It’s not only parents who are concerned about the SEND proposals for Education Otherwise Than At/In School (EOTAS/EOTIS).
Unison, the major union that supports public service sector staff, has already written for us about their concerns about the missing health aspects in the recent guidance consultation for Children in School with Medical Conditions. A large proportion of children educated outside of school, in particular, under the s19 duty, have medical conditions.
Chapter 3 of the EOTAS consultation focuses on children whose health needs cannot be met in school, yet it is very short on any details about what the NHS is expected to deliver, with ICBs mentioned only once, as part of a list of services that might be involved. It’s very clear the document is relentlessly—almost cruelly so—aimed at propelling very vulnerable (and sick) children back inside school gates.
Unison’s Joanna Parry has again written for us about their concerns…
The EOTAS consultation has a chapter on health – but where is the NHS? Joanna Parry, Unison
Special Needs Jungle has already highlighted serious concerns about the Government’s Education Otherwise Than at School (EOTAS) consultation. UNISON shares many of them. Chapter 3, however, raises a further concern for us. It deals with children whose health needs cannot be met in school, yet says remarkably little about the responsibilities of the NHS.
An important distinction
Although the consultation is labelled “EOTAS”, Chapter 3 deals with a different legal route. EOTAS is special educational provision arranged under section 61 of the Children and Families Act 2014 and set out in an EHCP. Chapter 3 concerns alternative provision arranged under section 19 of the Education Act 1996 for children who would otherwise be without suitable education because of illness. SNJ has an explainer here
Section 19 requires the local authority to arrange suitable education for children of compulsory school age in those circumstances, whether or not they have SEN or an EHCP. It is an education duty, not a duty to meet children’s underlying health needs. But arranging education is only part of the picture. If a child cannot attend school because healthcare is missing or delayed, who is responsible for making sure that care is provided?
A health problem framed as an education solution
Chapter 3 recognises that children whose physical or mental health needs prevent school attendance can spend long stretches out of education, and that their families face a confusing and disjointed system. Yet, when it considers why these delays occur and who should respond, the focus is largely on schools and local authorities. The NHS is barely mentioned. Instead, the chapter discusses building schools’ capacity, alternative provision outreach, reasonable adjustments and toolkits.
Health commissioners and Integrated Care Boards (ICBs) appear only once in Chapter 3, as part of a list of bodies that “might” support children receiving section 19 provision and their reintegration. Their responsibilities are not explained, nor does Chapter 3 explain the role of NHS organisations responsible for providing nursing, therapy or other clinical support, despite the chapter’s focus on children whose health prevents them from attending school.
Question 16 then asks how the roles of schools, local authorities and health services should be clarified, without first setting out what health services are responsible for. As written, attention is directed towards what schools and local authorities should do differently, rather than whether a child’s healthcare needs have been assessed and the necessary NHS support commissioned and made available.
Schools and local authorities have important responsibilities, but neither of these can make up for missing nursing, non-educational therapy support or mental health treatment. In some cases, the absence of that healthcare is precisely what prevents a child from attending school.
Alternative provision does not replace healthcare
Alternative provision under section 19 is important for the continuity of education. However, it cannot displace NHS commissioning responsibilities under the NHS Act 2006, and it cannot transfer them to the local authority, school or alternative provision provider.
That distinction is not made clear in DfE’s 2023 Guidance on arranging education for children who cannot attend school because of health needs. This explains the responsibilities of schools and local authorities in detail, recognising that not all children with health needs will have SEN or an EHCP. Yet it does not mention ICBs or health commissioning, and its only implicit reference to the NHS is a general call for services to “work together”.
Elsewhere, existing DfE statutory guidance makes clear that clinical support for children with long-term conditions and disabilities remains an NHS commissioning responsibility. Those local commissioning functions now sit with ICBs.
The EOTAS consultation should restate that responsibility and explain how it applies to children both with and without an EHCP. UNISON raised this omission directly with the Department for Education on 6th August. The Department has said it is seeking clarity from the relevant team, but at the time of writing we have not received a substantive answer.
Schools cannot fill gaps in NHS provision
The absence of NHS provision does not default to making a child’s healthcare needs the school’s responsibility. Nevertheless, when necessary clinical support is not provided, support staff too often come under pressure to carry out healthcare activities because no health professional is available. This is unfair to both the staff and to the children concerned. Training, reasonable adjustments or an Individual Healthcare Plan cannot, by themselves, transfer NHS responsibility for clinical care to a school or substitute for the care a child needs. Expecting schools to bridge that gap is not a sustainable approach to inclusion.
NHS responsibility applies with or without an EHCP
As famillies know, having an EHCP does not guarantee timely healthcare. Children often still face delays or failures, even where the health provision they need is appropriately specified in the plan.
Children with significant health needs but no SEN or EHCP are at particular risk of being overlooked. They may require section 19 education because their health prevents school attendance, yet lack the EHCP-specific duties and routes of redress available to children with a plan. The NHS’s responsibility to commission necessary healthcare applies equally to both groups.
