Supporting Medical Conditions in Schools

This guide provides information on the obligations of schools in relation to pupils with medical needs

This guide applies to maintained schools and academies unless otherwise stated.

Legal Obligations 

Under section 100 of the Children and Families Act 2014, there is a statutory duty on governing bodies of maintained schools, proprietors of academies (including alternative provision academies, except 16-19 academies) and management committees in the case of pupil referral units, to make arrangements to support pupils at their school with medical conditions. 

The aim is to ensure that all pupils with medical conditions, both physical and mental health, are properly supported in school so that they can play a full and active role in school life. Pupils who have been absent from school might face difficulties with educational attainment, the ability to integrate with their peers and it can also affect their general wellbeing and emotional health, therefore the social and emotional implications associated with medical conditions should also be considered in providing support. 

In making decisions about the support they provide, schools should establish relationships with relevant local health services to help them. 

Every school has access to school nursing services and they are responsible for notifying the school when a child has been identified as having a medical condition which will require support in school. School nurses can liaise with lead clinicians locally on appropriate support for the child and associated staff training needs.

Local authorities are commissioners of school nurses for maintained schools and academies. Under Section 10 of the Children Act 2004, they have a duty to promote co-operation between relevant partners, such as governing bodies of maintained schools, proprietors of academies, with a view to improving the wellbeing of children with regard to their physical and mental health and their education. 

School policy 

Governing bodies should ensure that all schools develop a policy for supporting pupils with medical conditions. This should be reviewed regularly and should be made accessible to parents and school staff. It is advisable that the school seek advice from the relevant healthcare professionals in relation to this. 

The policy should recognise that medical conditions can be life threatening, understand the impact it can have on a child’s ability to learn and make clear that every child with a medical condition is different and should be treated as an individual. The policy should address the following:

• The procedures to be followed whenever a school is notified that a pupil has a medical condition
• The procedures for managing prescription medicines at school
• The named member of staff who has overall responsibility for the implementation of the medical policy
• The roles and responsibilities of all those involved in the arrangements
• How staff will be supported in carrying out their role to support pupils with medical conditions, and how this will be reviewed. It must specify how training needs are assessed, and how and by whom training will be arranged and provided. (Training should be sufficient to ensure that staff  have confidence in their ability to support pupils with medical conditions. Staff must not give prescription medicines or undertake healthcare procedures without appropriate training)
• The arrangements for children who are competent to manage their own health needs and medicines
• The role of individual healthcare plans and the person responsible for their development
• The contingency plans for emergency situations
• How to facilitate the child’s participation in school trips and visits, or in sporting activities, and not prevent them from taking part
• How complaints concerning the support provided to pupils with medical conditions may be made and will be handled 
• It is advisable that the school policy should also address defibrillators, asthma inhalers for emergency use and home-to-school transport as it may find it helpful to be aware of a pupil’s individual healthcare plan and what it contains, especially in respect of emergency situations.

 In respect of implementation, it is advised that school policies should include:

• who is responsible for ensuring that sufficient staff are suitably trained; 
• a commitment that all relevant staff will be made aware of the child’s condition; 
• cover arrangements in case of staff absence or staff turnover to ensure someone is always available; 
• briefing for supply teachers; 
• risk assessments for school visits, holidays, and other school activities outside the normal timetable; and 
• Monitoring of individual healthcare plans. 

Insurance 

Governing bodies of maintained schools and management committees of PRUs should ensure that the appropriate level of insurance is in place and appropriately reflects the level of risk. Proprietors of academies should ensure that either the appropriate level of insurance is in place or that the academy is a member of the Department for Education’s Risk Protection Arrangement (RPA). 

Emergencies

The school’s policy should set out what should happen in an emergency situation. It is advisable that all schools should have arrangements in place for dealing with emergencies for all school activities. If a child needs to be taken to hospital, staff should stay with the child until the parent arrives, or accompany a child taken to hospital by ambulance.

Where a child has an individual healthcare plan, this should clearly define what constitutes an emergency and explain what to do, including ensuring that all relevant staff are aware of emergency symptoms and procedures. 

Staff members appointed as first-aiders should already be trained in the use of CPR and may wish to promote these techniques more widely in the school, amongst both teachers and pupils alike. Schools are advised to consider purchasing a defibrillator as part of their first-aid equipment. If schools install a defibrillator, they should notify the local NHS ambulance service of its location. 

Regulation 5 of the School Premises (England) Regulations 2012 (as amended) provides that maintained schools must have accommodation appropriate and readily available for use for medical examination and treatment and for the caring of sick or injured pupils. It must contain a washing facility and be reasonably near to a toilet. Please also see the DfE Guidance. 

Administering medication 

For pupils with long-term and complex medical conditions, they may require ongoing support, medicines or care while at school to help them manage their condition. Others may require monitoring and interventions in emergency circumstances. 

