Supporting students with medical needs

Written by: Jackie Wheatley | Published:
Vital support: Telepresence robots are used by Oxford Hospital School, such as in this case to enable a child undergoing cancer treatment to attend his mainstream school (Image: Wood Green School)

Many schools work hard to make the best provision they can for students with medical needs, but it is not always easy. Jackie Wheatley highlights key areas of best practice, considers some of the legal requirements placed on schools, and offers her advice

All children and young people with medical conditions are entitled to the fullest possible access to education, including the whole curriculum and special trips and visits. Only if it is not in the best interests of the student should they be doing less.

In my experience, most young people with a medical condition want to be treated “normally”. For a young person undergoing treatment, especially when that treatment extends over many months or even years, it is vital to hang on to as much normality as possible.

This includes the expectation of regular school attendance and participation in all the social and broader aspects of school life as well as lessons whenever possible.

Children do not want to feel different, and that generally means they do not want too much special attention. Their time in school can offer a respite from worries about their condition, and remaining in school with their friends as much as possible makes it much easier to pick up again when they might be feeling better.

In practice, of course, teaching a young person with a medical condition can pose some very real dilemmas for a school.

Teaching a student with persistent headaches, chronic pain, fatigue or mobility issues; diseases such as cystic fibrosis and cancer; or mental health conditions like anxiety or psychological distress can be a significant challenge.

And with up to 40 per cent or five million children in the UK diagnosed with some form of chronic illness or recurrent condition – ranging from mild asthma to diabetes – it is a challenge that every mainstream school has to address.

Common considerations include: what special arrangements should we be making? What should we do in an emergency? What should and shouldn’t we say to the student (and also to their class mates about the student and their condition)? How should we communicate with parents? Where can we access reliable information and support?

Best practice approaches

I regularly see excellent practice in the mainstream schools I work with and admire many examples of thoughtful, proactive, joined up working involving school staff and healthcare professionals including CAMHS collaborating closely with the student and their family.

Interestingly, it is not uncommon to find that these are the same schools with strong health and wellbeing policies. We often find that students with extra medical needs feel more supported in schools where the health needs of the whole school community are valued and talked about openly.

We have witnessed schools that offer regular sessions in mindfulness, self-esteem, managing anxiety and dealing with failure as part of the whole school curriculum also providing really outstanding support for students with complex medical needs. Happily, this approach is becoming increasingly widespread.

In recent years, I have also seen more schools with established medical needs policies extending the scope of their work to include mental health needs. In proactively seeking to understand and accommodate mental health needs, including those associated with medical needs, these schools are undoubtedly improving their students’ life experiences and academic outcomes.

In other cases, schools are harnessing the power of technology to make it easier for students with medical conditions to access mainstream education. This ranges from online planning systems to share information with all parties including parents, to telepresence robots (see images) which are giving students the chance to take part in lessons and extra-curricular activities with their class mates and teachers, despite not physically being there.

Some students with extra health needs have fantastic experiences of school and learning, but unfortunately this is not the case for all. There is a lot of variability in the quality of support that different students receive, with some receiving very little.

The legislative landscape

In 2014, the duty to support students with medical conditions (Section 100 of the Children and Families Act 2014) was introduced to govern the way schools teach and care for children and young people with additional health needs. This was followed by the statutory guidance Supporting pupils at school with medical conditions (DfE, 2015).

The new legislation is supportive in terms of clearly defining the full entitlements that young people with medical conditions have in school, and yet, according to national research, its impact is not being felt on the scale it was intended.

A survey by the Health Conditions in Schools Alliance suggests that at the beginning of 2017 less than 20 per cent of schools had suitable policies in place to satisfy these new guidelines.

Evidence from our own work shows that this has improved in the last two years, but from the outset the success of the legislation has been hampered for two key reasons. First, the new code of practice lies within legislation that brought in some massive changes, including the new national curriculum, life without curriculum levels and the SEND Code of Practice (DfE, January 2015).

It appears that these reforms initially took the attention of schools, and that policies affecting a small minority of pupils were swamped by higher profile rules that relate to the whole school community every day of the year.

Second, Ofsted does not yet monitor the policy or its implementation in the schools it inspects. To do so would be a helpful way of valuing what schools are doing for pupils with medical needs and would ensure that the legislation is making a difference.

Satisfying the rules

So what steps should all schools be taking to ensure they are doing the best they can for pupils with medical needs?

Schools must have a Medical Needs Policy in place and be using IHPs (Individual Healthcare Plans) for each student as part of their usual practice. Having the right paperwork is a good starting point, but living it every day is what really makes a difference to a young person.

