I work with children, young people and families Sensory, Physical and Medical Strategies Medical Needs in Schools

Medical Needs in Schools

SEND Code of Practice 0-25 (2015): Children and young people in alternative provision because of health. Working together across education, health and care for joint outcomes. Ensuring a good education for children who cannot attend school because of health needs. (2013) Ensuring children have a good education. Supporting children at school with medical conditions. (2015)

A medical diagnosis or a disability does not necessarily imply a special educational need. It may not be necessary for the student with any particular diagnosis or medical condition to have any form of additional educational provision at any phase of education, high needs funding or an Education Health and Care Plan. It is the child’s educational needs rather than a medical diagnosis that must be considered.

Some children may have medical conditions that, if not properly managed could hinder their access to education. The Equality Act 2010 states that public bodies must not discriminate and must make reasonable adjustments for disabled children and young people. The definition of disability in the Equality Act includes children with long term health conditions.

Children with medical conditions includes those with Asthma, Diabetes, Cancer, Arthritis, Epilepsy, severe allergies, Incontinence, Eczema, Cystic fibrosis, Tracheotomy, Colostomy and Ileostomy and mental health. (Mental health issues are covered in the SEMH section of this document.)

The SEN Code of Practice 2015 recognises that there is a significant overlap between disabled children and young people and those with SEN. Children and young people may therefore be covered by both SEN and disability legislation.

For children and young people with medical needs schools must have regards to the new DfE guidance (2015): ‘Supporting children at school with medical conditions: Statutory guidance for governing bodies of maintained schools and proprietors of academies in England.’

The Equality Act and Reasonable Adjustments Some children with medical conditions may be disabled. When this is the case the governing bodies must comply with their duties under the Equality Act 2010.

The Equality Act (2010) replaced all existing equality legislation such as the Races Relation Act, Disability Discriminations Act and Sex Discrimination Act. The guidance document “The Equality Act 2010 and schools” provides advice and is the source of the following information. “The law on disability discrimination is different from the rest of the Act in a number of ways. In particular, it works in only one direction – that is to say, it protects disabled people but not people who are not disabled. This means that schools are allowed to treat disabled pupils more favourably than non-disabled pupil, and in some cases are required to do so, by making reasonable adjustments to put them on a more level footing with pupils without disabilities. Provision for disabled pupils is closely connected with the regime for children with special educational needs.” Chapter 4 [of the guidance document] deals in detail with disability issues.” Further information can be found on the Equality and Human Rights Commission . The Equality Act defines disability as when a person has a ‘physical or mental impairment which has a substantial and long term adverse effect on that person’s ability to carry out normal day to day activities, Some specific medical conditions , HIV, multiple sclerosis and caner are all considered as disabilities, regardless of their effect. Long term is defined as lasting, or likely to last, for at least 12 months.

Reasonable adjustments and when they have to be made.

The duty to make reasonable adjustments applies only to disabled people.
When something a school does places a disabled pupil at a disadvantage compared to other pupils then the school must take reasonable steps to try and avoid that disadvantage.
Schools will be expected to provide an auxiliary aid or service for a disabled pupil when it would be reasonable to do so and if such an aid would alleviate any substantial disadvantage that the pupil faces in comparison to non-disabled pupils.
The Equality Human Rights (EHRC) has published technical advice to support schools, local authorities and college and further education settings on when it would be reasonable to make adjustments which can be found here .
Auxiliary aids can include things such as auxiliary aids, such as coloured overlays for dyslexic pupils, pen grips, adapted PE equipment, adapted keyboards and computer software.
Schools are not subject to the requirement of reasonable adjustment duty concerned with making alterations to physical features because this is already considered as part of their planning duties.
Some examples of reasonable adjustments from the technical guidance document are included below.
Example: An infant school disabled pupil with attention deficit hyperactivity disorder (ADHD) receives some individual teaching assistant support through the SEN framework. He is diagnosed with severe asthma and needs assistance with his nebuliser. Although this is not a special educational need, his asthma is likely to be a disability for the purpose of the Act and so a failure to provide a reasonable adjustment will place him at a substantial disadvantage. The school trains his teaching assistant and she provides him with the assistance that he needs. This would be a reasonable adjustment for the school to make.
Many disabled pupils may receive support in school through the SEN framework. In some cases, the substantial disadvantage that they experience may be overcome by support received under the SEN framework and so there will be no obligation under the Act for the school or local authority to make reasonable adjustments.
Example: A disabled pupil has an EHC plan and attends a maintained mainstream secondary school. Through her EHC plan, she receives two hours a week of specialist teaching and uses an electronic notetaker in lessons. Because the support that she requires is provided through her EHC plan, the school does not therefore have to make reasonable adjustments by providing these auxiliary aids and services for her.
Some disabled pupils are not classified as having SEN, but if they are disabled and are suffering a substantial disadvantage, they may still need reasonable adjustments to be made.
Example: A disabled pupil at an infant school has diabetes, and requires daily support with reading blood sugar levels and insulin injections. He is not classified as having SEN and therefore receives no support through the SEN framework. He is, however, disabled and therefore, if the lack of daily support places him at a substantial disadvantage, the school would be under a duty to make the adjustment of providing the support, if it would be reasonable to do so.
The Equality Act (as specified in Schedule 10 of the Act: Accessibility for disabled pupils) also contains a requirement for local authorities to put in place an accessibility strategy. The West Sussex Accessibility Strategy, in keeping with the legislation, sets out the ways in which West Sussex County Council will increase access to education for disabled pupils, in the schools and settings for which it is responsible. We will work with schools to ensure that the curriculum meets accessibility requirements set out within both Education and Equalities legislation. A copy of the West Sussex Accessibility Strategy can be found here .

