Children with medical needs in school

As more children with complex medical conditions are surviving and living well into adulthood, new challenges and opportunities arise for children to be included in mainstream schools, as well as in specialist settings. From September 2014 a new duty came into force for governing bodies to make arrangements to support pupils at school with medical conditions. The information below is intended to assist staff in understanding what they need to know and do when admitting a child with medical needs for the first time.

What is the legal position and responsibilities of the school?

In 2004 the Council for Disabled Children published “The Dignity of Risk” which contained advice from The Royal College of Nursing as to which procedures could be safely taught and delegated to non-health qualified staff. These include administering prescribed medication, stoma care and catheterisation. This list has been updated since then for “Including Me” (2005) and further updates have continued. There are also more complex invasive procedures that can and should only be carried out by medically qualified staff – such as the assessment of care needs, planning care programmes, and evaluating their outcomes, re-insertion of nasogastric tubes, use of syringe drivers, re-inserting indwelling catheters that have fallen out. The 1995 Code of Practice for Schools: Disability Discrimination Act (part 4) sets out what is meant by disability discrimination and the need to make reasonable adjustments so as to avoid placing pupils with disabilities at a substantial dis-advantage compared to other pupils.

The new 2014 special educational needs reforms in the Children and Families Act (Part 3) includes children with special educational needs and/or disabilities.

In June 2014 the Department for Education issued statutory guidance for governing bodies, “Supporting Children with Medical Conditions in School” (statutory guidance for governing bodies of maintained schools and proprietors of academies in England) which clarifies the duties of schools towards meeting the requirements of children with medical needs. It also sets out what it describes as “Unacceptable practice” (p.19) such as expecting or requiring parents to come into schools to give children prescribed medication, or change them if they are incontinent. The document also provides a template for individual health care plan and links to relevant reports and documentation.

Who within school carries the responsibility for meeting the care and medical needs of pupils?

“Managing Medicines in Schools and Early Years Settings” (2005) provides guidance on developing local policies and arrangements for effectively managing health care needs. But individual members of staff cannot be required to undertake these tasks. Staff should only agree to undertake these procedures if they feel competent and confident to do so, and have access to appropriate training and ongoing support from medically qualified nursing staff, and this is for named children. Adequate insurance cover should also be in place, and staff assured that providing they follow agreed protocols, they will not be held responsible if things go wrong. Additional remuneration for taking on such responsibilities may be appropriate, depending on the tasks to be undertaken.

What contribution can parents/carers make?

Parents/carers often have the job of managing their child’s medical needs outside of the school day. Their knowledge and experience can be a valuable starting point for schools in thinking issues through.

When setting up training for staff in school, involving parents also in the training can be very reassuring for children in adjusting to new staff and their role, as well as for the practitioners themselves who are taking on this new role. Setting up suitable protocols and guidelines are often assisted by parents’ expert knowledge of their child, and what works for them.

What advice can experienced staff from schools offer to colleagues in other schools who are taking on specific roles for the first time?

In order to practice safely in supporting children’s medical needs, comprehensive training and support from medical colleagues must have taken place, and that this training relates to individually named children rather than generalised advice. Having parents being involved also helps reassure parents the carer is competent and for the carer that the parent is happy for them to be the one undertaking this work for their child in school.

Setting up a Health Care Plan, in written form, agreed and signed by the parent as well as relevant professionals should be readily available to those working with the child.

Schools can seek advice and support if unsure of what they need to do – legal advice can be requested by speaking to HR (Human Resources), appropriate training and follow up support for staff from Health. It is the role of Health colleagues to assess the needs of the child and determine what support and intervention is needed. Ensuring there is appropriate insurance and risk assessment in place is the role of the headteacher but insurance usually must be validated by comprehensive written evidence of training by an appropriate healthcare professional and , and a detailed risk assessment has been conducted will help allay concerns of both parents and staff. It can be helpful for a school to seek advice from colleagues in schools who have successfully included pupils with similar medical needs.

Having parental confidence is key – and parents are often carrying out similar medical procedures when their child is not at school. So drawing on their experience can be a good starting position.

Final comments: 'The best interests of the child'

To work well, clear understanding of the issues, agreed protocols to be followed and shared understanding of what to do if the child appears to be unwell are essential for the safety of the child, the staff in school and health colleagues linked to the school, and the confidence of child and family. The health, safety and dignity of the child must be the priority at all times. This includes respect for privacy, providing suitable settings to allow medical procedures to be carried out without interruption. Respect for the wellbeing of staff carrying out medical interventions should also be afforded appropriate care and attention.