Plans to support the country’s most vulnerable children are often being drawn up without any input for health and social care providers, an investigation has found.
Education, health and care plans (EHCPs) are supposed to be created in collaboration with health and social care professionals.
But analysis of Ofsted area SEND inspections show this is not the case.
Ofsted flags missing health partners
An September inspection of Derbyshire’s SEND services found that some plans were “finalised without contributions from health or social care professional”.
In Milton Keynes, an inspection in March last year found “most EHC plans do not contain health and care outcomes, even when children and young people have demonstrable needs.
“This means that schools often lack the expert advice and support required to ensure the full ranges of a child’s needs are met.”
In Lancashire, contributions from health and social care in plans “can be scant and, in a number, not evident”.
“General practitioners (GPs) are not routinely asked to inform the EHC plan process, even as primary record holders. For some, they are not aware when there is an EHC plan in existence for a child or young person under their care,” the report added.
In Hillingdon, west London, a report last year found “too often health and social care professionals were not invited, did not attend, or did not submit updated advice for annual reviews”.
“Consequently, the plans focus too heavily on education.”
The report concluded that: “Overall, many EHC plans are not useful.”
Read the rest of our special, five-part investigation:
Investigation: How EHCPs are failing our most vulnerable children
Fidget spinners and learning styles: EHCPs’ interventions exposed
Copy and paste: Poor quality EHCPs shortchange schools
Feature: The case for a SEND evidence ‘custodian’
Comment: SEND provision is the last bastion of unevidenced practice
A report by the children’s commissioner in 2022 analysed about 650 EHCPs from two councils, one in London and the other the Midlands.
None of the EHCPs had a blank section F – which mandates education provision. But data was missing for 61 of the 152 (40 per cent) EHCPs for the “health” and “social care” provision sections.
In one of the councils, the average word count to describe all aspects listed under “general” provision was 150. For health and social care provision, the word counts were 16 and 38 respectively.
Reforms must look at health contribution
Warren Carratt, the chief executive of the Nexus MAT of mostly special schools, warned of a “myriad” of interventions that were “clearly misplaced” in the education section.
His trust has an EHCP which includes hydrotherapy’ “bundled” into section F, for instance. This means “schools have to provide it, and councils have to fund it”.
“To compound this issue, universal health services have been reduced over time.”
“There then isn’t the availability of health professionals for schools to commission, leaving more public money flowing to private providers.”
A Schools Week investigation in 2019 revealed how complex health needs of special schools pupils are delegated to school staff as the number of school nurses has dropped.
Leaders say the situation has worsened. One trust recently wrote to an NHS board about nursing service cuts at some of its schools, warning it creates “significant risk to the health and life of these children”.
Councils have to “abide by changes” directed in SEND tribunals over section F issues. But tribunals can “only recommend changes, they have no power to direct” over health and social care provision, Keer added.
Robert Gasson, the chief executive of the Wave Trust, said: “Health advice is supposed to be a core part of these plans, yet delays, vague recommendations, and poor coordination mean many children miss out on the support they deserve.”
Former government adviser David Thomas added the often-missing health contribution was the “main catastrophe of EHCPs. The big challenge for SEND reforms now is how you ensure health provision when the NHS is so stretched.”
NHS Providers, the membership organisation for health organisations, did not want to comment.
The Department for Health and Social Care did not respond to a request for comment.
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