There is a quiet absurdity at the heart of the English education system. We call them Education, Health and Care Plans (EHCP's), but too often the “H” sits there like a decorative initial; present in name, absent in practice. Education scrambles. Parents exhaust themselves. Local authorities haemorrhage money. Children wait. This is not a theoretical problem. It is lived, daily, in bedrooms turned into classrooms, in children trapped by anxiety and obsessive fear, in parents navigating a maze of professionals who all agree something is wrong yet somehow conclude that nothing is their responsibility. Let me be blunt; if we want to fix the EHCP crisis in schools, we need to make Health actually do something. When Everyone Says “Not Us,” the Child Pays the PriceImagine a child who has been diagnosed with autism and OCD for five years. Five years of evidence. Five years of escalating distress. Anxiety so consuming that school attendance becomes impossible, not because the child “won’t engage”, but because their nervous system is in survival mode. Medication that could reduce that distress exists. The evidence base exists. National guidance exists. And yet the child waits; sometimes for two years or longer. Why? Because GPs say only CAMHS can prescribe. Because CAMHS say they aren’t equipped to prescribe to Autistic young people. Because nobody is required to act, and nobody is held accountable when they don’t. The result is a grotesque paradox; the system acknowledges need, documents need, plans around need, yet refuses to fulfill the need that is making everything else impossible. This is not a failure of parents. It is not a failure of schools. It is a structural failure of Health. The Legal Fiction of Joined-Up WorkingUnder the Children and Families Act 2014, EHCP’s were designed to end siloed working. Health bodies were supposed to be equal partners, legally bound to deliver the provision they agree to. This, of course, is hypothetical. In practice, health advice is often vague, non-committal, or entirely absent. Recommendations are hedged. Interventions are “considered” rather than provided. And when provision isn’t delivered, enforcement becomes functionally impossible. Health services can opt out. Education cannot. This imbalance matters. Because when Health fails to act, Education is forced to compensate; through reduced timetables, online provision, personal budgets, or full EOTAS packages. These are expensive, reactive, and frequently isolating. They are not evidence of “parental choice”; they are evidence of systemic neglect upstream. EHCP’s become more costly not because children are asking for too much, but because health is doing too little. Children are left to suffer and then it is they and theory families that are criticised for the failures of the system at large. The Postcode Lottery No One Wants To NameThere is another uncomfortable truth we avoid saying out loud; access to healthcare depends on where you live. Some GPs will prescribe SSRIs for children and young people under NHS and NICE guidance. Others refuse outright. Some areas have CAMHS teams willing to prescribe and monitor medication. Others operate policies of avoidance dressed up as “thresholds” or “pathways”. This is not clinical caution. It is inconsistency masquerading as professionalism. Families without financial privilege cannot bypass this system. Private psychiatric care is not an option for the average English family, it is an emergency exit only available to those who can afford it. The NHS was not designed to work like this. When treatment depends on postcode or parental income, we are no longer talking about support. We are talking about inequality. What The Evidence Is Already Telling UsThe CAMHS Report 2024 paints a picture many parents already recognise; overwhelming demand, inconsistent access, and a system that responds too late, if at all. Long waits are not a side effect; they are a defining feature. Children deteriorate while forms circulate. Early intervention is repeatedly shown to reduce long-term cost and improve outcomes. Yet we persist with a model that withholds treatment until crisis; then wonders why crisis provision is so expensive. This is not just inefficient. It is unethical. Fixing The H Is Not Radical. It Is Basic Competence.Fixing the H in EHCP does not require new laws. It requires enforcing the ones we already have. Health bodies must:
Because when Health disengages, the system does not save money. It spends more. When Health delays, children lose years of their lives. And when everyone passes responsibility sideways, the only person with no escape route is the child. A Final, Uncomfortable TruthEHCPs were never meant to be firefighting documents. They were meant to coordinate care around a child, not compensate for institutional refusal. If we are serious about inclusion, about early intervention, about reducing pressure on schools and local authorities, then the solution is painfully obvious; Fix the H. Not tomorrow. Not after another report. Now. Because every delay is a decision, and children are paying the cost. This article is part of a wider campaign to support them mental health of neurodivergent children and young people, particularly those who have interactions with CAMHS. Below are links to three related petitions which I would love if you could sign and share. You're currently a free subscriber to David Gray-Hammond. For the full experience, upgrade your subscription.
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Sunday, 4 January 2026
Fix the H in EHCP
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