Chapter 3 - Developing Policies and Procedures for Supporting Children and Young People with Healthcare Needs - NHS Board and Education Authority Agreements and Policies
Local strategic joint agreements
76. As set out in chapter 2, it is for NHS boards to ensure that appropriate agreements are in place with the relevant education authorities which determine the respective responsibilities of each in relation to supporting the healthcare needs of children and young people in schools in their areas. The responsibility of facilitating and securing these agreements usually falls to the senior management team in each NHS board area.
77. In establishing local strategic joint agreements, effective communication is required between all parties involved to ensure that they are based on a sound understanding of the local context, resources available and the needs of children and young people in the area. It is good practice for children, young people, their parents or carers, and the wider education and health community to be consulted in the development of any local agreements. Such agreements may cover:
- Funding arrangements between NHS boards and education authorities to provide appropriate healthcare support in schools for children and young people with specific healthcare needs e.g. tracheostomy, intermittent catheterisation, etc.;
- The allocation of other resources including staff;
- Local procedures and protocols including, for example, the arrangements for training between NHS boards, education authority and staff in schools;
- When the agreement should be reviewed.
78. The local strategic joint agreements will complement or form part of the local arrangements in place for children's services planning and should reflect the principles of Getting it Right for Every Child. Further, in line with the anticipatory duty to make reasonable adjustments under the Equality Act 2010 for children and young people with disabilities, the joint agreements should enable NHS boards and education authorities to respond quickly to any request to help support healthcare needs in schools. NHS boards may wish to establish consistency in the arrangements that they make with the different education authorities in their area.
Policy framework on supporting children and young people with healthcare needs in schools
79. Based on these local strategic joint agreements, a clear policy framework should be developed to guide all staff across the NHS board and the appropriate education authority, on the local arrangements in place for supporting children and young people with healthcare needs in schools within the education authority area. The policy framework should ensure that reasonable steps, and where appropriate reasonable adjustments, are taken to support those healthcare needs to enable children and young people's attendance and participation in their learning.
80. The policy framework agreed between the NHS board and the appropriate education authorities might set out or include the local policies and procedures on a range of issues, for example:
Under rights and responsibilities:
- the roles and responsibilities of those involved in supporting healthcare needs in schools;
- children and young people's rights and the rights of parents;
- the responsibilities of young people and their parents;
- who is responsible for the training of staff in supporting the healthcare needs.
Under policy and practice or procedures:
- policy on identifying, meeting and keeping under review the additional support and wellbeing needs of children and young people including those with complex healthcare or medical needs;
- procedures for the administration of medicines in schools including the procedures for children and young people taking their own medication;
- storage and access to medication including the arrangements for children and young people carrying their medication themselves;
- procedures for notifying parents or carers of outbreaks of infections and other diseases particularly when children with certain health conditions have an increased risk of complications;
- emergency procedures and emergency contact information;
- details about the local arrangements and policies in place about the use of salbutamol inhalers (see Annex A) or defibrillators for use in emergencies.
Under individual arrangements:
- the arrangements for managing the transition of children and young people with healthcare needs e.g. from early learning and childcare provision to primary school, from primary school to secondary school, and from secondary school to further learning, training or employment;
- arrangements for the management of certain health conditions e.g. asthma, diabetes and epilepsy;
- circumstances where an individual healthcare plan or child's plan will be required, who will be involved and when will it be reviewed;
- arrangements for record keeping including standard written consent forms/templates;
- the circumstances in which children may take non-prescription medication, e.g. painkillers for managing headaches and period pain;
- the circumstances, related to ill-health under which children and young people should not attend school.
Under governance and accountability
- details about the authority's indemnity/insurance arrangements;
- arrangements for risk assessments including the arrangements in relation to school trips and other activities outwith school such as work placements, young people attending college as part of the arrangements made for their learning, or learning with a private or third sector training provider;
- where concerns should be directed and how they are handled;
- when local policies and procedures should be reviewed.
