Pupils with medical needs - Frequently asked questions

There isn’t a one size fits all strategy or answer to this question. It will be personal and based on the needs of the child or young person at the time. It will change over time.

Please contact your child’s home school as early as possible to share anything about your child’s medical needs. The home school is the school at which they are on roll. Even if you do not yet have a diagnosis, discussions can begin to take place about how to support them.

You will find more information on what this may look like within Good practice when a pupil has a medical condition.

In some cases it may be necessary to consider alternative options. Below are some examples of possible strategies:

• Inpatient provision - Through admission to a hospital, your child may receive one-to-one bedside and/or classroom based teaching.
• Bedside one-to-one - Receiving tuition in the home for physical recuperation or rehabilitation. This would be after an inpatient stay.
• Home one-to-one - Completing work in a family space at home. This can happen once no longer bed-bound.
• Community one-to-one - Tuition may take place within a public space such as a library, Sure Start centre or a hub. This is a bespoke one-to-one approach.
• Community Small Group Work (SGW) - SGW to meet within public spaces, schools or hubs
• School based - Reintegration strategy to enable the ending of medical needs provision. It also supports resuming mainstream education.
• Engagement work - This can run alongside or independent to any of the above examples. Using relationship and/or activity based work to help your child. This may be important for them to access education and achieve success.

Your child may enter medical needs support at any of these points. Or receive a combination of any of the above combined with online tuition. The needs of the child are the basis of this flexible approach. This aims to give the best chance of future success for them.

The ultimate aim is reintegration to a school setting. The ideal is a return to the child or young person’s home school. Southampton City Council believe in reintegration. They also believe in maintaining a stable placement within a school environment. These are the best options for children and young people that need support with their medical needs.

Pupils with a sense of community experience proven benefits and improved recovery rates. These children and young people need their social and emotional needs met. They also need a good quality education. Together this provides them with the best chance of future success.

EHCPs relate to Special Education Needs that affect how your child accesses education.

IHPs are about the management of your child’s medical need every day.

Children with a medical need often do not have any special educational needs. This may change over time. You should first speak with your child’s school and/or Inclusion Services to determine which plan (or both) to complete.

EHCPs are assessed, written and maintained by Southampton City Council Special Educational Needs Team. IHPs are assessed, written and maintained by the home school (where your child is on roll).

The funding for the plans is also separate and can be quite complicated. For help or more details please contact Inclusion Services.

Both plans are important, different and work well alongside each other. Generally, the IHP will come first and may have been completed in an Early Years setting. It can then follow your child and be reviewed and adapted when required.

Children with significant ongoing medical needs should have an Individual Healthcare Plan (IHP) or similar document. This is the best practice.

Supporting pupils at school with medical conditions, Department for Education statutory guidance, December 2015 states:

“Individual healthcare plans can help to ensure that schools effectively support pupils with medical conditions. They provide clarity about what needs to be done, when and by whom. They 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, healthcare professional and parent should agree, based on evidence, when a healthcare plan would be inappropriate or disproportionate. If consensus cannot be reached, the head teacher is best placed to take a final view.”

You can have meetings with the school to discuss the IHP. If you disagree with the school or Headteacher please contact the Inclusion Officer for Pupils With Medical Needs. You can discuss the details with them.

With mental health, outreach tuition may not be enough. Mental health can be an ongoing concern. Families should contact Southampton Child and Adolescent Mental Health Services (CAMHS).

Contact CAMHS through your GP or by direct referral. They particularly encourage self-referrals from young people and families.

Contact

Telephone: (direct dial) 023 81 030061 or 0300 123 6661

Email: snhs.camhswest@nhs.net

Website: Solent NHS Trust

Outreach tuition can form part of the jigsaw of support for your child. Your child’s home school can make a referral.

You can discuss the important steps towards reintegration and alleviating anxiety. Discuss this with your child’s home school (the school where they are on roll).

The Inclusion Service does not take referrals directly from families. This is because they provide the Medical Outreach Service packages to schools. The home school completes a referral form when needed.

Your child’s home school (where they are on roll) should work on your child's case. If you believe this is not happening, please contact us to discuss your concerns.

Length of provision is always based upon the needs of the child or young person. There is no definite timeline of support. Reintegration packages will be different for every referral that we take.

Our review period is based on a six-week rolling review. Reviews may take place more regularly. Reviews should never take longer than six weeks. In an ideal situation six weeks will be enough time.

If the early intervention strategies within the home school and joint working approach and support are in place, we would hope to be looking at reintegration within the six weeks.

No, the Medical Outreach Service is not a home tuition service.

