For the purposes of this document a child, young person, pupil or student is referred to as a ‘child’ or a ‘pupil’ and they are normally under 18 years of age.
Wherever the term ‘parent’ is used this includes any person with parental authority over the child concerned e.g. carers, legal guardians etc.
Wherever the term ‘Head teacher’ is used this also refers to any Manager with the equivalent responsibility for children.
Wherever the term ‘school’ is used this also refers to academies and Pupil Referral Units (PRU) and references to Governing Bodies include Proprietors in academies and the Management Committees of PRUs and will usually include wrap around care provided by a setting such as After School Clubs and Breakfast Clubs.
2 Statement of Intent
This Policy is based on the statutory Department for Education (DfE) guidance document ‘Supporting pupils at school with medical conditions: Statutory guidance for governing bodies of maintained schools and proprietors of academies in England’ (April 2014; Revised December 2015) to coincide with the application of section 100 of the Children and Families Act 2014 which came into force on 1 September 2014. Section 100 places a statutory duty on governing bodies to make arrangements to support pupils at school with medical conditions. It will be reviewed regularly and made readily accessible to parents, staff and, where appropriate, other adults working or volunteering in school.
The governors of Storth CE Primary School (hereinafter referred to as ‘the school’) believe that all children with medical conditions, in terms of both physical and mental health, should be properly supported in school so that they can play a full and active role in school life, remain healthy and achieve their academic potential including access to school trips and physical education (PE).
We understand that the parents of children with medical conditions are often concerned that their child’s health will deteriorate when they attend school because they may not receive the on-going support, medicines, monitoring, care or emergency interventions that they need while at school to help them manage their condition and keep them well. This school is committed to ensuring parents feel confident that effective support for their child’s medical condition will be provided and that their child will feel safe at school by putting in place suitable arrangements and procedures to manage their needs. We also understand that children’s health needs may change over time, in ways that cannot always be predicted, sometimes resulting in extended absences and our arrangements take this into account. We undertake to receive and fully consider advice from involved healthcare professionals and listen to and value the views of parents and pupils. Given that many medical conditions that require support at school affect a child’s quality of life and may even be life-threatening, our focus will be on the needs of each individual child and how their medical condition impacts on their school life, be it on a long or short-term basis.
In addition to the educational impacts, we realise that 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.
Local Authorities have a duty to arrange suitable full-time education (or part-time when appropriate for the child’s needs) for children who are unable to attend a mainstream or special school because of their health. This duty applies to all children and young people who would normally attend mainstream schools, including Academies, Free Schools, independent schools and special schools, or where a child is not on the roll of a school. It applies equally whether a child cannot attend school at all or can only attend intermittently. Further guidance on the Local Authority duty can be found in DfE statutory guidance ‘Ensuring a good education for children who cannot attend school because of health needs’ (January 2013).
We fully understand that reintegration back into school needs to 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 the support we have in place is aimed at limiting the impact on a child’s educational attainment and emotional and general wellbeing.
This school also appreciates that some children with medical conditions may be disabled and their needs must be met under the Equality Act 2010. Some children may also have special educational needs or disabilities (SEND) and may have an Education, Health and Care (EHC) plan (previously known as a Statement of Special Educational Needs) which brings together health and social care needs, as well as their special educational provision. For children with special educational needs or disabilities (SEND), this Policy should be read in conjunction with our SEND Policy and the DfE statutory guidance document ‘Special Educational Needs and Disability: Code of Practice 0-25 Years’, January 2015.
3.1 Local Authority
This school understands that our Local authority must arrange suitable full-time education (or as much education as the child’s health condition allows) for children of compulsory school age who, because of illness, would otherwise not receive suitable education.
Local authorities should:
• provide such education as soon as it is clear that the child will be away from school for 15 days or more, whether consecutive or cumulative. They should liaise with appropriate medical professionals to ensure minimal delay in arranging appropriate provision for the child;
• ensure that the education children receive is of good quality, as defined in statutory guidance, allows them to take appropriate qualifications, prevents them from slipping behind their peers in school and allows them to reintegrate successfully back into school as soon as possible;
• address the needs of individual children in arranging provision. ‘Hard and fast’ rules are inappropriate: they may limit the offer of education to children with a given condition and prevent their access to the right level of educational support which they are well enough to receive. Strict rules that limit the offer of education a child receives may also breach statutory requirements.
3.2 The Governing Body
The Governing body is legally responsible and accountable for fulfilling the statutory duty to make arrangements to support pupils with medical conditions in school, including the development and implementation of this Policy.