The allocation of support staff to meet the healthcare needs of children and young people in schools
81. The NHS board and education authority are required to consider their respective allocations of staff to support the healthcare needs of children and young people. Under the Equality Act 2010, the duty to make reasonable adjustments is anticipatory and so workforce planning is particularly relevant in regard to children and young people with complex healthcare and medical requirements. Workforce planning should take into account the evolving needs of the population that NHS boards and education authorities are mutually responsible for, take into account planning at points of transition, and cover for staff illness. Planning should also take into account cover to enable staff to attend training.
Training and development of staff to support healthcare needs in schools
82. NHS boards and education authorities should work collaboratively to ensure that all staff receive an appropriate level of training to understand and respond to both the educational and health needs of children and young people for whom they are responsible. Training requirements should be planned for and driven by the individual needs of children and young people in the schools in the area. However, education authorities and NHS boards also need to have arrangements in place to ensure that training can be provided for those children and young people with newly identified or fluctuating needs.
83. In many instances it will be the community children's nurse, AHP, or community paediatrician that provides or delivers the training - although training may also be delivered by third sector or private organisations with the appropriate responsibility and/or accreditation for providing suitable training. Where agreed evidence based training standards or competencies for the management of certain conditions exist, such as for the emergency treatment of epilepsy seizures or diabetic hypoglycaemia episodes, it is expected that all training will conform to these standards. More generally, all practitioners are encouraged to use the Common Core of best practice values and skills for engaging effectively with children and young people  .
84. The NHS board and the education authority should develop a programme of appropriate refresher courses to ensure that staff competencies remain current and that they understand the legal duties relevant to their role. Training should also be monitored and supported via effective record keeping. Where appropriate, and particularly in regard to the staff whose job it is to meet specific healthcare needs, any training should be signed off by both the trainer and the staff member.
85. General awareness raising training of common conditions should be provided to ensure that staff in schools have a basic understanding of these, can recognise symptoms, and seek appropriate support. Common medical conditions include, for example, asthma, diabetes, epilepsy, eczema and allergic reactions (including anaphylaxis). General awareness-raising training about less common conditions may also be provided if there are children or young people in the area diagnosed with that condition. This will help ensure that the needs of those children and young people can be met as fully as possible. Such training may be planned in partnership with the children, young people and their parents/carers who are involved.
Education Authority indemnification/insurance
86. Education authorities should ensure that their insurance/indemnification arrangements provide full cover for their staff who meet healthcare needs or administer medication within the scope of their employment. Education authorities must satisfy themselves as to the legality and safety of arrangements they have in place and recognise that the need for support for children. For example, as full and up to date training is a requirement of the indemnity/insurance arrangements, in all cases, an appropriate healthcare practitioner should deliver training to staff and confirm competency of staff on completion of the training and then on a regular basis. All staff involved in supporting children and young people with healthcare needs need to be clear about their responsibilities, and how often training should be undertaken. This will provide reassurance to all concerned about the protection and support they will receive in the event of any allegation of fault. Detailed records about the administration of medicines and other actions taken to support healthcare needs should be kept as these records provide evidence of whether procedures have been followed.
87. Any difficulties in securing indemnification/insurance to meet the needs of children and young people should be flagged up immediately with the NHS board for joint consideration of the arrangements that should be made for supporting those needs.
Sharing information and confidentiality
88. NHS Boards and education authorities must consider the existing legislative and policy framework  to ensure that they effectively share information to enable children and young people's needs to be met at school, whilst ensuring that the personal information is handled securely and appropriately and is only disclosed when necessary. A data sharing agreement ( DSA) should be put in place between organisations setting out what personal data will be shared and how it will be shared. All processes must respect a child's right to confidentiality as provided by Article 8 of the European Convention on Human Rights, and set out the considerations that should be taken into account before information is passed on, including arrangements for seeking the views of the child.
89. Where there are any concerns regarding the educational provision or support of children and young people with healthcare needs, the aim will be to resolve any disagreements as early and at as local a level as possible. Concerns should be raised with the school management team in the first instance, but, children over 12 with capacity, young people and parents have the right to access more formal processes of dispute resolution  for issues related to additional support for learning and discrimination. There is an extension of the rights of children under the Additional Support for Learning Act from January 2018. These include mediation, independent adjudication or consideration by the First-Tier Tribunal. Further information is available from Enquire, the national information and advice service for additional support for learning, at http://www.enquire.org.uk.
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