Summary: Miss X complained about a lack of services provided to her daughter, Y, from a local provider, Council and Integrated Care Board. We found fault with the Council which caused Miss X and her daughter frustration and a loss of opportunities. The Council agreed to our recommendations to remedy this situation.

The complaint

1. Miss X has complained about Provide Children and Family Services (Provide), Essex County Council (the Council) and Mid and South Essex Integrated Care Board (the ICB) in relation to a lack of provision of services from her daughter, Y’s, Education and Health Care Plan (EHC Plan) from September 2022 to September 2023.
2. Specifically Miss X has complained about:

• delays in provision of a suitable stander and walker;
• a lack of orthotic provision;
• a lack of physiotherapy planning;
• a lack of physiotherapy provision;
• a lack of occupational therapy (OT) planning;
• a lack of provision;
• a lack of Speech and Language Therapy (SALT) planning; and
• a lack of SALT provision.

3. Miss X says the impact of these failings is that her daughter’s health and development has suffered. Miss X’s health has also suffered. In addition, she has had to pay a significant amount of money for private care to meet the gaps left due the lack of provision of services from the plan.
4. As a result of this complaint Miss X would like:

• a financial remedy;
• recognition that Provide is not a fit service to provide care to Y;
• no further delays in equipment;
• appropriately qualified staff providing care to Y; and
• treatment outsourced through a personal budget.

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The Ombudsmen’s role and powers

5. 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).
6. 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).
7. 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.
8. 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
9. 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)
10. Under our information sharing agreement, we will share this decision with the Office for Standards in Education, Children’s Services and Skills (Ofsted).

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How I considered this complaint

11. I considered evidence provided by Miss X and the Council, Provide and the ICB as well as relevant law, policy and guidance.
12. I considered Miss X’s comments on my draft decision statement before making this final decision.

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What I found

Education and Health Care Plans

13. Children who have special educational needs may have an Education Health and Care Plan (EHC Plan). This sets out the child’s special educational needs and the provision needed to meet them. Local authorities have a duty to secure the special educational provision set out in an EHC Plan, unless the parent or young person has made suitable alternative arrangements. (Children and Families Act [the Act] 2014 section 42)
14. 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 Act).
15. 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)
16. 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

17. Y had an EHC Plan in September 2022 when she was five years old. It detailed that she had several health conditions such as developmental delay and had needs that required input from such specialisms as orthopaedics and neurology.
18. Provide was the organisation commissioned by the Council and the ICB to deliver services under the EHC Plan. Miss X was unhappy with what she felt was a lack of delivery of the services set out in the EHC Plan. Y had another EHC Plan in September 2023 which is not subject to this investigation.
19. Miss X complained about this and came to us after some correspondence with Provide and the Council.

Delays in a suitable stander and walker

20. Section F of the EHC Plan outlined that Y needed a standing frame to engage in activities including physiotherapy. Section G of the EHC Plan stated that Y had two walkers and two standers as mobility aids.
21. Standing frames can help stiff muscles to relax and other muscles to get stronger by providing additional support for people who cannot always stand to do so without the support of a carer. A walker is a walking aid for children who may have mobility issues and supports them to walk sometimes without the support of a carer.
22. Section F included an audit of equipment, and that new equipment should be ordered when needed. Therefore, it was the responsibility of the Council.
23. Miss X complained in September 2023 that from November 2022 her daughter had no standing frame at home as it had not been set up properly. In addition, she said one of the walkers was faulty and had not been replaced.
24. The Council said that Miss X first raised the issue with the walker in June 2023 and after checking it, it arranged for the walker to be fixed in July 2023 and in August it said Miss X was now happy with it. The Council said this was not a significant delay.
25. The Council agreed there were issues with the standers due to resources. It said the equipment was dependent on whether there was suitable equipment in storage and the staff in store were not child specialists.
26. There could be issues with getting the wrong equipment and the process took some time. The Council apologised for delays in the equipment process and said it was working to improve the process.

Analysis

27. In relation to the standers, there were delays in providing Y with these which impacted on her home life and education. From the records there was a period of several weeks where the stander at home was unsuitable, partly because the stander that worked was taken into school so that Y could use it there. This was fault on the part of Provide and so the Council.
28. Provide has apologised and stated it is improving the service, but has not outlined what the improvements are to prevent this happening again. In addition, Miss X experienced frustration and Y missed opportunities to develop for several weeks while Provide tried to replace the standers.
29. Regarding the walker, Provide said it fixed the walker within a short space of time from when Miss X raised it in 2023.
30. However, there is a record of Miss X raising issues with the walker in November 2022. She felt that the hydraulics were broken and the seat on the walker was sliding down throughout the day. The records also indicate that this problem was fixed in December 2022 and there is no further note of an issue until June 2023 and it was again fixed in July 2023.
31. Miss X said that the physiotherapist only reported the problem the following June 2023 despite her raising it with them throughout 2023.
32. There is not enough evidence to decide, even on the balance of probabilities, if the walker was broken for a longer period than that outlined in the notes. In addition, when the Provide started the process of fixing the walker, on both occasions it fixed it within a matter of weeks. Therefore, I have not found fault in relation to the walker.