Supporting a child with a medical condition and ensuring their needs are met effectively, however, is not the sole responsibility of one person – it is the responsibility of the Governing body as a whole to ensure that:
• no child with a medical condition is denied admission or prevented from taking up a place at this school because arrangements to manage their medical condition have not been made while at the same time, in line with safeguarding duties, ensure that no pupil’s health is put at unnecessary risk, for example, from infectious diseases;
• there is effective cooperative working with others including healthcare professionals, social care professionals (as appropriate), local authorities, parents and pupils as outlined in this Policy;
• there is clear understanding at this setting’s strategic level and, where relevant, across all partnership workers that:
– Local Authorities (LA) and Clinical Commissioning Groups (CCG) must make joint commissioning arrangements for education, health and care provision for children and young people with SEN or disabilities (S26: Children and Families Act 2014);
– LAs are responsible for commissioning public health services for statutory school-aged children including school nursing, but this does not include clinical support for children in schools who have long-term conditions and disabilities, which remains a CCG commissioning responsibility. When children need care which falls outside the remit of school nurses, e.g. postural support or gastrostomy and tracheostomy care, CCG commissioned arrangements must be adequate to provide the ongoing support essential to the safety of these vulnerable children whilst in school; and
– providers of health services should co-operate with school including appropriate communication, liaison with healthcare professionals such as specialists and children’s community nurses, as well as participating in locally developed outreach and training.
– Ofsted will consider how well a setting meets the needs of the pupils with medical conditions, making key judgements informed by the progress and achievement of these children alongside those of pupils with special educational needs and disabilities, and also by pupils’ spiritual, moral, social and cultural development.
• sufficient staff have received suitable training and are competent before they take on duties to support children with medical conditions;
• staff who provide such support can access information and other teaching support materials as needed.
• funding arrangements support proper implementation of this Policy e.g. for staff training, resources etc.
3.3 The Head Teacher
The Head teacher of this school Simon Brabant has overall responsibility for Policy development and implementation.
To achieve this, the Head teacher will have overall responsibility for the development of IHCPs and will make certain that school arrangements include ensuring that:
• there is a named person (usually the SENDCo) who can be contacted by, and will liaise with the LA and parents in relation to children with health needs – Sonya Robinson
• all staff are aware of this Policy and understand their role in its implementation;
• all staff and other adults who need to know are aware of a child’s condition including supply staff, peripatetic teachers, coaches etc.;
• every effort is made to ensure that the provision offered to the child is as effective as possible and that the child can be reintegrated back into school successfully;
• where a child needs one, an IHCP is developed with the proper consultation of all people involved, implemented and appropriately monitored and reviewed;
• sufficient trained numbers of staff are available to implement the Policy and deliver against all IHCPs, including in contingency and emergency situations;
• staff are appropriately insured and are aware that they are insured to support pupils in this way;
• appropriate health professionals i.e. the school nursing service are made aware of any child who has a medical condition that may require support at school that has not already been brought to their attention;
• children at risk of reaching the threshold for missing education due to health needs are identified and effective collaborative working with partners such as the Local Authority (LA), alternative education providers e.g. hospital tuition, parents etc., aims to ensure a good education for them;
• risk assessments take account of the need to support pupils with medical conditions as appropriate e.g. educational visits, activities outside the normal timetable etc.
3.4 School Staff
Any member of staff may be asked to provide support to pupils with medical conditions, including the administering of medicines, although teaching staff cannot be required to do so. While administering medicines is not part of teachers’ professional duties, they should still consider the needs of pupils with medical conditions that they teach. Arrangements made in line with this Policy should ensure that we attain our commitment to staff receiving sufficient and suitable training and achieving the necessary level of competency before they take on duties to support children with medical conditions.
Any member of school staff should know what to do and respond accordingly when they become aware that a pupil with a medical condition needs help.
Simon Brabant has specific responsibility for the development of IHCPs which are explained in Section 4.3.
3.5 School Nurses and Other Healthcare Professionals
This school has access to a school nursing service which is responsible for notifying the school when a child has been identified as having a medical condition which will require support. Wherever possible, they should do this before the child starts at school and our arrangements for liaison support this process.
While the school nurse will not have an extensive role in ensuring that this school is taking appropriate steps to support pupils with medical conditions, they are available to support staff on implementing a child’s IHCP and provide advice and liaison, for example on training. The school nurse can also liaise with lead clinicians or a child’s General Practitioner (GP) locally on appropriate support for the child and associated staff training needs.
It is recognised that the pupil with the medical condition will often be best placed to provide information about how their condition affects them. This school will seek to involve them fully in discussions about their medical support needs at a level appropriate to their age and maturity and, where necessary, with a view to the development of their long-term capability to manage their own condition well. They should contribute as much as possible to the development of, and comply with, their IHCP.
It is also recognised that the sensitive involvement of other pupils in the school may be required not only to support the pupil with the medical condition, but to break down societal myths and barriers and to develop inclusivity.
Parents are key partners in the success of this Policy. They may, in some cases, be the first to notify school that their child has a medical condition and where one is required, will be invited to be involved in the drafting, development and review of their child’s IHCP.
