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Information and coffee morning for parents 2026

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Information and coffee morning for parents 2026

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Please note that Mrs Campbell is only available for calls and meetings on Tuesdays and Wednesdays.

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Mrs Campbell - SENCo

Mrs Hanley - Early Years SENCo

Miss Johnson - SENCo assistant

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An additional padlet with support for children's areas of need

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Advice on SEND law and what your child is legally entitled to

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(IPSEA) Independent Provider of Special Education Advice

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(IPSEA) Independent Provider of Special Education Advice

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IPSEA (Independent Provider of Special Education Advice) - helping children and young people with special educational needs and/or disabilities (SEND) get the education they are entitled to by law

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Autism and Social Communication Team - Sefton Council | The Sefton Directory

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The Autism and Social Communication Team sits within Sefton’s Inclusion Service, Complex Needs Team. This new service offers support to children and young people with Social Communication Needs and Autism in mainstream settings. The team currently consists of a Lead Practitioner and three Inclusion Support Workers, who are specialists in providing advice, support, training, modelling, coaching and resources to primary and secondary mainstream schools across Sefton. We also offer support to meet the needs of the more complex cases within the borough. Alongside regular parent support/ consultation and drop in sessions, we offer INSET training within schools as well as bespoke centralised training, a training and networking support programme for Primary Teaching Assistants, and specialist transition support programmes for children moving from nursery to reception, and from Y6 to Y7. Post diagnosis sessions for parents are delivered with colleagues from Speech and Language Therapy. Referrals for the above autism services are accepted from mainstream schools within Sefton upon receipt of a completed referral pack. There are criteria for acceptance and Together Trust are not able to accept referrals directly; they must come via Sefton. Local Offer Team page

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A link to Sefton Council's Complex needs team to support with physical and medical needs.

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The Engagement Model

The DfE has now released the final guidance on The Engagement Model.

The guidance describes the formative and summative assessment of children as "not engaged in subject specific learning". It will be statutory assessment in schools for those children and young people, those who previously would have been on low P-Scales

The guidance is an output of the Rochford Review , who have piloted the Model. It builds on the research led for the 'DfE', by Professor Barry Carpenter as part of the Complex Learning Disabilities and Difficulties project.

This project identified, through a systematic review of the international literature around learning in children with SEND, that 'engagement was the single best predicator of successful learning in children with special needs/disabilities' (Carpenter et al, 2015.)

From this solid evidence based, a pedagogy evolved through systematic research across UK schools, and a series of International trials, which created the Engagement Framework for Learning: www.engagement4learning.com. This includes the 'Engagement Profile' which aids baseline assessment, and gives insight into the learning pathways of the child with Complex Needs. The Engagement Profile is a classroom based planning tool which links to formative assessment . Both are compatible with, and indeed inform, the summative assessment opportunities of the new Engagement Model.
Click here for further information https://www.gov.uk/government/publications/the-engagement-model

Medical Information and Resources for Schools

Please click below for useful information and resources.
Inclusive Education Muscular Dystrophy An Introduction to PEG feeding Tricuspid Atresia Factsheet DESST Info Sheet Teachers Staff Charcot Marie Tooth disease Everybody Different Talking to Children and their Parents/Carers Getting it right for the Child Counselling Same but different Education Guidelines in full
Batten disease or Neuronal Ceroid Lipofuscinoses ( NCLs) are several different genetic life-limiting neurodegenerative diseases that share similar features.

Although the disease was initially recognised in 1903 by Dr Frederik Batten, it wasn't until 1995 that the first genes causing Batten disease were identified.

Since then over 400 mutations in 13 different genes have been described that cause the various forms of Batten Disease. We estimate that approximately 11 - 17 children, young people and adults are diagnosed with a form of the disease each year; meaning there are between 100 - 150 affected individuals currently living with Batten disease in the UK.
http://www.bdfa-uk.org.uk/what-is-batten-disease/Chromosome and gene disorders
Unique provide free Information Guides to specific chromosome and gene disorders, as well as guides translated into various languages. Do scroll down to the bottom of the 'Chromosome Disorder Guides - English' table to view guides and reports on a wide range of related general topics like DNA sequencing, deletions and microdeletions, inversions etc. Be sure to check back regularly as new and updated guides are added.
https://www.rarechromo.org/disorder-guides
Learners with Complex Additional Support Needs: Resources and guidance for parents to support their child's learning
https://education.gov.scot/improvement/learning-resources/learners-with-complex-additional-support-needs-resources-and-guidance-for-parents-to-support-their-child-s-learning-at-home/
The resources take a wide range of formats including offline programmes, downloadable/printable resources, links to websites or apps, YouTube films, or practical resources/packages/games produced by schools on a range of topic areas. The resources are grouped into the following categories:

Communication : strategies, stories, games, picture cards, sing or sign along ideas, activities that involve choice.

