Concerns that schools are increasingly being pressured to provide medical support for pupils without the necessary resources and expertise have led school leaders’ union NAHT to publish new guidance for its members.
NAHT says it strongly supports inclusive education and believes children with medical conditions must be able to access and thrive in school. But it warns that too many schools are being left to plug gaps as local health services have become increasingly stretched.
The union says this has created a growing mismatch between what the law requires and what schools are being asked to do in practice.
It fears the issue could undermine the government’s much-needed reforms to fix the broken SEND system, which envisage mainstream schools supporting more children with additional needs.
Medical interventions carried out in school include everything from administering medication to respiratory and cardiac monitoring, catheter and stoma care, tube feeding and use of hoists.
NAHT says while some tasks can be delegated to schools with clear, robust arrangements in place, responsibilities, accountability and legal authority are often unclear, and a model has emerged that is overly-reliant on the education sector, creating risks for children and school staff.
It says some healthcare should only be delivered by qualified healthcare professionals.
Staff may be removed from classrooms to provide care which can require two adults, taking them away from the classroom and sometimes being logistically impossible - reducing teaching time.
NAHT has raised its concerns with the government, but promised new national guidance has been delayed and is now thought unlikely to appear before the start of the next school year.
In the meantime, the union’s guidance offers its members clarity on the existing legal position.
It follows a motion which was debated at NAHT’s annual conference in May on the ‘inappropriate at best, and unlawful at worst practice involved in pressuring education staff and settings to mitigate inadequacies in local health commissioning and resourcing’.
Paul Whiteman, NAHT’s general secretary, said: “Schools care deeply about their pupils and go above and beyond for them but teachers and support staff are not medical practitioners.
“We hear increasingly from school leaders that they are being pressured to deliver healthcare without the necessary expertise and support, and there are instances where what they are being expected to do is simply inappropriate. School staff are dealing with this issue right now, and they need help.
“This is not about basic tasks like first-aid, or providing a sugary drink to a diabetic child – this is specialist, time-intensive support.
“There is a real danger that it is only a matter of time before something goes very wrong.
“Like schools, NHS services and local authorities face severe financial pressures, but they have a responsibility to arrange healthcare within the existing statutory framework.
“It is clear that more investment is needed to ensure medical professionals are consistently available to support pupils with the most complex needs - especially given the government’s expectation that mainstream schools should accommodate more children with SEND.”
NAHT’s guidance aims to help members understand statutory duties across education, health and local government. It highlights the importance of legally-sound delegation of tasks to schools covering clearly defined responsibilities and accountability, training, competency and risk assessments, supervision, monitoring, and appropriate insurance arrangements.
The guidance advises school leaders how to identify and challenge arrangements that may be unsafe or non-compliant and on securing lawful, sustainable and child-centred provision.
Marijke Miles, head teacher at Baycroft School, a special school in Fareham, Hampshire, and chair of NAHT’s SEND Council, said: “This guidance is about giving school leaders the tools to insist upon the quality of care to which children and young people are entitled. It will be transformational for me in providing a sound, lawful and transparent basis for upholding the rights of my children and their families.
“It will help ensure that no child is subject to a two-tier health system where being school-age means they receive an inferior health provision. It is an entirely appropriate and reasonable expectation that young people with complex medical needs should be supported by a health service, not an education service.”
Emma Smith of ESC Management Services, an expert in the area who supported NAHT in producing the advice, said: “Over many years, schools have increasingly been expected to fill gaps in NHS-commissioned services, leaving school leaders under pressure to provide medical support that extends beyond their role as education professionals.
“This is neither sustainable nor safe, and it can place children, young people and staff at unnecessary risk.”