The case study looks at ensuring a child with medical conditions is able to access school full-time.

The parent contacted the SENDIASS helpline regarding their child aged 4 who has an EHC plan in place and is attending a mainstream primary part-time (reception year). 

The parent originally contacted SENDIASS for advice on challenging the plan and to appeal the named school as the family believed a specialist primary school is the most suitable educational setting for their child. 

SENDIASS provided advice, support and resources on appealing to the SEND tribunal including relevant paperwork and tribunal guides. During the initial conversation, the parent stated that they also wanted to appeal other contents of the plan, namely section G which is about health provision. 

The child has a health condition and needs a catheter, which needs to be changed every three hours. This health need is stated in the EHC plan but there is no mention of the provision required (trained staff) to support the child with this need. It clearly affects education as without this health provision taking place, the child would not be able to spend longer than three hours in school. 

At the time of the query, the child was only attending for up to one hour per day in school, so it was not yet an issue. But the parent knew that without support in place, any school would not be able to successfully escalate the child to full-time education. The query was that, without it being stated in the EHC plan, would that particular health provision be delivered? 

Does the provision educate and/or train?

If a child/young person (C/YP) with an EHC plan has a health need, which requires provision, the first thing to consider is whether that health provision educates and/or trains. If so, the health provision should be included in Section F of the EHC plan [paragraph 9.73 of SEND Code of Practice]. Section F of the EHC plan details the special educational provision required. An example of a health provision which educates and trains, and therefore be included in section F, is speech and language therapy. 

In this child’s case, the health provision cannot be considered to educate or train and it is not a health need related to his SEN. However, it is a health need, which requires management in an educational setting. Therefore, if it was to be included in the EHC plan, the health need is to be detailed in section C (my health care needs) and the corresponding provision belongs in section G (my health care provision). 

How to include health needs and provision in an EHC plan

Any health needs/provision that is included in an EHC plan, especially in this case where the health need does not relate to the child’s SEN, must first be agreed by the local health body, usually the Integrated health care board known as the ICB (previously known as Clinical Commissioning Group- CCG). The local authority cannot choose to include health needs/provision in these sections of the plan without this prior agreement.

Some examples of health provisions which may be agreed by the ICB in section G could be: 

• Medical treatments
• Physiotherapy
• Nursing support
• Wheelchairs
• Continence supplies
• Specialist equipment

ICB or NHS England is responsible for arranging all the health care provision in section G of an EHC plan once it has been agreed [paragraph 9.141 The Code details the duties on the health service to maintain the health care provision in the EHC plan.

Relevance to case study

For the child that would mean that the parent could not go back to the EHCP team about this point. There would be the requirement to go back to the consultant/health body to request agreement that this provision be included in the plan. The concern was that this would be time consuming and cause delays to the child’s increased time whilst in the mainstream school. 

There was no concern about the specialist school being able to deliver this health provision. The parent confirmed the preferred school has a full-time school nurse, who is already trained in changing these types of catheters. However, realistically, an appeal for specialist would take several months until the hearing and there is no guarantee of the outcome of the hearing. Therefore, it is safe to say the child would be in the mainstream setting for at least the remainder of this academic year. Health planning would need to take place immediately in order to facilitate their attendance at the current school.

SENDIASS advised that another way forward was to look at duties under section 100 of the Children and Families Act 2014 (C&FA) which requires certain types of schools to make arrangements for supporting pupils with medical conditions. 

The key aim of the duty is to: “ensure that all children with medical conditions, in terms of both physical and mental health, are properly supported in school so that they can play a full and active role in school life, remain healthy and achieve their academic potential.” 

The guidance contains a mix of statutory and non-statutory guidance which is meant to assist schools in meeting that duty. There is an expectation that a child with a medical need will have an ‘Individual healthcare plan’ (this is separate to an EHC plan - a child can have an individual healthcare plan without an EHC plan). There is information as well as a flow chart in the guidance on the steps a school should be taking to develop the Individual healthcare plan.