Movement, games and play : physical activities that can take place in the home, in the garden, on a walk, in the park and suchlike as well as ideas for movement to music or dance, ideas for games and play, activities that develop motor skills or coordination.

Making Sense of the World : any activity that connects the child to the world such as developing skills and knowledge, such as, safe use of social media; virtual tours of museums, art galleries, and places of interest; films on the wonders of the natural world; exploring sounds and music; using toys or tools for a purpose.

Daily routines and skills for independence : learning or practicing daily routines or activities, regular personal routines such as dressing, eating etc.

Sensory activities : this category overlaps with all the other categories however, these activities specifically focus on sensory stimulation or experiences. For example, a sensory story specifically exploring touch and textures.
Click here to visit Alder Hey Hospital Useful information leaflets.

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The Complex Needs Team supports and advises staff in Sefton schools and settings to facilitate the inclusion and academic progress of children and young people with physical and/or medical complex needs. Key support provided by the team includes: Build capacity in schools and settings to...

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Everyday we support our students with providing a lunch club to help children who do not cope at unstructured times to enjoy a calm and restful break.

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At Our Lady Star Of the Sea Primary School we use the PACE model to provide a framework for caregivers to interact with children in a way that promotes healing and development, particularly for those with complex needs.

Playfulness:

Approaching the child with a sense of lightheartedness and humor to help them relax and connect.

Acceptance:

Accepting the child for who they are, with their unique qualities and challenges, without judgment.

Curiosity:

Demonstrating a genuine interest in understanding the child's internal world and the reasons behind their behavior, rather than making assumptions.

Empathy:

Validating the child's feelings and experiences, and connecting with them on an emotional level.

Who is it for?

PACE training is designed for professionals and caregivers who work with vulnerable children, including: Foster carers, Social workers, Educators, Residential care staff, and Therapists.

What are the benefits of PACE training?

Stronger relationships: Builds trust and security between the caregiver and the child.

Improved emotional well-being: Fosters resilience and a sense of belonging for the child.

Trauma-informed care: Provides tools to support children who have experienced early-life trauma.

Positive behavior change: Creates an environment conducive to positive behavioral outcomes.

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The Local Offer provides clear and accessible information about the provision Sefton Council expects to be available locally for our children and young people from 0 to 25 who have special educational needs and/or disability (SEND).

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Local Offer - Special Educational Needs and Disabilities

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The Local Offer provides clear and accessible information about the provision Sefton Council expects to be available locally for our children and young people from 0 to 25 who have special educational needs and/or disability (SEND). For more details click 'What is the Local Offer?'

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We follow Sefton Council's graduated approach. A graduated approach is a continuous, cyclical process of support, primarily for children with Special Educational Needs and Disabilities (SEND), involving four main stages: Assess, Plan, Do, and Review

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The Local Offer provides clear and accessible information about the provision Sefton Council expects to be available locally for our children and young people from 0 to 25 who have special educational needs and/or disability (SEND)

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Local Offer - Special Educational Needs and Disabilities

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The Local Offer provides clear and accessible information about the provision Sefton Council expects to be available locally for our children and young people from 0 to 25 who have special educational needs and/or disability (SEND). For more details click 'What is the Local Offer?'

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https://www.seftondirectory.com/kb5/sefton/directory/advice.page?id=0emGdGlTp4Y

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ADDvanced Solutions Community Network is an open access offer that supports the emotional health and wellbeing of neurodivergent children and young people, their families and the professionals that work with them.

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Community Network

ADDvanced Solutions Community Network encourages, equips and empowers children, young people and their families living with neurodevelopmental conditions, learning difficulties and associated mental health needs. Our engaging, community-based, learning, coaching and mentoring programmes will help you and your family to better recognise, understand and meet your individual needs, enabling you to manage the day to day challenges.
Visit site

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ADDvanced Solutions Community Network encourages, equips and empowers children, young people and their families living with neurodevelopmental conditions, learning difficulties and associated mental health needs. Our engaging, community-based, learning, coaching and mentoring programmes will help you and your family to better recognise, understand and meet your individual needs, enabling you to manage the day to day challenges.

