Tag Archives: health

Should the NHS pay more to support children with SEND?

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The new index of deprivation, published today by the government, contains an important message about affluent areas such as Oxfordshire.  English indices of deprivation 2025: statistical release – GOV.UK

Oxfordshire ranks highly on three of the four areas I looked at, and especially so on Health and Employment, where the lowest rankings are 65/296 in health and 36/296 in employment, and the highest 8/296 in health and 4/296 in employment.

District CouncilEducationHealthCrimeEmployment
South Oxfordshire258288287292
Vale of White Horse235284283275
West Oxfordshire233279285263
Cherwell155252231260
City of Oxford156231123262
District CouncilEducationHealthCrimeEmployment
South Oxfordshire38894
Vale of White Horse61121321
West Oxfordshire63171133
Cherwell141446536
City of Oxford1406517334

However, the ranking for both Cherwell and City of Oxford districts for education, at 141 and 140/296 compare badly with the ranking elsewhere in the county. Overall, the education ranks are still the lowest ranking scores for all districts, except for the City of Oxford, where the ranking for crime is 173/296, over a hundred places lower than any other district in the county.

The comparison between the education rankings and the health rankings raises an interesting question. Why is education doing so badly in Oxfordshire, especially in the urban areas of Oxford and Banbury? It is difficult to blame the local authority, as all but one of the secondary schools and many primary schools are academies and part of MATs.

Perhaps the formula for education funding is so linked to the county’s rank across all indices that the current funding formula for schools cannot compensate for the needs of Oxfordshire children living in its most deprived communities.

It is clear that there are issues nationally with the formula for the High Needs Block that funds SEND, but again does Oxfordshire lose out more than other areas? After all, it schools are generally highly regarded by ofsted; it has two world class universities, and leading science and technology companies driving the economy.

On the SEND issues, one question is whether the NHS is pulling its weight on supporting children with SEND? Assuming that the overall ranking for the county is not going to see any government be more generous to Oxfordshire with regard to funding, however the present county may be configured post local government reorganisation, then there must be a strong case to require the NHS to spend more resources on supporting children with special needs even if its overall ranking slips a few places as a result. This would reduce the need for the county, and the schools within the county, having to prop up spending on SEND that should really come from the health budget.  

There is no doubt Oxfordshire is not a county with a high degree of deprivation, but what deprivation there is can be concentrated in a few wards in the urban areas abut also spread out across the rural parts of the county. The former is easy to identify, the latter more of a challenge. Both need more funding for education.

Windfall profits and SEND

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There is no doubt that the rise in demand for special school places over the past few years was neither anticipated nor effectively dealt with by the State. One consequence is that large amount of off-balance sheet debt being carried by many local authorities responsible for schooling in England. Another consequence, highlighted by the Liberal Democrats in a press release issued today, is what might be described as the ‘windfall’ profits being made by a few in the SEND sector. Lib Dems demand cap on SEND providers profits as top firms rake in £100m – Liberal Democrats

When the highest paid director of a company operating both care homes for children and special schools is paid over £300,000, or more than twice the salary of a Director of Children’s Services commissioning the use of places in the schools and homes, it seems sensible to question whether such use of public money should continue.

At this point, I must make clear that I am a capitalist. The 40 years I have traded on my own account and through a company, as well as held a portfolio of investments in other companies. However, there are two issues that concern me. Where should the boundary line between services offered by the State and those run by the private sector be drawn? And how should price be determined?

It is interesting, as I have noted before, that in the USA and many other countries, public transportation is just that: a service run by the State. In England it has become a battleground between the State and private enterprise and the differing political opinions. Most would expect SEND to be a public service.

What often seems to be lacking is a mechanism to regulate the costs of suppliers to the State. When the private sector funds its enterprise by borrowing to provide the services and then expects the State to service that debt with a profit element added, it seems to me like time to take the service out of the private sector, and back into public provision.

In the case of SEND school places, national and local government should work together to prove places in state-run schools that would obviate the need for private sector intervention. This means the State, in this case the DfE, being much more interventionalist than has been the case.

The Liberal Democrats, of which I am a member and activist, noted in their press release that

‘Research commissioned by the party and carried out by the House of Commons Library showed that the top handful of profiting companies each took home tens of millions a year. One Group, operators of 28 special schools, turned over just over £200 million a year, making £44 million in profit – a margin of over 20%. That profit is 150% what the company made in 2022.’

How many more teachers might the £44 million have funded? While we wait for the government to produce a White Paper on SEND, perhaps the Local Government Association should set up a taskforce to remove the need to use the private sector.

I am sure that when John Stuart Mill, the nineteenth century philosopher, said that’ it was the duty of the State to see it citizens were educated, not to educate them itself’ he did not expect the cost to the State to be more than a reasonable amount.