Findings of the Sense Public Inquiry into access to play opportunities for disabled children with multiple needs

Chaired by Lord Blunkett and Lesley Rogers 

What this inquiry covers:

• Foreword
• Background and executive summary
• Recommendations
• Inquiry findings: The benefits of play
• What are the barriers to play?
• Case studies
• Conclusion and recommendations
• List of participating organisations
• Endnotes

Foreword from Lord Blunkett, Chair

As a new member of the House of Lords, I am very pleased to be able to Chair this important Inquiry and ensure that it receives the attention it so clearly deserves.

Creating equal chances for children with multiple needs to enjoy the same opportunities as their peers is an issue close to my heart and something I have long campaigned for. Throughout my 28 years as an MP, and in my roles as Secretary of State for Education and Employment and Home Secretary, I have tried to raise the key issues which affect the families of disabled children, and called for better support from government.

The importance of play for a child’s development is fundamental. However, all too often the parents of children with multiple needs point to barriers they face in accessing and enjoying play.

This Inquiry was essential in not only gaining a full understanding of these barriers, but also in learning what can be done to improve this situation, highlighting the very real positives and benefits of play.

Working with Sense on this Inquiry has been both illuminating and thought-provoking. The picture painted was one of stark issues and tangible concerns that clearly need addressing if we are to ensure that children with multiple needs have adequate access to play opportunities and do not face exclusion.

Our report makes a number of key recommendations for national government, local government, and for play settings themselves, which are vital stepping stones towards making play a reality for all children.

The political will to build on this report is certainly there. The Government’s manifesto for the 2015 General Election highlighted the importance of equal opportunities for all, communities coming together to support one another, and removing barriers to people engaging fully in society.

These sentiments were shared by those currently occupying the Opposition benches, with my own Party also making equal chances for young disabled people a central plank of their policy offer; further emphasising a positive consensus on the need for action.

In fact, considering the Prime Minister’s recent drive to promote the importance of good parenting and equal opportunities for children and young people, our Inquiry has now become all the more salient.

I know that there is strong support across the political spectrum for addressing the findings of this report, and I look forward to working with colleagues from all parties to achieve real change for parents and families across the nation.

Lord Blunkett

Chair

Foreword from Lesley Rogers, Chair

We all have happy memories of how we enjoyed play when we were children. Play is important for every child – it makes them happy, helps them learn about the world and make friends. However, disabled children with multiple needs often do not get the same opportunities to play.

When my daughter Ruby was born, we struggled to find appropriate play opportunities for her. Many parents in this situation feel lost and isolated. Often when a child has to go through numerous medical procedures and follow a strict routine play is not a priority.

Play, however, is invaluable for children with multiple needs and their families. It enables us to experience those priceless moments of happiness and brings a sense of normality. Sadly, most toys, equipment, play groups and playgrounds are not accessible to our children.

There are many reasons for this, including the lack of information and specialist help for parents, poor disability awareness, problems with physical access and shortages of skills and funding. Parents feel vulnerable and reluctant to access mainstream play provision, and unfortunately even specialist play groups are not always able to accommodate disabled children with multiple needs.

The evidence that has been collected by The Case for Play Inquiry shows how significant this problem is and how important it is to address it. And whilst there are bigger issues around societal attitudes towards disability, this report also shows that even small changes can make a huge difference to the lives of disabled children with multiple needs and their families.

I sincerely hope this report will lay a foundation for important changes that will bring the joy of play to the lives of disabled children and their families.

Lesley Rogers

Chair

Background to the Inquiry

For three months between September and November 2015, Sense undertook a public Inquiry into the provision of play opportunities for children aged 0-5 with multiple needs in England and Wales.

The Inquiry was established in response to feedback received from families of children with multiple needs who had expressed concerns that they had fewer opportunities to access play services and settings in comparison to families with non-disabled children. Guidance on learning to play with their children is also the most common request from families who access support from Sense.

The Play Inquiry was designed to provide an evidence base and thorough understanding of the following questions:

1. What are the benefits of play for children with multiple needs?
2. Do barriers exist to young children with multiple needs accessing play settings and activities? If so, what are these?
3. What can be done to increase access to play opportunities for young children with multiple needs?

Inquiry scope

For the purpose of this Inquiry, by ‘children with multiple needs’ we are referring to children who  may have a combination of disabilities, including vision impairment, physical disability, hearing  impairment, complex learning difficulties, autistic spectrum disorders and degenerative conditions,  all of which combine and can affect children’s ability to access the world.1 Data on the numbers of children with multiple needs is extremely limited, but the most recent estimate suggests that out of the 570,000 disabled children in England, there are approximately 100,000 who live with complex care needs who need support from a wide range of services.2

We chose to look specifically at children with multiple needs because there is a shortage of evidence into the specific barriers to play for this group. Also, an increasing number of children who access support from Sense tend to have more than one need or a range of disabilities – especially those who have survived premature births or have complex medical conditions.

We decided to look specifically at the age range from birth to five years. This is because we are interested in play as part of children’s early development and because parents tend to request support from us for children within this age range. We are aware, however, that access to play is also an issue for older children and this may be the focus of future work.

By ‘play settings and activities’ we are referring to any play setting or activity that is aimed at providing children with opportunities to play and interact with each other. This includes settings and activities run or commissioned by local authorities and the voluntary, community and private sectors.

These settings include nurseries, Portage services, children’s centres, short breaks providers, childcare settings, health settings and playgrounds. For children aged 0-2, this can involve early support from professionals in the home.

Methodology

In order to gain the best possible understanding of the issues related to play, we invited input from a wide range of parents, play professionals, academics and local and national policymakers. During the period of the Inquiry, we received over 350 pieces of evidence:

• 30 telephone interviews were conducted with parents of children with multiple needs.
• We ran five focus group sessions – talking to parents across England about the types of play opportunities their children need.
• We held two roundtable discussion events for play workers, academics and policy specialists, which explored barriers to accessing play as well as what the possible solutions could be.
• We issued Freedom of Information (FOI) requests to all local authorities in England to find out how they deliver and resource their play provision – a total of 117 responded. We also analysed local authority Play Sufficiency Assessments in Wales and local and national level statistics on disabled children aged 0-5.
• 36 organisations provided written submissions in response to our call for evidence.
• We conducted ten telephone interviews with play specialists.
• 20 organisations shared their own research reports on play.

The following report contains a summary of the key findings from the Inquiry. It also includes a conclusion and a series of recommendations for local and national policymakers and play professionals, which are based on the evidence received. Sense will use the Inquiry findings to campaign for changes to the way play services are designed and delivered. We will also produce a series of toolkits for parents, providers and commissioners of play.

Acknowledgements

Sense would like to thank all the families and organisations who contributed to the Inquiry for being open and honest about their views. We would also like to thank Lord David Blunkett and Lesley Rogers for chairing the Inquiry and for providing invaluable advice and support. Many thanks also to Julie Jennings from RNIB and to Steve Rose from Sense for providing expert guidance throughout the process.

Executive summary

Key findings

The evidence submitted to the Play Inquiry highlighted a number of key issues.

Access to play:

• Early intervention through play is vitally important for children with multiple needs and their families, and brings a wide range of developmental and emotional benefits.
• There was a strong consensus in the evidence submitted to the Inquiry that children with multiple needs face significant barriers to accessing play. Where a child has multiple needs, the barriers they face to accessing play settings and activities are multiplied.
• 92% of parents surveyed felt that their child did not have the same opportunities to play as their non-disabled peers; 81% of parents also reported difficulties in accessing mainstream play groups and local play opportunities.
• Families would like to be able to access mainstream play settings in the community, local specialist settings, and early support delivered within the home.

Issues experienced by families:

• Many parents had experienced negative attitudes towards their child with multiple needs and most considered this to be the most significant barrier to accessing mainstream play settings.
• Despite clear duties in the Equality Act 2010, 51% of children had been intentionally excluded from play opportunities by providers of play.
• 95% of parents said that parents of children with multiple needs require support to find ways to play with their children.
• Many parents struggle to find out what accessible play opportunities are available to them, and word of mouth is commonly used in place of official sources of information, such as the Local Offer.
• 40% of families told us that they often face additional financial costs when seeking to access play opportunities.
• Families feel there is a lack of specialist support that can be accessed locally, and many make long journeys to access play settings.
• Very few play settings enable parents to take a break.

