Healthcare in schools: draft guidance

Chapter 4 - Supporting Children and Young People with Healthcare Needs at School Level

The role of schools

79. The policy framework as agreed by NHS boards and education authorities on supporting the healthcare needs of children and young people in schools should be adopted or reflected in any of the local policies and practices that are put in place by any individual school. This will ensure that the arrangements in place at school are consistent with other schools in the area, but are also appropriate to the local context of the school and the school community. Where school policies and procedures are necessary, these should be drawn up, agreed on, and clearly understood by children and young people, staff, parents and wider school communities. Specific school arrangements may include:

• who in the school accepts responsibility, in principle, for supporting the healthcare needs of children and young people in the school;
• any arrangements that may be different to the education authority's policy framework;
• who is responsible in school for staff training in regard to supporting healthcare needs and administering medication;
• emergency procedures at the school including a main point of contact in the school health team;
• details of any centrally held inhalers or defibrillators for use in emergency situations at the school;
• the storage of and access to medication in the school;
• the arrangements in place to ensure that staff are informed and kept up to date about children and young people's healthcare needs at school.

School level training issues

80. The school management team/and school health team should be aware of the arrangements in place for staff training. They must be satisfied that training gives staff with sufficient knowledge, understanding, confidence and competence appropriate to their role. Where staff are in any doubt about the support to be provided to a child or young person, they should refer immediately to the school management team and/or school health team or initiate emergency procedures, particularly if there are any concerns about the child or young person's immediate health or wellbeing.

81. School staff and school health team should work collaboratively to consider the needs of the school community and identify opportunities to support the delivery of the experiences and outcomes under Curriculum for Excellence and undertake health promotion activity ^[71] .

Identifying and supporting healthcare needs in schools

82. Children and young person's health can have a significant impact on their attainment and/or wellbeing. Therefore, many children and young people are likely to support with healthcare needs at school at some time in their school life. In most cases this will be for a short period only, e.g. to finish a course of antibiotics and minimise the time they need to be off school. In these circumstances it is the responsibility of parents/carers to provide their child's school with sufficient information about their child's health, care and treatment. Staff in schools will need to ensure that this information is complete and the appropriate consents are sought for the healthcare support that is required.

83. If a child and young person is diagnosed with a longer term condition or develops healthcare support needs, it is normally the role of parents/carers to notify the school that they require the school's input to support their child's needs. However, school staff should be aware that notification may come from a variety of sources such as the child or young person themselves, the named person, allied health professionals or community nursing or paediatric teams.

84. Staff in the school and the school health team need to work closely with the child or young person concerned and their parents to ensure they have all the information required to help meet their needs. Members of the school health team, paediatrics staff and other members of the community children's nursing service or AHP team may be able to supplement information and advice already provided by the child's parents or GP. They may also be able to advise on training for school staff who administer medication, or take responsibility for other aspects of health care support. They may also be able to provide specialist medical support for a child with healthcare needs in school, particularly if there is any question over whether the procedures in place to meet a child or young person's needs is covered by the education authority insurance.

85. The school management team should ask the education authority to provide written confirmation of the insurance cover for staff who support healthcare needs in schools. The school management team should inform staff in the school know about the provision for indemnity against legal liability, and the terms and conditions under which is it operative. Staff in schools should be clear when practice may fall outwith insurance cover, and seek advice and support from the school health team and education authority if the needs arises. See paragraphs 75-76 for further information about indemnity and insurance.

86. If staff in school notice any deterioration in the health of an individual child or young person, they should inform the named person or another representative in the school management team who should let the parents know, and where appropriate, the school health team.

87. All staff in school should know the school's procedures for responding to an emergency situation including how to access first aid support and how to contact emergency services. Where a child or young person is taken to hospital by ambulance they should be accompanied by a member of staff who should remain with the child or young person until a parent or carer arrives. The member of staff should take details of the child or young person's healthcare needs and/or details of any medication taken that day.

88. Generally, staff should not take children and young people to hospital by car, however, there may be circumstances where it is agreed with the school health team, emergency services and parents that this is the best course of action. In such circumstances and wherever possible the member of staff should be accompanied by another adult and have public liability vehicle insurance.

Individual healthcare plans

89. The main purpose of an individual healthcare plan is to identify the level and type of support that is required to meet a child or young person's healthcare needs at school. It is not anticipated that one will be required for short term needs where a child, for example, is taking a course of antibiotics. In such cases it would be sufficient to seek the appropriate consents and record details of the medication or procedure to be undertaken, time of administration or procedure and any possible side effects. Planning procedures should be proportionate and take into account the best interests of the child or young person. More detailed planning and co-ordination will often be required for those with longer term or complex healthcare or medical needs, and should be managed via an individual healthcare plan.

