How complex healthcare needs can be met in Scotland's schools

07 July 2016

The Scottish Government is currently reviewing its guidance on meeting healthcare needs in schools. Their guidance covers:

  • giving children and young people the medicines they need while at school, and
  • performing simple medical procedures at school.

We’ve produced a briefing around what we think the new guidance should include. You can download it below, or find out about the research we’ve done around the healthcare needs of children and young people.

Briefing summary

The number of schoolchildren with complex medical needs has grown since 2001, as

  • more premature babies and children with serious medical conditions survive to school age, and
  • conditions such as type 1 diabetes are diagnosed earlier in children's lives.

Children have a right to have their medical needs met at school, but meeting these needs can be challenging. However, schools are expected to provide medical care to children of a level a parent or guardian would.

Needs aren't always met

Research conducted by our office has shown that children’s needs aren't always met in school, and children have missed school because of a failure to meet their healthcare needs. In our research, one in ten school staff members reported being unable to respond to a request for administration of medication.

Children’s Rights and Healthcare Needs

A number of articles of the United Nations Convention on the Rights of the Child (UNCRC) are relevant to meeting healthcare needs in schools:

  • Article 3 says that the best interests of children should be considered when decisions are made that affect them.
  • Article 12 says that children have the right to a say in decisions made about them and for their views to be taken into account.
  • Article 23 says that children who have any kind of disability have particular rights. They have the right to special care and support so that they can live full and independent lives. Not all children who have healthcare needs at school will be disabled, but many will be.
  • Article 24 says that children have the right to the best quality healthcare.
  • Article 28 and Article 29 say that all children have the right to the best education possible to develop their personalities, talents and abilities to the fullest.

A cartoon of children in wheelchairs playing basketball.

Healthcare needs and the law

Children with additional support needs have their healthcare needs protected in Scots law. The Education (Additional Support for Learning) (Scotland) Act 2004 (as amended) and the Equality Act (2010):

  • place a duty on education authorities to provide for additional support needs— including healthcare needs, and
  • allow a failure to meet these needs to be challenged through an Additional Support Needs Tribunal.

The Standards in Scottish Schools etc. Act 2000 provides a presumption of mainstream education. This means that children should go to a mainstream school if they have the ability to do so, and shouldn't be made to go to a special school just because of their healthcare needs.

Failure to make reasonable adjustments

Education authorities have the key responsibility to provide support to children with healthcare needs at schools. This is because they have a duty to make reasonable adjustments, including providing auxiliary aids and services when needed.

However, enquiries received by our office and other agencies suggest this duty is not being consistently met in all schools.

As a result, children and young people are prevented from realising their rights to education— sometimes for a number of months.

We think any new Scottish Government guidance should make this duty around reasonable adjustments explicit. It should also refer schools to EHRC guidance around meeting the duty.

Staff concerns

Most local authorities don’t give any one group of school staff a specific duty to give children medicine or carry out other medical procedures.

Instead, schools rely on identifying volunteers to meet these needs— usually from among classroom support staff. If volunteers aren’t found, children may miss substantial periods of school.

Many staff aren’t willing to take on this responsibility at first. However, addressing issues around training and the law can help address their concerns.

Training needs

School staff who give children medication or perform medical procedures need to be properly trained by a medical professional or another accredited trainer. Good quality training can allow staff to meet the healthcare needs of children confidently. However:

  • staff can lack access to adequate training,
  • classroom support staff can find it difficult to get released for training,
  • school and NHS workloads can make it difficult to access training through the school nursing service or other NHS providers,
  • training provided by voluntary organisations may be of limited capacity, and
  • private training may be expensive.

While a school’s main priority should be training staff responsible for meeting pupil healthcare needs, a whole school approach is vital. School management teams, class teachers and support staff should all be trained to be aware of what children with healthcare needs might require. This would include training on:

  • specific conditions affecting children in their care,
  • how these conditions affect individual children, and
  • the educational impact of these conditions.

Legal issues

It should be made clear to school staff that – as long as they follow agreed procedures and policies – they are fully covered by their employer’s public liability insurance.

Conversely, not meeting a child’s healthcare needs carries the risk of legal action against the local authority— under either ASL or equality law.

A picture of children learning in school.

How to meet healthcare needs

Partnership working between education authorities and the NHS

Although it’s primarily the duty of education authorities to meet healthcare needs in schools, NHS boards also have duties around providing healthcare services.

For very complex healthcare needs to be met, these boards may need to provide funds and services from medically qualified staff.

For less complex conditions, schools need qualified staff to provide training that allows them to support children’s healthcare needs.

Supportive local authority and school management teams

Education authorities – with the support of NHS boards – should put permanent arrangements in place so that children’s healthcare needs can be met in all educational settings. By so doing, children with healthcare needs will become able to attend schools which are appropriate to their aptitude and ability.

These arrangements would include:

  • clarifying roles and responsibilities,
  • providing Headteachers with advice and support,
  • making sure schools are adequately resourced to meet needs, and
  • making sure schools have appropriately trained staff.

Within schools, Headteachers have a responsibility as managers and as named persons to make sure that healthcare needs are met. For example, they need to put in place clear procedures for the storage and administration of medicines and equipment.

To do this, they need to ensure they and their staff receive the necessary training and that all members of staff – including supply staff – are aware of the healthcare needs of children in their school.

Good communication between home and schools

Children and their parents should be involved in planning to meet healthcare needs in schools. This is an important part of making sure their needs are met and their rights realised. Local authority policies, school policies and the Child’s Plan should all be developed in consultation with children and parents.

The child should be at the centre of all planning to meet healthcare needs. Arrangements for them should take into account their rights as well as needs.

Ongoing communication will make sure that arrangements can be adjusted to continue to meet a child’s needs as they grow, and – where appropriate – allow them greater independence in meeting those needs.

Toileting assistance

The current Scottish Government guidance does not include toileting assistance within its scope.

Our research has shown that this is another area where failures to meet the needs of children can prevent them attending school.

The number of children in mainstream settings who need toileting assistance is increasing, yet there is currently no Scottish Government guidance on this important issue.

We urge the Scottish Government to ensure that new guidance is produced as a matter of urgency.

This will need to cover:

  • assistance for physically disabled children,
  • the needs of children and young people who require occasional assistance, and
  • the needs of children and young people with impairments which affect their ability to use standard school facilities.