Issues with play provision:

• Many play settings are not accessible to children with multiple needs.
• Few play settings are set up to welcome and support parents and non-disabled siblings.
• Parents highlighted that levels of awareness and training in medical conditions, communication methods and multiple disabilities by play professionals is a barrier to their child accessing play provision.
• Misguided notions of ‘health and safety’ can mean that children with multiple needs are sometimes denied the opportunity to play.

Barriers caused by local and national policy:

• There is no notional funding for special educational needs provision in the early years in England, and play providers can struggle to absorb the additional costs incurred.
• There is a lack of a strategic approach to providing play services across England and no mechanism for checking that there is enough provision to meet the needs of the population.
• Funding for play is not ring-fenced and the impact of ongoing funding cuts on play services is a key concern.
• The emphasis on child-led and free flow play set out in the Early Years Foundation Stage curriculum can mean that settings are not set up to provide for children who need more support to play.
• There is inconsistent recording of data by local authorities across England and Wales about the needs of disabled children in their early years, and their access to play provision.

Recommendations

Having collected evidence from a wide range of sources, the Inquiry has highlighted several areas where changes are needed to improve access to play for children with multiple needs.

National level

• There needs to be a nationwide policy of funding children with special educational needs in early years education. Notional funding must be provided to settings to enable providers to invest in accessible premises and staff training.
• Funding for play should follow the child and family, whether that is for support in the home or in specialist or mainstream settings.
• Issues around funding for the new childcare commitment in the Childcare Bill must be resolved, through ring-fenced funding.
• The Government should begin a national dialogue to promote the need for strategic local approaches on play. Local authorities should then be expected to draft and submit regional play strategies to the Department for Education based on local circumstances.
• Play should be instated as part of the ministerial brief of the Minister for Childcare, to highlight the importance of early education.
• Through the proposed Ofsted local area inspections, the Department for Education should ensure that Local Offers contain clear information about local play opportunities and entitlements.
• Developmental play services such as Portage should become a statutory service for disabled children under the age of two, with an increased emphasis on children with multiple needs.
• The Department for Business, Innovation and Skills should provide all local authorities with guidance on market management to ensure that demand for play settings for disabled children is met locally.
• Play should be a key strand of the Government’s policy on parenting and should be an explicit part of government- funded parenting classes.
• The Equality and Human Rights Commission should investigate the exclusion of children with multiple needs from mainstream play settings. It should provide clarity on the current legal requirements for settings and take action to support the enforcement of the Equality Act 2010.
• The Health and Safety Commission should investigate reports that a misguided interpretation and approach to health and safety is creating a barrier to accessing play settings and activities for children with multiple needs.

Local level

• Local authorities need to make better use of data in order to identify the number of children with multiple needs who are living in their local areas. Health and Wellbeing boards should take the lead in pulling together regional data on provision and demand.
• Local authorities should also be required to take action, as necessary, against settings that intentionally exclude disabled children and fail to meet their legal duties under the Equality Act 2010.
• Local authorities should take a lead on increasing awareness and understanding of the general public and other parents about disabled children. This could be centrally funded but locally delivered.
• Health and Wellbeing boards should consider the development of appropriate additional training of health visitors or other professionals to enable them to provide the support needed to help families of children with multiple needs to learn about and access play.
• Local authorities should provide easily accessible information for parents to help them to find out about existing play and support services. This should include signposting to potential sources of play and support soon after the child is identified as having multiple needs, and keyworker support.

Play settings

• Settings should ensure that play staff have received training on multiple needs and disability to help improve the way they support children and families. This should include responding to medical needs, communicating with children with specialist communication needs, and personal care. The training should also enable them to create an environment and ethos which is inclusive and developmentally appropriate.
• Where possible, treatments and therapeutic interventions should be delivered through play.
• Every play setting should have a play policy statement which stresses the inclusion of every child.
• Settings should plan carefully prior to the admission of every child in order to ensure their needs are met and that they will be welcomed and understood by other parents, children and both professional staff and volunteers.
• Voluntary sector organisations should do more to share their significant experience of supporting children with specific impairments and multiple needs with public and private play settings. This could include offering training and toolkits on inclusive play.

Inquiry findings: The benefits of play

Play is critical in giving children the best start in life and improving outcomes for children and their families. The Inquiry received compelling evidence from parents about the positive impact of play on the lives of children with multiple needs.

A sense of wellbeing

For children with multiple needs and their families, play contributes to a sense of wellbeing and normality. Life can sometimes be stressful for children who receive a large number of medical interventions and therapies; play enables them to relax and enjoy the moment. Play allows disabled children to be happy, thrive, and live in the here and now. It is simply about having fun.

“It makes him happy, smiling, laughing, feeling part of the family, self-confidence, self-esteem.”

Parent

Building strong family relationships

Parents and professionals who submitted evidence to the Inquiry stressed that play can be absolutely central to parent-child bonding, and helping adults to develop their parenting skills. It is a way for parents to undertake parent-child interaction therapy to build relationships, improve communication and raise aspirations for their child. Play can also be instrumental in building close relationships with siblings, as it offers an opportunity to spend quality time together as a family.

Having fun together is extremely important, especially when parents are under pressure to observe routines, attend appointments and manage their child’s medical needs. Parents told us:

“Laughing and having fun together is the most important thing”

“Play helped him to explore and us to bond”

Early education and development

Play acts as a bridge that helps children learn about the world around them – and their place within it. It is a crucial component of children’s lives, driving and building their early development. For example, by playing with toys children with multiple needs develop an understanding of major concepts, such as body awareness[i], object permanence[ii] and cause and effect, which are major milestones for all children. One parent described the profound effect that playing had upon her son:

“Play was so important; it helped him realise he existed. Before that he was not doing anything – just lying down.”

For children with multiple needs, access to play is arguably even more important to enable their physical, cognitive and emotional development. Investment in delivering early intervention through play is therefore an effective way to improve the life chances of children with multiple needs. A lack of play will mean they are less able to achieve their full potential.

This was a strong theme in the submissions we received from a range of professionals. Furthermore, the developmental benefits of play were not seen to detract from its value as a positive thing in itself:

“Play has a significant role to play in child development and this view is entirely compatible with viewing play as having intrinsic value.”3

Learning to socialise and communicate

Early childcare settings or play groups are where most children have their first regular contact with peers and make their first friends. This is where children learn how to operate as part of a group, which includes skills such as turn taking, communication with peers, negotiating, and learning about social norms.

Play helps all children gain social and communication skills. However, as children with multiple needs take longer to develop communication, child-led free play or tailored individual play programmes can be a vital mechanism through which they develop these skills.

A way to deliver assessments and treatment

A range of professionals told us that play is an important medium for carrying out assessments of children with multiple needs. Observing children in their natural environment enables therapists and clinicians to accurately identify children’s educational, physical and emotional needs. In particular, it was highlighted that play can be a highly effective way of assessing children with ‘hidden’ disabilities, such as autism and social communication disorders,4 and recognising the impact of sensory impairments.

“For children with multiple needs, play is often used alongside or as part of their regular therapy sessions ensuring they receive health input without realising they are receiving important therapy for their development.”5

Helping children to understand

Professionals often use play to help children to understand the nature of their medical and learning needs, and as a way to deliver treatments and therapies. For example, play workers in hospital and hospice settings regularly use play to help prepare children for medical treatments and procedures. Examples shared included a hospital play therapist putting bandages on to a doll and inserting a cannula into a teddy bear. When the time comes to receive medical treatments, having an element of playfulness can make the experience less traumatic.

“For children who require frequent surgery or treatments, play can be an innovative and valuable way for them to learn about their condition.”6

If therapies can be ‘packaged’ as play, young children are more likely to engage successfully because they will be having fun. Play can also help to explain and soften the transition between different settings, such as a move into nursery or school, or out of a hospital into the community.

Expressing feelings and developing resilience

Another benefit highlighted in several responses to the Inquiry is the idea that, through play, children can express and explore their fears and emotions in a safe space. Play provides a medium to explore and manage feelings, promoting resilience. It can also help children to learn to make choices, develop an awareness of risk and give them a sense of control and independence. This can be particularly important for disabled children with multiple needs, as so much in their lives can be beyond their control.7

“Play is very beneficial. It helps him understand what’s going on. It enables him to respond.”

