Health and wellbeing

See information and practical advice for parents with children and young people with medical conditions or health needs.

• Medical conditions and support in school
• School policy for supporting children with medical needs
• Childhood anxiety affecting attendance
• Referrals to specialist health services
• Assessment, including diagnosis
• Following assessment
• Help for families with children with special educational needs
• Health and Care Plans
• Reduced or part-time timetables
• School trips for children with a disability or medical condition
• Annual health check for people with learning disabilities

Medical conditions and support in school

Most children miss school on occasion due to short term illnesses, such as colds or sickness. Parents should report this type of absence using the school’s absence procedure.

Some children may not be able to attend school because a medical or mental health condition which affects their school life, whilst others have longer term or intermittent periods of illness and miss a lot of school.

For children with SEND, anxiety or sensory overload are common factors affecting attendance, which are not always easily identified. If you think there may be underlying needs affecting your child’s attendance, discuss and explore with school or college how these might be supported.

Share any relevant information from health professionals with the school and the local authority, particularly if this indicates attendance at school is going to be difficult.

All children and young people deserve to be healthy and happy. Good physical and emotional health plays an important part in helping them to lead a fulfilled life. Section 100 of the Children and Families Act 2014 places a duty on governing bodies of maintained schools, proprietors of academies and management committees of Pupil Referral Units (PRUs) to make arrangements for supporting pupils at their school with medical conditions.

The Department for Education has issued Statutory Guidance and Departmental Advice on supporting pupils at school with medical conditions. The governing bodies of maintained schools, proprietors of academies and management committees of PRUs must have regard to the statutory guidance in this document. This means that they must follow it unless there is a good reason not to.

If your child is considered to be disabled, the school has specific duties under the Equality Act 2010 to make arrangements for that child. See further information about inclusion and disability discrimination.

For pupils with longer absences, the Local Authority is required to follow statutory guidance on ensuring a good education for children who cannot attend school because of health needs. This relates to children and young people who are declared medically unfit for school by a medical professional.

City of York Council offers a medical and physical needs teaching service, part of the Specialist Teaching Team based at West Offices, to children who:

• are of compulsory school age (5 to 16 years old)
• are unable to attend their mainstream school due to their medical or health needs
• have missed more than 15 days of school in the academic year due to their long term medical condition

Referrals to this service are made on the advice of a medical professional who manages the child or young person’s treatment pathway.

A school or college may also refer for advice on supporting children and young people with physical or medical needs.

See further information and contact details for the Specialist Teaching Team.

Schools should also be supporting their pupils by providing a suitable education. This could be through things such as:

• work being sent home
• an IT application for learning
• home tuition
• provision of suitable Health and Care Plans
• a referral to the Specialist Teaching Team at City of York Council

See further information about medical conditions and support in school:

• Handling absence from school (Contact)
• Help at school if a child has medical needs (Contact)
• Illness and school attendance (IPSEA)
• Supporting children with medical needs in school (Child Law Advice)

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School policy for supporting children with medical needs

Every school should have a policy for supporting pupils with medical needs that is regularly reviewed. You should be able to view this policy on the school's website. If not, please ask your child’s school for a copy.

If your child's medical condition is unclear then the school should seek further medical advice, so that a judgement can be made about what support may be needed.

A child or young person doesn’t need a formal diagnosis for schools to offer support.

Read more about attendance and exclusion.

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Childhood anxiety affecting attendance

See attendance and exclusion advice for when your child is struggling to attend, or see further information about inclusion and disability discrimination.

See further information about childhood anxiety affecting attendance:

• anxiety in children (NHS)
• wellbeing support available in local schools (Vale of York Clinic Commissioning Group)

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Referrals to specialist health services

Where a setting, the local authority or health professional are unsure how to support your child, they might suggest you consent to a referral to a specialist service for advice so they can better understand your child’s needs.

You should have the opportunity to speak with or meet any specialist that sees your child. They will explain their role, any observations or assessments they will carry out and what will happen next.

Seeking diagnosis

Taking the step towards seeking diagnosis can often be a relief to both parent and child, who might be feeling different but not understanding why.

It's normal to feel unsure about what to do or even overwhelmed, as a parent you will hear lots of advice and sometimes this can be confusing or even conflicting. You might disagree with your partner about what to do, or feel worried about your child being labelled with a diagnosis.

Some things to consider if seeking a diagnosis:

• what does my child say, do they notice they are different, and how is this affecting them?
• what are the alternatives? Talk these through with school, GP and any other professionals involved.
• what will be the impact of going ahead with a referral, for example will a diagnosis mean we can access support?

Some parents decide to request a referral and then wait and see, using the waiting time (which can be lengthy) as additional time to decide.

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Assessment, including diagnosis

Support for any special educational need in schools is not dependent on a medical diagnosis.

Regardless of the service you have been referred to, there will likely be some element of assessment to go through in order to be able to access these services.