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Special Needs Jungle provides parent-centred information, news, resources and informed opinion about SEN, disability, children’s health and SEN politics

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Sefton Parent Carer Forum - A parent carer forum is a group of parents and carers of disabled children who work with local authorities, education, health and other providers to make sure the services they plan and deliver meet the needs of disabled children and families.

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The Visual Needs Team facilitates the inclusion and academic progress of children and young people with a clinical diagnosis of visual impairment. This is achieved through direct teaching and support to schools, settings and parents. The team receives referrals from the Ophthalmology departments at Alder...

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The Hearing Needs Team facilitate the inclusion and academic progress of children and young people with hearing needs through direct teaching and support to schools, settings and parents.

Referrals are accepted for children and young people who have been diagnosed with a permanent childhood hearing impairment. In addition, we provide information to schools and settings for children with prolonged or aided conductive hearing loss (Glue Ear). All referrals come from the Newborn Hearing Screening Programme or Audiology Departments, or movers into Sefton with an already diagnosed hearing loss.

What other information and advice is available for my child?

Sefton and West Lancs Deaf Children's Society
The Sefton and West Lancashire Deaf Children's Society (SWLDCS) is a local, voluntary, independent self help charity affiliated to the National Deaf Children's Society (NDCS).

The SWLDCS is run by parents of deaf children and professionals who work with deaf children to provide information and support to families of deaf children and to the deaf child.

You can contact the service on 0151 934 2347or by email: info@swldcs.org.uk

National Deaf Children's Society
The NDCS provides clear, balanced information and support for families of deaf children, deaf young people and professionals working with families. You can find out more about the NDCS at their website: http://www.ndcs.org.uk/
or you can call their helpline on 0808 800 8880.

The Ear Foundation bridges the gap between clinic-based services, where today's exciting hearing technologies, such as cochlear implants and bone conducting hearing implants are fitted, and home, school and work where they are used in daily life. You can find out more by visiting their website: http://www.earfoundation.org.uk/
or by contacting them on 01559 421985 or by email: info@earfoundation.org.uk

Deaf Education Through Listening and Talking (Delta)
Delta want a world in which deaf children are able to realise their full potential within their communities and we believe this is best achieved through support to learn to listen and, thereby, acquire spoken language. Delta believes that the vast majority of deaf children can learn to listen and talk. They believe that all parents of deaf children should be given this option.

You can find out more at the Delta website:
http://deafeducation.org.uk/
or by contacting them on 0845 108 1437 or by email: enquiries@deafeducation.org.uk

What support is provided by the Hearing Needs Team?

The work of the Hearing Needs Team involves:

Capacity building in Schools and Early Years Settings through the delivery of training.

Assessment and monitoring of children's' language development.

Direct teaching where appropriate to develop listening and language skills.

Carrying out audits and giving advice on the acoustic environment in schools and settings where necessary.

Information, advice and support to parents/carers including those of newly diagnosed babies from the Newborn Hearing Screening Programme.

Liaison with Audiology Departments in North and South Sefton.

Monitoring and overseeing use of Hearing Aids.

Providing and maintaining Radio Hearing Aid systems.

Liaison with Auditory Implant Centre.

Partnership working with Therapy Services where appropriate.

Contributing to local multi-agency developments through Children's Hearing Services Working Group.

How will I know what level of support to expect for my child?

For more information you can contact Sefton SEN and Inclusion Service on 01704 882038 or by emailing SEN & Inclusion Service: hearingneeds@sefton.gov.uk

You can find the Sefton SEN and Inclusion Service at:

Sefton SEN and Inclusion Service

4 th Floor, Magdalen House

30 Trinity Road

Bootle

L20 3NJ

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Hearing Needs Team | The Sefton Directory

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The Hearing Needs Team facilitate the inclusion and academic progress of children and young people with hearing needs through direct teaching and support to schools, settings and parents. Referrals are accepted for children and young people who have been diagnosed with a permanent childhood hearing…

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We are a team of community Occupational Therapists, assistant practitioners and therapy assistants who are based across two sites in Sefton, North Liverpool. We work with children from birth up to 19 years in a variety of settings including clinics, at home, in nurseries, mainstream and special schools.