Parents should provide school with sufficient and up-to-date information about their child’s medical needs. They should carry out any action they have agreed to as part of its implementation, e.g. provide medicines and equipment and ensure they or another nominated adult are contactable at all times.
4.1 Procedure for the Notification that a Pupil has a Medical Condition
While it is understood that school does not have to wait for a formal diagnosis before providing support to a pupil because in some cases their medical condition may be unclear or there may be a difference of opinion, judgements will still need to be made about the support to provide and they will require basis in the available evidence. This should involve some form of medical evidence and consultation with parents. Where evidence is conflicting, it is for school to present some degree of challenge in the interests of the child concerned, to get the right support put in place.
• The procedure(s) school will follow when notified that a pupil has a medical condition. The notification will be treated fully whether it is a medical practitioner through normal channels or a parent with or without a diagnosis. Protocol will be:
• recording of the notification, who made it and based on what evidence;
• who is informed immediately a notification occurs and what steps are taken next – how a decision is made as to whether the child concerned requires an IHCP or not and who is responsible for initiating the IHCP process and developing one. This will include the process of informing parents of any decision not to instigate an IHCP and what other steps school may take instead to provide the right support including any period of or triggers for a review;
• Section 4.3 explains the development of an IHCP;
• transitional procedures for children changing schools or who might be involved in alternative educational provision or attend another educational setting part time. This includes a commitment to having arrangements for children starting school in place in time for the start of the relevant school term or, where a child receives a new diagnosis or moves to school mid-term that every effort will be made to ensure that arrangements are put in place within two weeks.
4.2 School Attendance and Re-integration
Every LA must have regard to the DfE statutory guidance, ‘Ensuring a good education for children who cannot attend school because of health needs’, January 2013 and this school undertakes to liaise with the LA to ensure that everyone is working in the best interests of children who may be affected. Where a pupil would not receive a suitable education at this school because of their health needs, the LA has a duty to make other arrangements, when it becomes clear that a child will be away from school for 15 days or more (whether consecutive or cumulative across the school year).
o There will be a period of re-integration following a return to school after a period of hospital education or alternative provision – this will vary for each child so detail will be difficult, but general principles will be applied:
o The LA will be informed when a child becomes at risk of missing education for 15 days in any one school year due to their health needs;
o We might facilitate a child successfully staying in touch with school while they are absent e.g. email, newsletters, invitations to school events, e-links to lessons, blog style updates by classmates or staff etc. although it is important not to forget those that may not have internet access at home;
o School is committed to plan for consistent provision during and after a period of education outside school and the absent child can access the curriculum and materials that he or she would have used in school;
o School is committed to work with the LA to set up an individually tailored reintegration plan for each child that needs one, actively seeking extra support to help fill any gaps arising from the child’s absence and understand the need under equalities legislation to make any reasonable adjustments to provide suitable access for the child.
4.3 Individual Healthcare Plans (IHCP)
An IHCP is a working document that will help ensure that this school can effectively support a pupil with a medical condition. It will provide clarity about what needs to be done, when and by whom and aims to capture the steps which school should take to help the child manage their condition and overcome any potential barriers to get the most from their education. It will focus on the child’s best interests and help ensure that this school can assesses and manage identified risks to their education, health and social well-being and minimises disruption.
An IHCP will often be essential, such as in cases where conditions fluctuate or where there is a high risk that emergency intervention will be needed and are likely to be helpful in the majority of other cases, especially where medical conditions are long-term and complex. However, not all children will require one. The school, relevant healthcare professional and parent will need to agree, based on evidence, when an IHCP would be inappropriate or disproportionate. If consensus cannot be reached, the Head teacher is considered best placed to and will take the final view. Our flow chart for identifying and agreeing the support a child needs and developing an IHCP is at Appendix A.
The level of detail within an IHCP will depend on the complexity of the child’s condition and the degree of support they need and this is important because different children with the same health condition may require very different support. Where a child has SEND but does not have an Education, Health and Care Plan (EHCP), their special educational needs will be mentioned in their IHCP. Where a child has SEN identified in an EHC Plan, the IHCP will be linked to or become part of that EHC Plan.