The Medicines Act 1968 specifies the way that medicines are prescribed, supplied and administered within the UK and places restrictions on dealings with medicinal products, including their administration. Governing bodies should ensure that written records are kept of all medicines administered to children. 

Although schools may already have such procedures in place in relation to the administration of medication, it is advisable that they should reflect the following details: 

• Medicines should only be administered at school when it would be detrimental to a child’s health or school attendance not to do so
• No child under 16 should be given prescription or non-prescription medicines without their parent’s written consent – except in exceptional circumstances where the medicine has been prescribed to the child without the knowledge of the parents, while confidentiality should be respected every effort should be made to encourage the child or young person to involve their parents
• A child under 16 should never be given medicine containing aspirin unless prescribed by a doctor and parents should be informed
• Schools should only accept prescribed medicines if these are in-date, labelled, provided in the original container as dispensed by a pharmacist and include instructions for administration, dosage and storage. The exception to this is insulin, which can be available to schools inside an insulin pen or a pump
• All medicines should be stored safely. Children should know where their medicines are at all times and be able to access them immediately. Medicines and devices such as asthma inhalers, blood glucose testing meters and adrenaline pens should be always readily available to children and not locked away
• A child who has been prescribed a controlled drug may legally have it in their possession if they are competent to do so, but passing it to another child for use is an offence. Monitoring arrangements may be necessary including record should be kept of any doses used and the amount of the controlled drug held and consider need for the drug to be stored in a non-portable container which only named staff  have access to it. 

Furthermore, the school policy should cover arrangements for children who are not competent to manage their own health needs and medicines.

Day trips, residential visits and sporting activities

Arrangements should be clear and unambiguous about the need to actively support pupils with medical conditions to participate in school trips and visits, or in sporting activities, and not prevent them from doing so. 

It is advised that teachers should be aware of how a child’s medical condition will impact on their participation, but there should be enough flexibility for all children to participate according to their own abilities and with any reasonable adjustments. 

It is best practice to carry out a risk assessment so that planning arrangements take account of any steps needed to ensure that pupils with medical conditions are included. This will require consultation with parents and pupils and advice from the relevant healthcare professional to ensure that pupils can participate safely. 

Individual Healthcare Plans

Individual healthcare plans provide clarity about what needs to be done, when and by whom to support a child’s medical condition. An individual healthcare plan might be appropriate if a medical condition:

• is long-term and complex
• fluctuates
• is a recurring condition, or
• there is a high risk that emergency intervention will be required. 

Governing bodies should ensure that the school’s policy covers the role of individual healthcare plans, and who is responsible for their development, in supporting pupils at school with medical conditions. 

Head teachers have overall responsibility for the development of individual healthcare plans.

The plans should be reviewed at least annually or earlier if evidence is presented that the child’s needs have changed.

In deciding what information should be included in the individual healthcare plan, the following should be considered:

• The medical condition, its triggers, signs, symptoms and treatments
• The pupil’s resulting needs, including medication (dose, side effects and storage) and other treatments, time, facilities, equipment, testing, access to food and drink where this is used to manage their condition, dietary requirements and environmental issues, e.g. crowded corridors, travel time between lessons
• Specific support for the pupil’s educational, social and emotional needs – for example, how absences will be managed, requirements for extra time to complete exams, use of rest periods or additional support in catching up with lessons, counselling sessions
• The level of support needed (some children will be able to take responsibility for their own health needs) including in emergencies. If a child is self-managing their medication, this should be clearly stated with appropriate arrangements for monitoring
• Who will provide this support, their training needs, expectations of their role and confirmation of proficiency to provide support for the child’s medical condition from a healthcare professional; and cover arrangements for when they are unavailable
• Who in the school needs to be aware of the child’s condition and the support required
• Arrangements for written permission from parents and the headteacher for medication to be administered by a member of staff, or self-administered by the pupil during school hours
• Separate arrangements or procedures required for school trips or other school activities outside of the normal school timetable that will ensure the child can participate, e.g. risk assessments
• Where confidentiality issues are raised by the parent/child, the designated individuals to be entrusted with information about the child’s condition; and 
• What to do in an emergency, including whom to contact, and contingency arrangements. Some children may have an emergency healthcare plan prepared by their lead clinician that could be used to inform development of their individual healthcare plan. 

Special Educational Needs and Disabilities

The school should be aware of their duties both under the EHCP and also the Special Educational Needs and Disability (SEND) Code of Practice in relation to pupils who have an Education Health and Care Plan.

Some children with medical conditions may also be considered to be disabled under the definition set out in the Equality Act 2010, therefore it is important the school is also aware and comply with their duties under the Act. (For more information see Disability Discrimination page.)