“The fact that play allows children to create their own rules and use their own ideas can enable them to feel a sense of control, which is otherwise missing from their lives owing to their multiple needs.”8

Inclusion and equality

Play gives groups of children the opportunity to interact and can foster positive relationships between disabled and non- disabled children. By enabling children to have fun together, play helps to raise awareness about disability in a natural way, and without stigma. Inclusive play opportunities allow disabled children and their families to feel part of the community and help increase their sense of inclusion.

“Inclusive play for all children fosters an environment where diversity is respected and valued; it enables all children of all abilities to play together and develop relationships on an equal footing in a child-centred environment.”9

Support for families

Play can provide access to social networks and support for parents and the child’s wider family. Through attending specialist play settings in particular, parents told us that they often develop friendships with peers, and gain invaluable emotional and practical support. Where they are equipped to meet

“The benefits of play extend to the wider family: parents develop support networks with other families when attending play activities with their children.”10

Play: The legal and policy context

The following policy and legislation is relevant to the provision of play:

• Article 31 of the UN Convention on the Rights of the Child recognises engagement in play as a fundamental right of all children.
• The Education Act 1996 imposes a duty on local authorities to secure adequate leisure and recreation facilities for children and young people.
• The Childcare Act 2006 introduced a general duty on local authorities to improve the wellbeing of young children in their area.[iii]
• Through the Childcare Bill, working parents of three and four-year-old children will have their free childcare entitlement extended from 15 to 30 hours a week.
• Under the Children Act 1989, local authorities should provide services designed to minimise the effect of children’s disabilities, to give disabled children the opportunity to lead lives which are as normal as possible, and to assist individuals who provide care by giving them breaks from caring.
• Under the short breaks regulations, local authorities have a legal duty to provide short breaks for disabled children and their families, and these should meet a range of needs.
• The Children and Families Act 2014 sets out how support should be offered to children with special educational needs and disabilities (SEND). For children with SEND, local authorities should secure provision specified in an Education, Health and Care plan. For young children this could include support with play at nursery, or the development of certain skills through play.
• Through the Children and Families Act 2014, local authorities have to publish a Local Offer to provide information about the services they expect to be available for children with SEND in their area. This should include play services.

National policy and play

Under the most recent Labour administrations, play was made a priority at a national level, with significant investment devoted to delivering against a National Play Strategy. Nationally directed Sure Start local provision was introduced in 1998 to provide childcare, early education, health and family support, with play an intrinsic part of this. All local authorities had a local play strategy to deliver against national objectives.

Subsequent governments have placed more emphasis on local decision-making about how play services should be designed and delivered. This means that most areas related to play, such as early intervention, support for families with young children, information and advice, childcare and recreational spaces, are now the responsibility of local authorities. There is no longer a consistent and coordinated national approach to policy and practice on play.

What are the barriers to play?

Despite clear evidence on the value of play, there was a strong consensus in the evidence submitted to the Inquiry that children with multiple needs face significant barriers to access.

92% of the parents surveyed told us they felt that their child did not have the same opportunities to play as their non-disabled peers.

81% of parents reported that they had experienced difficulties in accessing mainstream play groups and local play opportunities.

Accessing play can be difficult for children with a single impairment. For example, a child with a hearing impairment may need to play in spaces with reduced background noise and have access to toys that provide sensory feedback. However, if that same child is also physically disabled and has learning difficulties, they will need a more complex range of support to enable them to access play settings and activities successfully. A key finding is that where a child has multiple needs, the barriers to accessing play are also multiplied.

The evidence submitted to the Inquiry highlighted a large range of different barriers to accessing play opportunities. Broadly speaking, the barriers can be broken down into three categories:

1. Barriers experienced by families with disabled children
2. Issues with the way play services are designed and delivered
3. Problems caused by local and national policy.

1. Barriers faced by families

Feelings of exclusion and attitudes to disability

For many families with disabled children, just ‘crossing the threshold’ into a new play setting can be a very uncomfortable and worrying experience. The initial reactions they receive from other parents and staff make a huge difference and often determine whether they will continue to attend a play setting. One parent described a positive experience:

“I took my daughter to a new nursery for the first time and straight away we were greeted by a support worker. She understood my daughter’s needs and reassured me that she would progress if she had enough opportunities to get out and about and interact with other children. She was so welcoming and kind and I totally broke down. We kept going back to the nursery after that.”

Despite this, by far the most common reason parents shared for not accessing a play setting was the negative attitudes of other parents, and, less commonly, from staff in play settings. For most parents, the attitudes of others were considered to be a more significant issue than any physical barriers to play.

Examples of the comments we received from parents include:

“With other adults you fall into the ‘pity’ stare or the outright rude stare.”

“I feel like when we go to different places other parents are reluctant to talk to me because I have a disabled child. It can be lonely.”                                                      

“One lady said to me, ‘you’re brave bringing him out.’”

“The other parents get frustrated and don’t realise that my daughter needs more time than other children to use play equipment.”

“I have to explain my child’s medical tubes and other medical needs. The experience generally can be awkward.”

“I’ve heard: ‘Don’t go near that child, she’s poorly’ – no, she isn’t!”

The negative attitudes parents experienced were seen to stem from a lack of understanding and awareness of disability, including how different impairments can affect children’s behaviours. Particular issues were raised around children with learning disabilities and difficulties, who may have challenging or unusual behaviours. In such cases, other parents tended to assume that these children were ‘naughty’ and, as such, objected to them attending play sessions alongside other children. One parent said:

“If there is not a ‘visible impairment’ other parents tend to suggest that your child has behavioural problems. Other parents look at me as if to say ‘you can’t control your child – you are a bad mother.’”

It was clear from the evidence we collected that the reactions of other people often have a profound and lasting impact on the parents of children with multiple needs, and sometimes, sadly, on the children themselves.

Parents we spoke to tended to respond to negative attitudes in one of two ways. Some developed a ‘thick skin’ and continued to attend play settings whilst seeking to reach out to the other children, parents and providers and explain the needs of their child. One mother told us:

“I’ve had to grow up and become broad shouldered and become blind to the ignorance in the world.”

Other parents chose to stop attending mainstream play settings in favour of play at home or specialist play sessions for disabled children with other parents in the same situation. The following quote reflects the experiences of many parents we spoke to, who wanted to attend more inclusive settings but, in the absence of these, felt more comfortable attending specialist groups:

“There needs to be more mixing of disabled and non-disabled children but this is difficult as if parents don’t feel welcome when they first access a setting, they are unlikely to go back to that setting again. When you have a disabled child it is much easier to mix with other families with disabled children who will understand the issues you are facing”

Another parent told us:

“At specialised services you just get more support. There’s sensitivity and shared experiences. Medical conditions are normal.”

The problem created by this is two-fold. It leads to families with disabled children becoming socially excluded from their communities and also means that opportunities for disabled and non-disabled children to interact are severely limited, to the detriment of inclusion and wider society.11

Sadly, the issue is not only one that relates to formal play settings. Parents also told us that there are barriers to disabled and non-disabled children playing together informally in the home and community. In our survey, 66% of parents said they have difficulty accessing informal play opportunities with friends. One parent stated:

“Play dates can be an issue – other children come over to our house to play but often do not give a return invitation. This is because other parents do not think they will be able to look after a disabled child.”

Exclusion from settings

Worryingly, we also received evidence that some children with multiple needs are being intentionally excluded from play settings. Our survey found that 51% of children had been excluded intentionally from play opportunities by providers of play. This is despite legal duties in the

Equality Act 2010 designed to prevent this from occurring. One parent told us:

“Before diagnosis, she went along to a play group but the manager of the group was not supportive. She thought my daughter was a hassle. They asked me to provide them with more support to look after her and suggested that there wouldn’t be a spare place for her next term.”

In response to our FOI requests, most local authorities asserted that all of their mainstream play provision is accessible for disabled children. These claims seem to be at odds with the experiences that parents shared with the Inquiry.