In general, an IHCP will cover:
• the medical condition, its triggers, signs, symptoms and treatments;
• the pupil’s resulting needs, including medicine (dose, side-effects and storage) and other treatments, time, facilities e.g. need for privacy, equipment, testing, access to food and drink (where this is used to manage their condition), dietary requirements and environmental issues e.g. crowded corridors, travel time between lessons etc. and being added to the register of asthma sufferers who can receive salbutamol where applicable;
• specific support for the pupil’s educational, social and emotional needs – for example, how absences will be managed, requirements for extra time to complete exams, use of rest periods or additional support in catching up with lessons, counselling sessions etc.;
• the level of support needed, (some children will be able to take responsibility for their own health needs and this is encouraged), including in emergencies. If a child is self-managing their medicine, this should be clearly stated with appropriate arrangements for monitoring;
• who will provide this support, their training needs, expectations of their role and confirmation of their proficiency to provide support for the child’s medical condition from a relevant healthcare professional (where necessary); and cover arrangements for when they are unavailable;
• who in the school needs to be aware of the child’s condition and the support required;
• arrangements for written permission from parents and the Head teacher for medicines to be administered by a member of staff, or self-administered by the pupil during school hours;
• any separate arrangements or procedures required for school trips or other activities outside of the normal school timetable that will ensure the child can participate, e.g. risk assessments;
• where confidentiality issues are raised by the parent/child, the designated individuals to be entrusted with information about the child’s condition; and
• what to do in an emergency, including who to contact, and contingency arrangements. If a child has an emergency health care plan prepared by their lead Clinician, it will be used to inform development of their IHCP.
IHCPs, (and their review), may be initiated, in consultation with the parent, by a member of school staff or a healthcare professional involved in providing care to the child. Partners should agree who will take the lead in writing the plan, but responsibility for ensuring it is finalised and implemented rests with this school.
An IHCP will be reviewed at least annually and earlier if there is any evidence that a child’s needs have changed. This review should also trigger a re-check of any registers held.
4.4 Pupils Managing their own Medical Conditions
After discussion with parents, children who are competent will be encouraged to take responsibility for managing their own medicines and procedures and this will be reflected in their IHCP.
To facilitate this, wherever possible, children will be allowed to carry their own medicines and relevant devices or will be able to access them for self-medication quickly and easily. Children who can take their medicines or manage procedures themselves may require an appropriate level of supervision and this will be reflected in the IHCP too. If it is not appropriate for a child to self-manage, then relevant staff will help to administer medicines and manage procedures for them.
If a child refuses to take medicine or carry out a necessary procedure, staff will not force them to do so, but will follow the procedure agreed in the IHCP as well as inform parents. This is an occurrence that may trigger a review of the IHCP.
The Head teacher has overall responsibility for ensuring that there are sufficient trained numbers of staff available in school and off-site accompanying educational visits or sporting activities to implement the Policy and deliver against all IHCPs, including in contingency and emergency situations. This includes ensuring that there is adequate cover for both planned and unplanned staff absences and there are adequate briefings in place for occasional, peripatetic or supply staff.
Any member of school staff providing support to a pupil with medical needs will receive sufficient training to ensure that they are competent and have confidence in their ability to fulfil the requirements set out in IHCPs. They will need an understanding of the specific medical condition(s) they are being asked to deal with; any implications and preventative measures and staff training needs will be identified during the development or review of IHCPs. It is recognised that some staff may already have some knowledge of the specific support needed by a child with a medical condition and so extensive training may not always be required, but staff who provide support will be included in meetings where training is discussed. The family of a child will often be key in providing relevant information about how their child’s needs can be met, and parents will be asked for their views – they should provide specific advice but will not be the sole trainer.
A relevant healthcare professional will normally lead on identifying and agreeing with school the type and level of training required, and how training can be obtained usually through the development of IHCPs. Healthcare professionals can also provide confirmation of the proficiency of staff in a medical procedure, or in providing medicine and school will keep records of training and proficiency checks.
Staff must not give prescription medicines or undertake health care procedures without appropriate training, which school undertakes to update to reflect any IHCPs. A first-aid certificate does not constitute appropriate training in supporting children with medical conditions, but some training could be very simple and delivered by an appropriate person in school – for example basic training covering school procedures for administering a non-emergency prescribed oral medicine.
In effect there are 3 distinct levels of training required:
Whole school awareness so that all staff are aware of the school’s Policy for supporting pupils with medical conditions and their role in implementing that Policy. Induction arrangements for new staff. If school has pupils on roll with specific medical conditions such as asthma, diabetes, anaphylaxis or epilepsy, training will include some basic information about the conditions staff may have to recognise and deal with, such as ‘How to Recognise an Asthma Attack’ and ‘What to do in the Event of an Asthma Attack’ from Department of Health ‘Guidance on the use of emergency salbutamol inhalers in school’, March 2015 (including using the emergency salbutamol inhaler where you have decided to hold one), and ‘Guidance on the use of Adrenaline Auto-Injectors in Schools’, September 2017, or signposting to where information can be found.
o General competence to administer non-complex oral or topical medicines. This would be delivered in-house.
o Specific competence to manage a specified condition and/or administer complex medicines and/or carry out medical procedures – usually delivered by an appropriate healthcare professional.
