Supporting children and young people with healthcare needs in schools: guidance

Introduction

Any child or young person at school in Scotland may require healthcare support or the administration of medication. Healthcare support or medication may be required for the management of short or long term conditions or in response to an emergency situation, such as an allergic reaction.

What is this guidance about?

This guidance has been developed in partnership with a range of key stakeholders to guide those working in and with NHS boards, education authorities and schools to support children and young people affected by health issues which require healthcare support in school ^[1] . This guidance contains the Scottish advice about the Human Medicines (Amendment) (No. 2) Regulations 2014 ^[2] , which enable schools to buy and hold salbutamol inhalers for use in emergencies with children and young people who have asthma.

It should be noted that many elements of the legislative and policy framework referred to within this guidance will also apply to early learning and childcare ( ELC) settings (nurseries), grant aided schools and independent schools. Those school settings will be inspected by Education Scotland (with ELC and residential schools also regulated by the Care Inspectorate) and they may use this guidance to help inform the arrangements they are required to make to ensure that the healthcare needs of all children and young people are met, taking into account the legislative and policy framework relevant to them. This will include, for example, the requirement to make reasonable adjustments for children and young people with disabilities under the Equality Act 2010.

In addition, this guidance will also contain reference to the Department of Health's guidance on the use of adrenaline auto-injectors ( AAIs) in schools ^[3] , which was published in September 2017. The Department of Health's guidance on AAI's has been published following the Human Medicines (Amendment) Regulations 2017 which came into effect on 1 October 2017. These regulations allow schools to obtain AAI devices, if they wish, for use in emergencies without the need for a prescription.

How should this guidance be used?

The guidance has been developed to inform local policy development between NHS boards, education authorities, schools and other partners in supporting children and young people with healthcare needs in schools ^[4] . It is intended to act as a guide to the strategic and operational matters which should be considered as part of policy development. The guidance is likely to be of interest to children, young people and parents/carers whose views should also be considered during the decision-making process.

It is not intended to consider each condition or circumstance which causes a healthcare need in school. Annex A provides information on asthma, whilst Annex B provides some information on specific conditions, but does not include all.

The guidance is structured to enable readers to be able to focus on the particular issue they require information on, in addition to being able to be read as an entire document. Care should be taken to ensure that practitioner responsibilities are fully understood if the document is being used for reference. References are provided as footnotes throughout the document.

What is the status of the guidance?

This guidance has been issued by the Scottish Government and replaces the guidance on the Administration of Medicines in Schools ^[5] . While this guidance makes general references to legislation, it is not an authoritative statement of the law. Interpretation of the law is a matter for legal advisers and ultimately the courts. Readers may wish to take legal advice regarding any particular set of circumstances.

Principles

There are a number of common principles that should be consistently applied when identifying, supporting and reviewing the healthcare needs of children and young people in schools to enable them to make the most of their learning. These are:

The rights, wellbeing, needs and circumstances of the individual child or young person should, at all times, be at the centre of the decision-making process. Under Article 24 of the United Nations Convention on the Rights of the Child ( UNCRC) ^[6] all children have a right to the highest attainable standard of health and to health care services that help them attain this. The arrangements for each individual depend on each individual's particular circumstances, taking into account health professionals' advice, their own views and, where appropriate, their parent's views. Article 7 of the United Nations Convention on the Rights of Persons with Disabilities states that children with disabilities have the right to express their views freely on all matters affecting them.

NHS boards, education authorities and school staff should work collaboratively to ensure that the principles of NHS clinical governance ^{[7] [8] [9] [10] [11]} are followed so that individuals receive the service they need in the way most appropriate to their personal circumstances and all policy and service developments are shown not to disadvantage any of the people they serve.

• All children and young people have a right to an education on the basis of equal opportunity and are entitled to support in their learning. Education authorities should ensure that arrangements for supporting healthcare in schools are subject to review and improvement within the How Good is Our School framework ^[12] to enable success in:
  - the fulfilment of statutory duties
  - increasing learner confidence, responsibility and resilience
  - promoting positive relationships, respect and fairness.
• Staff in NHS boards, education authorities and schools should work together with the children and young people concerned, their parents or carers and families to ensure healthcare needs are met within all schools.
• Wherever possible, there should be forward planning and resourcing agreed between all partners to meet the healthcare needs of children and young people, particularly in relation to the reasonable adjustments that children and young people with healthcare needs might need and require ^[13] .
• Schools should make arrangements for staff providing healthcare to children and young people to receive appropriate training from a health professional, or other accredited source in the care they are providing, and should not be expected to provide such care unless training and support is provided and is subject to appropriate clinical governance.
• Assistance with intimate care may be needed at any time, by children in all sectors and at all levels. Schools should have arrangements in place to deal with these needs quickly and with respect for children's privacy, dignity and rights.