Many parents who claimed they had never been intentionally excluded told us that they felt they had been indirectly or unintentionally excluded due to barriers in accessing play settings, including attitudes of staff. To avoid this, parents told us that it is vital for settings to have an inclusive ethos which is shared and demonstrated by all members of staff. The best settings were those where staff were positive about disabled children, had a ‘can do’ attitude, were willing to plan and adapt activities carefully for the needs of every child, and happy to challenge disablist attitudes.12

51% of children had been excluded intentionally from play opportunities by providers of play.

Finding the time and energy for play

Children with multiple needs often have a range of complex medical and therapy needs. Through the course of the Inquiry we heard that maintaining the care routine of a child with disabilities – as well as running a home and family – can be exhausting and, in some circumstances, emotionally draining. This can mean that play falls down the list of priorities. Tired families and children may also lack the energy to be playful. One parent told us:

“Sometimes this is not at the forefront of priorities. Care is so intensive and with working there’s little time for anything else. It’s not prioritised because sometimes you are just getting from day to day.”

Where the child has acute medical needs, parents and professionals may sometimes prioritise immediate health needs over opportunities to play. A written response to the Inquiry stated:

“Play may be the first thing to go when a child has very complex needs or a life-limiting condition – it’s often seen as frivolous or disposable.”13

Children with multiple needs often have complicated regimens of treatment and therapy, and the specialists involved often tell parents to perform specific activities with children in a prescribed way and at allocated times. For these children, this means that opportunities for spontaneous play can be seriously limited. This was summed up neatly in one response, which stated:

“It’s easy to get overwhelmed with, ‘Oh, I’ve got to do this five times a day’ and forget the value of playing for any developing child, no matter what their specific needs.”14

Simply finding the time and energy to play can therefore be a major challenge for families and the professionals who support them. There is therefore significant value in embedding therapies within play.

Learning the skills to play

We received strong evidence to suggest that parents of children with multiple needs can sometimes struggle to engage with their child through play – especially if the child is unresponsive. Help to bond with their children through play is also the most common type of support families request from Sense’s Children’s Specialist Services team.

Parents considered that the best settings were those where professionals were willing to spend time with them, teaching them techniques and strategies for playing with their child, and adapting toys and activities. Tailored support delivered in the home was also valued.

95% of parents who completed our survey said that parents of children with multiple needs need support to find ways to play with their children. 40% said that they did not receive this support.

Finding places to play

The Inquiry received strong evidence to suggest that many parents currently struggle to access information about what play opportunities are available to them.

63% of parents who filled in our survey told us they didn’t have enough information on suitable play opportunities in their area.

Parents told us that it can be difficult to find time to research suitable activities for their child, alongside their caring responsibilities. One parent described this as being like ‘a full-time job on top of a full-time job.’ Even when a play setting has been carefully researched beforehand, we heard that it is not uncommon for parents to turn up to attend a session only to find that it is not suitable. One parent summed up the problem:

“You turn up with a child with additional needs and they can’t meet them. You have to do a lot of research yourself beforehand and when you go and something is not accessible you feel like an idiot, standing outside the door and realising it’s not going to work. The only thing you can do then is leave.”

It can be difficult to find out what opportunities are available despite the duty on local authorities in England to publish a Local Offer of services for children with SEND under the Children and Families Act 2014.

There is a similar duty on local authorities in Wales to publicise the play opportunities in its area to families. Parents reported variable experiences with the Local Offer, but the vast majority felt that it was not meeting their needs.

For this reason, the most common way parents found out about the existence and quality of play settings and activities was by word of mouth. Locally based charities were also seen to be valuable sources of signposting. Parents really valued information from their peers but some felt that there should be ways to find out about opportunities in a more reliable and consistent way:

“It is not enough to know that a certain play group exists, you need to know how good it is and only other parents can tell you”

“Quite often you find out about things through word of mouth – this shouldn’t be the way”

The additional costs of play

40% of families told us that they often face additional financial costs when seeking to access play opportunities. Additional costs mentioned included the cost of travelling to specialist settings, entrance fees and the costs of specialist toys or equipment.

Through the Childcare Bill, the Government is increasing the level of free childcare for working parents of three and four-year-olds to 30 hours from 15. However, there are concerns that families with disabled children will not benefit, due to a shortage of suitable providers.15

Evidence submitted to the Inquiry from the Family Fund shows a steep incline in the number of families applying for grants related to recreation, leisure and play.

The number of families with children aged 0-5 helped by the Family Fund through grant requests relating to recreation, leisure and play are as follows:

• 2010 – 33
• 2011 – 121
• 2012 – 252
• 2013 – 430
• 2014 – 930
• 2015 – 1,360*

*figure up to October 2015[iv]

These figures demonstrate families’ growing need for financial support to access play and leisure opportunities.

Limited choice of specialist support

It was not uncommon to hear parents express the view that only specialist settings and groups are able to fully meet the needs of their child. Responses to the Inquiry suggested that families generally experience a limited choice of specialist services locally. The availability of suitable services across the country appears to be inconsistent, leading to a ‘postcode lottery’ in meeting children’s right to play. In rural areas, this problem is even more acute.

42% of parents responding to our survey said they had difficulty accessing specialist play groups for disabled children.

70% of parents reported that they would like better access to specialist play provision, such as a hydro pool and sensory room.

44% of parents said distance from specialist play provision was an issue for them.

For this reason, many families spoke of making long journeys to access specialist provision outside their local area. Long journeys on public transport can be impractical for families who need to take heavy equipment, such as oxygen cylinders and specialist seating, with them. For this reason, families without access to their own transport can really struggle to access specialist settings.16

Some mainstream settings run play sessions for disabled children, and families welcomed this opportunity for inclusion. However, we received feedback that such sessions tend to be infrequent, limited during school holidays, or at awkward hours for working parents. One parent expressed her frustration:

“It shouldn’t be – on the third full moon of the high tide – that’s when you can have a play session.”

We also heard that sessions intended for children with special needs can sometimes treat disabled children as a generic group when, in fact, all the children will have individual needs that need to be met. Thought is needed about how different groups can interact together.

Taking a break

Taking a break from caring to rest and recharge is vitally important for families of children with multiple needs. Many parents provide round-the-clock care for their children, often including through the night. Despite this, we heard that play settings are not providing sufficient support to allow parents to take a break.

Several parents spoke of a shortage of short breaks that are suitable for young children with multiple needs. We heard that many short breaks providers do not offer one-to- one support and tend to arrange standard activities for groups of children, when children with multiple needs often need a more tailored approach. They are often run by inexperienced members of staff or volunteers.

One comment we received from a parent was:

“Short breaks are often inappropriate, disorganised, unstructured, staff turnover is high and professionals there do not understand disabled children’s needs”

Parents told us that many settings are unwilling or unable to take over the care of their child, and expect parents to remain in the setting to provide one-to-one support for their child. This means that parents do not get a break and the child misses an opportunity to develop independence and form relationships with peers. One parent took her child along to a session only to be told: “Sorry, we didn’t realise how disabled she was”. The parent was told they would need to stay to look after the child during the activity. As the child had been looking forward to the session, the parent felt they had no choice but to stay and did not get the time off they had been hoping for as a result. One parent said:

“Other parents use play centres as a place to have a break, leaving their children to run wild – wouldn’t that be nice?”