There are several pathways within our service: Speech, Physiotherapy and Occupational Therapy (SPOT); Motor Skills; Sensory; Special Schools; and Equipment and Small Aids. Children may be referred to more than one of these pathways.

SPOT Pathway

The team is made up of Speech and Language Therapists, Physiotherapists and Occupational Therapists. Children may be referred for a SPOT assessment if there are concerns about how their development is progressing.

Important advice:

During an assessment within a SPOT clinic, we may assess any or all of the following areas:

Developmental progress

Patterns and quality of movement

Joint range of movement, muscle tone and muscle strength

Posture and positioning

Hand function

Play skills

Communication (in combination with other difficulties)

Functional difficulties including feeding and dressing

The therapists who work in the SPOT team are specially trained and very experienced in treating babies and toddlers.

The SPOT Team works flexibly to support families to access the service, providing appointments in a relaxed and welcoming environment for children and parents/carers.

Motor Skills Pathway

We work with children and young people to find solutions to reduce the difficulties they face and help them to get the most from life. We support children who are having difficulties with everyday activities that can have an impact on daily life.

We will help to identify a child or young person's difficulties in their daily life by assessing their needs, using play and purposeful activities to help them achieve their goals and become as independent as possible. We may also assess for small aids/equipment and recommend minor adaptations to support children and young people's independence.

Important advice:

The Occupational Therapist may look at the following areas:

Fine motor skills

Coordination and organisational skills

Classroom skills e.g., pencil and scissors skills

Visual perception skills

Self-care and independence skills

Posture and positioning

Sensory Pathway

The aim of the Occupational Therapy sensory team is to raise awareness and understanding of the sensory needs in children and young people, so that their needs can be positively supported in the home, at school/nursery and in the community.

Parent/carer workshops

School staff training

Nursery staff training

Health professionals training

Bookable support consultations for parents/carers, teaching staff, nursery staff & health professionals following attendance at a workshop or training session

Email and telephone support and advice

Sensory resources loan library

Special Schools Pathway

We work with children and young people who have complex needs and attend special schools within Sefton.

We work closely with physiotherapy colleagues to provide 24-hour postural management programmes, assessing and recommending specialist equipment, at home and school, to support posture and address manual handling issues.

We assess and recommend support for your child to access everyday activities including eating, drinking, bathing, and sleeping. We also assess and recommend specialist seating to support access to education.

Equipment and Small Aids Service

We assess for specialist equipment for the home, nursery and school and may recommend equipment for seating, sleeping, bathing, toileting, or manual handling.

This equipment is supplied by social services, education and health via Sefton Community Equipment Stores, and is monitored regularly, checking for safety, suitability, and general maintenance by the team. Depending on the complexity of a child's needs, the amount of equipment will vary.

We may also recommend the use of small aids to support everyday activities.

Important advice:

These are recommended with the expectation that they will be purchased by home, nursery or school and include:

Sloped writing boards - used to support a child's posture when writing

Dynamic air cushions - to improve a child's sitting posture, to support with attention and concentration and for children who seek movement

Pencil grips - to encourage a more efficient pencil grasp, to alter the pressure applied when using a pencil

Specialist scissors - to improve grasp of scissors

Cutlery - to improve grasp of cutlery to encourage more efficient coordination of hands together

Dressing aids such as button hooks - to encourage independence when dressing

We also carry out environmental assessments for minor adaptations which can include grab rails, stair rails and ramps. If more extensive adaptations are required, we will liaise with local services as needed.

Management Team

Kathryn Cunliffe - Head of Service, Community Physiotherapy and Occupational Therapy

Helen Crosdale - Deputy to Head of Service

Bex Winnard - Deputy to Head of Service

Administration

Pam Usher - Personal Assistant and Administrator (North and South Sefton)

Heather Campbell - Secretary (North Sefton)

Patricia Doran - Secretary (North Sefton)

Cathy McGrane - Secretary (South Sefton)

Specialist Children's Occupational Therapists

Helen Murphy - Mainstream and Sensory (North Sefton)

Jenny Benge - SPOT and Early Years (North Sefton)

Phillipa Turner - Special schools (North Sefton)

