1. Managing Medical Needs: Changes in Schools’ Responsibilities Mark Weston Lead Nurse for Paediatric Diabetes

2. Aims  Review new legislation  Wye Valley NHS Trust Proposal  Discussion and Thoughts

3. New Legislation Supporting Pupils at School with Medical Conditions: Statutory guidance for governing bodies of maintained schools and proprietors of academies in England Supporting Pupils at School with Medical Conditions: Statutory guidance for governing bodies of maintained schools and proprietors of academies in England (Dept of Education, 2014) (Dept of Education, 2014)

4. Key Points   Pupils at school with medical conditions should be properly supported so that they have full access to education, including school trips and physical education.   Governing bodies must ensure that arrangements are in place in schools to support pupils at school with medical conditions.   Governing bodies should ensure that school leaders consult health and social care professionals, pupils and parents to ensure that the needs of children with medical conditions are effectively supported.

5. The governing body should ensure that their arrangements give parents and pupils confidence in the school’s ability to provide effective support for medical conditions in school.

6. Collaborative Working   In making decisions about the support they provide, schools should establish relationships with relevant local health services to help them.   Schools, local authorities, health professionals and other support services should work together to ensure that children with medical conditions receive a full education. In some cases this will require flexibility and involve, for example, programmes of study

7. School Policy   Governing bodies should ensure that all schools develop a policy for supporting pupils with medical conditions that is reviewed regularly and is readily accessible to parents and school staff   Governing bodies should ensure that the school’s policy sets out the procedures to be followed whenever a school is notified that a pupil has a medical condition.

8.   Governing bodies should ensure that the school’s policy sets out clearly how staff will be supported in carrying out their role to support pupils with medical conditions, and how this will be reviewed. This should specify how training needs are assessed, and how and by whom training will be commissioned and provided.   The school’s policy should be clear that any member of school staff providing support to a pupil with medical needs should have received suitable training.

9. Individual Health Care Plans   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.   The governing body should ensure that plans are reviewed at least annually …. They should be developed with the child’s best interests in mind

10. Unacceptable practice   prevent children from easily accessing their inhalers and medication and administering their medication when and where necessary   assume that every child with the same condition requires the same treatment   ignore the views of the child or their parents; or ignore medical evidence or opinion, (although this may be challenged);   send children with medical conditions home frequently or prevent them from staying for normal school activities, including lunch, unless this is specified in their individual healthcare plans

11.   if the child becomes ill, send them to the school office or medical room unaccompanied or with someone unsuitable   penalise children for their attendance record if their absences are related to their medical condition eg hospital appointments   prevent pupils from drinking, eating or taking toilet or other breaks whenever they need to in order to manage their medical condition effectively;

12.  require parents, or otherwise make them feel obliged, to attend school to administer medication or provide medical support to their child, including with toileting issues. No parent should have to give up working because the school is failing to support their child’s medical needs; or  prevent children from participating, or create unnecessary barriers to children participating in any aspect of school life, including school trips, eg by requiring parents to accompany the child.

13. Who will provide medical support?   When deciding what information should be recorded on individual healthcare plans, the governing body should consider …… 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   there are good models of local specialist nursing teams offering training to local school staff, hosted by a local school   A first-aid certificate does not constitute appropriate training in supporting children with medical conditions

14. Current Health Care Provision in Herefordshire  Diabetes  Respiratory (asthma/CF) (asthma/CF)  Specialist Care: Tracheostomy/ Tracheostomy/ tube feeding tube feeding School training and visits Health Care Plans Mediation Safeguarding School trip care plans Diabetes also collaborated with local council for additional banded funding

15. Wye Valley NHS Proposal  Team of Specialist Nurses to provide educational days (3 per year)  Provide an accessible and structured training programme for schools  Provide the most expert medical support in the county  Displace training from private or Third Sector agencies as the single preferred choice by schools for all medical training  Costed through service level agreement between local council and NHS  Team covers: Diabetes Respiratory (asthma and CF) Respiratory (asthma and CF) Epilepsy (new service) Epilepsy (new service) Epipen Training (new service) Epipen Training (new service) Specialist requirements Specialist requirements

16. Education Programme  Awareness sessions: Diabetes Asthma and CF Asthma and CF Epilepsy Epilepsy (Specialist Care) (Specialist Care)  Followed by workshops: Diabetes Asthma and CF Asthma and CF Epilepsy Epilepsy Epipen training Epipen training Specialist care Specialist care

17. Workshops  Use of medical equipment  Administering medication  Recognition and treatment of crisis  Storage of medication  Individualised health care plans and school trip care plans  Assistance with school policy  Questions and answers

18. Specialist Care Workshop  Care of Nasogastric tubes and feeds  Gastrostomy Tubes and Buttons  Central Venous Lines  Tissue Viability – pressure areas/immunosuppressed  Catheterisation  Oxygen therapy  Tracheostomy  Continence

19. Additional Support  School visits: Diabetes Asthma and CF Asthma and CF Epilepsy (new service) Epilepsy (new service) Epipen Training (new service) Epipen Training (new service) Specialist care Specialist care  Mediation with challenging families  Support with CAF/safeguarding issues

20. Challenges to Proposal  Diabetes, Asthma, CF and specialist care funded but Epilepsy and Epipen training is an acute service only (no community)  Increasing workloads requires service development (hrs and staff)  Justification for specialist nursing services

21. Discussion and Thoughts