2. Design and delivery of play services

Unsuitable play facilities

The Inquiry received evidence that the way play environments are set up can sometimes act as a barrier to children with multiple needs accessing play.17

Several issues were raised:

• The lack of suitable changing facilities for older children was repeatedly highlighted as being a key issue for families. To make settings accessible, families need toilet facilities with full size changing beds and track hoists.
• There can be a lack of suitable seating and postural management[v] equipment for children who struggle to support their own bodies. Such children are generally only provided with one chair that meets their needs, and parents told us that these can be bulky and difficult to transport to play settings.
• Parents spoke about the lack of discrete spaces in settings to peg feed their children[vi] or provide necessary medical treatments such as suction or administering oxygen.
• Wheelchair accessibility of buildings and space for wheelchairs to move around inside is often a problem. We heard that tables are bolted to the floor in some settings, meaning they cannot be moved easily to create a more accessible space.
• Where children have a hearing impairment, poor acoustics in a setting can make it harder to engage in play. Similarly, for children with a visual impairment, poor lighting can be an issue.
• Some children can experience a ‘sensory overload’ and become over stimulated, in what may seem like a well-resourced environment.
• 77% of parents said that toys or equipment are often not suitable for their child. We heard that settings tend to use standardised play equipment designed for typically developing children, based on their ages and expected ability. Such equipment is often unsuitable for children with multiple needs. This was a particular issue in parks and outdoor play areas.
• Particular concerns were raised about local community play groups, which tend to be held in older buildings, such as local church halls and community centres, and are often not accessible.
• Outdoor play settings and parks were highlighted as being particularly hard to access for children with multiple needs.
• The issue of physical barriers are not limited to formal settings; the same barriers can also arise if children are invited to friends’ houses to play.
• Parents had mixed views about the effectiveness of play delivery for children with multiple needs in hospital settings.
• Cultural spaces such as museums and theme parks were valued by families as a space to play. We heard of very mixed experiences in relation to how accessible these venues can be.

Developmentally appropriate play

Children with multiple needs will have delayed or different development, meaning that activities and equipment designed for children of a much younger age can be more suitable for them.

Despite this, we heard that mainstream providers’ rigid adherence to age restrictions can lead to a lack of flexibility in including children with multiple needs in play activities. A lack of understanding of complex disabilities can mean that some settings do not recognise the need to be flexible in terms of the ages of children they admit.18 One parent described this dilemma:

“As she is very small and has complex needs, age appropriate activities are not suitable. This causes problems at the booking stage. She benefits more from activities for younger children. Should I be dishonest about her age?”

Although outside the scope of the Inquiry, we heard from a range of parents and professionals who made the point that play remains a significant issue for children over the age of five for these reasons.

Meeting the needs of the whole family

Play is a good way for siblings to spend time together. However, the Inquiry received evidence that play settings are not always set up to cater for the needs of the whole family. In general, this means that siblings of children with multiple needs can be restricted in their play opportunities, and may have to stay at home more often.19 A notable exception is Portage services. One parent told us:

“Portage services focus on the whole family and this is why they are so important.”

Staff skills and experience

It was commonly felt that professionals working in mainstream settings do not always have the confidence or appropriate training and expertise to include children with multiple needs in play activities. Play workers tend to have limited experience of using specialist communication methods, like British Sign Language, touch cues[vii] or Makaton.[viii]

55% of parents told us that low levels of awareness of conditions and multiple disabilities by professionals is a barrier to their child accessing play provision.

Very few will have received training in meeting children’s health needs such as tube feeding, responding to epileptic fits and administering oxygen or drips. The result is that parents may not feel confident leaving their children at play settings, especially if there are medical needs, and settings may be reluctant to offer support. One submission read:

“Staff feel insufficiently supported to offer these placements [to children with multiple needs] and are afraid of failure.”20

Providers report that the recruitment and retention of skilled staff can be a real difficulty for them. They find there is often a lack of applications from candidates with the sufficient experience to support a child with multiple needs. Once a member of staff has been recruited, in order to work with children with multiple needs safely and effectively, they need to receive training and experience in a range of areas – including dealing with medical needs such as epilepsy. We received evidence to suggest that many providers do not know where they can access training from, and struggle to resource the training of staff (see the section on funding).

As the play sector is characterised by short term contracts and low wages, there is an economic disconnect between the level of pay on offer to play workers and the level of responsibility and training needed to work with children who have multiple needs.

Professionals contacting the Inquiry felt that, in general, there has been an improvement in the quality of the workforce since the Government prioritised early years qualifications for nursery workers. However, some highlighted the fact that there is currently no course offering specialist teacher training for early years professionals – with all professionals completing generic early years teacher training and then attending in-service training courses. There was a strong feeling that the generic training does not incorporate enough information about working with disabled children, especially children with multiple needs.

Professionals told the Inquiry that play workers will often play a role in supporting the wider family, as well as the child. Parents of disabled children often go through a kind of ‘bereavement process’ when their child is first diagnosed. They need support from professionals to adapt and remain within the community, rather than withdrawing from it. However, we heard that play workers tend to be younger, and can sometimes lack the life experience needed to support parents in an effective and sensitive way.

Misguided notions of ‘health and safety’

A key theme in submissions to the Inquiry was the idea that providers’ concerns about risk and health and safety can limit children’s opportunities to play. Examples provided include professionals who saw the child’s medical equipment as a barrier to activity and professionals who refused to lift or touch the children in their care. In many cases these fears were felt to be caused by a misguided perception of legislation and regulation. It was also suggested that risk and hazards can be used as an excuse by practitioners who are unsure of themselves. Many felt that staff needed a better understanding of how to engage in more challenging play, including how to risk assess and protect children from hazards.

3. Barriers caused by local and national policy

Funding arrangements

Several responses to the Inquiry highlighted that the funding arrangements for early years providers can make it more difficult for play providers to offer places to children with multiple needs.

It can be more expensive for providers to offer a place to a disabled child compared to a non-disabled child. Additional costs include the need for higher staffing ratios and training, installing accessible changing facilities and purchasing or adapting specialist equipment.

Unlike with schools, there is no ‘notional’ funding for children with SEND[ix] in the early years, meaning that providers often have to make up the additional costs of admitting a disabled child. Statutory grants make up less than half of the funding for settings who must look elsewhere to make up the rest of their funding. Some reported that they are currently eating into reserves to meet the costs of delivering a service.21

Providers can struggle to find suitable grants to meet some of the costs of adapting a service, and application forms for the funding available tend to be long and complex (10- 11 pages was common). Where providers did make funding applications, funding was not always made available in a timely way, meaning resource shortfalls in the short term. Providers may also be unsure about how to measure quantitative outcomes from play to satisfy potential funding bodies.

There are also broader issues related to funding. Several submissions mentioned the perception that current government funding favours providers who can offer extended opening hours to fit in with the childcare and employment agenda. This may make funding provision for children with multiple needs more difficult. As one submission explains:

“Most children with special needs cannot cope with extended hours and are best suited to learning that is delivered in smaller parcels”22

In addition, children with multiple needs may be unwell or need to attend medical and other appointments. This can mean that providers will not be able to rely on them to regularly attend sessions and activities. Providers therefore need to be flexible as they deliver services and may struggle to resource this consistently.

Funding cuts

For professionals responding to the Inquiry, the impact of funding cuts on play services was a key concern.

We heard that overall funding to providers has reduced significantly since the early days of Sure Start. Sure Start centres have been affected by cuts to local authority budgets since the coalition government, as funding for them is no longer ring-fenced. Local authorities currently have discretion about whether to protect funding for the centres.

The charity 4Children carries out an annual survey of children’s centres to monitor levels of provision.23 The latest study claimed there has been an overall cut in spending on children’s centres and early years services of 20% over the last three years.

Due to budget cuts, many local authorities are currently restructuring or reducing their support teams, such as community nurses, SEN support, early years SEN support and sensory teams. As spending on play is not ring-fenced at a local level it is seen as vulnerable.

Specific concerns were raised that non-statutory play services such as Portage are currently at risk as a result of funding reductions at a local level. Last year, over a third of local authorities cut their funding for Portage[x] meaning the level of service is being reduced and one in five councils provide no funding to Portage whatsoever.24 One parent told us:

“We are on the waiting list. Portage services have been reduced drastically. There are only three people who work part-time in this area. It seems that they are trying to reduce the list as much as possible – asking people whether they can get other services and then taking them off the list. However, for us, so many services aren’t accessible so they have no choice but to keep us on, although we have been on it for a while.”

Funding for short breaks provisions is also currently at risk. Research from Mencap25 showed that 63% of local authorities reduced their expenditure on short breaks for children in 2011/12, and that there were projected cuts of 43% in 2012/13.

Ongoing funding cuts will place continued pressure on early years providers in the coming years, and may lead to fewer providers being willing to offer places to children with multiple needs.

A strategy for play provision

Several submissions to the Inquiry highlighted the differences in national play policy between England and Wales. In Wales, local authorities must have a Play Sufficiency Assessment Action Plan to check whether the amount of play on offer is adequate, and provide targeted actions for addressing gaps in play provision. In contrast, there is no requirement on local authorities in England to have local play strategies in place to ensure that the level of play provision available is sufficient for the population of children and families.

