Date of decision: 01 July 2025
Summary
A mother complained that her daughter was denied specialist transport and the education set out in her EHC Plan because the Council and the NHS body failed to work together. As a result, her daughter missed a full year of education and therapies, while her mother was left carrying the caring burden, without respite. The investigation was a joint one by both LGSCO and PHSO as the complaint involved the actions of both the Council and the ICB.
What happened
Miss D, a young adult with complex health and education needs, including reliance on tracheostomy care experienced the collapse of her college placement at College Z in September 2022. Thereafter, by June 2023, the Ombudsman had already found the Council at fault for failing to deliver six terms of education between 2021 and 2023.
Following an October 2023 review of her EHC Plan, Miss D was allocated a place at College X, located two hours from her home.
On 30 November 2023, the Council confirmed she met its eligibility criteria and would receive funded transport. However, a taxi alone was unsafe without a suitably trained escort competent in tracheostomy care.
The Council agreed to fund a taxi for transport, and NHS West Yorkshire Integrated Care Board (the ICB) agreed to fund a medically trained escort.
The ICB approved funding for an escort on 18 December 2023 and arranged for Agency A to cover the role. In January 2024, Agency A withdrew, leaving Mrs M to search locally for alternatives.
Between October 2023 and January 2024, Miss D was placed in out-of-county respite care due to lack of transport. By February 2024, Mrs M had found another provider, Agency B, which began providing care. However, Agency B staff lacked tracheostomy competency sign-off, meaning Miss D could not attend College X.
Between March and June 2024, the ICB could not find anyone within its own staff or externally to provide the competency sign-off. Mrs M sourced a person who could do this and the ICB and Agency B agreed to use this person’s services. Eventually, in July 2024, an escort was finalised. This delay of over seven months meant Miss D only accessed transport for the final four weeks of the academic year.
During this time, the Council did nothing to check whether transport arrangements enabled Miss D to attend college, failed to resolve problems or secure alternatives, and did not arrange alternative education as required under the EHC Plan duty. When Mrs M complained in February 2024, the Council wrongly assumed attendance had begun and expressed “hope her transition had now started,” without confirming with the college, ICB, or Mrs M herself.
In March 2024, following Office of the Public Guardian advice, Mrs M submitted a safeguarding alert, citing neglect. The Council dismissed it without adequate reasoning, despite statutory guidance recognising failure to provide appropriate education as a possible act of neglect or organisational abuse. The Council also failed to consider Article 8 rights to family life in its handling of Miss D’s prolonged absence.
Throughout this period, the ICB largely relied on Mrs M to source and monitor progress with care providers. Its failure to communicate proactively left Mrs M carrying responsibility for updates. Meanwhile, the Council failed to offer or review a carer’s assessment for Mrs M, despite being aware of her increased caring role when Miss D was excluded from education and respite.
As a result, Miss D lost all education, therapy, and social provision between July 2023 and July 2024. This included specialist one-to-one teaching, support from teachers of the deaf, speech and language therapy, physiotherapy, occupational therapy, swimming, and Makaton communication programmes. She also spent unnecessary periods in respite care away from home. Mrs M, left to provide full-time care without respite, described herself as “exhausted to an unimaginable level.”
What was found
The Council breached its legal duty under section 42 of the Children and Families Act 2014, by failing to secure the educational provision specified in the EHC Plan. Its failures to monitor transport arrangements, act on complaints, investigate safeguarding properly, and offer a carer’s assessment were all faults.
The ICB was at fault for delays in securing a trained transport escort, for poor communication, and for failing to uphold a person-centred approach required by the NHS National Framework for Continuing Healthcare.
Both bodies failed to address the impact on Miss D’s and her family’s rights under Article 8 of the Human Rights Act.
The Ombudsman found these systemic failures caused Miss D to miss an entire year of specialist education and support. Mrs M was left carrying additional caring burdens, suffering severe exhaustion, distress, frustration, financial strain, and loss of trust.
Remedies required the Council and ICB to ensure transport and support were in place urgently; plus paying £7,200 jointly for Miss D’s missed education; £1,000 jointly for lost enjoyment of family life; £2,000 jointly for Mrs M’s extended caring responsibilities; £500 from the Council and £300 from the ICB for poor communication; and written apologies. The Council was also required to offer a carer’s assessment and review its handling of safeguarding referrals. Both organisations were ordered to implement joint procedures for specialist transport within three months.
Points to note for councils, professionals, people using services and their carers, advocacy groups and members of the public
The Council must arrange for the transport it considers necessary for an adult with an EHC plan to attend their education or training placement (Education Act 1996, section 508F).
The Council has a post-16 transport policy statement. This specifies the assistance the Council considers necessary to facilitate adults’ attendance at education placements.
