managing medical needs: changes in schools’ responsibilities mark weston lead nurse for paediatric...

Managing Medical Needs: Managing Medical Needs: Changes in Schools’ Changes in Schools’

ResponsibilitiesResponsibilities

Mark WestonMark Weston

Lead Nurse for Paediatric Lead Nurse for Paediatric DiabetesDiabetes

AimsAims

Review new legislationReview new legislation

Wye Valley NHS Trust ProposalWye Valley NHS Trust Proposal

Discussion and ThoughtsDiscussion and Thoughts

New LegislationNew Legislation

Supporting Pupils at School with Medical Supporting Pupils at School with Medical Conditions:Conditions: StatutoryStatutory guidance for guidance for governing bodies of maintained schools and governing bodies of maintained schools and proprietors of academies in Englandproprietors of academies in England

(Dept of Education, 2014)(Dept of Education, 2014)

Key PointsKey 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.

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.

Collaborative WorkingCollaborative 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

School PolicySchool 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.

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.

Individual Health Care PlansIndividual 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

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

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;

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.

Who will provide medical support?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

Current Health Care Provision in Current Health Care Provision in HerefordshireHerefordshire DiabetesDiabetes

Respiratory Respiratory (asthma/CF)(asthma/CF)

Specialist Care:Specialist Care: Tracheostomy/Tracheostomy/ tube feedingtube feeding

School training and visits

Health Care Plans

Mediation

Safeguarding

School trip care plans

Diabetes also collaborated with local council for additional banded funding

Wye Valley NHS ProposalWye Valley NHS Proposal Team of Specialist Nurses to provide educational days (3 per year)Team of Specialist Nurses to provide educational days (3 per year)

Provide an accessible and structured training programme for schoolsProvide an accessible and structured training programme for schools

Provide the most expert medical support in the countyProvide the most expert medical support in the county

Displace training from private or Third Sector agencies as the single Displace training from private or Third Sector agencies as the single preferred choice by schools for all medical trainingpreferred choice by schools for all medical training

Costed through service level agreement between local council and Costed through service level agreement between local council and NHSNHS

Team covers: DiabetesTeam 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 requirementsSpecialist requirements

Education ProgrammeEducation Programme

Awareness sessions: DiabetesAwareness sessions: Diabetes Asthma and CFAsthma and CF EpilepsyEpilepsy (Specialist Care)(Specialist Care)

Followed by workshops: DiabetesFollowed by workshops: Diabetes Asthma and CFAsthma and CF EpilepsyEpilepsy Epipen trainingEpipen training Specialist careSpecialist care

WorkshopsWorkshops

Use of medical equipmentUse of medical equipment Administering medicationAdministering medication Recognition and treatment of crisisRecognition and treatment of crisis Storage of medicationStorage of medication Individualised health care plans and school Individualised health care plans and school

trip care planstrip care plans Assistance with school policyAssistance with school policy Questions and answersQuestions and answers

Specialist Care WorkshopSpecialist Care Workshop

Care of Nasogastric tubes and feedsCare of Nasogastric tubes and feeds Gastrostomy Tubes and Buttons Gastrostomy Tubes and Buttons Central Venous LinesCentral Venous Lines Tissue Viability – pressure Tissue Viability – pressure

areas/immunosuppressed areas/immunosuppressed CatheterisationCatheterisation Oxygen therapyOxygen therapy TracheostomyTracheostomy ContinenceContinence

Additional SupportAdditional Support School visits: DiabetesSchool visits: Diabetes

Asthma and CFAsthma and CF

Epilepsy (new service)Epilepsy (new service)

Epipen Training (new service)Epipen Training (new service)

Specialist care Specialist care

Mediation with challenging familiesMediation with challenging families

Support with CAF/safeguarding issuesSupport with CAF/safeguarding issues

Challenges to ProposalChallenges to Proposal Diabetes, Asthma, CF and specialist care Diabetes, Asthma, CF and specialist care

funded but Epilepsy and Epipen training is funded but Epilepsy and Epipen training is an acute service only (no community)an acute service only (no community)

Increasing workloads requires service Increasing workloads requires service development (hrs and staff)development (hrs and staff)

Justification for specialist nursing servicesJustification for specialist nursing services

Discussion and Thoughts Discussion and Thoughts