Friday, 24 September 2010

Policy for Children with Medical Needs in Schools


April 2010

Leicestershire County Council


1.1 Section 19 of the Education Act 1996 states that “each local education authority shall make arrangements for the provision of suitable education at school or otherwise than at school for those children of compulsory school age who, by reason of illness, exclusion from school or otherwise, may not for any period receive suitable education unless arrangements are made for them.”

1.2 It is expected that education for pupils who are unable to attend school because of medical needs can be provided for in a variety of ways.  This can include the use of an integrated hospital/home tuition service.

1.3 Such a service is provided by the Children’s Hospital School (CHS) based at Leicester Royal Infirmary. The authority has made use of this service for many years. Recent inspection evidence points to high quality provision by CHS.

This hospital school provides outstanding quality of education and care. Key to it all
is the tremendous teaching that is evident in all classes. The support that pupils
receive from the teachers and the teaching assistants is second to none. As a result,
pupils are able to achieve their best both personally and academically. Pupils'
achievement is outstanding in recovering from ill-health, developing social skills and
learning skills in a new environment and then reintegrating back into their home
school. It is an excellent accomplishment. (Ofsted Inspection Report, June 2008)


2.1 “Access to Education for children and young people with Medical Needs”  DfES 2001[1] sets out the guidance to be followed by local authorities in meeting their statutory obligations. The guidance applies equally to all children and young people unable to attend school because of medical needs, both those who are physically ill or injured and those with medical problems. Local authorities are expected to show particular care to ensure that there is adequate provision for pupils suffering from mental illness such as anxiety, depression and/or school phobia including separation anxiety and school refusal associated with depression.

2.2 Whilst the majority of pregnant schoolgirls and young mothers have their educational needs met by their mainstream school, a minority may require special provision to meet health, social or emotional needs. Such provision is not the subject of this policy, and is not made by CHS.

2.3 The Guidance sets out Local Authority’s responsibilities as follows:

LEAs’ responsibilities towards pupils who are unable to attend school because of their
medical needs should ensure that:
• Pupils are not at home without access to education for more than 15 working days.
• Pupils who have an illness/diagnosis which indicates prolonged or recurring periods of absence from school, whether at home or in hospital, have access to education, so far as possible, from day one.
• Pupils receive an education of similar quality to that available in school, including a broad and balanced curriculum.
• Pupils educated at home receive a minimum entitlement of 5 hours teaching per week This is a minimum and should be increased where that is necessary to enable a pupil to keep up with their studies. This is particularly important when a pupil is approaching public examinations.
Whether the child or young person is able to access this entitlement will depend on medical advice, and perhaps more importantly, when they feel able to cope with it. The right balance must be struck between encouraging pupils to study and recognising when they are not well enough to benefit from teaching. This must be kept under regular review. (DfES 0732/2001, page 8)

2.4 School’s responsibilities are similarly laid out:

Schools should:
• Have a policy and a named person responsible for dealing with pupils who are unable to attend school because of medical needs.
• Notify the LEA/EWO if a pupil is, or is likely to be, away from school due to medical needs for more than 15 working days.
• Supply the appropriate education provider with information about a pupil’s capabilities, educational progress, and programmes of work.
• Be active in the monitoring of progress and in the reintegration into school, liaising with other agencies, as necessary.
• Ensure that pupils who are unable to attend school because of medical needs are kept informed about school social events, are able to participate, for example, in homework clubs, study support and other activities.
• Encourage and facilitate liaison with peers, for example, through visits and videos.
(DfES 0732/2001, page 8)

2.5 The requirements of school policies in this area are also laid out:

• The school’s responsibility to monitor pupil attendance and to mark registers so that they show if a pupil is, or ought to be, receiving education otherwise than at school.
• Management structures and staff responsibilities.
• Strategies for ensuring support in cases of long-term absence, including the provision of assessment and curriculum plans within 5 working days and work programmes on a termly basis.
• A named contact within the school to aid communication with other parties, to attend reviews, and to facilitate communication generally between the pupil and the school.
• The provision of work and materials for pupils who are absent from school because of medical needs.
• Procedures for ensuring that pupils who are unable to attend school because of medical needs have access to public examinations, possibly as external candidates.
• Procedures for ensuring that pupils are reintegrated smoothly into the school.
• Issues related to pupils with statements of special educational needs.
• How the school’s procedures will take account of the pupil’s views.
(DfES 0732/2001, page 11)


3.1 Leicestershire’s policy is to support Leicestershire children and young people with medical needs who cannot attend school through the City Hospital School.
The aim of the Children’s Hospital School Service is to support the educational progress of pupils, who are temporarily unable to attend mainstream school on a full-time basis. Services are provided in three ways: to in-patients on wards, through a hospital day school, and through home-tuition. Pupils will at all times remain the responsibility of the school at which they are registered.