Jenny Banks - Mainstream (North Sefton)

Tracey Bickley - SPOT and Early Years (North Sefton)

Frances Jones - Special schools (South Sefton)

Cathy Peers - Sensory

Lindsey Mutch - Mainstream (South Sefton)

Melanie Harvey - SPOT and Early Years (South Sefton)

Andrea Kilroy - Mainstream (South Sefton)

Nina Lamont - Mainstream (South Sefton)

Assistant Practitioners

Angela Larsen (North Sefton)

Lizi Hogan (South Sefton)

Rachel Edwards - Special schools (North Sefton)

Elaine Coughlan - Special schools (South Sefton)

Occupational Therapy Assistants

Jo Mather (South Sefton)

Julia Mulrooney - Sensory

All Occupational Therapy services are 'opt in' and require completion of a referral form and consent gained from a person with parental/legal responsibility of the child.

All referrals into the service will be triaged and a decision made in relation to occupational therapy clinical need and priority. We currently operate a waiting list for initial assessments.

Speech, Physiotherapy & Occupational Therapy (SPOT) Pathway

We accept referrals from health and educational professionals, including health visitors, community paediatricians, GP, hospital consultants and other therapists

To refer a child for assessment by the SPOT service, you will need to complete a referral form

A child can be referred for a SPOT assessment up until their 3rd birthday. Two or more therapy assessments (Speech, Physio, OT) are required for a referral to SPOT. If only one therapy assessment is needed, please refer directly to that service

SPOT referral form
Motor Skills Pathway

We accept referrals from health and educational professionals, and parents/carers

To refer a child for assessment of their motor skills you will need to complete a referral form

An information leaflet about the OT service is provided with this form which must be read before completing the form. This is to make sure that the referral is appropriate for our service

Please provide as much information as possible on the referral form and check that it is fully completed before sending it to us. If we receive an incomplete referral form, it may not be accepted

If you are a health or educational professional, please provide a copy of the information leaflet to the parent/carer of the child you are referring

You must gain parental consent before completing the referral form

Motor skills referral

Sensory Pathway

We accept referrals from health and educational professionals, and parents/carers for sensory workshops

We request that parents/ carers attend a Sensory Workshop to gain baseline knowledge prior to requesting a support consultation session

An information leaflet is also available for parents/carers and referrers to read if completing a referral form, which provides more detail about sensory processing and what is provided by Occupational Therapy service

Once we have received your completed referral form, the team will confirm whether a sensory workshop is appropriate, and parents will be provided details of the workshops available and how to confirm a place on the workshop

For access to the parent/carer workshops, a formal referral must be made to the sensory team.

Training for Schools and Nurseries and Professionals are offered throughout the year, please contact the service to discuss the training requirements

For access to school, nursery and professional training, an electronic request form can be accessed by emailing the sensory mailbox: [email protected]

Support consultations for parents/carers, schools, nurseries and other professionals can be arranged by contacting the service on: [email protected] . Support consultations can be face to face or virtual

All referral forms are available to download online and can be printed and completed, or completed electronically and sent via email to the following address: [email protected]

Sensory referral form

Our office hours are Monday to Friday from 8.30am to 5pm (not including Bank Holidays). Depending on where you live, you can contact the Occupational Therapy Service in your area.

North Sefton Team:
(Areas covered - L37, PR8, PR9)

Children's Occupational Therapy Service,
Ainsdale Centre for Health and Wellbeing
174 Sandbrook Road
Ainsdale
PR8 3RW

South Sefton Team
(Areas covered - L20, L21, L22, L23, L30, L31, L38, Sefton parts of L10)

Children's Occupational Therapy Service
2nd floor, Sefton Carers Centre
27-37 South Road
Waterloo
L22 5PE

Tel: 0151 252 5836

Where are we?

Our team is located across two main sites in Sefton covering North Sefton community (Formby to Southport area) and South Sefton community (Hightown to Bootle to Lydiate).

The North Sefton team office is based at Ainsdale Centre for Health and Wellbeing (174 Sandbrook Road, Ainsdale, PR8 3RW). Clinics are run in Southport Centre for Health and Wellbeing (44-46 Houghton Street, Southport, PR9 0PQ)

The South Sefton team office is based at Sefton Carers Centre (27-37 South Road, Waterloo, L22 5PE) where we also run our clinics from

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Sefton occupational therapy - Alder Hey Children's Hospital Trust

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Find out about the Sefton Occupational Therapy team here at Alder Hey. Find out what the team do, how to contact them and more.

