Medical needs

The government guidance ‘Supporting pupils at school with medical conditions‘ says

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 properly understood and effectively supported.

(Key points, page 4)

It also says…

Schools, local authorities, health professionals, commissioners 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 that rely on part-time attendance at school in combination with alternative provision arranged by the local authority6 . Consideration may also be given to how children will be reintegrated back into school after periods of absence.

6 All children must receive a full-time education, unless this would not be in their best interests because of their health needs

(Page 7, Further advice point 5 and footnote 6)

Individual Healthcare Plans (not to be confused with Education, Health and Care or EHC plans!)

For children with complex health needs.

• An individual plan may not be appropriate for your child. Talk to school if you are not sure.
• An Individual healthcare plan will help a school to effectively plan what your child needs, and can provide reassurance about the support plan ie. who will do what, and when.
• You will be able to share your views and those of your child. Let school know of any changes to your childs needs so the plan can be amended
• This plan can also include your child’s Special Educational Needs (where an EHC plan is not in place).
• Though school will be responsible for finalising and maintaining the plan, healthcare and social care or other professionals should be involved in the process
• Annexe A on page 28 of the guidance for schools (PDF) includes a helpful flowchart of what the process should look like.

Children of compulsory school age have the right to a full-time education unless, due to health needs, it would not be in their best interests.

A part-time timetable must not be treated as a long-term solution. This should only be in place in exceptional circumstances and for a temporary period, with an agreed date for when the reduced timetable will end.  

If you are feeling pressured to accept a reduced timetable talk to school about whether there are other appropriate support options, for example…

• an Early Help Assessment – a way of working with families and assessing needs
• referral to the Specialist Education Services or to the Psychology and Therapeutic Service (for an Educational Psychologist or Inclusion Facilitator)
• Referral to a health service.
• a request to the local authority to carry out an EHC needs assessment or, where an EHC plan is already in place, requesting an early review

Helpful information from statutory guidance, Working together to improve school attendance

Part-time timetables

65. All pupils of compulsory school age are entitled to a full-time education suitable to
    their age, aptitude and any special educational needs they may have. In some
    circumstances their education may be provided partially at school and partially at another
    educational setting or through education otherwise than at a school in line with section 19
    of the Education Act 1996 or section 42 or 61 of the Children and Families Act 2014. Time
    away from school to receive education in other ways must be recorded in the attendance
    register using the appropriate codes (see chapter 8).
66. In very exceptional circumstances, where it is in a pupil’s best interests, there may
    be a need for a school to provide a pupil of compulsory school age with less than full-time
    education through a temporary part-time timetable to meet their individual needs. For
    example, where a medical condition prevents a pupil from attending school or another
    setting full-time and a part-time timetable is used to help the pupil access as much
    education as possible. A part-time timetable should not be used to manage a pupil’s
    behaviour.
    26
67. A part-time timetable should:

• Have the agreement of both the school and the parent the pupil normally lives with.
• Have a clear ambition and be part of the pupil’s wider support, health care or
  reintegration plan.
• Have regular review dates which include the pupil and their parents to ensure it is
  only in place for the shortest time necessary.
• Have a proposed end date that takes into account the circumstances of the pupil,
  after which the pupil is expected to attend full-time, either at school or alternative
  provision. It can, however, be extended as part of the regular review process. In
  some limited cases, a pupil with a long-term health condition may require a parttime timetable for a prolonged period……………..

………. 70.In agreeing to a part-time timetable, a school has agreed to a pupil being absent
from school for part of the week or day and therefore must record the absence accordingly
(normally using code X or C2). (p.26)

Sometimes a child’s anxiety prevents attendance at school – and this is sometimes referred to as ‘school-refusal’.

Here are a few commonly used support strategies to help with anxiety about school:

• asking your child to tell you what would need to change for them to feel happier about school – this can help identify specific worries
• help to understand and manage their feelings and emotions
• meet and greet by a trusted member of staff at the start (sometimes during or at the end) of the day
• adult-led approaches – checking in with a child that they are okay
• positive praise (for getting through a lesson – instead of sanctions for challenging behaviour)
• time-out card for when a child feels overwhelmed in lessons
• lesson breaks (to allow some calm down time)
• changes to timetable if particular lessons a trigger
• allowing a child to learn away from the classroom, in a dedicated area or room sometimes known as a ‘safe space’
• lunching away from the dinner hall, ask whether any lunchtime clubs available. (crowded dinner halls can cause anxiety)
• 1:1 or small group interventions, support programmes and friendship groups
• leaving lessons or school 5 minutes early to avoid crowded corridors
• school counselling

You can speak to a school nurse or your child’s GP for advice, recommendations or a possible referral to specialist services. Share this information with school so they have the full picture, and you can discuss next steps together.