Between 2008 and 2010, a National Play Strategy was in place in England. This led to an increase in funding for play and the creation of dedicated play officials and staff in local authorities. Since its removal, play provision has become more fragmented, with fewer staff dedicated to play at a local level.

Impact of the early years curriculum

The Early Years Foundation Stage (EYFS) curriculum is currently used to set the standards for learning, development and care for all children attending schools and Ofsted-registered early years providers.[xi] The EYFS contains a strong emphasis on choice and free flow play (referred to as child-led play), and many settings have arranged their play approach to be compatible with this.

However, children with multiple needs may be less able to learn by independent exploration, and play opportunities may need to be built around them.26 For example, children with severe learning disabilities may need more adult-led play, while children with multi-sensory impairments may need to be introduced to play opportunities in a gradual and structured way. For this group, the emphasis on child-led and free flow play set out in the EYFS may mean that they cannot benefit from the types of play opportunities on offer unless there are trained support staff who can introduce play sensitively.

Lack of local planning and data

The lack of a national and local strategy on play in England is concerning. Under the Children and Families (Wales) Measure 2010 there is a legal duty on local authorities in Wales to assess and secure sufficient play opportunities for children in their area (known as the Play Sufficiency Assessment).

The Play Sufficiency Duty is a one of two halves:

Part 1: requires local authorities to assess the sufficiency of play opportunities for children in their areas by compiling a Play Sufficiency Assessment (PSA) and accompanying Action Plan every three years.[xii]

Part 2: requires local authorities to secure sufficient play opportunities for children in their areas, as far as is reasonable and practical.[xiii] Local authorities should use their Play Sufficiency Action Plans to determine what action is needed to secure sufficient play opportunities in order to meet this duty.

No such duty exists in England.

All local authorities are also required to hold a register of disabled children under the Children Act 1989. Registration is important as it can support local authorities to estimate the number of disabled children in their area, enabling them to better plan services and anticipate need.

75% of the local authorities we requested data from claimed to keep a record of all children with impairments, including the number of children with more than one impairment. However, local authorities record data about disabled children using a wide variety of sources. A lack of coordination or a single comprehensive system makes it impossible to identify the groups of children who face the greatest difficulties to accessing play. This also makes it almost impossible to draw a comparison between local authorities and identify good practice.

This means that information on the prevalence of children with multiple needs – and the nature of those needs – is patchy at best, making planning of services that truly meet the needs of children in their area difficult.

The responses to our FOI requests to local authorities showed that most do not have good systems to record how many children with multiple needs access play opportunities.

42% of local authorities did not collect data on how many disabled children access play provision in their area, and only four that responded had a specific play strategy.

Case study

Luke

“Parents treated our son like his condition was contagious.”

The attitude of other parents is just one of the challenges faced by parents with multiple needs, Liz Randall reveals.

For Luke Randall, play is not simply about having fun, it’s a crucial development tool that teaches him how to engage with the world around him. The five-year-old from West Sussex has multiple needs, including epilepsy, limited hearing and poor vision. While most parents consider playtime for their child a right, Luke’s parents, Liz and Simon, struggled to access essential play opportunities for their son.

“For the first three years a Portage organisation visited the home and advised on educational and play needs,” says Liz. “The sessions were great and we could see Luke opening up and beginning to use his senses, exploring his environment and interacting with us through touch and his remaining sight and hearing. We only received this once a week, and we wish there had been more, but we were still grateful for the support and the difference it made.”

Not enough play settings accommodate children with multiple needs

Outside of Portage, the parents were unable to find suitable play settings for Luke. “There is a lack of information on what support is available and where to find accessible play opportunities,” says Liz. “The playgroups and nurseries we found weren’t equipped for a child with complex needs. The environment was often hazardous, whether that was the layout of the area, the furniture or unsuitable toys.”

“Luke needs lots of sensory stimulation; he responds really well to toys with bells, whistles, different textures and lights and sounds, but it’s rare that these are provided. We also need somewhere soft, like a ball pool or trampoline; however, many facilities seem to have hard surfaces which are not great for Luke who likes to lie on the floor a lot and test things with his head.”

Often, other parents treated Luke like his condition was contagious

It was, however, the attitude of other parents towards Luke that made attendance at mainstream play groups particularly difficult. “We’re often confronted by quite ignorant views and attitudes,” says Liz. “Other children tend to be inquisitive about Luke, but many parents are reluctant to include us. You can see them steering their child away, like they think his condition is contagious. For this reason, it is tempting to stick to specialist settings and just spend time with people who see Luke, for Luke.”

A friend recommended that the family contact Sense. Practitioners were able to provide a specialist assessment, identifying Luke’s skills and the support required to develop further. This helped in the development of Luke’s Special Educational Needs Statement, which ensured he received the right support to enable him to make progress in school. However, despite Luke’s severe multi- sensory needs, the family has had to fight for the support he is legally entitled to. Sense provided the family with expert knowledge, advice, and support at meetings, in which Luke’s case for specialist support was presented. The success of these meetings enabled the family to apply for funding for two teaching assistants to be trained to provide Luke with the specialist one-to-one Intervenor support he is legally entitled to.

You need the time and energy to fill in lots of complex forms in between tube feeds and visits to the hospital

Liz says: “It’s scary to think of what we could have missed out on if someone hadn’t told us about Sense. Without this support I don’t think I would have had the time or energy to fight for Luke’s right to intervenor support. This is a massive barrier for parents; you need to find the energy to fill in lots of complex forms in between tube feeds and visits to the hospital. The process can be exhausting.”

With the right support Luke is now building his confidence and his personality is shining through

With the right facilities and support Luke is now able to play and participate in leisure activities. He now attends a facility run by a local charity that provides accessible facilities such as a sensory room, soft play area and outdoor play space, with equipment such as roundabouts which are flat to the floor.

Specialist facilities like this provide the family with an opportunity to meet with others who have had similar experiences.

The experience of Luke’s family suggests that parents of children with multiple needs require greater information on play opportunities for their children, and that more mainstream play settings could make adjustments to include disabled children. It is also further evidence that in 2016 we have a long way to go in promoting understanding of disability among the wider public.

“Luke is now able to play and explore the world around him. He’s building in confidence and his personality is shining through. It would be really easy to treat him with kid gloves, but doing normal things, playing and having fun in the face of medical treatments and therapies are essential for Luke and the rest of the family.”

Luke at play

Luke’s favourite toy is the sensory bubble tube. He likes to get close to the glass, watching the lights and changing colours, and he uses his remaining sight, hands and mouth to explore the object. The bubble tube encourages stimulation of the senses and helps develop coordination, cause and effect skills, and relaxes Luke when he gets agitated or stressed.

Liz says: “When we took Luke to one of the Sense children’s centres for the first time, we thought the sensory room was amazing. Luke loved the bubble tube; we got such a positive reaction from him. He was hugging and licking the tube and it had a really calming effect on him. We’ve since tried to recreate our own sensory space at home.”

Case study

Jake

“Play is a time that we don’t have to think about tube feedings, hospital visits and tests, but unfortunately there are so many obstacles in the way.”

Abi Roman explains the barriers that prevent her son from accessing the play opportunities that are essential to his development.

“Play is not just about development, it’s a really special moment parents and their children can share. When I play with Jake I feel like I’m doing something ‘normal’; we don’t have to think about tube feedings, hospital visits or tests. Unfortunately, there seems to be so many obstacles in the way of doing it.”

For children with multiple needs, like eight-year-old Jake Roman from London, opportunities for play can be few and the barriers many.

Jake has CHARGE syndrome, a rare genetic condition that has resulted in dual sensory loss and problems with his balance. He lives with his parents, Abi and Nick, and sisters, 14-year-old Mia and nine-year-old Ruby. He initially benefitted from early support from Portage, a home-visiting educational service for pre-school children. The team brought toys with flashing lights and sounds to stimulate Jake’s hearing and vision, which aided Jake’s development, but after two years the sessions stopped, leaving the family feeling alone, in need of guidance and support.