If the Council decides that an adult meets its eligibility criteria for transport, it has discretion in the types of support it can offer. But the transport support offered must be capable of achieving the objective of facilitating attendance at the educational placement.
NHS Continuing Healthcare (CHC) is a package of ongoing care arranged and funded by the NHS where a person has been assessed as having a ‘primary health need.’ Where a person is eligible for CHC, their local ICB is responsible for care planning, commissioning services and case management. This includes:
- ensuring the person has a care plan to meet all their health and associated care and support needs; and
- monitoring their support arrangements and responding to any difficulties in a timely manner.
We don’t think that the woman was a CHC recipient, however. We think that she was getting shared care on account of the very specific health need that she had for trachy care and that the transport being provided was not being provided under the Care Act but by Education, which meant that the NHS had no option but to meet the specific health need separately.
The National Framework for NHS Continuing Healthcare (National Framework) says at paragraph 288 that, where there are overlapping powers and responsibilities, councils and ICBs should adopt a flexible, partnership-based approach including which organisations will take the lead commissioning role. In Practice Guidance note 43, the National Framework says that ICBs should commission in partnership with councils where appropriate.
The report references the Education Act 1996, Children and Families Act 2014, Care Act 2014, and the National Framework for NHS Continuing Healthcare.
Councils have a duty under section 10 of the Care Act 2014 to assess a carer’s needs when it appears support may be required, regardless of whether the carer requests this, and must also review support plans if circumstances change.
There is a statutory safeguarding duty under section 42 of the Care Act 2014 to make enquiries when there is reasonable cause to suspect an adult at risk is experiencing or is likely to experience neglect, including omissions in educational or social care provision. Statutory guidance on safeguarding (Care and Support Statutory Guidance) explicitly recognises psychological abuse, organisational abuse, and failure to provide appropriate services as potential forms of neglect.
Community care law also requires councils to act in a way that respects service users and carers’ human rights, including rights to private and family life under Article 8 ECHR, with any restriction needing robust, well-explained justification. Failures in communication, carer assessments, or to reassess needs when education and respite provision are withdrawn can represent breaches of statutory duties, not just administrative failings.
Where a council knows a carer is being asked to do much more as a result of a service failure, there is a positive duty to assess the sustainability and risks of the caring arrangement and to act promptly to provide additional support. Article 8 of the Human Rights Act 1998 was engaged in this complaint because:
- Miss D needed to stay in out-of-county respite care, away from her family home, for longer than usual when she could not go to college; and
- Mrs M could not leave Miss D unsupervised with care workers until they were fully trained in caring for Miss D’s tracheostomy and signed off as competent in doing so. This reduced Mrs M’s ability to have a break from her caring role and to spend time with Miss D’s brother.
Neither the Council nor the ICB had shown how they considered the impact of the delays in resolving transport on Miss D’s and her family’s Article 8 rights.
Practically, this means councils and professionals must ensure systems are in place for immediate review and support when provision in EHC Plans is interrupted, for both the cared-for person and their carer, and robust, evidence-based safeguarding assessments must occur whenever reasonable doubts of neglect or abuse arise due to service withdrawal. The consequences of non-compliance include legal risk, further distress and breakdown of support at home, and, ultimately, legal challenge in the Administrative Court.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s City of Bradford Metropolitan District Council (24 001 929) report.
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I don’t believe that this woman was “getting shared care on account of the very specific health need that she had for trachy care”.
The reasons I think this are 14 “Miss D is a young adult with an EHC Plan. She also receives care funded through NHS continuing healthcare (CHC).” and 18 “College X is around two hours away from Miss D’s home. The Council agreed to fund a taxi to College X and the ICB agreed to fund a care worker trained in tracheostomy care to escort Miss D in the taxi.” and 24 “NHS Continuing Healthcare (CHC) is a package of ongoing care arranged and funded by the NHS where a person has been assessed as having a ‘primary health need’. Where a person is eligible for CHC, their local ICB is responsible for care planning, commissioning services and case management. “. I think the council were responsible for the taxi only and specifically, and Miss D has CHC so 100% of her eligible health and social care needs can only be met by the ICB.
The National Framework for NHS CHC mentions ‘joint packages’ as you suggest this applied to. It says 20 “Where
a package of support is commissioned or funded by both a local authority and an ICB, this is known as a ‘joint package of care’”. At 22 it is clear that people receiving CHC are different from people receiving a joint package of care. It never talks about people having CHC who have a joint package of care.
I think the LA had responsibility for the transport (only). Though the person in this report is now an adult, there is more information specific to the interaction between CHC and EHCP’s in the children’s CHC framework document.