For over a decade, teenagers too sick to attend classes have been left without guaranteed education support after age 16 due to a long-standing gap in hospital education law.
A rule that provides schooling for the long-term sick up to age 16 was left outdated when from 2015 teenagers had to remain in education or training until 18.
The anomaly has left hospital school leaders using their own funds and charity partnerships to help seriously ill young people pursue FE courses.
Now, the Department for Education’s SEND reform consultation aims to amend the 30-year-old duty on local authorities and increase support to teenagers up to adulthood.
Hospital headteachers have welcomed the reform, saying it could reduce the risk of 16 to 18-year-olds falling through the gaps and prevent hospital schools from using their own funds to support learners transitioning to post-16 education.
But with pressures on children’s health services and mounting council SEND budget deficits, experts warned the changes could prove little more than a “narrow” technical fix that doesn’t guarantee dedicated post-16 funding.
Bedside education
There are around 35 hospital schools in England, each with multiple sites ranging from inpatient CAMHS units to at-home provision. Bespoke (and often bedside) education is provided for anxious school refusers, long-term ill young people and those with the most serious mental health difficulties.
Current DfE guidance suggests hospital education should be arranged for children with inpatient stays of more than 15 days.
Just over 17,000 under-18s have been unable to attend mainstream education due to serious healthcare needs, according to the latest data by the Children’s Commissioner.
Local authorities’ “section 19” duty to provide education arrangements is triggered when a child is admitted to paediatric wards, long-stay specialist units such as oncology, or psychiatric inpatient units, up to age 16. Ministers are considering correcting this “anomaly”.
Headteachers are providing unfunded provision and relying on charity partnerships to facilitate access to functional skills, work experience or volunteering for young people on the mend.
“Morally and ethically that’s the right thing to do,” said Cath Kitchen, chair of National Association for Hospital Education.
“There’s no way we’d say, ‘Sorry, you’re now in year 12, we won’t be funding you’.”
Medically vulnerable young people are not always classed as having special educational needs, though some have disabilities and qualify for funded provision via their ECHP.
“Many of those children with medical needs don’t have an EHCP and are reliant on third sector support,” added Sarah Johnson, founder of Phoenix Education Consultancy.
Expansion and enrichment
Extending the section 19 duty up to 18-year-olds could allow hospital education providers that already facilitate post-16 education, typically inpatient CAMHS units, to enrich their offer.
Therapeutic curriculum at Magpie Learning Centre, Leicester Children’s Hospital School
“We might be able to extend the offer or maybe employ teachers who can teach up to A Level, rather than trying to outsource it,” Kitchen said.
At The Leo Kelly School, one of six sites in Manchester Hospital School, provision is strictly bound by the section 19 duty and caters to around 60 children with anxiety, eating disorders and autism.
“When they get to the end of year 11, we start identifying an appropriate next destination for them so we encourage applying for college places or apprenticeships,” says Gwen Rees-Moffitt, deputy headteacher of Manchester Hospital School.
She explained that due to the “incredibly complex” needs of its learners, who are often bedbound from their conditions, the school frequently faces barriers to access “appropriate” FE college placements, partly from their historically poor attendance in mainstream education.
“They’re going from a small, nurturing, very bespoke education package to something that is only as flexible as the college can be under their own funding restraints,” Rees-Moffitt added.
She told FE Week that her hospital school would “absolutely welcome this change” proposed in the SEND white paper, “because we would then be able to support young people all the way up to 18”.
Former Leo Kelly school student Bethany Fletcher was diagnosed with Crohn’s disease and spent two years in hospital with added complications. Fletcher passed her English and maths GCSEs but struggled to receive an offer to enrol at a sixth form college.
“She would have been one of those high achievers, but she had a really tough time of it with her health,” her mother Fiona said.
Joshua Pelled, chief executive of charity Bright Futures, which delivers education support programmes to re-engage sick young people, said the transition at 16 can become a “cliff edge”.
“They may be academically capable, but historic attendance, treatment demands, fatigue, fluctuating health and complex support needs can make mainstream sixth forms or colleges reluctant to offer a place,” he said.
Pelled welcomed the proposal to correct the funding anomaly but warned that it must not be treated as a “narrow technical fix”.
“There are already duties under the equality act and SEND framework to avoid discrimination, make reasonable adjustments and use best endeavours to meet special educational needs, but these duties are not always translating into confident, consistent practice,” he added.
Funding boost doubts
Local authorities pumped £120 million into hospital education this academic year via the dedicated schools grant high-needs funding block, a 6 per cent uplift from the previous year.
While local authorities are free to make discretionary arrangements with individual school needs, hospital leaders are doubtful about receiving any topped-up future funding while policy consultations are ongoing.
Kitchen said: “I don’t know if it will mean any additional funding.
“Hospital education funding is not ringfenced. If it was, I think that would make a big difference, as we’ve sadly got a postcode lottery.”
Hospital schools receive annual funding pots, but quantifying how much is dedicated to post-16 is difficult.
Leicester Children’s Hospital School executive headteacher Stephen Deadman said its CAMHS unit picks up “some” 16 to 18-year-olds but is ultimately funded for 15 beds regardless of age.
“I don’t know who’s going to be taking up that bed, whether it’s a 12-year-old or an 18-year-old. We’re funded for 15 beds.”
Deadman was dubious about the DfE proposal to extend funding to post-16.
“Just by saying local authorities’ duties increase to 18, it won’t necessarily help if they haven’t got any funding to do that,” he said.
Deadman, who is a member of the DfE’s complex needs group, told FE Week his hospital school had seen a real-terms cut in its budget, which has stayed at £3.6 million for the last two years.
Council deficits related to high-needs costs swelled to the point of government intervention last year, where the so-called SEND deficit “statutory override” was extended until the end of 2027-28.
The Local Government Association recently suggested that around eight in 10 councils were teetering on insolvency due to exorbitant high-needs funding.
Clear guidance needed
The DfE’s SEND consultation will close next month. Leaders have warned the “devil will be in the detail” of local authority SEND strategies.
“We need some detailed guidelines of what post-16 providers need to have in place so that all of the support doesn’t drop away when they turn 16,” Rees-Moffitt said.
The DfE is simultaneously consulting on whether to extend statutory guidance for managing medical conditions to post-16 providers.
Pelled added FE colleges should be issued national guidance on flexible admissions and attendance expectations for sick young people.
Association of Colleges senior policy manager David Holloway said he hoped the reforms would also address poor access for colleges to external health experts and an “inflexible funding model” for small groups of high-needs learners.
The reforms have earmarked £1.8 billion over three years for a new ‘experts at hand’ scheme, bolstering external support for students with SEND.
“I’m encouraging our members to contact their local authority to talk about how we can support them with experts at hand,” Kitchen added.
Meanwhile, the DfE’s 2018 rollout of mental health support teams (MHSTs) in colleges still remains much lower than in schools.
Just 41 per cent of learners in post-16 settings were supported by an MHST, compared to 70 per cent in schools, according to 2025 data.