It is crucial to consider each student as an individual. Two students with the same condition may need quite different approaches. Equally, the same young person with an on-going condition may need different support at different times throughout the course of their illness.

The school has to work within its resources and systems, but should be prepared to implement all reasonable adjustments to make school life as accessible as possible: part-time timetables, time out during the school day if needed, individually adapted work, work to complete at home, a dedicated support worker to liaise with the student’s family, somewhere private to each lunch or take medication.

Having this kind of additional support is an entitlement for a child or young person with a significant medical condition, not a special favour.

Proactive planning

Most schools I have worked with have appropriate medical needs policies in place, and it is easy to download and adapt generic policies. But the issue for some schools is that policy and practice have not yet come together; systems are less developed and knowledge and understanding are not being shared across the staff as a whole.

Writing an IHP takes time and demands proper process, but done properly it can make life so much easier for students and staff. A good IHP proactively considers how to make things go right and encompasses situations like trips and exams, which might not be of immediate concern but need to be thought about sensibly in advance. I see lots of well-meaning but ad-hoc support for individual students, but having a proper process in place avoids the need to be reactive when problems present.

In general, planning for a student with medical needs will be more successful when it is done with good communication, ideally face-to-face and in the same room, between the school, family, healthcare team and, importantly, the student themselves. This sounds obvious, but it is common for schools to find that coordinating these discussions is difficult, especially when it comes to the school identifying and liaising with the student’s healthcare team, which may well involve several disciplines at the same time.

Interestingly, the same legislative obligation to work in a joined up way applies to health as well as education, though schools tend to feel responsibility falls predominantly to them.

Once the plan has been formalised in an IHP that references the student’s medical, physical and mental health needs and details the solutions that will be put in place to accommodate them in school, it is then essential to share it with every adult in the school who will have contact with the student.

It is important that everyone understands the plan and how to make it happen, so that it is implemented consistently. This is a real challenge for any school, but more so for a busy secondary school where students have contact with many members of staff.

There may well be a training need to help staff understand the learning implications of a particular medical condition and its associated physical or mental health needs. It is quite normal for people’s judgements to be influenced by their own personal experiences and assumptions about a condition and the relative symptoms and implications, but in my experience it really helps if they can put them aside as much as possible and instead consider the facts of each student’s case in isolation.

It is important that staff work to the plan, rather than making their own decisions about what approach to take.

In our work we find people’s responses to a child or young person can vary depending on their condition. For example, people tend to show sympathy towards a student with cancer – sometimes overwhelmingly so – yet may feel scepticism towards a student with chronic fatigue.

This is where education and access to clinical advice are important as a way of gathering evidence and challenging preconceptions.

Bridging the gap

In Oxfordshire, a pioneering initiative is addressing the need to make advice and support easily available to schools. The Medical Needs in Schools (MNIS) project is a partnership between the Oxfordshire Hospital School and Oxford University Hospitals NHS Foundation Trust and is designed to improve the educational outcomes of children and young people with medical conditions in mainstream schools.

Now in its second year, the project – which is free for schools in Oxfordshire to join – is helping schools to build internal capacity and expertise in medical needs teaching.

Partner schools benefit from a programme of professional development as well as close links and collaborative working practices with local hospitals and mental health services, which have been set up to help them create the most favourable conditions for students with medical needs to learn.

At the OHS, we teach more than 1,000 children and young people each year in Oxford’s children’s hospitals and in the community because they are too unwell to attend their usual schools. We are part of a team of teaching and health professionals working together to ensure that collectively we meet the emotional, social and educational needs of every child in our care.

The MNIS Project is a way for us to extend this know-how to help support children with medical conditions who are able to attend mainstream settings. Our aim is to share our knowledge and experience with schools to give them the tools and the confidence to help children and young people with medical needs be fully included and integrated in their school communities.

To make the project a sustainable, long-term resource, we hope to create a permanent community of teaching and health professionals which will be a source of on-going support and best practice learning. Our psychology colleagues, working closely with a small number of young people, schools and families, are also on track to produce an evidence-based national framework for achieving positive educational outcomes for students with medical needs.

It is fantastic to see the impact that good professional support and training can have on schools, and we hope that the project can be used as a model to inspire other hospital and mainstream schools and their local authorities.

Our ambition is to see this style of partnership between health and education become the norm, making it easier for schools to give every student access to high-quality learning regardless of medical need.SecEd

  • Jackie Wheatley is a teacher at the Oxfordshire Hospital School.

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