The reaction from staff and parents to Jake’s condition left me feeling isolated and vulnerable

The family found that many mainstream play providers aren’t set up to accommodate a child with multiple needs. Aside from the inadequate facilities, the staff are often not trained or experienced in dealing with disability. Abi reflects on her experience of tube feeding: “Many nurseries had never seen anything like it. I often felt isolated and vulnerable taking him to mainstream settings. I was still coming to terms with Jake’s condition so to have to explain why he needed suctioning or tube feeding was upsetting. Some of the mums would be quite horrified when I got the feeding tube out.”

The right toys are very expensive

Playing at home also had its challenges. Parents of children with sensory impairments are encouraged to use multi-sensory toys with bright colours, sounds and different tactile surfaces to encourage the use of their child’s remaining vision and hearing senses. However, these toys can be expensive, often £100 or more.

Abi says: “Due to Jake’s sensory impairments he can sometimes suffer from sensory overload and can become overwhelmed by what’s around him. When he was little it was through play that we encouraged him to explore and use his residual sight and hearing; if we hadn’t encouraged this he would have been quite happy to sit in a low lit room.”

“Now that Jake is older it is much harder to find toys that are both appropriate for his age and level of understanding, and give the sensory feedback he is after. And when you do they’re usually very expensive. He loves to play with his iPad, but it’s an expensive item. Jake would also love a bike but due to his balance he would need a bespoke one to ensure he won’t fall off – this would cost upwards of £700.”

The right support

The family turned to charities for additional support. Sense provided the family with a specialist assessment, and this helped them to see what Jake could do and how he could be supported to develop further. They also supported Jake’s entry into a mainstream nursery that would accommodate his needs.

“Jake was able to interact with other disabled and non-disabled children and I think this helped massively with his early development. I was able to leave him at the nursery, which gave me a bit of breathing space for a few hours. I know that other parents are not so lucky and often have to  stay with their child because staff do not have the right training to care for their child’s needs.”

My child doesn’t deserve to miss out

The family believes that to improve play opportunities for children like Jake, more information needs to be made available. “It takes a lot of time and energy to seek out appropriate play opportunities, and unfortunately all too often it ends up down to chance if you hear about an accessible club, play group or playground.

“Jake is a normal boy, who happens to have sensory impairments and learning difficulties. He wants to do all the things other children do and although it might take him longer he will get there with extra support. He certainly doesn’t deserve to miss out on any of the play opportunities his peers enjoy simply because they are not accessible, accommodating or he lacks support.”

Jake at play

Jake is incredibly outgoing and in a new environment he immediately begins to explore his new surroundings, speedily moving around, investigating objects with his hands.

His favourite ‘toy’ is the iPad, which provides an instant response to his every touch and a level of engagement he’s not able to get from most other toys. Its accessibility features such as large text, assistive touch and voice over mean settings can be adapted to make play more accessible. The apps don’t just offer entertainment they are also good for honing Jake’s motor skills, teaching cause and effect and encouraging vocalisation and communication – and even help with relaxation.

Abi says: “When Jake plays with his iPad he is much more engaged than when he plays with other toys. His attention is held for longer. And he’s not just playing, he’s learning. It’s been essential to developing his communication skills.”

Case study

Stella

“You have to fight hard to ensure that your child is treated equally.”

Jo Snow reveals some of the barriers that prevent her child from having equal opportunities to play.

As any parent knows, play is a vital part of a child’s development – it helps them to learn, understand and build relationships. However, for seven-year-old Stella Snow, who has multiple needs including cerebral palsy and visual impairments, and is wheelchair dependent and requires 24 hour care, opportunities to play are limited.

Stella’s parents, Jo and Brad, five-year-old sister, Lexi, and two-year-old brother, Felix, struggle to access play opportunities the whole family can enjoy.

It’s a struggle to find places to take Stella

Due to the complexity of Stella’s needs, Jo and Brad have been unable to find suitable play opportunities for Stella outside of specialist settings. It is also a struggle to find somewhere to take the whole family. “We really struggle to find places to take Stella, and it’s near impossible to find somewhere suitable for all three of the children. Out of desperation, we often resort to trips to the local shopping centre as Stella enjoys the fountains and glow of the lights,” says Jo. “If we take Stella somewhere not specifically for children with disabilities, we find equipment and toys are often unsuitable. As Stella gets older we are also starting to find the changing and toilet facilities are inadequate. Everything requires meticulous planning ahead; it can sometimes make you think ‘is it worth the effort for what she’s going to get out of it?’”

You have to fight hard just to ensure your child is treated equally

When the family heard a consultation had launched on proposals for a new play area to be built opposite the family home, they got in touch with the council and requested that they include equipment accessible for children with disabilities. However, when the play area was built, no such equipment was included.

“We were really upset when the park was built without anything safe or accessible for Stella, having already provided our feedback. We followed up with the council and eventually they added an accessible swing, and it’s great – it means that Stella is no longer excluded. It’s just unfortunate that you have to fight so hard, take up so much time and energy, just to ensure your child is treated equally.”

Specialist toys are expensive so we make our own or adapt toys

Jo has accepted that most mainstream settings will be unable to accommodate Stella; as a result, Stella’s main opportunity to play is at home. This, however, has its own set of challenges. “Specialist toys are very expensive; it seems like as soon as the words ‘special needs’ are added to the description the price goes up by £50. We really have to do our research; if I find something on a specialist website I’ll look to see if a mainstream supplier is selling something similar.”

Brad and Jo have taken to adapting mainstream toys to ensure Stella can use them, and have also developed their own. Jo says: “We’re always on the lookout for ideas; we’ve made our own sensory toys and mobiles using a golf umbrella and cloth. I’ve also taken a class at Stella’s school on adapting switches on toys as Stella has weak muscles so struggles to press buttons.”

Most of our information comes from conversations with other parents

The family now visit Sense’s Woodside Family Centre in Bristol, which offers facilities for children with dual sensory loss and complex needs. Woodside provides Stella with a tailor-made environment to play, explore and learn, and also offers much needed support to the family. Jo and Brad are able to borrow specialist toys and equipment and take ideas from sessions at Woodside to replicate at home.

Stella’s parents believe information, support and advice should be more readily available. Jo says: “There really is a lack of information out there on everything, from where you can go to for support, to playparks that may be suitable. Most of our information comes from conversations with other parents, reading forums and parent Facebook groups; it’s not a comfortable situation to be in. There needs to be more coordination.”

Jo concludes: “Children like Stella face considerable barriers to play, and she could easily lose her natural playfulness, but with the right encouragement and support Stella is able demonstrate her preferences, choice and independence through play.”

Stella at play

Stella enjoys interacting with other people and lights up when someone communicates and plays with her. Due to her limited vision, Stella really enjoys playing with coloured and flashing lights that she can hold or get closer to see. She also loves to lie under activity arches handmade by her parents from tinsel and wind chimes. Using lamps and torches, light can be shined to reflect the light and encourage Stella to reach out and touch the objects, which is helping to develop her tactile skills and stimulates her residual vision.

Jo says: “Often through trial and error we’ll find a toy or object that Stella responds well to and enjoys playing with. We’ve made all sorts of mobiles and activity arches that she enjoys playing with. It’s great to see her responding to the different objects.”

Conclusion and recommendations

The Sense Play Inquiry received a large amount of evidence from a wide range of professionals and organisations, including play providers, local authorities, voluntary sector organisations and academics. Nearly 200 parents of children with multiple needs contacted us to make their views known. The evidence submitted to the Inquiry clearly makes the case for early intervention through play and demonstrates the considerable developmental, social and emotional benefits for children with multiple needs and their families.

However, despite the vital importance of play for children and families, there is clear evidence that significant barriers exist, and these prevent children with multiple needs from accessing play.

The barriers in play settings are both physical and practical, which mean that children with multiple needs do not have their needs met. Significantly, it was often the attitudes of other people towards children with multiple needs and their families that presented the greatest barrier.

The findings of the Sense Play Inquiry highlight that much more needs to be done to ensure that families and all those involved with designing and delivering play settings receive the right support to reduce the barriers to play. It also shows that a more strategic approach is needed at a national and local level to make sure that children with multiple needs do not miss out.

Recommendations

Having collected evidence from a wide range of sources, the Inquiry has highlighted several areas where changes are needed to improve access to play for children with multiple needs.

