Madeleine Murphy

Madeleine Murphy

Schools in England are failing children with medical conditions

7 April 2017

child in school uniform waving the British flag

Schools across England are failing to provide adequate care for children with health conditions, despite a legal requirement to do so, according to data from a charity alliance.

It is a legal requirement in the UK for schools to have a medical conditions policy in place.

The law was introduced as part of the Children and Families Act 2014. On behalf of the Health Conditions in Schools Alliance, of which it is a member, Diabetes UK set out to discover how many schools were meeting this requirement. Of the 200 schools across England that the charity investigated:

  • 132 (66%) failed to demonstrate that they had a medical conditions policy
  • 45 (22.5%) had a policy that missed one or more of nine key statutory requirements (see Table 1) so was evaluated as ‘inadequate’
  • Only 23 (11.5%) demonstrated that they had an adequate medical conditions policy, meeting all nine statutory requirements.

Table 1. Statutory requirements of a school’s medical conditions policy

Provision for training, including a plan for staff absences
Measures for inclusion in all school’s activities, without requiring a parent to attend
Mention of the statutory duty
Procedures for emergency, including a plan to make all staff aware about which children have medical conditions
Procedures for communicating with parents and guardians
Roles and responsibilities
Revision within the last two years
Procedures for management and storage of medication
Mention of Individual Healthcare Plans

That almost 90% of the schools could not present an adequate medical conditions policy is extremely worrying. Potentially life-threatening conditions such as diabetes, epilepsy and asthma affect tens of thousands of children. These conditions often require continual treatment – a child with type 1 diabetes will usually require an injection of insulin at least four times a day. And ongoing treatment doesn’t necessarily prevent medical emergencies: approximately 30% of children with epilepsy have breakthrough seizures despite being on medication. It is recommended that, to stop prolonged seizures from progressing to potentially fatal status epilepticus, children receive rescue medications (benzodiazepines) within 5–10 minutes of seizure onset. But for this to be possible, there must be someone present who is able to administer those medications.

Yet teachers are seldom offered training on epilepsy or seizure management at all, let alone how to administer rescue medications. While some school staff may be trained to administer daily medications, such as insulin injections for children with diabetes, there is a lack of knowledge around how to handle medical emergencies. And children can’t rely on school nurses: according to the Royal College of Nursing – following a 10% drop in the workforce between 2010 and 2016 – there are just 2,700 school nurses in England, providing care for more than 9 million pupils.

Daily struggles for children with health conditions

Children with health conditions face numerous challenges. Parents of children with diabetes have reported that their children have been excluded from activities and after-school clubs. Some have had to sit exams without appropriate support, which can have a hugely damaging effect on their academic development.

For children with epilepsy, dependence on a trained caregiver to administer medication may make them particularly vulnerable to stigmatisation and poor social integration with their peers.

For children with epilepsy, dependence on a trained caregiver to administer medication may make them particularly vulnerable to stigmatisation and poor social integration with their peers. There is also a detrimental impact on parents, who must always be ‘on call’ for their children.

Diabetes UK shared the story of one mother who reported that her son’s school had placed his life in danger. The boy, who has type 1 diabetes and coeliac disease, experienced a low blood sugar episode and his school failed to call an ambulance immediately, calling his mother instead. While the Department for Education acknowledged that the school was at fault, the mother was told that it was up to her to resolve the issue with the school or governors.

Ensuring adherence to the law

But if the Department for Education won’t hold schools accountable for failing to adhere to regulations regarding medical conditions, what incentive is there for them to do so? Will a school wait until a potentially catastrophic incident occurs before implementing the necessary policies?

The Health Conditions in Schools Alliance wants the Department for Education to do more to make schools aware of their legal responsibility to put these compulsory policies in place. It is also calling on Ofsted, the schools inspectorate and regulator, to start checking whether schools are complying with the legislation.

The challenge for schools

Of course, it’s not a case of schools simply not bothering to follow the rules. Across England, schools face serious cuts to resources. Some schools are reported to be considering reducing the number of teaching hours because they cannot afford enough teachers to cover the timetable. Meanwhile, class sizes in UK schools are among the largest in the world; the number of secondary school children in England being taught in classes of over 35 pupils has trebled in the last five years.

With the current crisis in school funding, there have even been reports that mainstream schools may have to turn away pupils with special educational need and disabilities, as they simply do not have the resources to support them.

The need for a whole-system approach

There’s no easy solution. Lack of funding is a problem that permeates every level of society, with both healthcare and education in England facing ongoing cuts. But it is not acceptable for schools to ignore legislation on implementing crucial health conditions policies.

The only way to address this issue is through a whole-system approach, where the education and health sectors work together with parents and children. Policymakers in both health and education must provide joint guidance and ensure schools have the resources to address the needs of children with medical conditions. Many things are inevitably sacrificed when funding is scarce – but children’s safety and right to education must not be among them.


To read more about this topic:

The Health Policy Partnership has published previously on policies relating to the administration of emergency medication for children with epilepsy in schools. See the ‘childhood epilepsy’ section on our Publications page.


The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.