Link to the guidance 

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/803956/supporting-pupils-at-school-with-medical-conditions.pdf

Relevance to the case study

Duties under s.100 C&FA mean that the child’s school have a duty to identify and support their medical needs to allow them to play a full and active role in school. Even though currently the child is only attending part-time, the school should be engaging in forward planning on how this medical need will be met – this may include getting medical information from parents, contacting health professionals regarding relevant training to deliver the required health provision, identifying or employing staff to carry out the provision and working with the local authority on any issues which may affect the school’s ability to meet this duty. 

”SENDIASS’s next steps were to explain this to parents and to inform the school SENCO of duties under s.100 C&FA. Liaising with both, SENDIASS supported the start of the process which then school and parents can continue between them. 

SENDIASS also informed school about the duties of the Local Authority which are stated in the guidance (p.15): “Local authorities should provide support, advice and guidance, including suitable training for school staff, to ensure that the support specified within individual healthcare plans can be delivered effectively. Local authorities should work with schools to support pupils with medical conditions to attend full-time.”

The reality is that sometimes it may take a while for schools to be able to access relevant training from the NHS. This is why the health planning needed to start early, so that when the child increased their time in school, the health provision they required would be already in place. 

The outcome of this course of action is not yet completed as it is still ongoing with regards to setting up the individual healthcare plan, accessing training etc.

The family are also still in the process of preparing for mediation, with SENDIASS support, and then will be appealing to the Tribunal if issues are not resolved in the mediation meeting (the main point is the part I appeal, but parents are appealing other contents of the plan as well). 

Regardless of the outcome of the appeals process, it is reassuring for the parent to know that planning has started to support their child’s health care needs in an educational setting. 

This case study allowed SENDIASS to extend knowledge on law around health care needs and provision in an EHC plan, as this is not a common query. 

More importantly this led to learning by SENDIASS that it is not always appropriate to only focus on the law surrounding EHC processes and appeals procedures (namely part 3 of C&FA which has to do with EHC plans). Depending on the case, circumstances and timescales, other legal duties may be more relevant and should be relied upon. 

This case led SENDIASS to explore the duties under S.100 C&FA and the knowledge gained will allow the SENDIASS advisor to inform other parents/young people accessing the service with queries of a similar nature. 

The particularly interesting side of this legal duty is that is covers ‘mental health’ and states this clearly in the introduction: “The aim is to ensure that all children with medical conditions, in terms of both physical and mental health, are properly supported in school…” 

Further down in the introduction it states:

“In addition to the educational impacts, there are social and emotional implications associated with medical conditions. Children may be self-conscious about their condition and some may be bullied or develop emotional disorders such as anxiety or depression around their medical condition. In particular, long-term absences due to health problems affect children’s educational attainment, impact on their ability to integrate with their peers and affect their general wellbeing and emotional health. Reintegration back into school should be properly supported so that children with medical conditions fully engage with learning and do not fall behind when they are unable to attend. Short-term and frequent absences, including those for appointments connected with a pupil’s medical condition (which can often be lengthy), also need to be effectively managed and appropriate support put in place to limit the impact on the child’s educational attainment and emotional and general wellbeing.”

The above is particularly of interest because it states that schools do have a responsibility to support children not to fall behind with learning if they are not able to attend due to health/mental health conditions. SENDIASS gets frequent queries about this issue, with schools not providing schoolwork during times when pupils are unable to attend due to mental health issues, anxiety and similar for both short term and longer term emotionally based school avoidance (EBSA). 

SENDIASS will undertake further learning about s.100 C&FA to provide parents accessing the service with more comprehensive advice. 

The SENDIASS website for parent/carers, YP’s and professionals has lots of relevant information with links, podcasts and factsheets. https://www.iasmanchester.org 

There are several ways parent/carers can gain information and knowledge. SENDIASS Manchester Information is shared verbally through volunteer parent groups:

1. Manchester Parent Carer Forum – For Parents and Carers of Children and Young People with Special Educational Needs and Disabilities (SEND) Aged 0-25 in Manchester , 
2. Manchester Parent Champions (on Facebook)
3. Manchester's Local Offer  
4. The SPACE Group | Help & Support Manchester           

SENDIASS also attends local drop-ins in North, Central and South Manchester 

SENDIASS is contactable on the 24-hour answerphone call back service 0161 209 8356 , email sendiass@manchester.gov.uk and via our contact page through the website Contact us (iasmanchester.org)