In Search of Hidden Healthcare Workforces: NHS Therapists for Children and Young People with Special Educational Needs and Disabilities (Part 2)

Prof Ian Kessler of the NIHR Policy Research Unit in Health and Social Care Workforce is Professor of Public Policy and Management at King’s Business School. He introduces a new report from the Unit, scoping the demand and supply of NHS therapists for Children and Young People with Special Educational Needs and Disabilities.

This, the second of two blogs, focuses on the supply of, while the first addressed the demand for, therapists for children and young people with Special Educational Needs and Disabilities.

The Supply Side

Commissioning. While the capacity to address this increased demand rests in large part on the scale, structure, and capabilities of the therapy and, as already implied, the wider health and care workforce, the commissioning process for CPY with SEND, is pivotal. Commissioning determines the services available and at what level of resource, inevitably feeding through to determine the workforce required to provide them: to put it crudely, if a service is not commissioned, a workforce is not required. The close connection between service design and the workforce is apparent from various ‘good practice’ commissioning models [1]. These typically distinguish different levels of services linked to the nature of need and support, with implications for the requisite workforce: for example, accessible universal services delivered by a wider workforce; targeted services provided by registered therapists and their support co-workers; and specialist services the exclusive preserve of the registered therapist. Continue reading

In Search of Hidden Healthcare Workforces: NHS Therapists for Children and Young People with Special Educational Needs and Disabilities (Part 1)

Prof Ian Kessler of the NIHR Policy Research Unit in Health and Social Care Workforce is Professor of Public Policy and Management at King’s Business School. He introduces a new report from the Unit, scoping the demand and supply of NHS therapists for Children and Young People with Special Educational Needs and Disabilities.

This, the first of two blogs, focuses on the demand for, while the second discusses the supply of, therapists for Children and Young People with Special Educational Needs and Disabilities.


The workforce delivering care and support for children and young people (CYP) with special educational needs and disabilities (SEND) is an elusive one. In part this elusiveness stems from the diffuse and fragmented nature of the workforce as CYP with SEND typically engage with a variety of services- education, health, social care and sometimes housing. Even drilling down into these discrete service segments, tying the SEND workforce down in terms of its size, skill mix, and capacity remains challenging. Take health as an example. CYP with SEND will have a range of developmental, physical, and mental health care needs, addressed by a variety of staff groups to be found in different clinical settings including: nursing in both community, acute and mental health settings, clinical consultants in a similar range of settings, GPs in primary care, and healthcare visitors in the community. Adding to the challenges is the fact that those in any one of these staff groups will have clients which include but are rarely limited to CYP with SEND. With policies often framed by and centred on ‘children and young people with SEND’ as the named client group [1], the hidden nature of the workforce caring for and supporting them becomes a real challenge in meaningfully delivering on the policy initiative. Continue reading

Addressing homelessness in social work education

Carolin HessCarolin Hess is a PhD student in the NIHR Policy Research Unit in Health and Social Care Workforce who has been awarded Doctoral funding from the NIHR School for Social Care Research. She reports from a recent webinar, the latest in the Unit’s Homelessness series. (920 words)

The webinar, attended by over 200 people, presented emerging findings from an innovative study ‘Addressing Homelessness in Social Work Education’, conducted by Jess Harris and Karl Mason and funded by the National Institute for Health and Care Research (NIHR) School for Social Care Research (SSCR).

The study delved deeper into an aspect of a previous study on Safeguarding responses to homelessness and self-neglect, which examined why social workers, including those in safeguarding roles, may be inadequately prepared for working with people experiencing homelessness. The study is also connected to a previous webinar on a study on the ‘Homelessness Social Worker Role’ which explored the experiences and support needs of specialist homelessness social workers, as well as the systemic barriers they face. This earlier webinar revealed that many social workers reported limited exposure to homelessness-related topics during their qualifying courses and uncertainty about their role in this area. Continue reading

What’s New? LGBTQ+ in Social Work Practice Education, Placements, and the Assessed Supported Year in Employment

Victoria Grimwood is a Pre-Doctoral Local Authority Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce, King’s College London. (304 words)

Victoria Grimwood

Victoria Grimwood

In the recently published Social work in England: State of the nation 2023 report Social Work England, the regulatory body of social work in England, announced an intention to increase the focus on equality, diversity and inclusion, and a commitment to the development of improved standards in education and training for the profession. As many in social work have observed, the social work profession is more diverse than the general population in England in relation to ethnicity, gender identity and sexual orientation.