The assessment process may include:

• considering the referral against the service criteria
• information gathering from family and professionals involved
• observations in school, clinic or at home
• diagnostic tools, such as questionnaires
• assessments carried out with your child

See further information about the specialist CAMHS referral process (NHS Vale of York CCG).

Autism assessments

See guidance about the process of an autism assessment (National Institute for Health and Care Excellence).

Attention Deficit Hyperactivity Disorder assessments

See advice and information for parents and young people about ADHD:

• NICE Guidelines on ADHD: diagnosis and management (NG 87)
• ADHD - A Guide for Children (NHS Tess, Esk and Wear Valleys NHS Foundation Trust)
• ADHD assessment process (National Institute for Health and Care Excellence)

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Following assessment

You may receive a diagnosis for your child. It is important to share this information with the education setting.

You could feel really emotional if your child gets a diagnosis and coming to terms with this may take some time, your child may also feel this way and may deal with it differently to you. You and your child may be offered support or therapy from health services.

You might find it helpful to explore national charities offering advice around specific conditions, or local support groups.

Read more about specific conditions and getting a diagnosis:

• NHS Health A-Z
• health and medical conditions, including an A to Z of medical conditions (Contact)
• getting a diagnosis (Contact)
• when your child has a rare diagnosis (Contact)
• support when your child does not have a diagnosis (Contact)
• information about developmental delay (Contact)

See information about making a complaint if you're unhappy with the diagnosis, the assessment carried out or the services or provision offered.

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Help for families with children with special educational needs

The benefits of early identification of special educational needs or disabilities are widely recognised - identifying need at the earliest point and then making effective provision improves long-term outcomes for children.

For children with complex needs identified at birth, after an injury or illness, or through their early years, it's likely that you will have health professionals already working with you. They will let you know if they believe your child has SEN needs or a disability, and can also guide you to other sources of support and information.

If a health professional is of the opinion that a young child under compulsory school age has, or probably has, special educational needs or a disability, they have a duty to inform the child’s parents and bring the child to the attention of the appropriate local authority.

When children start at nursery or school, their parent might be the person who notices differences around development or behaviour. If you have concerns about your child you can talk to their keyworker or teacher about your observations, discuss what support might be needed, and decide next steps together. You can also see your child’s GP and together you might talk about whether to make a referral to a specialist service or paediatrician.

If your child continues to make less than expected progress, the setting may talk to you about a referral to a specialist health service, such as a school nurse or a speech and language therapist. Settings can make a referral into some health services, but not all - the York Local Offer will give you information about health services and how to access them.

Health professionals have a role to play in supporting staff in identifying and planning for special educational needs and disabilities in schools and colleges, and in supporting those with medical conditions. Health professionals, schools, colleges and local authorities should work together to ensure there are clear paths for identifying and supporting children and young people with SEN or disabilities, both with and without Health and Care Plans.

Health professionals such as a school or specialist nurse or therapist may work directly with your child or young person and advise or train settings to manage health conditions such as epilepsy and diabetes, or provide training in schools for techniques such as tube feeding or tracheotomy.

Designated Clinical Officers (DCOs) are the point of contact for local authorities, schools and colleges seeking health advice on children and young people who may have SEN or disabilities. They can support schools with their duties under the Supporting pupils with medical conditions at school guidance (GOV.UK).

See further information about finding help:

• the York Local Offer - ‘Where do I go if?’ guide provides useful suggestions for a number of common queries
• our SEN Support guidance explains the ‘assess, plan, do, review’ cycle of support in schools
• the joint Department for Education and Department of Health publication 0 to 25 SEND code of practice: a guide for health professionals includes advice for clinical commissioning groups, health professionals and local authorities
• chapter 3 of the SEND Code of Practice explains how education, health and social care professionals work together including their roles and responsibilities
• Designated Medical Officer and Designated Clinical Officer resources from the Council for Disabled Children
• The York Local Offer SEND Updates includes information about the Designated Medical Officer or Designated Clinical Officer for SEND in York
• The York Local Offer - Making sense of SEND guide is a useful dictionary of acronyms and unfamiliar words used in SEND
• Hospital and home tuition team information (City of York Council)
• Access to education for sick children (City of York Council)
• Useful websites related to physical and medical needs (City of York Council)
• York’s Local offer - Information about the school’s wellbeing service

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Health and Care Plans

Children may have an Individual Health Care Plan (IHCP) if they have a medical condition. They may have and IHCP and/or an Education, Health and Care Plan (EHCP) if they have special educational needs (SEN).

Both documents should be reviewed at least once every 12 months, or earlier if the pupils needs have changed.

Individual Health Care Plans

IHCP’s are written for pupils with long-term and complex medical conditions who need ongoing support, medicines or care at school so that they can manage their condition and remain well. An IHCP is a document that records important information about the medical condition, symptoms, and the support a child or young person needs to ensure they can make the most of school.

The IHCP are developed in partnership between the school, parents, pupils, and the relevant healthcare professional who can advise on a child's case. It is used to ensure that schools know how to support your child effectively and clearly explains what needs to be done, when and by whom.

