Plans and making the moderation of plans a truly multi-agency exercise became a key priority in our SEND improvement strategy overseen by the SEND Core Leadership and Partnership Board. 

An EHC Plan is for children and young people aged up to 25 with SEND who have a complexity of need that requires targeted support. The plan sets out a child’s educational, health and social care needs and the support that will be provided to meet those needs. EHCPs are essential statutory plans that enable children and young people, who would otherwise be disadvantaged, to achieve their aspirations and best possible outcomes – at each stage of their education and into adult life. We knew that EHC plans in our area were inconsistent, but we were unsure on how to effectively address the problem. EHC Plans had long been viewed by partners in health and social care as an education or SEND issue. As a result, crucial health and social care advice was sometimes missing from plans and there was no clear way of identifying the changes that needed to be made to improve the quality of EHC plans.

There was also an inconsistent and subjective understanding amongst partner agencies of what a ‘good’ EHC plan looks like. As a result, there were huge disparities in auditing approaches and outcomes for children and young people across the local area. To make the changes we wished to see, we knew we needed a digital solution that would:
– Drastically streamline the quality of EHC plans across all relevant partners
– Change ingrained cultural attitudes towards EHC planning
– Create a far more efficient method for quality assuring EHC plans

Crucially, a sustainable solution was required, one that would prevent us from going backward, enable ongoing scrutiny and provide long term benefits to our SEND community. An Innovative Digital Solution, for a long time, we were stuck. Our Knowsley SEND Partnership Board recognised that the quality of EHC plans for children
and young people needed to improve, but we did not have the data telling us what those improvements should be or how to target these areas.

We knew that the only way to obtain clear objective data was to introduce a digital EHC plan audit tool. In fact, we were already exploring an in-house resource when the opportunity to further develop an emerging tool (Invision360) presented itself. A digital partnership with Invision360 would give us everything that we would need. It would:
– Allow us to objectively audit the quality and consistency of EHC plans against recognised national quality standards on an ongoing basis.
– Provide data and evidence to enable our Board to target improvements and enable better outcomes.
– Educate everyone involved in EHC plan writing on what ‘Good’ looks like.

Most importantly, our partnership with Invision360 was to be a truly collaborative one. We would not just be integrating a tool in the hope that it would give us the data we required. It needed to support a QA framework that was resource-efficient. One that improves consistency and objectivity so that children and young people have EHC plans that meet their needs.

What is Invision360?
Invision360 is a digital tool that EHC plan writers and auditors can access online. It enables colleagues working in education, health and social care to all contribute to the EHC plan auditing process. The step-by-step guidance, criteria and examples of what ‘good’ looks like enable our plan writers to see that the information they are including is of an appropriate standard to ensure that the child concerned has an EHC plan that meets their needs. The tool draws its criteria from nationally recognised
good practice documentation (SEND Code of Practice, CDC examples of good practice, ipsea EHCP good practice and other resources)

What are the key achievements?

A Catalyst for Cultural Change
Introducing Invision360 has very much been a catalyst for change, with partners taking real ownership of their part in EHC planning.

Before we went live with the tool in November 2020, there was always a strong feeling by partners that EHC plans sat within our SEN team. There was no wider accountability because the data did not exist to show where the quality issues were. However, the introduction of Invision360 has led to a complete U-turn in partner agency accountability. Following the first 20 audits using the tool, we created a briefing document that was sent to the core leadership team identifying exactly what improvements were needed. The tool allowed us to go to the Partnership Board with a genuine data set for the first time and say, “we’ve been grading these plans, and some of our areas are actually quite good. There are, however, areas we’re falling down on, such as the social care and health submissions, which if improved, would drastically improve the overall quality of plans.” Explaining the cultural shift, Mike Wharton, Head of Service KMBC, says: “It was a lightbulb moment. Once partners had proof of what improvements were needed and were being held to account by the audit tool, they became much more heavily invested in a collaborative approach to improving quality.”

We now have a far more joined-up approach rather than everyone working in silos. Our Partnership Board uses the data from the tool to identify service gaps and solutions. An example of this is the creation of three new roles. There’s now a Deputy Designated Clinical Officer from the CCG who sits within our inclusion department two days a week. As a fluent user of Invision360, she helps our case workers when the health advice comes in and provides guidance on what should be included within plans to ensure input is of a high quality. Social Care have also introduced a Social Care Advice Writer and Coordinator. If the child or young person is already open to a social worker, they send the request for advice, coordinate the response and bring it back to the team. If not already open to social care, they contact the family, write the advice, and send it in. So there has been a significant structural change within social care’s ownership and input into EHC plans.

