Meeting the healthcare needs of children and young people in school. Does the law need changing in Wales?

View this post in Welsh | Darllenwch yr erthygl yma yn Gymraeg

There is a concern that the rights of Welsh children and young people with healthcare needs during the school day are not protected in law to the same level as children in England, putting them at risk of an academic and health disadvantage in comparison.

Providing children with the support they need to participate in all aspects of school life

Image from flickr by alishavargas. Licenced under Creative Commons.

Image from flickr by alishavargas. Licenced under Creative Commons.

Most pupils will at some time have a medical condition that may affect their participation in school activities. For many this will be short-term; perhaps finishing a course of medication. Other pupils have long term chronic medical conditions that, if not properly managed, could limit their access to education. Such pupils are regarded as having healthcare needs. Most children with healthcare needs are able to attend school regularly and with some support from the school, can take part in the normal school day. However, evidence suggests that support for children and young people with healthcare needs in school is inconsistent across Wales.

The Welsh Government published draft guidance ‘Supporting learners with healthcare needs’ in February 2016 which replaces the previous 2010 guidance: ‘Access to Education and Support for Children and Young People with Medical needs. The Welsh Government published its Consultation document alongside the draft guidance and sought views between February and April 2016. The revised version is due for publication early in 2017, but will it go far enough to make sure children with health conditions get the care and support they need in school?

The 2010 guidance document provides advice on meeting the educational needs of children and young people with healthcare needs in the education setting. The guidance offers advice on how schools formulate policies to support children and young people with healthcare needs. Whilst stakeholders have welcomed the updating of the guidance document, it is not part of a legislative framework and many argue that the new guidance will not be adequate.

There are over 15 health and children organisations (including the Royal College of Paediatrics and Child Health and Diabetes UK) working together to collate evidence of issues faced by families and to influence legislative change in Wales. There is a strong feeling amongst these stakeholders and their supporters that there is a need for a change in the legislation in Wales to introduce a statutory duty of care for children and young people with healthcare needs. The group believes that updating the guidance does not address or resolve common issues regularly experienced by families in Wales and that increasingly variable results for this most vulnerable group of children will continue.

The current guidance frameworks for the management of children’s healthcare needs in a school setting differ in Wales and England. In England, the Children and Families Act 2014 came into force on 1 September 2014. Section 100 contains a statutory duty to support pupils with medical conditions, meaning that in practice schools must make additional arrangements for supporting children and young people at schools with healthcare needs. This legislation does not apply to schools in Wales.

Schools in England are required by law to have a medical conditions policy in place, as well as an Individual Health Plan (IHP) for each child with medical needs. The policy should recognise that some health conditions can be life threatening and that they can also affect how a child learns. Schools must regularly review and audit their policy and IHPs to make sure the arrangements for children with healthcare needs are working. Together, the documents detail how the school will care for any children with medical conditions, the procedures for getting the right care and training in place and who is responsible for making sure the policy is carried out.

There are concerns in Wales that many schools do not have a healthcare/ medical conditions policy, with many children with healthcare needs being excluded from the school day and in some cases for up to several weeks at a time. Stakeholders want to see all children and young people with healthcare needs in Wales – in terms of both physical and mental health, properly supported in school so that they can play a full and active role in school life. It is also important that parents feel their children are safe.

There has been some debate about whether the Welsh Government’s Additional Learning Needs and Education Tribunal (Wales) Bill should be extended to include the healthcare needs of children and young people in school, or other educational setting. However, the definition currently used for Special Educational Needs (SEN), which the Bill retains for the replacement term Additional Learning Needs (ALN), does not explicitly include learners with healthcare needs. 4% of children in Wales have a medical need, whilst 22% of children have additional learning needs.

Additional Learning Needs (ALN) Bill

The Minister for Lifelong Learning and Welsh Language, Alun Davies AM introduced the Additional Learning Needs and Education Tribunal (Wales) Bill, with its explanatory memorandum, to the National Assembly on 12 December 2016. In his plenary statement on the Bill on 13 December 2016, the Minister explained that the current legislative framework for supporting learners with additional learning needs is based on a model introduced more than 30 years ago.  The Minister explained that the Bill creates a single legislative system to support learners with additional learning needs aged between 0-25 years.

During the debate, the Minister was asked specifically about learners with healthcare needs. Darren Millar AM highlighted that some children and young people may not have additional learning needs, but they may have healthcare needs that require some interventions in the classroom or their place of learning to ensure that they can sustain their learning in the classroom.

In response to concerns highlighted by Assembly Members that “too often guidance is implemented in a patchy way, and sometimes ignored” (Plenary Record), the Minister set out his position on this:

We believe that local authorities and governing bodies already have responsibilities to support children and young people who do have healthcare needs. We are delivering and revising specific guidance on these matters, which will be published in the new year. If Members, having read through those guidelines, believe that they need to be improved or strengthened, then we’ll have an opportunity to do that in the new year.

He went on to say:

Let me say this: the Bill is silent on those issues, but our minds are open to conversations on those matters. If the guidance that will be published does not deliver the sort of certainty that people wish to see, then we will consider that at Stage 2.

It is clear that stakeholders, such as Diabetes UK and the RCPCH believe that children and young people, and their parents do not feel confident at the moment that schools have arrangements in place to provide effective support for the healthcare needs of these learners. They highlight that having asthma, epilepsy, diabetes and a range of other medical conditions should not prevent children and young people having full access to education. These organisations want to see children with potentially life-threatening medical conditions better protected at school and are calling for the same protection for this group as children with additional learning needs. The Welsh Government will publish revised guidance soon which it believes will strengthen the current arrangements and alleviate such concerns.


Article by Sarah Hatherley, National Assembly for Wales Research Service.