Southampton City Council believe that reintegration and maintaining a stable placement within a school environment are the best paths forward for these children and young people (CYP). There are proven benefits and improved recovery rates associated with pupils having a sense of community. We want these CYP to have the best chance of success. Meeting their social and emotional needs and giving access to good-quality education helps with this.

There are two initial questions. Is it a medical need or a special educational need your child needs support for?

Address special educational needs with the school’s Special Educational Needs Coordinator. If this does not help, contact Southampton City Council Special Educational Needs Team.

Discuss medical needs with the school first. The Headteacher or designated member of staff will decide on whether to put in place an Individual Healthcare Plan, or not. You are welcome to contact the Inclusion Officer for Pupils with Medical Needs if they do not put this in place.

Although uncommon some children or young people cannot attend school, even with adjustments. There are actually no official 'sick notes' or 'fit notes' for children from medical professionals. Instead, a medical professional can confirm that a child or young person is medically unable to attend school, even with adjustments. This should be added to evidence if your child’s school wishes to make a referral to Southampton City Council Inclusion Service.

The outreach teaching service is mostly about reintegration. This should be within a six-week package of support. The Medical Outreach Service aims are:

• Improving pupil confidence, attendance and engagement
• Identifying and meeting pupils’ personal, social and academic needs. Increasing resilience and removing barriers due to medical or clinical presentation supports this
• Reducing the lack of engagement and attendance at school. This could be due to anxiety-based school refusal. High-quality short-intervention programmes for pupils in both the primary and secondary phases can help
• Supporting pupils’ re-integration and progression into mainstream education and further education. This should be effective, bespoke and timely
• Ensuring that pupils make academic progress, with good attainment. A high-quality education offer, which fills learning gaps can achieve this. It also leads to appropriate accreditation and qualifications including English, Mathematics and Science

Each referral is unique and, if appropriate, the intervention may well begin in the home. The initial meeting with the Medical Outreach Service provider will decide this.

Accepted referrals are part of a service provided by the Local Authority to schools for pupils that live in Southampton. There will be no cost incurred on families associated with a reintegration package.

There are currently no plans to offer tutoring outside of the Medical Outreach Service reintegration packages. There are many local tutors and national agencies that could provide private tutoring. This would be the responsibility of the family.

Children and Young People with Education, Health and Care Plans (EHCPs) will have a package of support in place through this. Southampton City Council Special Educational Needs and Disability (SEND) Team provide these plans. Raise any concerns you may have with the school and/or associated SEND Officer.

All plans are reviewed yearly unless concerns are raised about the suitability of provision. Discuss this with the school’s Special Educational Needs Coordinator (SENCO) first as soon as you have any concerns.

Pupils will be of national school age. By law, Children in the UK must attend primary and secondary education. This runs from about five years old until the student is sixteen years old.

Many pupils accessing outreach tutoring will be on a reduced timetable to begin with.  The pupil’s home school (the school where your child is on roll) and the Medical Outreach Service provider will track this. They aim to increase the timetable, in line with the needs of the child or young person. Eventually they should return to a full-time timetable.

The home school in conjunction with the Medical Outreach Service provider track attendance. They apply normal school coding in line with national attendance coding guidance. As an example, while on a reduced timetable, pupils are expected to attend timetabled sessions. This is unless illness or a medical appointment prevent attendance. The home school will follow up evidence for non-attendance. As pupils remain on roll with their home school, normal rules apply.

The home school agreement with the Medical Outreach Service provider highlights the expectation on families. The Local Authority Medical Outreach Service panel will review (non-evidenced) absences that highlight a lack of engagement.

Engagement and support from the family are essential to positive outcomes. It may be the case that the service pull out and an Education Welfare Service referral takes place.

The Local Authority believe that reintegration and maintaining a stable placement within a school environment are the best paths forward for these children and young people. This should occur wherever possible. There are proven benefits and improved recovery rates associated with pupils having a sense of community. Meeting the needs of these pupils both socially and emotionally whilst enabling access to good quality education provides them with the best chance of future success.

The Medical Outreach Service provides reintegration packages for these particularly vulnerable pupils. While the outreach support may not initially be in school, the aim is reintegration. Returning to school can cause anxiety to some pupils and parents should be aware of this leaflet for parents called, ‘EBSA Information for Families’. We hope that at some point in their programme it will be a natural progression for them.

It may be the case, as it has been in the past, that tutors aid reintegration through an overlap of provision. The aim of this is not to provide long-term, one-to-one support within a school setting. Instead it provides a period of settling in and acclimatising to the new normal.