An IHCP is not a legal document, but is good practice. It is developed in partnership between the school, parents, child and relevant healthcare professionals. The aim is to make sure that the schools knows how to support the child or young person with a medical condition, or conditions, being clear about what needs to be done, when and by whom.

If possible, your child should be involved in any discussions about their medical support needs and be able to contribute to the development of their plan.

You and your child's school should agree how often the healthcare plan will be reviewed. It's advised that this happens at least once a year, but it may need to happen more frequently if your child's condition is unstable or their medication changes, for example.

The plan can also include adjustments and alternative arrangements that need to be made so that a child can participate as fully as possible in school life, such as arrangements for PE or what to consider when going on a school trip. Procedures should also be put in place for transition between schools.

Common conditions that might require an individual healthcare plan include:

• allergies
• asthma
• continence issues
• diabetes
• epilepsy

There are many other circumstances in which a child will need a healthcare plan. Some pupils may be awaiting a diagnosis or may never receive a diagnosis, such as those who have medically unexplained symptoms or rare new conditions, but they will still have a medical need. They may require reasonable adjustments for the symptoms they are experiencing.

The Children’s and Families Act 2014 places a duty on maintained schools and academies to support those pupils that have medical conditions.

You can find out more about IHCPs in the Department for Education document, Supporting pupils at school with medical conditions at school.

Many of the charities for conditions that may affect children provide templates for individual healthcare plans, such as Epilepsy Action and Diabetes UK:

• Getting my child the best support in school (Epilepsy Action)
• Diabetes in schools - a child's IHCP (Diabetes UK)

An IHCP may not be appropriate for your child. Talk to school if you are not sure.

Education, Health and Care Plans

An Education, Health and Care (EHC) plan is a legal document that describes a child or young person’s special educational, health and social care needs, explains the extra help that will be given to meet those needs and how that help will support the child or young person to achieve what they want to in their life.

EHC plans are for children and young people whose special educational needs require more help than would normally be provided in a mainstream education setting such as a college, school or nursery.

Although the plan can include health or social care needs, if your child or young person only has health or social care needs that do not affect their education they will not get a EHC plan.

An EHC plan can be issued to a child or young person between the ages of 0 and 25 years.

See information about EHC needs assessments and EHC plans.

EHCP reviews

If your child is too unwell to attend school, or refusing to attend the school named in their Education, Health and Care plan, you could contact the local authority to request an early or interim review.

An early or interim review provides the opportunity to update circumstances, discuss progress being made towards outcomes, and ask for any amendments you would like to make to the plan.

You will also have an opportunity to request a particular school to be named, where the local authority decide to amend the plan following review.

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Reduced or part-time timetables

Children of compulsory school age have the right to a full-time education. Reduced timetables are unlawful unless they are implemented following medical opinion that this would be in the child’s best interests.

A reduced timetable can be an effective temporary measure to support some children. There should be a plan to support an increase to full-time, regular reviews, and reduced timetables should only be implemented with parental agreement and involvement of appropriate services.

If you're feeling pressured to accept a reduced timetable, talk to your school about whether there are other appropriate support options, for example:

• a referral to the Local Area Team for family support
• a referral to the specialist teaching team
• a referral to a health service.
• speaking to the Inclusion Officer at City of York Council
• where support options in school have been exhausted, a request to the local authority to carry out an EHC needs assessment
• where an EHCP is already in place, requesting an early review

See further advice and information on the use of part-time timetables and informal exclusions (IPSEA).

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School trips for children with a disability or medical condition

All children benefit from participating in off-site educational visits and with careful planning all children can be included.

For many children and young people accessing school trips and experiences outside of school is essential to having a sense of inclusion.

The Equality Act 2010 stipulates that schools must not discriminate in the way they afford pupils access to a benefit, facility or service, which includes school trips. Treating a pupil less favourably, or policies and practices that result in pupils with a particular characteristic being treated worse than other pupils, can be seen as direct or indirect discrimination or harassment.

The SEND Code of Practice 2015 says nurseries and schools must ensure that children and young people with SEN engage in the activities of the school alongside pupils who do not have SEN.

Any organising or planning of trips and activities should plan for the inclusion of students with disabilities from the outset, and should ensure appropriate ‘reasonable adjustments’ to enable participation. See further information about inclusion and disability discrimination.

It is the school’s responsibility to fund these reasonable adjustments and they are never allowed to charge parents for them.

City of York Specialist Teaching Team advice on including children who have additional needs in educational visits is available on York’s Local offer.

The Department for Education (DfE) has published statutory guidance on supporting pupils with medical conditions.

Or see information on supporting children with medical needs in schools from Child Law Advice.

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Annual health check for people with learning disabilities

People with a learning disability often have poorer physical and mental health than other people, but this does not need to be the case.

An annual health check can help you stay well by talking to a doctor or nurse about your health and finding any problems early, so they can be sorted out.

Young people aged 14 or over (Year 9) with a learning disability are entitled to a free NHS health check every year.

You do not have to be ill to have a health check, in fact most people have their annual health check when they are feeling well.

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