Summary: Mrs X complained that the Council and Integrated Care Board did not deliver the provisions of her daughter, Y’s Education and Health and Care Plan. This led to frustration and distress for Mrs X. We found fault with both the Council and Integrated Care Board leading to the distress Mrs X has suffered. The Council and Integrated Care Board agreed to take actions to remedy this situation for Mrs X.

The complaint

1. Mrs X complains Kingston Upon Hull City Council (the Council) and NHS Humber and North Yorkshire Integrated Care Board (the ICB) have failed to fulfil some of the provision in her daughter, Y’s Education and Health and Care Plan (EHC Plan) after a Tribunal hearing in August 2023. She says that the Council and ICB have failed to deliver part of Sections F and G of her daughter’s EHC Plan from August 2023 to between April and June 2024.
2. The specific parts of Section F that were delayed or not delivered are:

• A desensitisation plan to support Y to access health appointments; and
• a minimum of monthly meetings with parent, teaching and school nursing staff with the aim of planning and delivering a programme of support to enable Y to attend and tolerate health procedures across different health settings. To be delivered by Specialist Nurse, working jointly with all agencies and parent. This is also included in Section G with identical wording.

3. Mrs X says the following parts of Section G have also not been delivered or have been significantly delayed:

• vaccination desensitisation; and
• a health passport and one page profile.

4. Mrs X said the impact of this is that Y’s needs were not fully met, particularly her ability to access health services. This has been a particular problem since discovering that Y was having kidney problems.
5. Mrs X was worried for her daughter’s health and felt she has been put at unnecessary and prolonged risk. Mrs X felt frustrated, ignored and in a constant battle with services. Mrs X said this also impacted on her time and availability spend time with Y’s brother, who also has complex needs.
6. As an outcome Mrs X wants the care and support that Y is entitled to in her EHC Plan to be in place.

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The Ombudsmen’s role and powers

7. The Local Government and Social Care Ombudsman and Health Service Ombudsman have the power to jointly consider complaints about health and social care. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA).
8. We investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, we consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A(1), as amended).
9. If it has, they may suggest a remedy. Our recommendations might include asking the organisation to apologise or to pay a financial remedy, for example, for inconvenience or worry caused. We might also recommend the organisation takes action to stop the same mistakes happening again.
10. When investigating complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that during an investigation, we will weigh up the available evidence and base our findings on what we think was more likely to have happened
11. If we are satisfied with the actions or proposed actions of the organisations that are the subject of the complaint, we can complete our investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(i), as amended)
12. Under our information sharing agreement, we will share our final decision with the Office for Standards in Education, Children’s Services and Skills (Ofsted).

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How I considered this complaint

13. I considered evidence provided by Mrs X, the Council and ICB as well as relevant law, policy and guidance.
14. I considered comments from Mrs X, the Council and the ICB before making this final decision.

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What I found

Education, Health and Care Plans

15. Children who have special educational needs may have an EHC Plan. This sets out the child’s special educational needs and the provision needed to meet them.
16. The Council has a duty to secure the specified special educational provision (Section F) in an EHC Plan for the child or young person (s.42 of the Children and Families Act). The Courts have said this duty to arrange provision is owed personally to the child and is non-delegable. This means if a council asks another organisation to make the provision and that organisation fails to do so, the Council remains responsible. (R v London Borough of Harrow ex parte M [1997] ELR 62), R v North Tyneside Borough Council [2010] EWCA Civ 135)
17. If the EHC Plan specifies health care provision in Section G, the responsible commissioning body must arrange the specified health care provision for the child or young person unless the family has made its own arrangements. (s.42(3) The Act). In this case, the responsible commissioning body for provision in Section G was the ICB.

Background

18. Y has a diagnosis of Autism Spectrum Condition (ASC) which affects her communication, learning and eating.
19. Y had an EHC Plan in 2023 which Mrs X appealed to a tribunal. The tribunal found in her favour and the EHC Plan was amended and issued in August 2023.
20. Mrs X complained that the Council and ICB did not deliver services from this amended plan and the Council responded before she approached the Ombudsmen.