3.2 All children who are hospital in-patients will receive support from the Children’s Hospital School as set out in section 5.

3.3 Support for other children and young people with medical needs will be delivered through a tiered approach as set out below and referrals to the Children’s Hospital School will follow the pathway described.

3.3.1   Most cases of medical need will be dealt with by the school. The school will liaise with the family of a pupil who is not attending for medical reasons and ensure that the child or young person is able to maintain progress by setting appropriate work and giving appropriate feedback and support. The school will offer this level of support to their pupils where the absence is anticipated to last for no longer than 3 school weeks[2]. Schools are also expected to make reasonable adjustments to a pupil’s time-table and to offer part-time education for a limited period to help the pupil maintain access to education.

3.3.2   Where a school is encountering difficulty in maintaining effective liaison with a pupil, or progress is poor, the LA will offer support. A number of support services may be able to offer specialist advice:
            - The Educational Psychology Service;
            - The Education Welfare Service;
            - The Advisory Teacher for Children with Physical Difficulties (Specialist                           Teaching Services).

The Children’s Hospital School may also be contacted for specialist advice.

3.3.3   Where a pupil’s absence for medical reasons has been or is likely to be greater than 3 weeks, the school should inform the Education Welfare Officer (EWO).  If written evidence from a health professional[3] recommends that the pupil is medically unfit to attend mainstream school the EWO will make a referral to the Children’s Hospital School (CHS) by submitting a referral form, together with supporting evidence, to the Attendance Strategy Manager, who will, if it is deemed appropriate[4], authorise and refer on to Leicester City authority[5]. On receipt, the Children’s Hospital School (CHS) will scrutinise all referrals to ensure compliance with the service level agreement and then initiate action directly with the pupil and carers. Schools should continue setting appropriate work and giving appropriate feedback and support to pupils while referrals for CHS support are considered. Internal procedures should ensure that no more than 15 working days elapses between the referral to the Education Welfare Service by the school, and the provision of CHS support, or notification to the family that the case does not meet the criteria for CHS support.
3.4       Home tuition will not be agreed without careful consideration and discussion with the family. It will always be supported by a Personal Educational Plan which includes a strategy for reducing reliance on individual teaching at home where this is consistent with the young person’s difficulties. Alternatives to home tuition, for example, support from relevant support services, will be considered before a referral to CHS is agreed.
3.5       Locality based teaching will be explored where young people are on extended periods of support through either the day school, or home tuition. Local area school partnerships could take a lead in developing such provision with guidance from CHS and budgets delegated from the local authority.
3.6       Once a referral to the service has been agreed, the service will write to both school and family setting out the general terms of their involvement, and a point of contact with the service.


4.1 The following services are required:

  • provision for pupils whilst in hospital as in-patients (which offers continuity with what the child is learning in their mainstream school);

  • home tuition for pupils who by reason of medical needs are unable to attend either their mainstream school or the Children’s Hospital School day school;

  • a day school for pupils who by reason of medical needs are unable to attend a mainstream school;

  • guidance and consultancy to the authority and its schools in order to assist in the meeting of statutory requirements and best practice in meeting the educational needs of children and young people with medical needs;

  • places available as per demand.


5.1 The school provision offered will be expected to meet the following general requirements and objectives in so far as it is possible given a child’s medical condition:-

  • To provide a high standard of education which is consistently being updated to meet the needs of the children;
  • A curriculum that enables children to succeed;
  • Education that can offer academic, vocational and leisure as part of the curriculum as appropriate and addresses all five outcomes[6] of the Every Child Matters framework;
  • Offer a range of external examinations opportunities and vocational courses;
  • Provide a safe, secure and caring environment;
  • Offer links with the wider community;
  • Enable young people to achieve as much as they can;
  • For all children to make measurable progress;
  • Children and Young People with medical needs are not at home without access to education for more than 15 working days.

5.2 For children who are in-patients, the school will normally liaise with the child’s mainstream school to ensure that progress is made towards a child’s school based programme of study. The hours of teaching will vary according to a child’s medical condition but will normally deliver two sessions per day.

5.3 For children who are in receipt of home tuition, the Hospital School will normally liaise with the child’s mainstream school to ensure that progress is made towards a child’s school based programme of study. Except in agreed[7] unusual circumstances, a pupil will be timetabled to receive an entitlement of 5 hours per week. Where a pupil is in year 11 and is approaching public examinations and would benefit from additional support, the time allocated will be increased in so far as staffing and resources permit.

