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

Chapter 2 - Supporting Children and Young People with Healthcare Needs in Schools: The Rights of Children and Young People and Responsibilities of Service Providers

Introduction to rights and responsibilities

43. Supporting the medical needs of children and young people at school is the statutory responsibility of NHS boards and the day to day management and support of these needs may be met by staff in schools in line with the provisions set out in the Equality Act 2010 in respect of pupils with disabilities. While the arrangements for such support should always seek to include the views of the children and young people affected, it may also include a range of individuals and agencies including: parents/carers and other family members, teachers and staff, public health workers, GPs, registered nurses, health visitors for pre-school children, outreach teachers, education or health support staff, college staff, partner employers, psychological services, allied health professionals, voluntary organisations, local authority youth work provision and others. Whilst not providing direct support, pharmacists play a key role in dealing with queries about medication. This list is not exhaustive but close cooperation is crucial in providing a suitable and supportive environment for children and young people to participate fully in their learning and in the life of the school.

44. Children and young people should be supported in developing their ability to meet their own needs and become as independent as they are able to. In doing this, it is important that the responsibility and accountability of all those involved is clearly defined and that each person involved is aware of what is expected of them and where to seek further support and advice.

45. The following paragraphs outline the framework of responsibility and accountability that local services may wish to consider when putting in place arrangements. While some of these responsibilities are set out in the legislative and policy framework, others will need to be agreed and implemented at a local level. When working in partnership, services will need to take their wider responsibilities into account. Arrangements should be in place to monitor and review the effectiveness of the partnership working and ensure that services work effectively and improve outcomes for children and young people.

Children and young people's rights

46. UN Convention on the Rights of the Child, it defines the rights of all children and young people up to the age of 18. Under the Convention they have a right to the highest attainable standard of health and to healthcare services that help them to attain them. Every child also has the right to an education on the basis of equal opportunity which must aim to develop personality, talents and abilities to their fullest potential. Under the Children and Young People (Scotland) Act 2014, public authorities have a duty to report on what they have done to progress children's rights. Within domestic legislation, children and young people have a number of rights in relation to their own education and healthcare ^[65] .

• Education authorities must make arrangements for the provision of education where a CYP is too ill to attend school. Guidance on children unable to attend school due to ill health was published in June 2015 ^[66] ;
• Children and young people under the age of 16 can consent to any surgical, medical or dental procedure, or treatment if they are capable of understanding the nature and possible consequences of the procedure or treatment ^[67] ;
• Education authorities are under a duty to seek the views of children about the decisions that affect them, including decisions around their healthcare needs, and take these into account alongside their parent /carer's view;
• Children over 12 with capacity and young people have the right to request an assessment of their additional support needs and have their views considered and taken into account in decisions about their learning and support ^[68] .

47. Wherever possible, children and young people should be empowered and supported to manage their own healthcare needs and work in collaboration with the school health team, school staff, and their parents/carers, to reach an understanding about how their health affects them and how their healthcare needs will be met.

Responsibilities

Parents/carers

48. Parents/carers are responsible for making sure that their child attends school when well enough to do so. They also have the same responsibilities and rights as young people do for themselves in regard to seeking support of their child. They should be allowed to work in partnership with their child, the school health team and school staff to reach an agreement about how their child's needs will be met and the school should inform parents/carers of their right to participate in the decision-making process. Confidentiality should be respected with regards to meeting a child's healthcare needs since, in some cases, parents or carers may feel hesitant or reluctant about sharing sensitive information – this will be helped if confidentiality is trusted.

49. Parents/carers should provide their child's school with sufficient information about their child's health, care and treatment. Parents/carers should also provide the school with the necessary medication and help their children understand how to comply with agreements in place to cover their healthcare needs at school, However, it should be recognised that some parents or carers may have difficulty understanding or supporting the child or young person's medical condition themselves. The Community Paediatric Service or General Practitioners ( GPs) should be able to provide additional assistance in these circumstances, whilst Allied Health Professionals ( AHPs), such as hospital paediatrician or specialist paediatric nurses, may also support and advise schools on managing healthcare needs. Parents/carers also have the right to use a supporter or advocate in conversations or meetings with an education authority in regard to the authority's functions under the Education (Additional Support for Learning) (Scotland) Act 2004 (as amended) in relation to their child ^[69] .