Continue reading

Improving care for people with Parkinson’s through learning

Fiona Barrett is the Education Programme Manager at Parkinson’s UK. The charity works alongside health and care professionals in the UK Parkinson’s Excellence Network to provide resources and learning to drive improvements in the care of people with Parkinson’s. (500 words)

With the recent publication of the updated Parkinson’s NICE guideline and quality standard, it’s a great time to highlight some of the learning we provide to help health and social care professionals improve the quality of care they offer to people with Parkinson’s. Continue reading

Why we need to pay more attention to student funding in social work education

Jo Moriarty is Senior Research Fellow and Deputy Director at the Social Care Workforce Research Unit. The report on the social work bursary, published today, is available free to download. (604 words)

There has been a large rise in the volume of social work research undertaken in the UK over the past 20 years but one topic remains stubbornly under researched: student funding in social work education. This is all the more surprising when we remember the attention given to tuition fees in the last three general elections.

In June 2017, the Department of Health and Social Care Policy Research Programme commissioned the Social Care Workforce Research Unit to undertake a short review of the social work bursary.

We had already done a similar piece of work so we had not expected to uncover a large research evidence base. However, it still seems surprising that there is so little research on social work students finances given that many social work students are drawn to social work after being in care or experiencing discrimination or poverty. Continue reading

The Prato moment: thinking about leadership in social work education

Mary Baginsky, Senior Research Fellow at the Social Care Workforce Research Unit, introduces an invited post by Professor Charlotte Williams:

I was fortunate to have attended the second colloquium held at Monash University’s Prato centre. This is the second year that the group has come together to explore social work education. Prior to a more formal summary of proceeding, Professor Charlotte Williams, Professor and Deputy Dean of RMIT’s Social Work in the School of Global, Urban and Social Studies, reflects on the context and culture within which the discussions took place. In so doing she made me realise how much I miss the intensity of the discussions, the opportunity to learn from the experiences of others and the time to talk and disagree.—Mary Baginsky

Professor Charlotte Williams writes:


Professor Charlotte Williams

There’s a special magic about Prato that is so conducive to commune. The ambition of the Prato Group, a collaboration of Social Work educators, reflects many of the attributes of this ancient and vital textile producing city in which it was inaugurated. The Prato textile enterprise with its yarns, designs, collective and innovative technologies has approached its futures over an 800-year history with enormous creativity, energy and pragmatism in an effort to remain relevant, stable and future-oriented. Through epochs of profound social, economic, political and technological change the ability to anticipate, capture and engage judiciously with disruptive forces and to lead through change has meant a threatened industry thrived largely through the efforts of small and distributed artisans working with common purpose. Continue reading

The Prato Moment

imageProfessor Charlotte Williams OBE reports from Prato, Italy, on an international colloquium organised by the Deans of Social Work Education in Australia on 12-13 September 2016, at which Jill Manthorpe and Mary Baginsky participated. (570 words)

There are few opportunities to bring together a group of individuals in leading roles in social work education cross-nationally; particularly so in providing them with the thinking space to reflect critically and strategically over a two day ‘lock in’. This gathering could never be representative; it could never be comprehensive in the scope of issues, perspectives or topics it engaged with, nor could it be conclusive. Those ambitions are best left to the International Association of Schools of Social Work. But it did bring together a group of ‘thought leaders’, people who happened to hold significant positions across social work education East to West, in a catalytic moment. There was, we all hoped, an opportunity with some potential to reimagine social work education, present and future. Continue reading

Student placements in children’s service departments: lessons from Canada

Dr Mary Baginsky

Dr Mary Baginsky

Mary Baginsky is Visiting Senior Research Fellow at the Social Care Workforce Research Unit at King’s College London. Here she suggests how universities and social work services could be brought into closer partnership.