‘Mild’ Medical Needs

What do you notice about the child / young person?

May mean occasional absence from school.
The condition may influence tiredness and concentration levels.
Children may need access to specific items of small equipment if medical conditions have resulted in minor motor impairments.
Medical conditions may result in bullying and social isolation.
Pregnancy is not a medical condition and needs should be met in school. Girls are entitled up to 18 weeks maternity leave to be used before and after the birth.
Differentiation may be required to take account of slower pace in performing some tasks – may tire easily.
Integration into school after a period of absence needs to be carefully planned and managed.
Schools may need to plan for pupil with support and guidance from medical practitioners, parent /carer and pupil.

Strategies

Planned support and intervention may be part of the Individual Healthcare Plan (IHP) DfE guidance: Supporting children at school with medical conditions. (Dec 15):

Relevant information, assessments & links

Medical Issues are affecting students progress

What do you notice about the child / young person?

Medical condition may necessitate supervision or support for medication needs at specific times, e.g. medication, diet, toileting
Progress within the curriculum may be affected by condition or medication.
May participate in most/all activities but at a slower pace that peers or show signs of increasing fatigues during the school day.
Student has short term health need requiring pupil to be educated in alternative provision identified by the student’s consultant.

Targeted support strategies (some children)

Pupil is likely to have an IHP managed by a named member of staff.
Access to word processors. Some limited items of special equipment and teaching approaches.
May need more supervision in potentially hazardous situation e.g. science lab, swimming, using PE apparatus.
Differentiation may be required to take account of slower pace or to catch up following periods of absence.
Extra help may be required at times in the school day, e.g. dressing, undressing, steps, stairs.
Focussed support via a Provision Map in place by class/form teacher to allow the children to catch up following periods of absence.
Suitable arrangements may be needed for administration of emergency medication.
Suitable training to school staff or other emergency measures in school.
Supervision of health and hygiene procedures.
Access to alternative methods of recording if required.
Class or subject teachers are responsible for working with the student on a daily basis, delivering any individual programmes.
Some additional support may be required at periods throughout the day and social situations such as breaks may need particular attention.
Possibly teaching assistant trained in managing care needs.
Training in Manual Handling may be necessary.
Differentiation required accessing some curricular areas, e.g. PE, handwriting tasks, unstructured times and environmental adaptation.

Relevant information, assessments & links

Medical condition will be generally stable and under control, but may need monitoring in school and close liaison maintained with home.
School curriculum promotes personal care and safety and school staff arrange and take responsibility for any regular medical intervention to be carried out.
Risk assessment + emergency plan for medical emergency.
Teaching staff and therapist to assess changing needs.
Input to the provision map/IEP may be required from a physiotherapist, occupational therapist.
Consideration of access arrangements for examinations etc.
Specific information on the causes and implications of the medical condition may need to be circulated to relevant members of staff.
Refer to Fair Access Team .
Training on our Local Offer.
SEN Support: research evidence on effective approaches and examples of current practice in good and outstanding schools and colleges

Student has severe medical needs

What do you notice about the child / young person?

Student has severe difficulties with the ability to function independently in the school environment and in their everyday life.
May require daily therapy and medical intervention to crucially avoid pressure damage and maintain joint integrity.
May have a chronic condition, potential degenerative condition, newly acquired condition or has special educational needs in addition to physical difficulties.

Personalised interventions/ specialised approaches/ adaptations (few children)

Needs differentiation of opportunity and extra time to access the curriculum.
Needs one-to-one adult support 100% of the time.
May need help to record work.
May need help eating and drinking.
May need adaptations for PE curriculum and all practical subjects.
May need support with transport arrangements

Download the PDF version of the Graduated Approach

Medical Needs in Schools

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