Headteachers’ leaders have warned that an “erosion” of NHS support in schools has resulted in the unsafe substitution of educational staff to provide medical support to pupils rather than clinicians.
The NAHT school leaders’ union highlights that school staff face ambiguity over the level of health provision being delivered in schools that requires clinical expertise.
Responding to a government consultation, the union calls for updated guidance to explicitly state that schools’ duty is to make reasonable educational arrangements and not to replace NHS-commissioned healthcare.
It adds that where support goes beyond basic first aid, emergency response or clearly agreed reasonable adjustments, the expectation should be NHS involvement, health-led planning and expert-led clinical support.
The government consultation, which closed last month, concerns plans to update statutory guidance for schools on supporting pupils with medical conditions.
Staff ‘already overstretched’
The NAHT says the final guidance document should include a clear escalation route when a school concludes that a pupil’s needs cannot be safely met by education staff alone.
It warns that schools should not be left to choose between refusing support, accepting unsafe responsibility or “relying on goodwill from already overstretched staff”.
The NAHT submission to the consultation adds: “The core issue is not due to schools’ unwillingness to support pupils, but the ambiguity that currently exists in the threshold between reasonable arrangements made by schools to support health provision and more complex provision that requires clinical expertise.”
The government has been consulting on changes, including requiring every school to have a published medical conditions policy “owned” by a named senior leader and governor that is reviewed at least annually.
It also proposes strengthening the use and standardisation of individual healthcare plans (IHPs) and introducing clear expectations for schools on recording, reporting and learning from serious incidents and “near misses” relating to children and young people with medical conditions.
In its response, the NAHT warns that having a named senior leader and governors on a school’s medical conditions policy could have unintended consequences.
“For example, supporting pupils with medical conditions in school has to be a whole-school responsibility – while some staff may have a more proactive or direct role, in some cases, it cannot be the sole responsibility of one or two leaders and staff; all will need to be prepared to keep children and young people safe.”
It adds that the named person in a medical conditions policy would need some degree of knowledge and expertise, meaning that training would be crucial.
The NAHT warns that this expectation will be difficult for leaders in small schools, as “they often have a reduced leadership team who are already named persons for a range of other obligations on schools”.
Workload and funding concern
The NAHT also says that the government’s proposals have significant workload and funding implications for schools.
“At a time when schools are losing support staff and reducing provision because of budget pressures, new statutory expectations must be accompanied by protected funding, access to clinical expertise and increased workforce capacity,” it says.
The National Network of Special Schools for School Business Professionals (NNoSS) has also raised concerns about the role of schools in providing medical support to students.
In its consultation response, NNoSS says that its members consistently report that they cannot reliably access the clinical input required to produce, review and maintain IHPs.
In response to the proposals for schools to record and review near misses, NNoSS says the government must ensure that this takes special schools’ context into account.
Its response says: “In special schools, events that would constitute a ‘serious incident’ in a mainstream setting – a seizure, a feed pause, an emergency medication administration – may occur daily, and are anticipated, managed and recorded. As one member put it, ‘post-incident review would be impossible, as you may have incidents every day’.
“Without a calibrated definition, the proposed reporting regime will generate volume without learning.”