o Arrangements for general competence to administer non-complex medicines:
o an awareness of safeguarding issues around Fabricated or Induced Illness (FII) –Guidance provided by the Cumbria Safeguarding Children Partnership (CSCP);
o hygiene requirements e.g. washing hands before handling medicines, using a clean measuring device for oral medicine liquids, ensuring containers are clean before they are stored again etc.;
o pre-administration checks e.g. having the correct record sheet and checking the medicine has not already been administered, child’s identity, child’s medicine (including that the dosage, frequency etc. on any IHCP matches the prescription label), expiry date of medicine, that storage instructions have been adhered to (i.e. if it should be refrigerated that it was in the fridge) etc.;
o procedures for administration e.g. whether the child self-administers, the minimum assistance or supervision required (or as described in the IHCP), what should be done with used administration devices (spoons, oral syringes, self-administered sharps etc.), what to do if a child refuses a medicine etc.;
o recording procedures.
o We will take appropriate advice from a relevant healthcare professional when the development of an IHCP determines a need and update our Policy as required.
o It is a recommendation that the governing body consider providing staff with details of relevant continuing professional development provision opportunities.
4.6 Managing Medicines
This school is committed to the proper management of medicines and there are clear procedures that must be followed.
• Medicines are only to be administered at school when it would be detrimental to a child’s health or school attendance not to do so.
• No child under 16 is to be given prescription or non-prescription medicines without their parent’s written consent – except in exceptional circumstances where the medicine has been prescribed to the child without the knowledge of the parents. In such cases, every effort will be made to encourage the child concerned to involve their parents while respecting the child’s right to confidentiality.
• A child under 16 is never to be given medicine containing aspirin unless prescribed by a doctor. Medicine, e.g. for pain relief, is never to be administered without first checking maximum dosages and when the previous dose was taken. Every effort will be made to contact parents prior to administration, where necessary, to check this and to inform them that pain relief has been given.
• Where clinically possible, medicines should be prescribed in dose frequencies which enable them to be taken outside school hours.
• Only prescribed medicines that are in-date, labelled, provided in the original container as dispensed by a pharmacist and which include instructions for administration, dosage and storage are to be accepted. The exception to this is insulin which must still be in date but will generally be made available to school inside an insulin pen or a pump, rather than in its original container. This may also be the case for certain emergency administration medicines such as a reliever inhaler for the treatment of an asthma attack or adrenalin for the treatment of anaphylaxis. This is to be made clear within a child’s IHCP as appropriate.
• With written parental consent non-prescription medicines can be administered to children e.g. anti-histamines, paracetamol etc. This will only happen in exceptional circumstances e.g. pain relief in an emergency where there will be a significant delay before medical attention can be sought or during a residential trip or where a child requires regular pain relief which doctors refuse to prescribe or where a child does not benefit from a medicine which others can limit to taking outside normal school hours such as the once a day anti-histamine. The head teacher should make decisions on a case by case basis and may need to liaise with the child’s GP or practice nurse to ensure school will be acting appropriately.
• It is best practice for the parent to bring medicines into school and personally deliver them to a named member of staff and Appendix C – Parental Consent to Administer Medicine, contains a parental declaration to that effect. In exceptional circumstances, this may not reasonable (such as in cases where pupils are transported significant distances to school) and any different course of action should be agreed and form part of the IHCP.
• All medicines are to be stored safely, in their original containers and in accordance with their storage instructions. Medicines can be kept in a refrigerator containing food but should be in an airtight container and clearly labelled. Access to a refrigerator holding medicines should be restricted. If large quantities of medicine are kept refrigerated school will consider purchasing a lockable fridge. Children should always know where their medicines are kept and be able to access them immediately they might need them. Where relevant, they should also know who holds the key to any locked storage facility. Medicines and devices such as asthma inhalers, blood glucose testing meters and adrenaline pens are to always be readily available to children and not locked away. Off-site this will be especially considered as part of the risk assessment process for educational visits.
• When no longer required, medicines will be returned to the parent for them to arrange safe disposal. Sharps boxes will always be used for the disposal of needles and other sharps.
4.6.1 Controlled Drugs
The supply, possession and administration of some medicines e.g. methylphenidate (Ritalin) are strictly controlled by the Misuse of Drugs Act 1971 and its associated regulations and are referred to as ‘controlled drugs’. Therefore, it is imperative that controlled drugs are strictly managed between school and parents.
Ideally, controlled drugs should be brought into school daily by parents and the medicine details and quantity handed over be carefully recorded on the child’s own Record of Medicine Administered to an Individual Child sheet (Appendix D). This sheet must be signed by the parent and the receiving member of staff. If a daily delivery is not a reasonable expectation of the parent, supplies should be limited to no more than one week unless there are exceptional circumstances. In some circumstances, the drugs may be delivered to school by a third party e.g. transport escort. In this case, the medicine should be received in a security sealed container/bag.
We recognise that a child who has been prescribed a controlled drug may legally have it in their possession if they are competent to do so but passing it to another child for use is an offence. Monitoring arrangements may be necessary and will be agreed on in the IHCP, otherwise school will keep controlled drugs prescribed for a pupil securely stored in a non-portable container to which only named staff will have access. They will still be easily accessible in an emergency and clear records kept of doses administered and the amount of the controlled drug held in school.
