NHS ALN Provision Wales: How Health Therapies Get Written Into Your Child's IDP

One of the most contested battlegrounds in Welsh ALN disputes is health provision — speech and language therapy, occupational therapy, physiotherapy, and specialist mental health support. Parents frequently discover that even when an IDP is in place, the NHS provision that should be attached to it is missing, delayed, or delivered at a fraction of what the child needs.

Understanding how health provision is supposed to work under Welsh ALN law — and what to do when it doesn't — is essential.

How Health Provision Gets Into an IDP

Under the ALN Act 2018, there are two types of additional learning provision that can appear in an IDP: educational ALP (Section 2B) and health-related ALP (Section 2C). The distinction matters enormously because it determines who is legally responsible for funding and delivering it.

For health provision to be written into Section 2C of an IDP, a formal referral mechanism under Section 20 of the ALN Act must be used.

If the LA or the school maintaining the IDP believes a child's ALN requires medical or therapeutic intervention — speech therapy, OT, CAMHS support — they must formally refer the matter to the relevant Local Health Board (LHB), asking it to consider whether there is a "relevant treatment or service" that would benefit the child.

If the LHB identifies such a treatment (e.g., speech and language therapy 3 times per week), it notifies the body maintaining the IDP, and that provision is recorded in Section 2C. Once written into Section 2C, the statutory duty to fund and deliver that provision falls legally on the NHS body — completely separate from the school's or LA's education budget.

This is why getting the right provision into Section 2C is so important: it removes the "we can't afford it from our education budget" argument entirely.

The Section 20 Referral Process

In theory, the process is straightforward: the LA or school refers to the LHB, the LHB assesses and responds within 6 weeks, and the provision is incorporated into the IDP.

In practice, this is where the system breaks down most severely.

The 6-week LHB response time is routinely breached. Health boards in Wales operate under clinical prioritisation frameworks and lengthy waiting lists. A child not already known to NHS therapy services cannot always be assessed within 6 weeks. Audit Wales has documented widespread failures to meet this statutory deadline.

Timetable misalignment is fundamental. Schools have 35 days to produce an IDP. LAs have 12 weeks. But NHS services require 6 weeks' notice just to attend a Person-Centred Planning meeting — which falls entirely outside the school's 35-day window. The result is that IDPs are frequently finalised with "placeholder" health provision, or with educational ALP substituted for what should be NHS provision.

NHS provision gets mislabelled as educational ALP. When the NHS cannot respond in time, some LAs and schools record therapy provision in Section 2B (educational) rather than Section 2C (health). This shifts the funding burden to the LA or school — and gives them an argument for not delivering it based on cost.

What to Do When Section 20 Health Provision Is Missing

If your child's IDP exists but Section 2C is empty — or contains provision that the NHS has not agreed to provide — you have grounds to challenge.

Step 1: Request a copy of the Section 20 referral. Ask the LA or school in writing whether a Section 20 referral has been made to the LHB, and if so, what the LHB's response was. If no referral has been made and the child needs health provision, demand one in writing.

Step 2: Write to the LHB directly. Contact the LHB's ALN lead (the DECLO — see below) and ask for confirmation of what health provision the LHB has agreed to provide under Section 20, and when delivery will commence.

Step 3: Request an IDP review. If the LHB confirms provision that has not yet been written into Section 2C of the IDP, request a formal IDP review meeting to update the plan. The provision should be added to Section 2C with specifics: type of therapy, frequency, duration, and the name of the NHS service responsible.

Step 4: Complain about non-delivery. If provision is written into Section 2C and not being delivered, complain to the LHB's Patient Experience team. NHS bodies have their own complaints procedures, and delivery failures of Section 2C provision are NHS failures — not school or LA failures.

The DECLO: Your Health-Education Contact Point

Every Local Health Board in Wales is required by Chapter 9 of the ALN Code to designate a DECLO — Designated Education Clinical Lead Officer. The DECLO is the named executive responsible for coordinating the health board's ALN functions.

The DECLO must ensure:

• The LHB responds appropriately to Section 20 referrals
• Health practitioners are aware of their duty to notify LAs if they believe a child under compulsory school age has ALN
• Section 2C provision is identified and delivered to the standard required

If you are experiencing systemic failures — the LHB is not responding to Section 20 referrals, health professionals are not attending IDP meetings, or Section 2C provision has been identified but not delivered — you can complain formally to the DECLO. Ask the LHB's patient experience team for the DECLO's contact details if they are not publicly listed.

For persistent, unresolved health provision failures, the Public Services Ombudsman for Wales can investigate complaints against NHS bodies in the same way it investigates complaints against LAs.

Speech Therapy in IDPs: What to Demand

Speech and language therapy is the most common health-related ALP dispute. If your child's SaLT provision is missing, inadequate, or being funded through the school budget rather than NHS:

• Obtain an independent SaLT assessment (if you don't already have one) specifying the exact provision required in quantified terms
• Write to the LA requesting a Section 20 referral to the LHB if one hasn't been made
• Write to the LHB's ALN team requesting a response to the referral within the 6-week statutory window
• If the LHB agrees provision is needed but puts the child on a waiting list without an interim plan, formally request an interim provision arrangement and note that the 6-week statutory response deadline creates a legal obligation to act

The Wales ALN Dispute Playbook includes guidance on navigating the Section 20 referral process, template letters for the DECLO and LHB, and a framework for ensuring health provision gets into Section 2C of the IDP and not lost in the gap between the NHS and education systems. Access it at /uk/wales/advocacy/.

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