Orthotics

33. The EHC Plan outlined that Y had Ankle Foot Orthoses (AFOs).
34. An AFO is worn to help correct the position of the foot and ankle.
35. Section F of the EHC Plan stated that Y should have a review of the AFOs on a needs led basis including checking of fitting, growth and assessment in orthotic clinic. This means it was the responsibility of the Council.
36. Miss X said that she had been waiting for an appointment since February 2023 for Y to have new AFOs fitted. Provide informed her that there was a waiting list for appointments.
37. Y had new AFOs fitted in July 2023 and this was a wait of five months from February 2023.
38. This delay of five months is outside a reasonable time limit for the AFOs which were integral to Y’s mobility and comfort and so it was fault on Provide and so the Council’s part. The delay led to discomfort for Y and frustration for Miss X.

Physiotherapy

39. Section F of 2022 EHC Plan outlined to support Y’s physical and sensory needs as well as her independence, Y would require 18 hours of direct and 3 indirect hours of physiotherapy.
40. Miss X complained that she did not feel Provide planned physiotherapy properly, Y did not receive the hours outlined in the EHC Plan, and a large proportion of the hours were fixing equipment rather than providing therapy.
41. Provide outlined the hours of physiotherapy which it carried out with Y, which it said were more than outlined in the EHC Plan.
42. Provide also said it wrote two care plans during this period.

Analysis

43. From the records there is evidence that Provide carried out more hours, both direct and indirect, than outlined in the EHC Plan.
44. I agree that a substantial amount of these hours was fitting and checking equipment. However, that was the role of the physiotherapist so that they could provide therapy and this task had to be done as Y grew and her needs changed.
45. In addition, Provide is correct in that it created more than one care plan during this period which it used to carry out physiotherapy for Y.
46. In view of this, whilst we understand the frustration for Miss X that a proportion of the time spent in physiotherapy was fitting and checking equipment, Provide did carry out the number of hours and planning outlined in the EHC Plan. Therefore, there was no fault on the part of the Council in relation to this part of the complaint.

Occupational Therapy

47. Section F of the EHC Plan stated that to meet Y’s physical and sensory needs as well as her independence, she would require 18 hours from the OT team. This was a six hour block of direct therapy providing advice on her goals and reviewing her equipment, a six hour block of OT direct therapy within school and another six hour block at home.
48. Miss X complained that Provide did not fulfil the allotted hours as per the EHC Plan. She also said that there was no plan in place for fine motor skills for Y during this period.
49. Provide stated, and the records confirm, that it did not meet the target for the number of hours of OT that Y should have had under the EHC Plan. There was a shortfall of 1.5 hours direct OT. It said this was due to recruitment and staff retention difficulties.
50. In addition, although Provide said it provided a plan in May 2023, there is insufficient evidence of a care plan before this or one after this relating to fine motor skills. On the balance of probabilities, we can say that there was a fault in care planning on the part of Provide on behalf of the Council in relation to OT.
51. This shortfall in provision and planning left Y without her physical and sensory needs being met and impacted on her independence. This also led to frustration for Miss X in seeing that her daughter was not fully supported.

SALT

52. Section F of the EHC Plan stated that for her educational needs, Y would require a total of 9.5 hours of SALT. This was to consist of 6 hours direct support to include individual sessions for assessment, planning and liaison with her family and professionals. It would also include 3.5 hours indirect support for writing of care plans and preparation of resources.
53. There was also a health provision in Section G of the EHC Plan for 6.5 hours. This comprised 4.5 hours of direct support to include assessment and review of eating and drinking skills. The other two hours was to be indirect support for report writing and professional liaison.
54. Provide outlined the amount of SALT carried out with Y with both direct and indirect hours being more than specified in the EHC Plan.
55. Provide said the decision to increase direct therapy was based on her pressing needs at that time.
56. Miss X was unsure if all the SALT hours outlined in the EHC Plan had been fulfilled by Provide. She also complained there was no new care plan from April 2023 to the next EHC Plan in September 2023.

Analysis

57. There is evidence in the records that Provide fulfilled all the hours outlined in the EHC Plan and did carry out more hours with Y.
58. In relation to the care plan, Provide did review Y and issue new eating and drinking guidelines in May 2023. I did not find sufficient evidence of a lack of SALT planning to represent a fault in this aspect of the case. However, it does seem that Y’s needs were more than first thought when the 2022 EHC Plan came into place and so the hours outlined could have been insufficient to meet her needs. This is a separate issue to that which this investigation is concerned with.

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Action

59. Due to the frustration for Miss X and the discomfort and lack of mobility and opportunities to develop for Y caused by the faults I have outlined, I make the following recommendations to the Council.
60. By 13 August 2025, the Council should:

• write to Miss X acknowledging its faults and apologising for the frustration they have caused her and the lack of mobility, development opportunities and comfort they caused for Y; and
• make a payment to Miss X of £250 to reflect the injustice caused to Miss X and of £750 for the injustice caused to Y.

61. By 15 October 2025, Council should:

• outline what improvements Provide has made or will make to improve the provision of equipment to children with special educational needs;
• outline what improvements Provide has made or will make to its orthotics and OT services to prevent the shortfall in service that occurred in this case; and
• outline how it will monitor the above improvements on a regular basis.

62. The Council should give us with evidence it has complied with the above actions.

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Decision

63. I find fault with the Council which caused injustice to both Miss X and Y. I have made recommendations to remedy this. I did not find fault with the ICB.

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Investigator's decision on behalf of the Ombudsman