Both Martin Narey’s and David Croisdale-Appleby’s reviews of social work education have reported on the shortage of placements for social work students, as well as raising questions about consistency in the quality of those that do exist. The President of the Association of the Directors of Children’s Services (ADCS), Andrew Webb, has also said that there is neither the range nor breadth of placements to keep pace with student numbers. Martin Narey went so far as to say that the endorsement process should include an evaluation of the quality of practice placements and recommended that universities which fail to provide every student with at least one statutory placement (or an alternative which is genuinely comparable and accepted by employers as comparable) should not receive endorsement from The College of Social Work. There is, perhaps, an alternative approach whereby the placements a student has completed on their registration are recorded. Anyone who had not completed a statutory placement in the relevant sector would then be required to do one subsequently if they wished to be employed in a statutory setting. The cost effectiveness of this would need to be calculated.

However, making this and similar suggestions does not get away from the seriousness of the situation facing courses and students, but neither is it confined to social work students. The Nursing Times (12 February 2014) reported that student nurses are struggling to get good practice placements because hospital wards are overstretched and staff too busy to supervise them.

It is not surprising that the pressures under which children’s service departments are operating and the number being judged to be inadequate by Ofsted are having an effect on the willingness of managers and practitioners to take students on placements. I am well aware of good practice around the country where universities and local authorities have established strong working relationships. They are usually distinguished by a commitment of the university and/or the local authority to take on responsibility for placements at a relatively senior level. This is usually linked with a commitment on the part of local authorities to embed placements in their workforce strategies and on the part of universities to provide a high level of support, not only to students but also to authorities. As training budgets are slashed and more authorities struggle to retain experienced staff such support from universities is an important factor in being placement-possible if not placement-friendly. In the past some authorities have complained that they have had to take what (and whom) universities have offered but the world has moved on. It is in the interests of both parties to collaborate over the training of existing and future practitioners and this is the conclusion that more authorities and universities are reaching.

Thirty-five years ago Hayward (1979) wrote that:

The assessment of practice aspects of the course has traditionally been regarded as different in quality and far more problematic than the assessment of coursework. (p.175)

Assessment of student practice is still the issue that is commonly cited by practice educators and university tutors as the one that is most likely to lead to disagreement, whether this is in terms of practice educators’ concerns about aspects of the student’s practice or perceived generosity or leniency of one party. On a recent visit to Canada I encountered two initiatives that could be introduced in this country and which have brought universities and social work services into closer partnership.

First, there are many examples in the literature that illustrate how individuals come to quite different outcomes when making an assessment and there are also many examples in the literature of attempts to devise competency-based checklists. One of the most reliable is the Objective Structured Clinical Examination (OSCE). The OSCE is used as an assessment tool for licensing exams in nursing, medicine, midwifery and other subjects in the UK, Australia, Canada and the United States. It is used to assess knowledge, clinical skills, and the transfer of knowledge into practice while providing a standardised assessment method irrespective of variations in client or assessor. Marion Bogo, Professor of Social Work at the University of Toronto, has developed an OSCE for social work which is now being used and adapted across Canada and USA. It consists of ‘laboratory’ interviews and structured reflective exercises to see how the student has integrated concepts. OSCE performance and reflections are rated on standardised scales. Initial tests and subsequent applications have shown that the test is a valid tool for assessing practice, even though further development is required. It is being adopted in a number of countries and the question arises as to why it is not as prominent in this country. It is time and labour intensive which, in the current climate, is likely to prove a disincentive. But it is hard to remember a time when this would not have been the case. As well as a potentially more reliable way of assessing students it also offers the opportunity for universities and practitioners to work together on its development.

The second suggestion comes from a visit to McGill University in Montreal. Anyone taking a student on placement who is attending McGill is required to take a course on supervision before the placement. Not only is this a way of attempting to ensure the quality of placements, it means practice educators engage with McGill at an early stage and the university then builds on this relationship in a number of ways. One way is by inviting their practice educators to regular meetings with the faculty members of the Social Work department. I was fortunate to be able to attend one of these meetings and I was struck both by the understanding of the course that the practice educators displayed and by the breadth and depth of the discussion. So while administrative and progress issues around the actual placements were covered, there was much more discussion of issues around the integration of theory and practice and of specific elements of the training. It was evident that there was a shared understanding of the curriculum, which must in turn benefit all involved but most of all the students on placement. It represented a real partnership of practice and academy that is often talked of but not often achieved in England. It is a model that would transfer to this country but again one that demands a significant level of commitment.