90. The need for an individual healthcare plan and the medical detail of such a plan should only be assessed by an appropriate designated health practitioner. This input is likely to come from the community paediatrician or community children's nurse. Where it is identified that an individual healthcare plan is required, the school health team should work with the school management team, parents/carers and the individual child or young people to draw it up. Other health practitioners may also provide input if they are involved in supporting that child's healthcare or wellbeing needs, whether at school or home, to ensure a continuum of support is in place. The plan should always be tailored to identify and address the individual needs of the child or young person and may include:

• details of any diagnosed condition or symptoms;
• the impact that the condition or symptoms has to the individual;
• details of any medication, dosage, side effects and storage information;
• the healthcare support/procedures;
• whether any learning support required;
• special requirements e.g. dietary needs, pre-activity precautions, access to facilities and other reasonable adjustments etc…;
• who is responsible for providing the support;
• arrangements for staff cover;
• what to do, and who to contact, in an emergency;
• training needs for the support, how often these should be reviewed and who will deliver the training;
• consent;
• arrangements for support if a child or young person needs to attend regular hospital appointments or spend time in hospital;
• how often and when the plan should be reviewed.

91. Individual plans will contain different levels of detail according to the needs of the individual child or young person, but drawing up the plan should not be onerous. The co-ordination and sharing information will be in line with the arrangements under the GIRFEC approach and take into account the data sharing legislation (see paragraph 77). The school management team and school health team may delegate responsibility for leading this process or it may fall to the named person. The lead in the process may be a first contact for children, young people, parents/carers and any staff who may a role in supporting the child or young person's healthcare needs in school.

92. For children and young people with healthcare needs to benefit fully from their education, consideration must also be given to the impact that their health needs has on both their learning and wellbeing. As such, consideration should be given to whether a child would benefit from an individualised learning plan or a Co-ordinated Support Plan ^[72] . In order to streamline the planning processes for certain individuals with complex additional support or wellbeing needs, an individual healthcare plan and other learning plans will be contained within or as part of child's plan or Co-ordinated Support Plan as appropriate.

93. As the plan provides a written agreement about the support to be provided at school it should be signed off by all those involved in its development, including the individual child or young person and parents/carers. Where there is any concern about whether a child or young person's needs can be met within these arrangements, or any dispute in regard to the support being planned for a child or young person or the content of the plan, it may be necessary for the school management team and the school health team to seek the advice from the NHS board or education authority. This should be done quickly, to ensure there is no delay to appropriate support being put in place to support the healthcare needs of the individual child or young person.

94. Individual healthcare plans may reveal the need for some staff to have further information about healthcare procedures or specific training in administering a particular type of medication or in dealing with emergencies.

Dealing with medicines safely

95. Medication should only be taken to school when absolutely essential, and in line with local policies and procedures. Parents/carers (and where appropriate the young person themself) are responsible for supplying information about any medication that needs to be taken at school and for letting the school know of any changes to the prescription or the support needed. The school should seek written consent (usually through a standard form) that the medication may be administered.

96. Where possible, medication should be prescribed in dose frequencies which enables it to be taken outside school hours. Although this should be discussed with the prescriber, a child or young person's health or wellbeing needs should never be compromised.

97. Schools should ensure that medication is not stored in large quantities and parents provide weekly or monthly supplies in their original manufacturer's or pharmacy dispensed container or box. Some medicines may be harmful to anyone to whom they are not prescribed and particular care needs to be taken where a school stores controlled drugs such as methylphenidate ^[73] . Community pharmacists and school healthcare teams should be able to assist the education authority in producing their policy on the safe storage and handling of medicines in schools which manages the risks to the health of others if they are not properly controlled.

Self-management

98. It is good practice to allow children and young people who manage their own medication from a relatively early age and schools should encourage and support this. Examples include children using their inhalers or checking their blood sugar levels during the school day. Where required, facilities should be provided to allow for this to ensure privacy.

99. There should be an assessment of the child's or young person's capability to manage their health needs and carry their medication. This should identify actions to help support children and young people, if possible and appropriate, to progressively manage their medical or health needs over time. The arrangements must also be flexible and sensitive to the needs of children and young people on any given day. Illness, for example, may impact on how much support the individual requires. It may, therefore, be appropriate to supervise children and young people who self-medicate or manage their health needs routinely, particularly if there is a risk of negative implications to their health or education.

Access to medication

100. Where a child is managing medication themselves they should not normally be expected to give up their medication for storage. In allowing children to retain medication, an assessment must be made of the potential risk to others, with actions put in place to manage those risks appropriately.

101. Where individual children and young people do not hold their own medication, they must know where it is stored. Medication should always be accessible at the point of need. However, it is also important to make sure that medicine is only accessible to those children and young people for whom it is prescribed.

102. Some medicines need to be refrigerated. The temperature of refrigerators containing medication needs to be monitored regularly. Medicines can be kept in a refrigerator containing food but should be in an airtight container and clearly labelled. If a school has to store large quantities of medicines then a lockable medical refrigerators might be preferable.

103. If the school locks away medication, all school staff, and where appropriate, individual children and young people, should know where to obtain keys to access the locked cabinet or fridge.

104. Schools may also need to make special arrangements for any emergency medication that children and young people require.

