Chronic health conditions can permanently damage a young person’s educational chances without the right support. Libby Dowling looks at the policies, training and other measures schools need to think about under a new legal duty.

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For young people with a long-term illness, leading an active school life and reaching their full academic potential can be difficult. Many are well supported at school but there are others who struggle to get the extra help they need.

In September 2014, the Children and Families Act introduced a legal duty on schools to support young people with long-term health conditions. It requires schools in England to make arrangements so that pupils with long-term health needs, such as type 1 diabetes, epilepsy and asthma, are safe and supported at school and have full access to education, including school trips and physical education.

But while the law, accompanied by new statutory guidance from the Department of Education (DfE), has been welcomed by parents and young people, some schools may be daunted by the prospect of implementing the new legislation.

Medical conditions policy

The new statutory guidance, Supporting Pupils at School with Medical Conditions, states that all schools must have a medical conditions policy that sets the framework for looking after young people and gives guidance on how best to do so. The school may wish to consult with healthcare professionals, such as the local school nursing service, when drawing up the policy. It should be reviewed, evaluated and updated regularly, and be accessible to parents and school staff. The arrangements set up should include details on how the school’s policy will be implemented effectively, including a named person who has overall responsibility. It should include:

• who is responsible for ensuring that sufficient staff are suitably trained
• a commitment that all relevant staff will be made aware of the young person’s condition
• cover arrangements in case of staff absence or staff turnover
• briefing for supply teachers
• risk assessments for school visits, holidays and other extra-curricular activities
• monitoring of individual healthcare plans (IHPs)
• clear guidance about the storage and administration of medicine
• procedures to be followed when the school is notifi ed of a child with a medical condition
• actions in the event of an emergency

Role of the head

The statutory guidance states that it is the responsibility of the head to ensure that their staff understand the policy and their role in its implementation, as well as making sure that sufficient staff are trained to support pupils with medical conditions. Heads must also make sure that staff are covered by the school’s insurance and that the staff are aware that this is the case.

The guidance also says that an individual healthcare plan will often be necessary for a young person with a medical condition. For a complex condition like type 1 diabetes, an IHP is essential. The plan details the care that the young person, and that person alone, needs. It should say what support a young person needs, when they need it and who is going to provide it.

Developing the IHP

The IHP should be drawn up with input from the young person (if appropriate), their parent or carer, relevant school staff and, in the case of a pupil with type 1 diabetes, the young person’s paediatric diabetes specialist nurse (PDSN). The guidance recognises the key role a parent will play in developing a plan, given their detailed understanding of their child’s condition, and makes clear that their views should not be ignored. The IHP can be thought of as a written agreement between the parties and, in order for it to be effective, it needs to be as detailed as possible. For a pupil with type 1 diabetes, it should include things like:

• when he/she needs to test their blood glucose levels and take insulin
• what help they need around meals and snacks
• what needs to be done before or after PE
• plans for school trips and exams
• where insulin and other supplies are stored
• the written permission from the parent or carer and the headteacher for insulin to be administered by a member of staff

Supporting a young person with a medical condition during school hours is not the sole responsibility of one person. There are a lot of people involved in making sure that a pupil with a medical condition gets the support they need at school and it is vital that they work together in the interests of that pupil. If schools identify the need for additional, paid support (that is, they have to hire a new member of staff to provide care to a child with a medical condition) then the school, the local authority or a health service provider will have to fund it. Where this responsibility falls will differ across the UK but what must remain consistent is that health service providers, local authorities and schools work together in the interest of the child and family.

Training and awareness

It is also crucial that all staff are given the training and awareness they need to care properly for a pupil with a long-term illness. The medical conditions policy should set out clearly how staff will be supported in looking after children with medical conditions.

In the case of type 1 diabetes, it is the school nurse or paediatric diabetes specialist nurse’s responsibility to lead on finding the type of training required, whether it is diabetes awareness for the school or specific training on how to look after an individual pupil. School staff who will provide hands-on care must be trained by a paediatric diabetes specialist nurse, who should confirm that staff are proficient before they begin providing support to a pupil. There must be more than one person trained to cover absences.

Diabetes UK’s campaign

Diabetes UK’s ‘Type 1 Diabetes: Make the grade’ campaign is working with schools, healthcare professionals and families to make sure that the right support is in place for every young person with the condition. As well as enabling them to participate fully in school life and maximise their educational potential, getting the right support in school is vital for a young person’s health.

Unless managed properly, type 1 diabetes can lead to a young person’s blood glucose levels rising either dangerously high or falling to a dangerously low level. In the long term, high blood glucose levels in childhood can increase risk of serious complications. In the shorter term a lack of support is likely to lead to more episodes of high and low blood glucose levels, which can affect concentration and result in more time out of the classroom.

By working together and ensuring that the right policies and procedures are in place, all schools can ensure that children with a long-term illness get the support that they need in school. Many schools are already providing an excellent level of support for pupils with a medical condition, so we know that great care for all young people is possible.

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Find out more

As part of its ‘Type 1 diabetes: Make the grade’ campaign, Diabetes UK has produced free resources to help parents and schools get the right care in place. This includes free advice packs that outline what level of support young people should receive and how schools can provide it. The Diabetes UK website includes videos, tools and information for parents and schools while its Care in School helpline is staffed by volunteers who are experienced in making sure that young people with type 1 get the care they need.

• Call the helpline on 0345 123 2399, Monday-Friday, 9am-7pm. To order the free resource packs and for further information go to www.diabetes.org.uk/schools
• For more details about the Diabetes UK’s ‘Type 1 diabetes: Make the grade’ campaign, see www.diabetes.org.uk/make-the-grade
• The Department for Education’s statutory guidance, Supporting Pupils at School with Medical Conditions, is available at http://tinyurl.com/nrv8wxy

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Libby Dowling is Clinical Adviser at Diabetes UK

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