“1. L will always need to be transported in his wheel chair when travelling in education transport as it would be unsafe for carers to lift him in and out. He would need to travel in his wheelchair with seating system so he is in a good safe position. 2. Ms K reported that L suffered from dehydration last summer. If he were to travel for any length of time it would be much more comfortable if he were in an air conditioned vehicle. 3. One of the documented findings regarding L’s condition is that stress and anxiety often leads to an increase in spasticity. If travelling long distances caused L stress than this should be taken into consideration when considering school placement.”
“I am concerned that L has been offered a secondary school, Lonsdale, which is 33 miles away. This entails a 3 hour return journey, which would be detrimental to a child with L’s condition. It has been shown that L’s musculo-skeletal system deteriorates when he is not well managed and a journey of this length would only serve to increase both his muscle tone and his fatigue levels, which in turn would leave him unable to fully benefit from the education this school would offer.”
“I do apologise for my delay in replying to your letter of 4/04/06. I understand you are acting for L’s mother, Ms K who is appealing against the contents of L’s Statements of Special Educational Needs. One of her concerns is the travel time that L will endure if he attends Lonsdale School. You asked for my opinion on the likely physical impact of this journey upon L in his general well-being and his ability to access the curriculum. L was last seen in our clinic 22/02/06 by my colleagues Dr D Howard, Dr S Bhate and Ms L Katchburian. The report to which you refer followed an assessment by Dr J Sergent and colleagues on 7/09/05. From para 16 of the appeal I note that if L does not attend Lonsdale School he would be facing a journey of 1 hour 15 minutes on a Monday morning, Wednesday evening and trips to and from the school on Thursday and Friday. I agree this represents significant travelling time, which could indeed be arduous, tiring and possibly distressing to L. However the travelling conditions, the company L enjoys during the journey and his ultimate experiences in Lonsdale School (as to how stimulating and enjoyable he finds the environment) will affect his ability to cope with the journey. It is indeed possible that the whole experience will be unduly fatiguing for L but this is not guaranteed. I note that Ms K is in favour of residential placement at Treloar School where the travel would but be an issue and which offers an educational package that is not available at Lonsdale.”
“Following my report of 10/05/06 I have had further discussion with Ms K, L’s mother and we are ourselves discussed things over the telephone 13/06/06. The main issue remains the potential detrimental effects of the long journey that L will require if he is to attend Longsdale School as is currently planned. It is certainly Ms K’s opinion that this will be the case. Clinically L has abnormal muscle tone and prolonged periods of immobility will have a negative impact on this; increasing his tone and causing discomfort. As a result he requires extra stretches after periods of immobility. Given the time that is going to be spent in travelling to and from school there is additional concern that he will not receive his usual stretches before or after school, which again will negatively impact, on his overall muscle tone. Furthermore L has oromotor difficulties. Long journey times could compromise his inability to keep up with his fluid demands. He needs frequent small amounts of oral fluid but in the past has become dehydrated in the hot weather. At the end of the day I would have concerns at L facing such a long journey on a regular basis. I think it has to be considered very carefully along with his very specialist educational needs. A residential placement may well be better suited to L’s needs.”
“At the Lonsdale School, the School has no control over the therapy support provided for the students and therapy support is allocated on the basis of the greatest need, meaning that all students receive only a share of the available ‘cake’ and there would be no guarantee that L would obtain the daily therapy management that he needs. To date, this level of daily physical management support has not been specified by the North Herts NHS Trust and provision made is only at the discretion of the Trust.”
“10. The appellant also believes that L requires a 24 hour curriculum so that he has an opportunity to transfer learnt provision to after school hours. Due to the complexity of his profound needs, L has a particular need for constant stimulation and provision which will not be available other than through a waking curriculum.”
“24 hour curriculum The Appellant seeks a waking day curriculum for L on the grounds that a day placement will not enable him to increase his independence skills. She refers to paragraph 15 of Mr. Davies’ report where he advises that L “requires a much more aggressive and consistent physical management programme” in light of his diagnosis. The Appellant submits that L can only obtain the full benefits and consistency of such a programme if it is provided through a 24 hour curriculum. She also submits that the FLAME programme at Treloar School is the most appropriate programme to provide the degree of physical management recommended by Mike Davies.”