NHS boards

50. NHS boards must ensure that appropriate arrangements are in place with education authorities, which determine the respective responsibilities of each in relation to supporting children and young people with healthcare needs in schools including those with complex healthcare and medical needs. In doing so, NHS boards should work with the appropriate education authorities to facilitate joint agreements. They should plan and co-ordinate effective local provision within the resources available, taking into account needs of the local population, and ensure that the arrangements enable effective communication between all appropriate agencies and services, at all levels. In doing so, they should ensure that children, young people and their families are consulted.

51. This responsibility for securing the joint agreements between the NHS board and the appropriate education authorities for supporting children and young people with healthcare needs is often delegated to the Child Health Commissioner as part of their overall responsibility for regional planning and feeding into children's services plans (refer to the circular linked at footnote 63 for more information about the role of the Child Health Commissioner).

52. Under the Education (Additional Support for Learning) (Scotland) Act 2004 (as amended), NHS boards, have a duty to help education authorities discharge their duties under the Act ^[70] . Further in discharging their functions with regard to meeting health care needs of children and young people, NHS boards have a duty to make reasonable adjustments and due regard to the requirements of the public sector equality duty (for more information refer to Annex C).

Education authorities

53. Education authorities are required to work collaboratively with NHS boards and ensure that there is adequate and efficient provision in place in the schools in their area to support the healthcare needs of children and young people. As set out in Chapter 3, the education authority should work with the NHS Board to agree a policy framework on supporting the healthcare needs of children and young people in schools.

54. Education authorities will have staff in both strategic and operational roles with responsibility for the arrangements in place for additional support for learning, including, for example, education psychologists. The education authority will have a named contact from whom parents or carers, young people and others can obtain advice and information about the arrangements in place for the provision of additional support for learning ^[71] , including healthcare needs. Education authorities are also under a duty to publish ^[72] information about their arrangements in place for additional support for learning, and this should include arrangements for identifying, providing support and reviewing the additional support needs of their pupils including those arising from the healthcare needs of all children and young people. It should also include the contact information for the NHS board that parents/carers of children with additional support needs, or the young people who have those needs, can obtain advice.

The school health team ^[73]

55. The role of the school health team is to provide support to children, young people and their families in school and provide advice, guidance and sometimes support on supporting healthcare needs in school. While there is considerable variability in the makeup of the school health team and its role across NHS boards and education authority areas, these functions will be provided by a team of staff employed by the NHS board working collaboratively with the education authority within schools and communities.

56. The team may include healthcare support workers, community children's nurses and other registered nurses working within schools, as well as those working with children and families with additional needs within the community ^[74] . Teams may also include a doctor (from the community paediatric service), clinical psychologist and allied health professionals, such as speech and language therapists, dieticians, occupational therapists and physiotherapists. The school health team may also include the involvement of representatives from third sector organisations providing support to specific children or conditions.

57. The school health team must work collaboratively with staff in the education authority and schools, to ensure that the health needs of children and young people are identified, supported and kept under review. This will rely on strong support and leadership from within the team and the school. All schools should appoint a main point of contact from within the school health team - from among the professional contacts listed in paragraph 56 above, although this should be determined by each school health team.

The school management team

58. As set out in chapter 4, it is the responsibility of the head teacher and the school management team to ensure that appropriate arrangements are in place to meet the healthcare needs of children and young people in their school. As such, they need to be aware of and familiar with the joint NHS board and education authority policy framework in place.

59. Based on this framework, and through the appropriate planning processes, the school management team are required to put in place the arrangements for supporting the healthcare needs of children and young people taking into account the local context of the school. These arrangements should be drawn up in consultation with the children and young people at the school, their parents, the school health team and wider school community.

60. In most circumstances, the head teacher, or their delegate, will also fulfil the role of the named person for the children and young people in their school. It will be the responsibility of the named person to play a key role in ensuring communication with children and young people and where appropriate their families, although in some complex, long term cases, it may be that a lead professional ^[75] is also designated. The named person will use professional judgement to ensure that the response to those needs is appropriate and safeguard the child's or young person's wellbeing. This role does not remove the responsibility of any other practitioners who work in partnership with others to identify, address and review the arrangements in place for supporting that child or young person's needs.