These applications are known as in-year applications. They can be made at any time in the year.

In-year applications are when you need to apply for a school place at any time in the year that it is not part of the 'normal admissions round'. There are three main reasons for making an in-year application. You might:

• Be moving to a new home
• Be unhappy with your child's current school
• Want your Year Two child enrolled at an infant school to start Year Three in a primary school

Changing schools is a big decision and should not be made lightly. If your child is having difficulties at their current school, discuss the reason you want to change schools with that school. Try and resolve the situation before making an application.

Changing school can be difficult for a child and rarely solves their difficulties. It is important to consider the emotional, social and academic consequences for your child. Consider these before making an application. In-year places are not always available.

See further details of in-year applications at Southampton admissions process.

There is no hard or fast rule to how long a referral takes. Southampton City Council first receives the referral from your child’s school. The Medical Outreach Service panel makes decisions on these referrals. They sit every two weeks however urgent decisions can be made outside of panel.

If they make a decision to offer outreach tuition, the start date will depend upon the needs of the pupils versus the capacity within the service. Some pupils offered places will be on a temporary waiting list until a space becomes available.

Decisions are made on a case-by-case basis. A school may need to make an urgent referral through contact with the inclusion Team. These will be dealt with as situations arise.

Yes. All schools can organise invigilation for exams where pupils are unable to get in to school. Measures and steps are required for this to take place. The home school and Medical Outreach Service provider handle this when necessary.

Provision normally ends after successful reintegration. The pupil should be back in their home school.

In a minority of cases there may be:

• A lack of engagement with the provision
• An extended period with this lack of engagement
• Measures taken not redressing the situation

Please see the section above, What happens if they don’t attend? for what happens in these cases.

Reintegration packages in most cases will provide the core subjects:

• English
• Maths
• Science

Schools, particularly secondary, should have ample online and remote teaching. Or, subject resources for independent learning outside of the one-to-one tutoring sessions.

This will be dependent upon the clinical or medical needs of the child or young person. Southampton schools should maintain contact with pupils being offered outreach support. If it is appropriate for these offers to take place, they should.

Service referrals mean many pupils requiring outreach support will need a reduced timetable. This timetable will be built upon during reintegration packages.

Reduced timetables:

• Are subject to Local Authority protocols and guidance
• Should be temporary
• Should be regularly reviewed with the aim of reintegration

See parent advice on the local guidance.

Attendance coding and absence has been covered within the section What happens if they don’t attend?

School will have a contact for all pupils with medical needs. Particularly where a package of support through the Medical Outreach Service is taking place. This will be your point of contact with your child’s home school. It may well be your child’s class teacher, form tutor, Head of Year or SENCO.

You will also have contacts within the Medical Outreach Service following a successful referral and initial meeting.

Are you finding it difficult to contact through the above methods or you have concerns you wish to share with the Local Authority? Email the Inclusion Officer for Pupils With Medical Needs.

The Medical Outreach Service and their outreach tutors can feed into any element of the EHCP process, should that be appropriate.

It is key to understand who makes applications for Education, Health and Care Plans (EHCPs). The child or young person’s home school or parents make this application.

The Medical Outreach Service provider can supply extra evidence to support an application. The child or young person’s home school or parents can request this.

The Local Authority SEND Team handle decisions, writing and review of EHCPs. Raise requests or questions with the SEND Team. Please see the Key Contacts section.

All parties should make plans for what may happen in each case. Sometimes this is not possible.

If your child's condition deteriorates they may become an inpatient at University Hospital Southampton. If they are there for three or more days Southampton Hospital School will help. They will pick up the education and teaching of your child. If they are an existing pupil of the outreach service, the service will work to keep the placement open for as long as possible.

There is no blanket policy or blanket decision-making process surrounding these situations. They will be dealt with on a case by case basis.

The needs of the child are our paramount concern and will inform planning and strategies.

There is no simple answer to this. Ultimately, this behaviour may well be hiding things like:

• Separation anxiety
• Social anxiety
• Depression
• Panic disorder

Treatment or solutions will be as part of a team around the child or involve a wider support network.

Early intervention strategies in place within schools should pick this up. These should also address issues before school refusal becomes worse. When worse this is a much more complicated problem. The school may know about these difficulties. A member of staff may have strategies in place to help.

If there have been ongoing mental health concerns and families have been in touch with CAMHS, they may well have an allocated CAMHS worker.

The outreach tutors and packages provided through the Southampton Hospital School can help a family, child or young person. They work to complement treatment and reintegration. Use the normal referral route through the home school. Further information can be shared through initial meetings.