School staff may administer a controlled drug to the child for whom it has been prescribed in accordance with the prescriber’s instructions and a record will be kept in the same way as for the administration of other medicines. It is considered best practice for the administration of controlled drugs to be witnessed by a second adult. The name of the member of staff administering the drug will be recorded and they will initial under ‘Staff initials (1)’. The second member of staff witnessing the administration of controlled drugs will initial under ‘Staff initials (2)’. These initial signatures should be legible enough to identify individuals.
4.7 Record Keeping
School will keep a record of all medicines administered to individual children, stating what, how and how much was administered, when and by whom. Any side effects the pupil experiences are also to be noted.
Where a pupil has a course of or on-going medicine(s) they will have an individual record sheet which a parent should sign when they deliver the medicine (Appendix D: Record of Medicine Administered to an Individual Child).
Where a pupil requires administration or self-administration of a controlled drug they will have an individual record sheet which allows for the signature of a second witness to the administration. Details of receipts and returns of the controlled drug will be accurately recorded on the administration record (see Appendix D).
Where a pupil is given a medicine as a one-off e.g. pain relief, it will be recorded on a general record sheet along with such medicines administered to other children (Appendix E1: Record of Medicine Administered to All Children).
4.8 Emergency Procedures
The child’s IHCP should be the primary reference point for action to take in an emergency. It will clearly state what constitutes an emergency for that child and include immediate and follow-up action.
To ensure the IHCP is effective, adequate briefing of all relevant staff regarding emergency signs, symptoms and procedures is required and will be included in the induction of new staff, re-visited regularly and updated as an IHCP changes. Similarly, appropriate briefings for other pupils are required as far as what to do in general terms i.e. inform a teacher immediately if they think help is needed.
In general, immediately an emergency occurs, the emergency services will be summoned in accordance with normal school emergency procedures and Appendix G.
If a child needs to be taken to hospital, a member of school staff will remain with them until a parent arrives. This may mean that they will need to go to hospital in the ambulance.
4.9.1 School Meal and Wrap Around Care Providers
Our meals contractor assures us that they adhere to all allergen requirements and their staff are suitably trained and made aware of all potential allergens in the foods they provide. They have undertaken to:
• liaise directly with us and take the pupil IHCPs that we share into account when planning menus and allergen management;
• record the ingredients used in each dish to display in the food preparation area, or be readily available to all relevant staff, and keep a copy of the ingredient information on labels of pre-packed foods e.g. sauces, desserts etc.;
• keep ingredients in their original containers, or a copy of the labelling information in a central place, with each product suitably enclosed to prevent cross-contamination in storage;
• ensure allergen information is kept up to date e.g. if foods purchased are changed or products substituted.
Their recipes are analysed and details of allergen contents is available from our kitchen with each menu cycle. This information is available from the contractor’s website
Information is passed to, and we meet regularly with the kitchen team to make sure all dietary requirements and food intolerances are met and catered for. Children with food allergies have an IHCP which is shared as necessary to inform menus and practices.
When setting up or reviewing a child’s IHCP, part of the process includes appropriate information sharing, such as dietary restrictions, with the kitchen team and others. Part of the educational visits planning process written into our risk assessment is to ensure dietary needs are addressed in advance and needs shared appropriately with third party providers like residential centres.
All food handlers receive suitable training on their first day of employment and before food handling duties commence in relation to managing food allergens to include:
• cross referencing IHCPs with ingredients regularly, especially when changing products or recipes;
• handling requests for allergen information;
• how cross contamination can occur and how to prevent it;
• the signs and symptoms of an allergic reaction and what to do, and who to report to should this occur.
4.9.2 Other Food Handlers
Other potential food handlers (food technology, classroom baking, cookery club, nursery and other staff serving snacks and treats etc.), will be made aware of information about the Major Food Allergens, and understand that they must take this into account when planning any food-related activity for children with known allergies.
Staff or volunteers working with food in play or the curriculum will receive sufficient instruction on and follow the good practice outlined in Section 4.10.1 above in managing exposure to allergens.
4.9.3 Emergency Situations
All staff receive (as outlined in Section 4.5 above) basic awareness training in the common medical and health needs that we manage at school. This includes anaphylaxis, the causes, signs, symptoms, and treatment.
There are three brands of adrenaline auto-injector (AAI) device licensed for distribution in the UK. Specific training in administering the Jext, the Emerade, and/or the Epi-Pen has been provided for relevant staff and will always be requested of our first aid providers on first aid courses that our staff attend. We are also able to view appropriate training videos provided by the manufacturer via their websites at any time and trained staff are encouraged to view them regularly.
Procedures are in place to ensure that every child requiring AAIs, and who is deemed competent to by us, carries them on their person at all times with other arrangements in place where impractical e.g. carried by staff in a travel first aid kit on shore whilst canoeing. Arrangements are also in place to ensure that a spare AAI is available in suitable locations depending on the likelihood and severity of an incident of anaphylaxis.