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Zones of Regulation organises our feelings, states of alertness, and energy levels into four coloured Zones – Blue, Green, Yellow, and Red. The Zones of Regulation helps make the complex skill of regulation more concrete for learners and those who support them. We learn to regulate our Zones to meet our goals and task demands, as well as support our overall well-being.

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Dyslexia is a combination of abilities as well as difficulties. It is the disparity between them that is often the give-away clue. A dyslexic learner, despite certain areas of difficulty, may be orally very able and knowledgeable, creative, artistic, or sporting. Alongside these abilities will be a cluster of difficulties - these will be different for every person.

Dyslexia can only be diagnosed through a Diagnostic Assessment. However, there are indicators which can help you to identify a young person who may be dyslexic.

Written work

Has a poor standard of written work compared with oral ability

Has poor handwriting with badly formed letters or has neat handwriting, but writes very slowly

Produces badly set out or messy written work, with spellings crossed out several times

Spells the same word differently in one piece of work

Has difficulty with punctuation and/or grammar

Confuses upper and lower case letters

Writes a great deal but 'loses the thread'

Writes very little, but to the point

Has difficulty taking notes in lessons

Has difficulty with organisation of homework

Finds tasks difficult to complete on time

Appears to know more than they can commit to paper

Is hesitant and laboured, especially when reading aloud

Omits, repeats or adds extra words

Reads at a reasonable rate, but has a low level of comprehension

Fails to recognise familiar words

Misses a line or repeats the same line twice

Loses their place easily/uses a finger or marker to keep the place

Has difficulty in pin-pointing the main idea in a passage

Has difficulty using dictionaries, directories, encyclopaedias

Has difficulty remembering tables and/or basic number sets

Finds sequencing problematic

Confuses signs such as x for +

Can think at a high level in mathematics, but needs a calculator for simple calculations

Misreads questions that include words

Finds mental arithmetic at speed very difficult

Finds memorising formulae difficult

Other areas

Confuses direction - left/right

Has difficulty in learning foreign languages

Has indeterminate hand preference

Has difficulty in finding the name for an object

Has clear difficulties processing information at speed

Misunderstands complicated questions

Finds holding a list of instructions in memory difficult, although can perform all tasks when told individually

Behaviour

Is disorganised or forgetful e.g. over sports equipment, lessons, homework, appointments

Is immature and/or clumsy

Has difficulty relating to others; is unable to 'read' body language

Is often in the wrong place at the wrong time

Is excessively tired, due to the amount of concentration and effort required

A cluster of these indicators alongside areas of ability may point to possible dyslexia and further investigation is recommended.

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Signs of dyslexia (Secondary school age) - British Dyslexia Association

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Dyslexia is a combination of abilities as well as difficulties. It is the disparity between them that is often the give-away clue. A dyslexic learner, despite certain areas of difficulty, may be orally very able and knowledgeable, creative, artistic, or sporting. Alongside these abilities will be a cluster of difficulties - these will be different for every person.

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You may want to print this off and keep with you in class.

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SEND@olsscps.org.uk

This is our central email for Mrs Campbell, Miss Johnson and Mrs Hanley. It is checked daily and we will get back to you as soon as we can.

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Some little things to try

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Free and impartial information, advice, and support for the families of children and young people with disabilities or special educational needs.

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Kids SENDIASS offers high quality information, advice and support on all aspects of special educational needs and disabilities.

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Developmental paediatrics - Alder Hey Children’s Hospital Trust

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This page provides information on our Developmental Paediatrics service at Alder Hey. Find out more about what the team do here.

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series of videos to support transition/

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Starting secondary school - BBC Parents’ Toolkit - BBC Bitesize

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Advice for parents who have a child starting secondary school this year, with tips on the emotional and practical sides of the transition.

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Little help with going from meltdown using this handy flowchart

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The ADHD Foundation is the UK’s leading neurodiversity charity, offering a strength-based, lifespan service for the 1 in 5 of us who live with ADHD, Autism, Dyslexia, DCD, Dyscalculia, OCD, Tourette’s Syndrome and more.

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The ADHD Foundation Neurodiversity Charity - an integrated health and education service.