R(A) v North Central London Integrated Care Board

An integrated care board owes an absolute and non-delegable duty to arrange healthcare provision specified in Section G of an education, health and care plan. Where that provision includes a health care plan, the board may arrange for a commissioned provider to draft it, but must satisfy itself that an adequate and current plan is in place and take reasonable further steps where necessary.

An outdated plan predating a comprehensive review does not discharge the duty. A decision to replace a care provider is assessed contextually under the high threshold for irrationality. Family involvement is essential, but the care package need not follow family preferences where they conflict with the child’s needs or commissioning strategy. A child cannot claim restitution for expenditure incurred by the parents.

The claimant, a severely disabled child receiving Children and Young People’s Continuing Care, challenged decisions by the responsible integrated care board concerning his healthcare plan and care provider. His education, health and care plan specified that he would be provided with a health care plan.

The claimant argued that the board had failed to arrange a lawful and updated plan, acted irrationally by terminating the existing registered provider and appointing another without a safe transition, and was liable to reimburse expenditure incurred by his parents after they privately maintained the package.

The claim raised the scope of the board’s statutory duty, the rationality of the provider change, and whether restitution for unjust enrichment was available to the claimant.

1. Ground 1 succeeded. Section 42(3) of the Children and Families Act 2014 imposed an absolute and non-delegable duty to arrange the healthcare provision specified in Section G of the EHC plan. The duty included satisfying itself that the specified health care plan had been put in place and taking further reasonable steps if it had not.
2. The board could arrange for the registered care provider to compile the plan. That did not transfer or discharge the board’s ultimate responsibility. There was no general statutory requirement governing the existence or contents of a health care plan for children’s continuing care. However, once the plan was specified in Section G and agreed by the board, it became mandatory healthcare provision.
3. The existing plan predated the multidisciplinary review which culminated in the EHC plan. The board accepted that it was outdated. Merely relying on it, and requesting an update only in May 2024 while considering termination of the provider’s contract, did not amount to reasonable steps to arrange the plan specified in the EHC plan. The board was in breach of section 42(3).
4. Ground 2 failed. The decision to terminate the registered provider and arrange replacement provision was not irrational. The rationality assessment was contextual and required a high, although not insuperable, threshold. The board was entitled to take account of the provider’s prolonged inability to staff the package, reliance on an unregistered staffing provider, governance concerns, the absence of an updated plan, the withdrawal of consent to the provider prepared to take over, and the need to avoid a gap in care. The decision fell within the range reasonably open to it.
5. Family involvement was essential, but the care package was not required to follow family preferences where those preferences conflicted with the child’s needs or the commissioning strategy.
6. Ground 3 failed. It was unnecessary to decide whether restitution for unjust enrichment was available in judicial review proceedings. The claimant had incurred no pecuniary loss: the expenditure had been incurred by his parents. He therefore could not establish that any enrichment of the board had been at his expense. The parents remained free to pursue any available civil claim.

The court was minded to make a mandatory order requiring arrangement of the health care plan, subject to identification of a mutually acceptable registered care provider. Further submissions on relief were permitted.

First-instance judicial review in the High Court (Administrative Court). The claim succeeded on Ground 1 but failed on Grounds 2 and 3.