Staff will refer to ‘Guidance on the use of Adrenaline Auto-Injectors in Schools’, September 2017, or KAHSC Safety Series M02 – Managing Anaphylaxis and Allergies for further guidance and useful record keeping templates as necessary.
4.10 Emergency Adrenaline
Anaphylaxis is a severe and often sudden allergic reaction. It can occur when a susceptible person is exposed to an allergen e.g. food or an insect sting. Reactions usually begin within minutes of exposure and progress rapidly, but can occur up to 2-3 hours later. It is potentially life threatening and always requires an immediate emergency response.
From 1 October 2017 the Human Medicines (Amendment) Regulations 2017 allows (but does not require) all schools to buy adrenaline auto-injector (AAI) devices without a prescription, for emergency use in children who are at risk of anaphylaxis but their own device is not available or not working e.g. because it is broken, or out-of-date.
We feel that keeping an AAI for emergency use will benefit children at this school and have decided to purchase and manage devices on a risk assessment basis i.e. one or more depending on likelihood of device failure and need.
Our procedures will ensure that the spare AAI will only be used on pupils known to be at risk of anaphylaxis, and for whom both medical authorisation and written parental consent for use of the spare AAI has been provided.
4.10.1 Steps to Reduce Anaphylaxis Risks
We seek the cooperation of the whole school community in implementing the following to reduce the risk of exposure to allergens.
• Bottles, other drinks and lunch boxes provided by parents for children with food allergies should be clearly labelled with the name of the child for whom they are intended.
• Where we provide the food, our staff will be educated on how to read labels for food allergens and instructed about measures to prevent cross-contamination during the handling, preparation and serving of food. Examples include: preparing food for children with food allergies first; careful cleaning (using warm soapy water) of food preparation areas and utensils.
• Food will not be given to food-allergic children without parental engagement and permission e.g. birthday parties, food treats.
• Trading and sharing of food, food utensils or food containers will be actively discouraged and monitored.
• Training will include that unlabelled food poses a potentially greater risk of allergen exposure than packaged food with precautionary allergen labelling suggesting a risk of contamination with allergen.
• Careful planning for the use of food in crafts, cooking classes, science experiments and special events (e.g. fetes, assemblies, cultural events) with adequate substitutions, restrictions or protective measures put in place (e.g. wheat-free flour for play dough or cooking), non-food containers for egg cartons.
• Careful planning for out-of-school activities such as sporting events, excursions (e.g. restaurants and food processing plants), outings or camps, thinking early about the catering requirements and emergency planning (including access to emergency medication and medical care).
4.10.2 Supplies of Auto-Injectors
We will use the template letter available from www.sparepensinschools.uk, signed by the headteacher, to purchase a reasonable number of AAIs of the brand our pupils most commonly use, in the doses necessary (based on the ‘Guidance on the use of Adrenaline Auto-Injectors in Schools’, September 2017), on an occasional basis (due to their expiry dates averaging 12-18 months) and, in accordance with our assessment of the risks.
4.10.3 The Register and Emergency Adrenaline Kit
The spare AAI in the Emergency Adrenaline Kit may only be used in a pupil where both medical authorisation and written parental consent have been provided.
This includes children at risk of anaphylaxis who have been provided with a medical plan confirming this, but who have not been prescribed AAI. In such cases, specific consent for use of the spare AAI from both a healthcare professional and parent or legal guardian must be obtained. Such a plan is available from the British Society for Allergy and Clinical Immunology (BSACI www.sparepensinschools.uk/plans or www.bsaci.org/about/pag-allergy-action-plans-for-children).
The spare AAI can be used instead of a pupil’s own prescribed AAI(s), if these cannot be administered correctly, without delay. This information will be recorded in the pupil’s IHCP and where they have no healthcare needs other than the risk of anaphylaxis, we will consider only using the BSACI Allergy Action Plan suitable for their prescribed device.
We will compile a register of all children who have a diagnosed allergy and have been prescribed an AAI (or where a doctor has provided a written plan recommending AAI(s) to be used in the event of anaphylaxis) which includes:
• Known allergens and risk factors for this individual’s anaphylactic reaction;
• Whether the individual has been prescribed AAI(s), and if so, what type and dose;
• What type and dose of AAI the individual can receive if they have not been prescribed one of their own, but they do have a written medical plan confirming that an allergen exposure incident could require AAIs to be administered which includes specific consent for use of the spare AAI from both a healthcare professional and parent or legal guardian;
• Whether written parental consent has been given (usually agreed as part of the IHCP) for use of the spare AAI which may be different to the personal AAI prescribed;
• A photograph of each pupil to allow a simple visual check to be made;
The spare AAIs will be stored as part of an emergency anaphylaxis kit which will include:
• One or more AAI(s);
• Instructions on how to use and store the device(s);
• Manufacturer’s information;
• A checklist of injectors, identified by their batch number and expiry date with monthly checks recorded (including the locations of other devices if more are needed);
• A note of the arrangements for replacing the injectors;
• A list of pupils to whom the AAI can be administered;
• An administration record (see Appendix E3).