“Given L’s multiple and complex needs, I would recommend that he has a comprehensive management program that should be delivered by experienced paediatric therapists including a full physiotherapy program with regular review. Deterioration cannot be entirely avoided but an active program will optimise L’s abilities and may ameliorate the rate of deterioration.”
“There are three factors that the writer has noted about the School in relation to L’s SEN: a. No student at the School is Statemented to receive any therapy intervention and the therapy provided to the School is ‘at the discretion of the North Herts NHS Trust’. This will not be sufficient for L and he will require an intensive daily programme that is closely monitored by the physiotherapists and occupational therapists because of the higher than usual risk of physical deterioration because of L’s condition. b. L also requires a very high level of speech and language therapy and this also needs to be written into his Statement at a far higher level than he is likely to receive on a routine level at the Lonsdale School. c. The writer supports Ms K’s request for a waking day curriculum for the reasons previously outlined: L will benefit from the therapy and educational programmes throughout the waking day and this will assist the necessary physical management programme that has been described to reduce L’s physical deterioration. The partial residential provision at the Lonsdale School does not appear sufficient and does not allow for the more extensive independence programmes that L requires – there are no facilities for the students to cook for themselves, for example, and the time available, of course, is much less and is limited to 2 nights per week only.”
“72. Consequently, L’s physical independence does become the most important aspect of his educational needs because if his physical functioning regresses, so does his access to the curriculum. 75. The fear is that where there is not a very detailed and intensive physical management programme in place with close monitoring by the therapy services, there will be the risk of creeping deterioration because the staff with the main responsibility for looking after L will not have the level of knowledge or skill to know how to best manage L from minute to minute during the whole of the educational day. 79. L needs to attend a school where the therapy staff are employed directly by the school and who deliver their programmes largely in the classrooms, alongside the teachers and with programmes fully integrated into the educational curriculum. 80. L will not just benefit from the waking day curriculum, he requires it. 81. At the Lonsdale School, the School has no control over the therapy support provided for the students and therapy support is allocated on the basis of the greatest need, meaning that all students receive only a share of the available ‘cake’ and there would be no guarantee that L would obtain the daily therapy management that he needs. To date, this level of daily physical management support has not been specified by the North Herts NHS Trust and provision made is only at the discretion of the Trust. 82. The Lonsdale School does not offer a waking day curriculum and this cannot meet this aspect of L’s SEN.”
“4. E – Physiotherapy Needs We cannot comment on the FLAME programme at Treloar School but would agree that L needs a consistent approach to his physical management. We would also agree that during adolescence, L will require close monitoring of his musculo skeletal system. The information provided by the Developmental Vision Clinic at the Wolfson Centre suggested that strategies for L’s visual perceptual skills were unlikely to improve. 6. H – Physiotherapy Input required to meet the above needs We would agree that L requires a 24 hour postural management programme incorporating specialist seating, standing and sleeping equipment. This will facilitate the maintenance of L’s joint ranges and muscle length. I -hours of physiotherapy provision needed to meet above A daily exercise and activity programme that is aimed at maintaining and developing L’s gross motor control could incorporate sitting, mobilization and hips and spine, rolling and crawling. This should be devised by a qualified physiotherapist but could be carried out by non-teaching support staff.”
“The initial main priority from the occupational therapy perspective would be to review and alter L’s seating system. As outlined above, L does have complex needs and from discussion with both Mrs Carter and Ms K, it has proved difficult to meet his seating needs over the past few years. There have been long periods of delay with getting new seating and there appears to have been nothing done to date with altering his present seating system. It would be much easier for L’s seating needs to be monitored and altered quickly if he were in a specialist school where there was an on-site technician who was able to work with the therapists to alter this as and when necessary. Without good seating not only is L’s posture likely to deteriorate this will have an impact upon his general functioning and so therefore will affect how well he can access the educational curriculum.”
“L needs to work through an intensive program of postural management and physiotherapy exercises throughout his school day and, furthermore, throughout the 24 hour day. …”