Desensitisation and school nurse

21. Mrs X complained in February 2024 that the school her daughter was attending did not have a specialist nurse.
22. In addition, Mrs X said the desensitisation plan outlined in Sections F and G of the EHC Plan to support her daughter with attending health appointments had not been delivered. She said that the vaccination desensitisation outlined in Section G, which was to start as soon as possible, had also not been delivered. The plan said that this was to be carried out by health services and the school.
23. The Council said that some desensitisation work had been carried out in the lead up to recent health appointments and this work was ongoing. Regarding vaccination desensitisation the Council said it had planned a forthcoming meeting with Mrs X and health workers to plan vaccination desensitisation. It also said liaison was continuing with nurses to ensure good practice.
24. The Council told the Ombudsman in August 2024 that a desensitisation plan was now in place and Y’s vaccinations were all up to date. Desensitisation sessions were now taking place at school.
25. The ICB said the school did not have a specialist nurse. However, it said that the school was supported by the Community Children's Nursing Team and a Learning Disability Nurse. The Nursing Team supported Y in monthly visits to monitor her blood pressure respiration and weight recording and three-month visits for protein tests. It also said the Learning Disability Nurse supported the school.
26. The desensitisation work was not completed until August 2024. This was a delay of nearly a year after the provision should have been delivered. This led to distress for Mrs X in seeing her daughter was not being properly supported and worry for her daughter’s physical and mental health.
27. There was also the provision of a minimum of monthly meetings with parent, teaching and school nursing staff with the aim of planning and delivering a programme of support to enable Y to attend and tolerate health procedures across different health settings.
28. There is insufficient evidence this took place from August 2023 to May 2024. This is another fault on the part of the Council and ICB which led to distress for Mrs X as it indicated a lack of planning in her daughter’s care.
29. In addition, the school did not have a specialist nurse and the Council and ICB did put this in place. The first time a specialist nurse saw Y was in April 2024, but this was not one based at the school. Although the ICB has outlined some health support at school, this was not the same provision as outlined in the EHC Plan.
30. This was another fault on the part of the Council and ICB which left Y without support and led to frustration and distress for Mrs X.

Health passport and one page profile

31. Section G of the EHC Plan said that Y should have a comprehensive health passport that would sit alongside a one page profile. This would be shared with health professionals before appointments. This was to be fully completed by December 2023. A health passport is a document designed to help individuals with disabilities, learning difficulties, or long-term health conditions communicate their specific needs to healthcare professionals. It acts as a record of important information, such as allergies, communication preferences, and any necessary reasonable adjustments, to ensure individuals receive appropriate and effective care.
32. A one page profile is a document designed to help individuals with disabilities, learning difficulties, or long-term health conditions communicate their specific needs to healthcare professionals. It acts as a record of important information, such as communication preferences, and any necessary reasonable adjustments, to ensure individuals receive appropriate and effective care.
33. Mrs X complained in February 2024 that a health passport for her daughter had still not been created by the ICB.
34. The ICB said that the health passport was created in June 2024 and added to her record. The Council said the one page profile was completed in November 2023 and the ICB said it had been added to Y’s health record.

Analysis

35. The evidence shows the health passport was delayed by six months and completed in June 2024. This was fault by the ICB and led to frustration and distress for Mrs X that health professionals would not be properly aware of her daughter’s needs during health appointments for six months.
36. There was no fault on the part of the ICB in relation to the one page profile as it was completed before the December 2023 deadline.

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Action

37. Due to the faults I have identified by the Council and ICB, leading to the injustice Mrs X has suffered, I make the following recommendations.
38. By 15 August 2025 the Council and ICB should write to Mrs X apologising for the distress and frustration caused by the faults in delay in delivery of Section F and G of the EHC Plan.
39. By 3 November 2025, the Council and ICB should write to Mrs X to outline what work they have done, or intend to do, to improve the timeliness of providing desensitisation plans and health passports to children with similar learning needs.
40. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
41. The organisations should provide us with evidence they have complied with the above actions.

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Decision

42. I find fault with the Council and ICB causing frustration and distress to Mrs X. I have made the above recommendations to remedy this injustice.

Investigator’s decision on behalf of the Ombudsmen

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Investigator's decision on behalf of the Ombudsman