5.4 For children, who attend day school, the Hospital School will normally liaise with the child’s mainstream school to ensure that progress is made towards a child’s school based programme of study, except where it is agreed[8] that a child in Key Stage 4 is not likely to return to their mainstream school. In these circumstances the Children’s Hospital School will determine an appropriate programme of study. All children attending school have an entitlement to receive full time education appropriate to their age and stage. Where a young person’s medical condition is such that s/he is not able to manage full time education an agreed specified time allocation will be established through discussion.

5.5 All children and young people attending the hospital school will continue to be on the role of a mainstream school and have dual registered status. The mainstream school will be considered and the main school and the Hospital School the subsidiary school for the purpose of recording attendance and absence. Details are included in Appendix 3.


6.1 The following specific requirements must be met:-

6.2 The Hospital School will:-

·         Liaise with a child’s mainstream school to ensure that:
-      the programme of study will facilitate a child’s return to that school.
-      the school receives regular progress reports.
-      the school receives regular attendance reports.
-      the child’s return to school is supported.

·            Liaise with officers of the County Council:
-      agree the terms of a child’s placement in day school or receipt of home tuition.
-      to report on a child’s attendance and progress (not in-patients).
-      to vary the terms of a child’s original placement
-      Provide regular reports summarising county pupils being supported by the school.

·            Liaise with Health Care Services e.g. Child and Adolescent Mental Health Services, Occupational Therapy, Physiotherapy and other agencies to share information about individual cases.

6.3 Recoupment will be termly in accordance with the City Council agreement for all recoupment between the two authorities.  A schedule of County children’s names, dates of birth, home address, mainstream school, and dates when tuition was provided, will be kept by the Hospital School and reported to the County Council. A suitable proforma is included in appendix 2.


Parents and carers hold key information and knowledge and have a crucial part to play. They should be full collaborative partners and should be informed about their child's educational programme and performance[9].

7.1 Children and young people also have a right to be involved in making decisions and exercising choices.    

7.2 Wherever possible, parents, carers and pupils are informed about the education available before a child is admitted to hospital. Booklets and leaflets will be available to provide information about educational and medical services and about the organisation of the hospital day.

7.3 All parent and carers are consulted before teaching begins at home and offered advice and support during the child's illness. Parents' and carers' views of their child's education are taken fully into account when planning programmes. Parents and carers are encouraged to provide additional liaison with the pupils' home school both at the beginning and end of a stay in hospital and with the hospital school tutor. The positive involvement of parents with the school once the child has returned to school provides reassurance for the child, teachers and parents themselves and promotes rapid and effective reintegration.

7.4 In the case of a child or young person in public care the local authority, as the corporate parents, is responsible for safeguarding and promoting their welfare and education.

7.5 Parents should have a named contact within both the home school and the Children's Hospital School for all issues relating to their child's education.

7.6 Parents may decide not to accept the offer of home teaching.

7.7 The Local Authority may withdraw support if it believes the arrangements to be ineffective. It will always consult with the family and other partners before withdrawing the service.


7.1 It shall be the responsibility of Leicestershire County Council to arrange for and meet the costs of transporting pupils to the Hospital School.


9.1 This will be undertaken with the City Council to ensure that the service continues to meet the needs of both City and County Children and Young People. It will focus on learning outcomes of children and young people using the service, the views they and their parents have of the service, and the views of other stakeholders, including schools. Monitoring and evaluation will be led by the Named Officer (see section 9).

9.2 The Hospital School will provide information pupils attending the provision each term. A proforma for this purpose is included in appendix 2. The one return will be used for both monitoring and recoupment. The information should be sent to the named officer, Attendance Strategy Manager, Principal Educational Psychologist, and Special Needs Assessment Service.


10.1 The named officer with responsibility for the provision of education for children and young people who are unable to attend school because of medical needs in Leicestershire, is:
                        Dr Charles Palmer, Head of Specialist Education Services,
                        Leicestershire Children and Young People’s Service,
                        County Hall, Glenfield, Leics, LE3 8RF.
                        Telephone 0116 305 6767

10.2 The named officer will appoint a representative to sit on the governing body of the hospital school.


11.1 Appendix 1 includes an action plan covering work related to the further development of provision for Children and Young People with Medical Needs.