The NHS Constitution states that access to NHS services is based on clinical need and that NHS accountability should be clear and transparent. Those principles apply whether a child is educated at home, in school or in alternative provision.
The omission is also difficult to reconcile with the Government’s wider SEND reform proposals, which promise stronger accountability and clearer statutory roles for ICBs.
What the consultation should say
Chapter 3 should therefore set out:
- ICBs’ responsibilities for commissioning necessary healthcare, and how timely assessment and provision will be secured for children with and without an EHCP.
- Who is accountable, and how concerns can be escalated, when missing healthcare prevents an individual child from attending school.
- That alternative provision, staff training, reasonable adjustments and healthcare plans cannot substitute for necessary NHS care.
- How, at system level, delays in NHS assessment or provision that prevent school attendance will be identified, monitored and reported.
Together with other unions, UNISON is calling for a needs-led, NHS-commissioned clinical school nursing service embedded in every state-funded education setting. Under this model, clinical care would be arranged through the NHS and delivered by NHS-employed staff, including appropriately trained healthcare assistants working under registered nurse oversight.
The missing question
No child should spend months without suitable education. When missing healthcare is keeping a child out of school, section 19 provision alone does not resolve the problem. Chapter 3 must also ask: “What healthcare does this child need, who is responsible for providing it, and how will it be put in place?”
Unless Chapter 3 addresses that question, schools and families risk being left to manage the consequences of missing NHS provision.
The consultation closes on 18 September 2026. Those responding to Chapter 3, particularly Question 16, can press the Government to set out the NHS’s responsibilities, and how NHS bodies will be held accountable when missing healthcare prevents school attendance.
Live SEND-related Consultation Links:
- Register for the SNJ/SOS!SEN EOTAS webinar! Tues 2 Sept 7:30pm
- SNJ’s Politics Page with all our latest SEND politics articles
- EOTAS Consultation main page
- EOTAS Consultation Document
- EOTAS Response page
- SEND reform: education otherwise than at school – what parents and carers of children and young people need to know
- BSL version
- Upfront funding for mainstream schools: creating a ‘local SEND inclusion formula
- Closes 18th September 23:59
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Key Content
Also read:
- WEBINAR RECORDING! The implications for children’s legal rights to EHCPs and EOTAS of the Government’s SEND proposals
- When things go right: Shining a light on SEND Practitioners making a positive impact [Giveaway!]
- From suspicion to support: why the Government’s child protection reforms matter for disabled children
- Have your say on the future of transport for disabled children and young people
- Unison voices major concerns over SEND reform health plans for sick and disabled children out of school in the EOTAS consultation
- Top Tips for the EOTAS & EHCP consultation: Protect your child’s rights to statutory SEND support
- REGISTER NOW! WEBINAR on the Government’s plans to cut EHCP and EOTAS rights. With SNJ & SEND legal charity, SOS!SEN
- Navigating constraints: Why a former PCF chair thinks the current model is missing the mark for families
- Dear Secretary of State for Education, Lucy Powell: an Open Letter from Special Needs Jungle and SEND legal charity SOS!SEN
- Research: Disabled young people define inclusive education as “learning in the place that’s right for them”
- Why every child deserves Portage, wherever they’re born
- Mainstream SEND Funding: A simple explainer, another consultation, and why it really matters
- WEBINAR RECORDING! The implications for children’s legal rights to EHCPs and EOTAS of the Government’s SEND proposals
- Unison voices major concerns over SEND reform health plans for sick and disabled children out of school in the EOTAS consultation
- REGISTER NOW! WEBINAR on the Government’s plans to cut EHCP and EOTAS rights. With SNJ & SEND legal charity, SOS!SEN
- Allergy Guidance issued—but wider medical conditions guidance back for more work
- WEBINAR RECORDING: Will school SEND funding be ringfenced? Minister Gould said so, but does she understand what that means?
- ARFID: Avoidant/Restrictive Food Intake Disorder is much more than just “fussy eating”
- Draft medical conditions guidance raises “serious concerns” says union, over shift in clinical responsibilities to schools
- WEBINAR RECORDING! The legal implications of the Schools White Paper’s SEND Proposals
- Consultation: Supporting pupils with medical conditions at school. What’s new, what’s missing and what you need to know
- Living with PoTS: Understanding Postural Orthostatic Tachycardia syndrome and how schools can help
- 10 things you probably don’t know about the emerging neuropsychiatric conditions of PANS and PANDAS
- Shameful state of continence services leaves disabled children “robbed of fundamentally important experiences”
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- WEBINAR RECORDING! The implications for children’s legal rights to EHCPs and EOTAS of the Government’s SEND proposals - September 3, 2026
- From suspicion to support: why the Government’s child protection reforms matter for disabled children - August 28, 2026
- Have your say on the future of transport for disabled children and young people - August 25, 2026
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