It may not seem the most sensible approach to suggest initiatives that will take even more time and application. But it seems that while social work courses have been forced to address the criticisms leveled against some academic input for its lack of rigour and consistency, similar standards need to be applied to placements and ones that go beyond the revised Practice Educator Professional Standards, however welcome these have been. Practice and professional trainers need to address this subject together. They will find many ways of doing so but perhaps these two examples could be in the portfolio of actions they consider.

Dr Mary Baginsky is Visiting Senior Research Fellow at the Social Care Workforce Research Unit, King’s College London. Follow Mary on Twitter: @abbotsky


Hayward, C. (1979) A Fair Assessment: Issues in Evaluating Coursework. London: CCETSW.

Compassion and consistency – the key to enabling positive change

Natalie Atkinson

Natalie Atkinson

In this, her second guest post at the Social Care Workforce blog, Natalie Atkinson, a student at the University of Cumbria, updates us on her progress in getting support from her local authority for her studies. There is also news of an upcoming BBC 3 documentary on young people’s experience of the Criminal Justice System and prison. Natalie took part in the Communities of Practice programme: Delivering on the integration agenda for people with multiple and complex needs as an ‘expert by experience’.

Taking part in the ‘Communities of Practice’ research programme run by the Social Care Workforce Research Unit (SCWRU) and Revolving Doors Agency as an expert by experience, has been the start of an amazing year. Having been given the chance to positively use my own ‘lived experience’ to assist in improving front line collaborative responses to people facing multiple needs and exclusions, has given me more confidence to succeed. I never imagined that writing a guest post for the Social Care Workforce blog back in July would play such a huge part in opening doors of opportunity; the power of social media in today’s society is immense. Following on from the guest post I became a contributor for and was drawn into the world of Twitter; now I am probably classed as a ‘tweeter’.

In November 2013 I finally won my battle with the Local Authority (LA) and received commitment from them to support me through my journey in higher education but more importantly received an apology for how my case had been handled. At the age of 21 I felt that I had been abandoned by Children’s Services when they closed my case and this ultimately made me resent the LA. Yes, Children’s Services have shown compassion and heart in my case, but how many other young people are out there who are not in a position to challenge the decisions that are made about them by different LA’s? Consistency needs to be demonstrated throughout the care system as that is one of the main things a lot of looked after children do not experience. I consider myself to be lucky enough to have the determination and support to challenge decisions.

With only seven months until I graduate with a BSc in Policing, Investigation and Criminology from the University of Cumbria, I still find myself pinching myself to see whether it’s all been a dream. However, the closer I am getting, I am starting to realise that it is reality and this is actually the start of a new chapter in my life. I no longer have to feel ashamed of being a care leaver and an ex-prolific offender because I am actually able to use this to challenge the judgement and prejudices that exist. I can stand as a prime example that you should never give up on a child or a young person and hopefully this will empower individuals, who are in a similar position to one that I have once been in to make changes.

Having left school at such a young age and spending my time snowballing through the Youth Justice System and then the Criminal Justice System (CJS) makes me appreciate the importance of education. A big part of my journey has been returning to education and discovering that I can use my ‘lived experience’ to assist in gaining academic knowledge and I plan to carry on studying and go on to complete an MSc and then a PhD. I have recently been appointed as a Service User Trustee for Homeless Link and I am hopefully able to use my own life experience to campaign for continued and improved support services. One of the biggest opportunities to arise from the guest blog for SCWRU and being a contributor for has been to use my own experiences as a basis for a BBC 3 documentary on young people’s experience of the CJS and prison, which is due to be aired in April 2014.

Since a young age my life has been like a roller coaster and to this day I still consider my life to be the same but the only difference is, is that I am now part of a positive roller coaster and I get to decide the route I take. I am not able to say for sure what the future will hold for me, but what I do know is that I will always be standing behind the children and young people that are labelled by society; saying if I can do it then so can they. My mission is not to change the world but to challenge the policies and practices that effect children and young people and hopefully one day I might be in a position to influence change.

Natalie Atkinson was an expert by experience on the Communities of Practice programme. Lead researcher at King’s on this project was Senior Research Fellow, Dr Michelle Cornes.

Follow Natalie on Twitter @Nat89atk