Within the SEND team itself, we created a Quality Assurance Officer post to maximise the benefit from the tool. They are an Invision360 superuser and coordinate all review activity. Likewise, we are also seeing greater collaboration with other professionals, including our colleagues in Educational Psychology, Occupational Therapy, Paediatrics and Speech and Language. Measurable and sustainable transformation, Constantly Improving. Over the last 12 months, we have seen demonstrable and sustained improvements in the quality of EHC plans since introducing Invision360. In just the last quarter, the percentage of EHC plans scoring as Inadequate has dropped from 34.2% in the previous quarter to 12.9%. There has also been an increase from 23.7% to 54.8% (a 31.1% increase) in the percentage of plans scoring Good or
better from the last quarter to the most recent. There have been huge strides made by health and social care to improve their advices over the last year. When comparing
data from when we introduced Invision360 to 12 months following the implementation, we can now evidence that 86% of plans have sufficient health and social care advice that is graded Good or better. This is a tremendous change, as the percentage of plans with sufficient information was just 31% during the initial audit; in addition the percentage of ‘inadequate’ section Cs (health) has reduced from 41% to 0%, highlighting the huge progress we have made as a result of the digital auditing tool. Although we are still on an improvement journey, we are proud to say that every measurable indicator within our Assurance Learning Framework is showing a sustained improvement.

How Innovative is your initiative?

Introducing and developing Invision360 for our own use has stopped us from going backward. As a digital solution, it is truly innovative and, most importantly, sustainable. It provides us with ongoing scrutiny to ensure we continue to focus on our SEND improvement journey. It stops us from taking our foot off the gas. It also gives us the opportunity to see where else we can use tools like this (such as Annual Review and PEP tools) to make other service improvements.

Improved accessibility to data
12 months into the introduction of Invision360, there is a much better understanding of what a ‘Good’ EHC plan should contain. Before integrating Invision360, we were unable to accurately report why some children and young people with certain needs had appropriate plans, and others did not. Now, there is far more clarity, as Mike Wharton says: “Detailed data analysis allows us to drill down into each service provision to identify and address specific concerns within each audit cycle.” The tool also helps us detect where there is a need for performance plans or workforce development to close the gap. Being able to access the tool remotely is also a game-changer. As there is no identifiable data held of the system, managers can quickly use the laptop to call on data when required. This is especially useful when communicating with partners.

Breaking ground in the sector
The more local authorities that use Invision360, the better it is for us as a local authority. Not only do we benefit from their input into the development of the tool, we also benchmark our performance nationally. Furthermore, we can cross-moderate EHC plans with other local authorities, which would have previously been impossible. This is the really exciting aspect of what we’ve helped to develop – it’s a solution that will help children and young people across the UK and not just in our locality. It’s a great example of how public and private partnerships can work together effectively in the digital space to create sustained change. It is certainly a relationship that we will measure future contracts and digital transformation projects by.

What are the key learning points?

Streamlining and Improving Practice

Before introducing Invision360, one person prepared EHC plans. There was not enough resilience to risk when they were off sick, which left the service exposed. Now, we have more blended job roles. Plan writing sits with case workers who use the Invision360 tool to quality assess their plans and identify areas for improvement. Crucially, the tool allows case workers to understand what ‘good’ looks like and amend their practice in plan writing to see those significant improvements right the way across the partnership.

There’s no hiding from the data. We have audited just over 10% of all EHC plans now and are able to see where service improvements have been made, and crucially, where they are still needed. It is helping to ensure ownership of each section of the EHC plan by the relevant provider. Before Invision360, plan writers would also include surplus information. Now, with the integrated prompts within the tool and a clear understanding of the information is needed, and where, it takes less time to prepare a suitable EHC plan. Having access to previously inaccessible data sets has also enabled us to introduce new indicators into our Assurance Learning Framework so that we can benchmark quality. These data sets assist us in pushing forward with improvements on the operational side and enable us to identify the need for the three new posts.

In fact, here’s some feedback from the people in those newly created posts: Social Care Feedback: Andrew McKensie, from Knowsley’s Social Care Quality Assurance Unit, says: “There have been some notable improvements over the last 12 months. For example, we’ve seen significant improvements in the quality of Sections C and D in relation to health and social care needs. “Without the Invision360 audit tool, this level of analysis and this type of targeted approach would not have been possible. I
am convinced that the EHCPs would now still be at a reduced level of quality in contrast to the significant improvements we have seen over the last few months.”

CCG Feedback:
Maria Burney, Deputy Designated Clinical Officer from the CCG, says: “Our health colleague added to this, stating that the audit tool gives robust examples to audit within the same parameters so that each QA person follows the same guidance. It allows the reporting to be accurate and gives monitoring a clear narrative of what we need to improve. We are at such an advantage in Knowsley to have this tool.”
SEND Feedback:
Our new Quality Assurance Officer commented: “Coming to Knowsley with experience of two other Local Authorities I can really see the benefit of the tool. The step by step process aligning to key benchmarks give clarity on how we can continue to improve with a sustained pace. The buy in from other agencies who now see their own performance indicators measured through the tool is fantastic”