Administering medication

105. Where it is considered that medication will need to be administered at school, medication should always be supplied by the parents/carers to the school in its original packaging including any patient information leaflet. Parents/carers may, therefore, need to obtain a separate prescription for medication to be taken and held at school. If this isn't possible, then it should be decanted by an appropriate medical practitioner with an appropriate label or instruction. The parent/carer should also ensure that they provide clear instructions about how long the medication needs to be taken, and any other relevant information that isn't provided on the label or patient information leaflet. This information may be captured as part of a standard consent form that must be completed by parents or carers.

106. Staff should not administer medication if they are not sure what the medication is or what it is for. If a member of staff is in any doubt they should check with the parents/carer or a medical practitioner before taking further action. Further, staff administering or overseeing the administration of medication in school will want to ensure:

• they follow the instructions on the label and/or patient information leaflet (or in line with manufactures recommended dosage if the medicine is non-prescription (see paragraphs 109-112 for more information about Paracetamol and the use of other non-prescription medicines in schools).
• that they are giving the right medicine to the right child or young person at the right time;
• they are aware of the side effects and how to deal with them;
• the medication has been stored and handled as per the label or other instruction;
• a signed record is completed each time medication is given to any child or young person.

107. Wherever practical, the dosage and administration should be witnessed by a second adult. In some school situations this will not be possible and children, young people and their parents should be involved in decisions about managing any situations that may arise via standard written consent forms or an individual healthcare plan.

108. If there is likely to be any problems encountered with the administration of medication at school; or the provision of medication is not straight forward, this should be covered in an individual healthcare plan

Paracetamol (and the use of other non-prescription medicines in schools)

109. Children and young people in schools sometimes ask for painkillers (analgesics) or other non-prescribed medication at school such as antihistamines. However, schools should not hold non-prescribed medication. If a child or young person suffers regularly from acute pain or symptoms, such as a headache, period pain or hayfever, parents may provide the school with non-prescribed medication alongside clear and appropriate instructions and consent for the medication to be (often via the completion of a standard form). Alternatively parents (or where appropriate the young person) may ask for the medication to be prescribed by a GP.

110. A member of staff should supervise younger children taking the medication and ensure that the individual's parents are informed on the day the medication is taken.

111. Some children and young people with the maturity and capacity to carry and self-manage their own non-prescribed medication and symptoms (for example, for period pain, occasional headaches, minor viral illnesses, coughs, sore throats or hayfever) should be allowed to do so. In such circumstances it is recommended that only medication that can be purchased by a pharmacy should be carried and that children and young people carry as little medication as possible in the original pack or bottle. It is recommended that children and young people should carry as little medication as possible in the original pack or bottle - normally only enough for a single school day (although this may not be possible for liquids or sprays). Blister packs, for example, can be cut to ensure only a single day's medication is carried.

112. It should be noted that children under 16 should not be given or take aspirin, unless prescribed by a doctor ^[74] . Further, codeine should not be provided to children under 12 as it is associated with a risk of respiratory side effects, and is not recommended for adolescents (12 to 18) who have problems with breathing ^[75] .

Hygiene/infection control

113. All staff should be familiar with standard infection control precautions for avoiding infection and must follow basic hygiene procedures such as handwashing. Where advice on infection control is required, school staff should consult the school health team in the first instance. Staff should have access to protective disposable gloves and take care when dealing with spillage of blood or other body fluids and disposing of dressings or equipment.

Refusing medication

114. If a child or young person refuses to take medication, school staff should not force them to do so. If the child is below the age of legal capacity, or is not considered to have capacity, the school must inform the parents or carers of any child that refuses to take medication as a matter of urgency. If the parents or carers cannot be contacted, school staff should seek urgent advice from the school's health team about the impact of the child or young person refusing their medication. In the case of long term conditions or treatments the school health team may wish to contact the child's healthcare team for advice. If necessary, the school should call the emergency services for an ambulance.

Disposal of medication

115. Staff in schools should not dispose of medication. Date expired medicines or those no longer required for treatment should be returned directly to the parent or carer to return to a pharmacy for safe disposal. Medication that is in use and in date should be collected by the parent/carer at the end of each term. Where this isn't possible, schools are required to dispose of medication in a safe and appropriate manner in accordance with current waste management legislation ^{[76] [77]} . This will normally mean that medication is sent to a community pharmacy. To do this legally, schools must register as a professional carrier and transporter of waste with the Scottish Environment Protection Agency ( SEPA). Registration is free and can be done online on the SEPA website ^[78] . Clinical or healthcare waste, including needles for example, should be disposed of in line with the arrangements in place for the disposal of such waste. Again, more information is available on the SEPA website ^[79] .

Intimate care

116. Intimate care encompasses areas of personal care, which most people usually carry out for themselves but some are unable to do so because of their additional support needs or impairment or medical condition. It may also apply to certain invasive medical procedures. Support to meet a child or young person's intimate care needs should be covered as part of the individual healthcare plan.

117. Appropriate training should be put in place for staff who provide intimate care. Staff protect the rights and dignity of the child or young person as far as possible, even in emergencies. Education authorities may have separate procedures in place for the management of intimate care and these must be adhered to at all times.