Talk to school about whether there are other options, for example…

• Early Help Assessment (EHA) – a way of working with families and assessing needs
• referral to the Specialist Education Services or to the Psychology and Therapeutic Service (for an Educational Psychologist or Inclusion Facilitator)
• Referral to a specialist health service.
• a request to the local authority to carry out an EHC needs assessment or, where an EHC plan is already in place, requesting an early review 

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Useful links

Wellbeing in education ( Suffolk County Council information)

Emotional Wellbeing Gateway (access advice and support if you are worried about your child’s mental health)

Suffolk information around anxiety based school avoidance (EBSA)

Devonshire council information around anxiety based school avoidance

Unity Research School – Blog about helping children to be fine in school

Young Minds guide to School Anxiety and Refusal

Section 19 of the Education Act 1996 sets out the legal duty for a local authority to provide a suitable full-time education for compulsory school-age children who are unable to attend due to ‘illness, exclusion or otherwise’.

If your child is unable to attend school, share any relevant information from health professionals with school and the local authority, particularly anything which indicates regular attendance at school is going to be difficult.

Alternative provision

The term ‘Alternative Provision’ is used to describe the education arrangements for pupils to continue to have a suitable, full-time education whilst they are excluded from school or cannot attend school for illness or another reason, or where directed by schools to off-site provision to improve their behaviour.

Read the Government guide ‘Arranging Alternative Provision’ for local authorities and schools

You can contact the local authority directly with any questions about alternative provision: Specialist Education Services

The Department for Education health needs guidance says:

….‘Local authorities, working closely with the child’s home school, medical practitioners (such as a GP or consultant) and the child’s family, should make every effort to minimise the disruption to a child’s education by identifying the most suitable provision.

Where specific medical evidence, such as that provided by a medical practitioner, is not readily available, the child’s home school or the local authority should consider liaising with other medical practitioners and consider other evidence to ensure appropriate provision can be arranged as soon as possible.’

(Page 8)

If your child is too unwell, or refusing, to attend a school named in an Education, Health and Care plan you could contact the local authority to request an early annual review.

Annual reviews provide the opportunity to update circumstances, discuss progress being made towards outcomes, and ask for any amendments you would like to make to the plan. 

You will also have an opportunity to request a particular school to be named, where the local authority decide to amend the plan following review. 

A Head Teacher or the local authority may issue a penalty notice when they are concerned about attendance.

Read more about Suffolk School Attendance Penalty Notices 

If you believe you have been incorrectly issued with a penalty notice you should raise your concerns with Governing body.

If you believe school are recording illness as ‘unauthorised absence’ it might be helpful to look at the following guidance:

The Department for Education guidance ‘Working together to improve school attendance‘ says:

Schools should not routinely request that parents provide medical evidence to support illness

Only where the school has a genuine and reasonable doubt about the authenticity of the illness should medical evidence be requested to support the absence.

Unauthorised absence is where a pupil’s absence is not one of the types of absence listed…

or where the reason for a pupil’s absence has not been provided and cannot be established

(Code I illness, paragraphs 219, 220 and Unauthorised absence paragraph 235)

The Suffolk County Council Family Services team and how to contact them.

Specialist Education in Suffolk

Government guidance around Alternative Provision

Guidance around anxiety based school avoidance

DFE Guidance Ensuring a Good Education for Pupils who cannot attend school because of health needs

DFE Guidance for pupils with medical needs (PDF)  

DFE School Attendance Guidance (PDF)

‘Not fine in school’ – Action and support for school-refusal and attendance difficulties (PDF)

Medical Conditions and School Partnerships (Health Conditions in Schools Alliance) – Includes Individual Healthcare Plan templates for particular conditions.

Equality Act guidance for schools 2014 (PDF)

Equality & Human Rights Commission guidance for schools 2014

Ombudsman Report ‘Out of School, Out of Mind’ (PDF)

Care and Education Treatment Reviews (for children and young people with Autism and/or a learning disability who are at risk of being admitted to or are currently being detained in an in-patient psychiatric service)