National level

• There needs to be a nationwide policy of funding children with special educational needs in early years education. Notional funding must be provided to settings to enable providers to invest in accessible premises and staff training.
• Funding for play should follow the child and family, whether that is for support in the home or in specialist or mainstream settings.
• Issues around funding for the new childcare commitment in the Childcare Bill must be resolved, through ring-fenced funding.
• The Government should begin a national dialogue to promote the need for strategic local approaches on play. Local authorities should then be expected to draft and submit regional play strategies to the Department for Education based on local circumstances.
• Play should be instated as part of the ministerial brief of the Minister for Childcare, to highlight the importance of early education.
• Through the proposed Ofsted local area inspections, the Department for Education should ensure that Local Offers contain clear information about local play opportunities and entitlements.
• Developmental play services such as Portage should become a statutory service for disabled children under the age of two, with an increased emphasis on children with multiple needs.
• The Department for Business, Innovation and Skills should provide all local authorities with guidance on market management to ensure that demand for play settings for disabled children is met locally.
• Play should be a key strand of the Government’s policy on parenting and should be an explicit part of government- funded parenting classes.
• The Equality and Human Rights Commission should investigate the exclusion of children with multiple needs from mainstream play settings. It should provide clarity on the current legal requirements for settings and take action to support the enforcement of the Equality Act 2010.
• The Health and Safety Commission should investigate reports that a misguided interpretation and approach to health and safety is creating a barrier to accessing play settings and activities for children with multiple needs.

Local level

• Local authorities need to make better use of data in order to identify the number of children with multiple needs who are living in their local areas. Health and Wellbeing boards should take the lead in pulling together regional data on provision and demand.
• Local authorities should also be required to take action, as necessary, against settings that intentionally exclude disabled children and fail to meet their legal duties under the Equality Act 2010.
• Local authorities should take a lead on increasing awareness and understanding of the general public and other parents about disabled children. This could be centrally funded but locally delivered.
• Health and Wellbeing boards should consider the development of appropriate additional training of health visitors or other professionals to enable them to provide the support needed to help families of children with multiple needs to learn about and access play.
• Local authorities should provide easily accessible information for parents to help them to find out about existing play and support services. This should include signposting to potential sources of play and support soon after the child is identified as having multiple needs, and keyworker support.

Play settings

• Settings should ensure that play staff have received training on multiple needs and disability to help improve the way they support children and families. This should include responding to medical needs, communicating with children with specialist communication needs, and personal care. The training should also enable them to create an environment and ethos which is inclusive and developmentally appropriate.
• Where possible, treatments and therapeutic interventions should be delivered through play.
• Every play setting should have a play policy statement which stresses the inclusion of every child.
• Settings should plan carefully prior to the admission of every child in order to ensure their needs are met and that they will be welcomed and understood by other parents, children and both professional staff and volunteers.
• Voluntary sector organisations should do more to share their significant experience of supporting children with specific impairments and multiple needs with public and private play settings. This could include offering training and toolkits on inclusive play.

List of participating organisations

• 4Children
• Action for Children
• Barnardo’s
• Cambridgeshire Community Services
• Cardiff Metropolitan University
• Children in Wales
• Contact a Family
• EACH Children’s Hospice
• Early Childhood Forum
• Eureka!
• Great Ormond Street Hospital
• Institute for Education, Cambridge University
• Jabadeo
• Julia House Children’s Hospice
• Kent Portage Association
• Kids
• Kids Active
• KIDS Adventure Play Hackney
• Leeds Beckett University
• Leeds Community Healthcare Trust
• Leeds Trinity University
• Mabis Inclusion Support Wales
• Margaret Wells-Furby Child Development Centre
• Medina House School
• Mencap
• Mudiad Meithrin
• National Association of Head Teachers (NAHT) Cymru
• National Day Nurseries Association
• National Deaf Children’s Society (NDCS) Cymru
• Noah’s Ark Hospice
• Paradise Park
• Parks 4 Play
• Pen Green Centre for Children
• Play England
• Play Wales
• Policy for Play
• Professional Association for Childcare and Early Years
• Rainbow Children’s Trust Charity
• Rainbows Hospice
• Scope
• SENDirect
• Sense
• SNAP Cymru
• Snug and Outdoor
• Southwark Portage Service
• The Family Fund
• The Hamlet Centre
• The National Portage Association
• The Newlife Foundation
• The Playwork Inclusion Project
• The Pre-School Learning Alliance
• The Royal National Institute of Blind People (RNIB)
• The Sensory Project
• Tiny Town, Larkfield
• Together for Short Lives
• University of Leeds
• Wales Pre-school Providers Association
• West Suffolk Portage Service

Endnotes

1. Definition taken from Mary Lee Learning together: A Creative Approach to Learning for Children with Multiple Disabilities and a Visual Impairment (2002) London: RNIB
   
2. Aiming High for Disabled Children: Better Support for Families (2007) London: HM Treasury and  Department for Education and Skills
   
3. Written submission to the Play Inquiry from the British Academy of Childhood Disability
   
4. Written submission to the Play Inquiry from the British Academy of Childhood Disability
   
5. Written submission to the Play Inquiry from the National Portage Association
   
6. Written submission to the Play Inquiry from Together for Short Lives
   
7. Written submission to the Play Inquiry from the East Anglia Children’s Hospice
   
8. Written submission to the Play Inquiry from the Rainbow Trust Children’s Charity
   
9. Written submission to the Play Inquiry from the Wales Pre-school Providers Association
   
10. Written submission to the Play Inquiry from the National Deaf Children’s Society Cymru
    
11. Also reflected in Time to play: Disabled children and their families experiences of accessing mainstream services (2014) London: Scope
    
12. This was also a key finding in I want to play too: Developing inclusive play and leisure for disabled children and young people (2004) London: Barnardo’s
    
13. Written submission to the Play Inquiry from Cardiff Metropolitan University
    
14. Written submission to the Play Inquiry from Leeds Beckett University
    
15. Levelling the playing field for families with  disabled children and young people (2014) London: Every Disabled Child Matters campaign
    
16. This issue was also highlighted in Everybody here? Play and leisure for disabled children and young people (2002) London: Contact a Family
    
17. Many of these themes were also reflected in the Playday survey (2013) Bristol: Kids
    
18. Also reflected in Everybody here? Play and leisure for disabled children and young people (2002) London: Contact a Family
    
19. Written submission to the Play Inquiry from Contact a Family and The Family Fund
    
20. Written submission to the Play Inquiry from Paradise Park
    
21. Written submission to the Play Inquiry from First Opportunities
    
22. Written submission to the Play Inquiry from First Opportunities
    
23. Sure Start Children’s Centres Census (2014) London: 4Children
    
24. Research based on FOI requests from Mencap and The National Portage Association, 2015
    
25. Short breaks support is failing family carers (2013) London: Mencap
    
26. Written submission to the Play Inquiry from The Margaret Wells-Furby Child Development Centre

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[i] This includes where the body starts and ends and the place it inhabits in space.

[ii] Object permanence’ is the process of understanding that objects continue to exist even when they cannot be observed.

[iii] Wellbeing includes physical and emotional health and emotional wellbeing, education, training and recreation.

[iv] Items requested included bikes, hobby equipment, play houses, hobby rooms, garden equipment and trampolines.

[v] Postural management is a programme of suitable handling, treatment and positioning of children that promotes motor development and reduces the risk of postural deformity.

[vi] This involves providing nutrition through a tube straight into the stomach, bypassing the child’s mouth.

[vii] Touch cues (also known as on-body-signs) are simple signs used consistently on the body to inform someone that something is about to happen.

[viii] Makaton is a language programme which uses signs and symbols to help children communicate.

[ix] Every school receives a notional SEN budget to cover the additional costs of meeting the needs of children with special educational needs and disabilities.

[x] Some local authorities fund Portage services (a home visiting educational service). Portage workers support parents of disabled children with play and development and provide specialist toys.

[xi] This will include child minders, pre-schools, nurseries and school reception classes.

[xii] This duty was commenced in November 2012, with local authorities compiling their first PSAs in early 2013.

[xiii] This duty was commenced in July 2014.

This content was last reviewed in April 2022. We’ll review it again next year.