61. As day to day decisions normally fall to the school management team in partnership with the school health team, decisions may need to be made about a school's response to outbreaks of infections and other diseases. Where appropriate, it is also the responsibility of the school's management team to report any outbreak of disease in the school setting or dangerous incidents to their own local authority.

Pre-school children - the Health Visitor

62. Health outcomes for children in their early years is set out in Hall 4 (Health for all children) ^[76] , The Universal Health Visiting Pathway ^[77] set out under this programme consists of 11 home visits to every family by a health visitor, 8 visits in the first year of a child's life and a further 3 child health reviews at key time points 13-15 months, 27-30 months and 4-5 years. Under Getting It Right for Every Child the public health nurse – the health visitor – will be the lead contact for children between the ages of 0 and 5 (or until they start school).

Community paediatric services

63. Within the community paediatric service, the community paediatrician or community children's nurse are specialists in disability, chronic illness and the impact of ill health on children. While staff from the community paediatric service or children's nursing service may make up part of the school health team in the role of the school doctor or nurse, the community paediatric service may be a separate service that works alongside other school health teams.

General Practitioners ( GPs)

64. GPs are part of primary healthcare teams. Parents are encouraged to register their child with a GP. Although the GP will often play a key role in diagnosing and prescribing for certain conditions, in most circumstances it will be more practical for schools to seek information and advice from the school health team or community paediatric service, rather than the GP.

Other health practitioners

65. Other health practitioners may be involved in the care of children and young people with healthcare needs in schools. For example, pharmacists employed by NHS boards may provide pharmaceutical advice to school health teams. Community pharmacists are a useful source of information about medicines, and may be able to advise on the management of medication, including recording, storage and disposal.

66. Consultants in public health medicine or communicable disease and environmental health advise school health teams and others on the circumstances in which children and young people with infectious diseases should not be in school, and the action to be taken following an outbreak of an infectious disease.

67. Some children and young people with healthcare needs will receive specific or individual support from specialist nurses or healthcare staff. They can provide advice on the individual medical needs of a child or young person, particularly when a medical condition has just been diagnosed and the child or young person is adjusting to new routines. Where a new condition has been diagnosed, health staff should liaise with educational colleagues to ensure they are aware of the new condition.

68. Psychological services and services provided by allied health professionals, including speech and language therapy, physiotherapy, occupational therapy, and dietetics may be particularly relevant to children and young people with healthcare needs.

Voluntary and third sector organisations

69. In addition to advice from Health Board colleagues, many voluntary and third sector organisations specialising in particular medical conditions are able to provide advice, support, resources and training on how to manage the condition in schools.

All school staff

70. The day to day responsibility of supporting the healthcare needs of children and young people in schools is likely to fall to education support staff or healthcare support staff, working in partnership with the children and young people concerned, their parents, the school management team, teachers and the school health team. Staff who play a direct role in supporting the health and wellbeing needs of an individual child or young person should have access to relevant information which includes information about their health needs.

71. All other school staff have a duty of care to the children and young people. As such, they should be aware of how to respond to an emergency situation when required It is not expected that teachers will routinely administer medication or support children and young people's healthcare needs.

Complaints

72. There may occasionally be disagreements between the parents of children and young people with healthcare needs and the people who work with those children and young people. The first course of action should be to make a formal complaint through the local authority's own internal complaints procedure. There are a range of mechanisms for resolving such disputes ^[78] for pupils with additional support needs.

73. The most informal route within dispute resolution mechanisms is through voluntary mediation whereby an impartial third-party mediator will help those involved find a shared solution to their dispute. Mediation can be used at any time during a disagreement or dispute and local authorities must provide independent mediation services free of charge for young people and their parents.

74. Other methods of resolving disagreements include the setting up of an Education Appeals Committee or Tribunals. Education Appeals Committees hear appeals against decisions to exclude or refuse a child a place at a mainstream school, whilst the First-Tier Tribunal ^[79] hears, and decides upon, appeals made by parents and young people. These appeals may be about co-ordinated support plans or a failure to provide the additional support set out in a child or young person's co-ordinated support plan. The First-Tier Tribunal also hear appeals about disability discriminatory treatment.