One of the most common frustrations I hear from SEND families is that the health section of their child's EHCP is either nearly empty or full of vague statements about what might be considered at some point. Health provision is often the weakest part of the plan, partly because the NHS operates separately from local authorities, and partly because many families do not know what they are entitled to ask for. Let me explain how it is supposed to work.
How the EHCP is structured
An Education, Health and Care Plan has sections covering different areas of your child's life. The sections most families focus on are B (special educational needs), F (special educational provision), D (health needs), and G (health provision). Section D describes your child's health-related needs. Section G sets out what health provision should be put in place to meet those needs.
Crucially, Section G health provision is not legally enforceable in the same way that Section F educational provision is. The duty to secure provision in Section F sits with the local authority and is one of the strongest duties in the Children and Families Act 2014. Health provision in Section G involves a "duty to arrange" rather than a direct duty to deliver, and the NHS body involved has some flexibility. This is a real limitation in the current framework.
What the NHS is required to contribute
Under the Children and Families Act 2014, NHS bodies, specifically the relevant Clinical Commissioning Group or Integrated Care Board, must respond to a request from a local authority to contribute to an EHC needs assessment. They must provide relevant advice and information about your child's health needs. And they must be involved in the planning process if health provision is to be included in the plan.
The NHS England guidance on children and young people's SEND provision sets out the NHS's responsibilities and how Integrated Care Boards are expected to work with local authorities on EHCPs. It is worth reading if you want to understand how health bodies are supposed to engage with the process.
Common problems families face
The reality on the ground often looks very different from the framework on paper. These are the problems families report most often:
- Health reports are provided too late or not at all during the needs assessment process
- The health section of the EHCP is copied and pasted from an old report without being updated
- Health provision is listed in Section G but then not delivered because of NHS waiting lists or funding disputes
- The NHS body disputes whether something is "health" provision or "educational" provision, leading to it being excluded from both sections
- Families are told that health provision cannot be specified in the EHCP because the NHS cannot guarantee delivery
What you can do
If health reports have not been contributed to your child's needs assessment, you can request them directly and submit them yourself. You are allowed to contribute evidence from any professional, including private reports. If the health section of your child's EHCP is thin or missing, you can request an amendment and set out specifically what provision you believe should be included, backed up by professional evidence.
If health provision in Section G is not being delivered, the first step is to raise it with the local authority, who has a duty to work with the NHS body to ensure the plan is implemented. If that fails, the local government ombudsman handles complaints about local authorities, and the Parliamentary and Health Service Ombudsman handles NHS complaints.
Where to start
Look at Sections D and G of your child's current EHCP and compare what is listed against what is actually being received. If there are gaps, write them down with dates. Then contact the local authority's SEND team in writing to raise the discrepancy. Keep copies of everything. Your local SENDIASS service can advise you on next steps and help you draft correspondence if needed.