Children and Young People with Medical Needs

The Government guidance Supporting children with medical conditions‘ says:

The statutory guidance in this document is intended to help governing bodies meet their legal responsibilities and sets out the arrangements they will be expected to make, based on good practice. The aim is to ensure that all children with medical conditions, in terms of both physical and  mental health, are properly supported in school so that they can play a full and active role in school life, remain healthy and achieve their academic potential.

 

Schools, local authorities, health professionals, commissioners and other support services should work together to ensure that children with medical conditions receive a full education. In some cases this will require flexibility and involve, for example, programmes of study that rely on part-time attendance at school in combination with alternative provision arranged by the local authority6 . Consideration may also be given to how children will be reintegrated back into school after periods of absence.

 

6 All children must receive a full-time education, unless this would not be in their best interests because of their health needs

(Page 7, Further advice point 5 and footnote 6)

Individual healthcare plans are for children and young people with complex health needs (not to be confused with Education, Health and Care or EHC plans!)

• An individual plan may not be appropriate for your child. Talk to school if you are not sure.
• An individual healthcare plan will help a school to effectively plan what your child needs, and can provide reassurance about the support plan i.e. who will do what, and when.
• You will be able to share your views and those of your child. Let school know of any changes to your childs needs so the plan can be amended
• This plan can also include your child’s Special Educational Needs (where an EHC plan is not in place).
• Though school will be responsible for finalising and maintaining the plan, healthcare and social care or other professionals should be involved in the process
• Annexe A on page 28 of the guidance for schools (PDF) includes a helpful flowchart of what the process should look like.

You can read further information on What is an individual healthcare plan?

Sometimes, a child may need a part-time timetable – for example, where a medical condition prevents a pupil from attending school or another setting full-time and a part-time timetable is used to help the child access as much education as possible.

Read our information on Reduced Timetables

Some children may not be able to attend school for health reasons (physical or mental health need), for long term or intermittent periods.

You should contact your child's school as early as possible on the first day of absence to explain the reason they are unable to attend school.  If you do not, your child’s school will contact you on the first morning of their absence to find out why your child is not in school. 

If your child is too ill to attend school, it will be recorded as Code I Authorised.  If the absence due to illness is ongoing or frequent you should speak to your child’s school to see what support can be put in place. Unauthorised absence codes are for very limited circumstances including holidays taken in term-time, for a short term period to allow time to check the exact reason for absence, or where the school is not satisfied they can classify the absence as authorised (where they doubt the genuineness of the illness). If you have any questions or concerns about how your child’s absence has been recorded on their attendance record, talk to school as soon as possible.  

You can read our information on Attendance and Emotionally Based School Avoidance

Providing Medical Evidence 

The Department of Education Working Together to Improve School Attendance August 2024  states that in the majority of cases a parent’s notification that their child is too ill to attend school will be that evidence and can be accepted without question or concern.  Only where the school has genuine and reasonable doubt about the authenticity of the illness should medical evidence be requested to support the absence.

Code I: Illness (not medical or dental appointment)

 

62. Medical evidence for recording absences should only be needed in a minority of cases (see Code I).  Where a pupil’s health need means they need reasonable adjustments or support because it is complex or long term, schools can seek medical evidence to better understand the needs of the pupil and identify the most suitable provision in line with the statutory guidance in supporting pupils at school with medicalconditionsor arranging education for children who cannot attend school because of health needs.

 

365. Schools are not expected to routinely request that parents provide medical  evidence to support illness absences.  Schools should only request reasonable medical evidence in cases where they need clarification to accurately record absence in the attendance register, i.e. making a decision that code I is the absence code that accurately describes the reason the pupil is not in school for the session in question.  In the majority of cases a parent’s notification that their child is too ill to attend school will be that evidence and can be accepted without question or concern.  Only where the school has genuine and reasonable doubt about the authenticity of the illness should medical evidence be requested to support the absence.

 

366. Where medical evidence is deemed necessary, schools should not be rigid about the form of evidence requested and should speak to the family about what evidence is available.  Schools should be mindful that requesting additional medical evidence unnecessarily places pressure on health professionals, their staff and their appointment system, particularly if the illness is one that does not require treatment by a health professional.  Where a parent cannot provide evidence in the form requested but can provide other evidence, schools should take this into account.  Where a parent cannot provide any written evidence the school should have a conversation with the parent and pupil, if appropriate, which may in itself serve as the necessary evidence to record the absence.

If your child is unable to sustain regular school attendance for reasons relating to a physical or mental health need, or other circumstances beyond parental control, a Section 19 referral should be considered for alternative arrangements to best support your child. 

Parents, schools and other professionals may make a request for Section 19 support. You can ask your school to make a medical referral to the Education Access Service for support. 

You can read our information on Alternative Provision and  Emotionally Based School Avoidance

If your child is too unwell, or unable to attend the school named in their Education, Health and Care plan you should contact the local authority to request an Annual Review

Annual reviews provide the opportunity to update circumstances, discuss progress being made towards outcomes, and ask for any amendments you would like to make to the plan. 

The SEND Code of Practice 2015 says:

Schools have a notional SEN budget and many schools will commission services (such as speech and language therapy, pastoral care and counselling services) to support pupils...The school’s governing body must ensure that arrangements are in place in schools to support pupils at school with medical conditions and should ensure that school leaders consult health and social care professionals, pupils and parents to make sure that the needs of children with medical conditions are effectively supported.

 

(3.66)

Colleges...

...should ensure they have access to external specialist services and expertise. These can include, for example, educational psychologists, Child and Adolescent Mental Health Services (CAMHS), specialist teachers and support services, supported employment services and therapists.