11.2 The action plan and policy will be subject to regular review.


Code of Practice No 18: Management of Children’s Toileting Needs, January 2005, Leicestershire County Council

Code of Practice No 5: The Voluntary Administration of Medicines, January 2005 Leicestershire County Council

Access to Education for Children and Young People with Medical Needs, DfES 0732/2001 (
Managing Medicines in Schools and Early Years Settings, DCSF 2005

Appendix 1: Action Plan

Area of Work
Specific Action
Who, by when
ICT and VLE support for children with ill health should be developed

Develop service level agreement with Hospital School

Time limited nature of mental health provision needs discussing with Specialist CAMHS

Develop local area working to enable Hosp Schl staff to better support local schools and families

Appendix 2: Annual Return on  County Pupils

Pupil Name
Mainstream School
Home Address
Pupil Needs
Date Start
Date Finish

Appendix 3: Pupil Registration and Attendance Management

Extract from DCSF guidance (2009) on attendance codes:[10]

Dual registration (i.e. pupil attending other establishment)
Statistical Meaning
Approved Educational Activity
Legal Meaning
Attending approved educational activity      
Physical Meaning
Out for whole session
DCSF Definition

The law allows for dual registration of pupils at more than one school. Where a pupil is dually registered at institution X and Y, institution X marks the pupil approved educational activity while they are attending institution Y and vice-versa. Both institutions share responsibility for the child. Failure to attend either institution at the proper time without good reason is unauthorised absence.

Additional useful information:
This code is to be used when a pupil is dually registered at two schools and, for the session in question, they are not required to attend your school.
The school where the child is expected to attend is responsible for accurately recording the pupil’s attendance and chasing up non-attendance.
Pupils who are dually registered at two schools should be registered as such in both schools’ information management systems (MIS) under “pupil enrolment status”. For example - A student who is on roll at school A but attending school B (which could be the PRU or a special school).
·         School A - record M (Main – dual registration)
·         School B – record S (Subsidiary – dual registration)
This code can be used for Traveller children when it is known that:
·          they are attending another school; and
·          are dually registered at both schools.
It should NOT be used unless these two conditions are met.
Schools should ensure that they have in place arrangements whereby the school where the pupil is scheduled to be can notify the “other” school of any absences by individual pupils so that both schools can record the pupil absence using the relevant absence code.  For safeguarding and educational reasons, one of the schools must follow up all unexplained and unexpected absence in a timely manner, such as through “First Day Calling” procedures.
Approved Educational Activity must be supervised by someone approved by the school.  It must also take place during the session for which the mark is recorded.

Appendix 4: Evaluation of casework undertaken prior to hospital school referral

This schedule is designed to assist the evaluation of case work support to a family where a young person has an ongoing medical need that may require hospital school support. It seeks to ensure that all alternatives have been explored before a referral to the hospital school is considered.
The scheduled should not be used where young people are in-patients or already on a fast track procedure for chronic conditions.

Evidence Cited
Scoring Criteria

1. Assessment of Need

1. Limited evidence of action
2. Satisfactory evidence of action
3. Good evidence of action

2. Exploration of Support from other agencies

1. Limited evidence of action
2. Satisfactory evidence of action
3. Good evidence of action

3. Design and Implementation of support programmes

1. Limited evidence of action
2. Satisfactory evidence of action
3. Good evidence of action

4. Monitoring and evaluation of support programmes

1. Limited evidence of action
2. Satisfactory evidence of action
3. Good evidence of action

Continues on next page
5. Think family focus to support

1. Limited evidence of action
2. Satisfactory evidence of action
3. Good evidence of action

6. Resources committed to support

1. Limited evidence of action
2. Satisfactory evidence of action
3. Good evidence of action

Appendix 5:

[1] DfES/0025/2002 includes a summary of the fuller guidance issued in 2001 (
[2] 3 weeks equates to 15 working days
[3] Where ever possible the medical evidence should be from the consultant with responsibility for the child’s condition.
[4] The Attendance Strategy Manager will evaluate previous case work support using the schedule in appendix 4.
[5] Where the child or young person attends a hospital other than LRI- individual arrangements will be made with local services by the attendance strategy manager.
[6] Staying safe; being healthy; enjoying
 and achieving, achieving economic well-being, making a positive contribution
[7] Agreed should be taken to mean agreed by all relevant parties: CHS, mainstream school, EWO, parent, and clinician.
[8] As footnote 5

[9] This section of the policy has been based on Leicester City’s policy, permission sought.

the reason given for its absence from the website is that it is a draft policy an investigation of properties suggests that they have had from 20 October 2009 12:46:00 to move to the final document.

I also wonder if the excuse is reasonable and removes their responsibility to have information available completely.

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