A joint visit by Ofsted and health watchdog the Care Quality Commission found that partnership work across schools, Medway Council and health organisations is poor.
Inspectors said the organisations are failing to work together on long-term strategies to improve support, with the relationship between some head teachers and Medway Council leaders highlighted as particularly weak.
As a result, problems faced by children with SEND are not being effectively addressed, in particular the area's high rates of exclusions among SEND pupils and a lack of specialist school provision.
"Medway's education and service leaders do not share one vision and strategy for SEN and/or disabilities," the letter to care, education and health leaders outlining the findings states.
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