 

(7.23)

The local authority, Education Access Team, has responsibility under Section 19 of The Education Act 1996 (as amended by the Children and Families Act 2010) for commissioning suitable education for pupils who are unable to attend school.

The Education Access Team commissions support for the following:

• ​pupils who have been permanently excluded from school
• where physical/mental health prevents attendance at school,
• where pregnancy prevents attendance at school.
• pupils unable to attend school due to emotionally based school avoidance,
• pupils who are not in school due to other exceptional circumstances.

Schools should make appropriate referrals to the Education Access team for children who are unable to attend school due to ongoing physical or mental health needs, or other circumstances beyond parental control.  Referrals should be made where a child will be away from school for 15 days or more, whether consecutive or cumulative.

The school will need to demonstrate they have made all the necessary reasonable adjustments and have involved the appropriate services or professionals for advice and guidance.   It is good practice guidance for schools to follow the Lets Talk We Miss You Guidance and for One Planning to be in place. 

It will be necessary for parents to share with the school any medical advice from involved health professionals  i.e. if your child is under a consultant then they should provide the medical advice rather than your local GP.  Where possible, it is helpful for the advice to offer a view on how the medical condition is impacting on school attendance and suggest what interventions/ adjustments are needed to support. If your child is too unwell to receive education, then this would need to be clearly stated. If parents/carers are struggling to obtain medical advice, schools should not delay making a referral to the Education Access team but should clearly outline how your child’s medical condition is currently being supported.

The Local Authority will engage with families throughout the Section 19 process and will confirm, in writing, the outcome of the referral. If the Section 19 referral is agreed, the Local Authority will work in partnership with families, schools and professionals to determine what is the most appropriate support.

You can read more from the Essex County Council Advice for Parents/Carers on Medical Referrals September 25

Section 19 of the Education Act 1996 outlines the legal duty for the local authority to secure suitable, full-time alternative education or otherwise than at school (EOTAS) for those children of compulsory school age who, by reason of :-

• illness is preventing them from being able to attend school
• they have been permanently excluded from school or otherwise, or
• may not for any period receive suitable education unless such arrangements are made for them

The Government guidance ‘Supporting pupils at school with medical conditions‘ says:

All pupils of compulsory school age are entitled to a full-time education suitable to their age, aptitude and any special educational needs they may have. In some circumstances their education may be provided partially at school and partially at another educational setting or through education otherwise than at a school in line with section 19 of the Education Act 1996 or section 42 or 61 of the Children and Families Act 2014. Time away from school to receive education in other ways must be recorded in the attendance register using the appropriate codes (see chapter 8).

If a Section 19 referral is accepted, the local authority will listen to parents views but the local authority's duty is to provide what they deem to be 'suitable' provision and they will ultimately determine the provision that will be offered. 

If parents refuse the provision offered, this may lead to the Section 19 referral closing and the case being referred back to the school to discuss alternative options.

If your child is not on a school roll, the local authority may then apply for a School Attendance Order under section 437(3) Education Act 1996.  The order will require the child’s parents to register the child at a named school. Failure to comply with a School Attendance Order amounts to an offence which the parent can be prosecuted for.

In the first instance, you should speak to your child's school and discuss options with all professionals involved.  You can discuss the option of alternative provision and take a look through the Essex Alternative Education Directory 

We encourage you to talk through all the options with the school and the professionals supporting your child. If these conversations do not resolve things, parents can contact the Local Authority directly at section19@essex.gov.uk.  

If you have contacted the local authority directly but experience any difficulties with your request, IPSEA provide a template letter for parents to request alternative provision Getting temporary education put in place

Is there a duty for local authorities to provide alternative provision for pupils aged 16-18?

Yes, but only if the child is of compulsory school age and who, by reason of :-

• illness is preventing them from being able to attend school

• they have been permanently excluded from school or otherwise, or

• may not for any period receive suitable education unless such arrangements are made for them

Supporting evidence must be provided to show that your child meets the Section 19 duty for the local authority to arrange alternative provision. 

Parents can contact the Local Authority directly at section19@essex.gov.uk. 

IPSEA provide further information on What support should the LA give me if my child is out of school for any reason?

IPSEA also provides a template letter for parents wishing to request for alternative provision Getting temporary education put in place.

You can read more on the definition of Section 19 'Otherwise' 

There is not a statutory definition of what constitutes "full time"    

The Department for Education Alternative Provision Guidance states

7. While ‘full-time’ is not defined in law, pupils in alternative provision should receive the same amount of education as they would receive in a maintained school. Full-time can be made up of two or more part-time provisions.

Section 19(3A) Education Act 1996 makes an exception for children who, “for reasons which relate to [their] physical or mental health”, it is not considered to be in their best interests to be provided full-time education.

There is a requirement that the education provided is "suitable".

Section Section 19 of the Education Act states

The education to be provided for a child in pursuance of arrangements made by a local authority under subsection (1) shall be—

(a)full-time education, or

(b)in the case of a child within subsection (3AA), education on such part-time basis as the authority consider to be in the child's best interests.

For post-16 education, local authorities have the power to provide alternative provision rather than a duty to provide it.

Hospital education means education provided at a community special school or a foundation special school established by a hospital, or education provider, under section 19 of the Education Act 1996.

The decision to provide hospital education is made by a medical practitioner. Example – Children’s Hospital School at Great Ormond Street Hospital (GOSH) and University College Hospital (UCH).

Hospital education will need a medical professional to state the child cannot attend school due to a medical condition.