This kit will be stored with the emergency asthma kit and in other places as necessary because many food-allergic children also have asthma, and asthma is a common symptom during food-induced anaphylaxis.
4.10.4 Storage and Care of Auto-Injectors
It is the responsibility of Susan Goodfellow and Susan Barker to maintain the emergency adrenalin kit ensuring that, on a monthly basis, the AAIs (and sharps box if necessary) are present and appear to be in working order and that replacement AAIs are obtained when expiry dates approach.
AAIs are kept in the office which is a safe and suitably central location, known to all staff, accessible at all times, but which is out of the reach and sight of children. They will not be locked away and will be kept separate from any child’s own prescribed AAI (if stored nearby) and be clearly labelled to avoid any confusion with a child’s own AAI.
Storage will always be in line with manufacturer’s guidelines, usually at room temperature in a cool dark place preferably at 18-26C, and we take into account what the prolonged ambient temperature might be in storage locations during holiday periods without any heating on.
4.10.5 Staff Use and Training
Staff will be trained on managing anaphylaxis in accordance with Section 4.5 above. When staff recognise the signs of anaphylaxis:
• the child should be made as comfortable as possible and their own AAI located, and the spare sent for at the same time;
• the spare AAI will be administered only if the child’s own devices are not functioning, in-date, sufficient, or available;
• the child will be checked against the register for confirmed identity, consents, and dose before administration;
• although all staff have received allergen awareness training which included training videos on AAI administration and there are very clear administration instructions in each kit, where possible, the AAI will be administered by a first aider whose first aid course included AAI practice;
• administration will be recorded in the kit record and on the individual child’s personal administration record (where one is being kept);
• in line with the Department of Health guidance, arrangements will be made as soon as possible to transfer to hospital any pupil that we have administered adrenaline to for further monitoring of their condition;
• parents will be informed about AAI administration through normal emergency contact arrangements as soon as possible, and usually by telephone.
4.11 Day Trips, Residential Visits and Sporting Activities
Through development of the IHCP staff will be made aware of how a child’s medical condition might impact on their participation in educational visits or sporting activities. Every effort will be made to ensure there is enough flexibility in arrangements so that all children can participate according to their abilities and with any reasonable adjustments. This may include reasonable adjustment of the activities offered to all children i.e. changing a less accessible venue for one that is more so but can still achieve the same educational aims and objectives. A pupil will only be excluded from an activity if the Head teacher considers, based on the evidence, that no reasonable adjustment can make it safe for them or evidence from a clinician such as a GP states that an activity is not possible for that child.
A risk assessment for an educational visit may need to especially consider planning arrangements and controls required to support a pupil with a medical condition. The IHCP will be used alongside usual school risk assessments to ensure arrangements are adequate. This may also require consultation with parents and pupils and advice from a relevant healthcare professional.
Sudden cardiac arrest is when the heart stops beating and it can happen to people at any age and without warning. When it does happen, quick action (in the form of early Cardio-Pulmonary Resuscitation – CPR – and defibrillation) can help save lives. A defibrillator is a machine used to give an electric shock to restart a patient’s normal heart rhythm when they are in cardiac arrest. Modern defibrillators are easy to use, inexpensive and safe and this school has one as part of our first aid equipment.
School staff are appropriately trained in its use and the local NHS and ambulance service have been notified of its location.
4.12 Unacceptable Practice
While it is essential that all staff act in accordance with their training, in any given situation they should be confident in using their discretion and judging each case on its merits with reference to a child’s IHCP. It is not however, generally acceptable practice at this school to:
• prevent children from easily accessing their inhalers and medicine and administering their medicines 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 staff will be supported to appropriately challenge this where they have genuine concerns);
• 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 e.g. 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 medicine 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, e.g. by requiring parents to accompany the child.
Staff will be appropriately insured to carry out tasks associated with supporting pupils with medical conditions and the Insurance Policy wording is made available to such staff on request.
The Insurance Policy provides liability cover relating to the administration of medicines and any required healthcare procedures as identified through the IHCP process.
Every IHCP review must consider whether current insurance arrangements remain compatible with any identified changes required. A significant change, for example an entirely new medical procedure required, will be checked as compatible with current insurance arrangements direct with the school’s insurers. If current insurance is inadequate for the new procedure additional insurance will be arranged.
Should parents or pupils be dissatisfied with the support provided they should discuss their concerns directly with the Head teacher (Simon Brabant). If for whatever reason this does not resolve the issue, they may make a formal complaint through the normal school complaints procedure – on website.