Supporting pupils with healthcare needs in schools. Joanna Coates Education & Children s Services, UNISON j.coates@unison.co.uk

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1 Supporting pupils with healthcare needs in schools Joanna Coates Education & Children s Services, UNISON j.coates@unison.co.uk

2 Context UNISON & the RCN UNISON and RCN are the leading unions representing health care professionals and school support staff Campaign to ensure members are given support, protection and training to provide safe and effective care to young people

3 Mainstreaming & Inclusion 1978 Warnock report (England) began process Formalised by Labour in 1997

4 Health facts - UK One in 11 children has asthma 2 in every classroom 60,000 children have epilepsy on average 1 in every primary school and 5 in every secondary school 29,000 children have diabetes, increasing by 4% each year 1 in 550 children Increasing need to provide emotional, behavioural and mental health support to pupils

5 Joint UNISON / RCN survey 2012 Concerns identified with: individual care plans training & supervision competence deployment school policies & insurance Many examples of good practice, but more needs to be done to ensure that all schools are able to provide safe and well-planned health care support

6 Individual care plans When nurses were asked if up-to-date individual care plans were in place, the response was:

7 Training and supervision nurse view 35.7% of nurses said that school support staff always received appropriate training 60.4% of nurses said support staff sometimes received appropriate training 3.9% of nurses said support staff never received appropriate training

8 I worked very hard to put in place systems to ensure that school staff received high quality training to administer emergency medication for epilepsy. This took time, energy and a lot of commitment- it is not an easy task Some schools are very reluctant to allow school nurses to provide training such as epipen/allergy training until an incident occurs Staff updates on health issues are not given sufficient priority on training days or need to be done after hours in their own time

9 Training & supervision support staff view Most support staff attended a first aid course Less than half of support staff received any additional, specific training Over half of support staff did not receive annual refresher training

10 We got full training from the child care team at the hospital and from the child s mum. The nurses came back to watch us and to sign us off as trained. We always administer medications with two of us present and keep a record book that is checked and signed every day There are two children in our school that have rectal medication. There are no staff that have been trained in administering this

11 Confidence and competence Nearly 1 in 3 school support staff did not feel competent with the responsibility of administering medicine or providing health care support to pupils As a consequence, there is increased pressure on school nurses Staff feel worried and vulnerable but do not want to let pupils down

12 Toileting and/or dealing with soiling incidents 75.4% Administration of medicines other than oral or rectal 74.9% medication (e.g. eye drops, skin creams, inhalers and nebulisers, medipens) Administration of oral medication (e.g. paracetamol) 63.7% Dressing wounds 45.8% Supporting the use of equipment, e.g. wheelchairs, hoists 44.7% Physical therapy 26.9% Tube (PEG) feeding 18.8% Administration of rectal medication (e.g. rectal diazepam) 12.4% Assistance with catheters and/or colostomy bags 11.2% Administering syringe injections (not medipens) 6.3% Tracheostomy care 5.9% Blood pressure checks 1.6%

13 I worry about the distribution of medication at lunchtime especially. I have three pupils on the same medication (Ritalin) that are all on different strengths. I worry that due to pressure and time constraints I may mix them up accidentally One member of staff has been asked to tube feed pupils, but they find it very difficult and they gag when the stomach content comes back up the tube but if they don t do it they are made to feel that they are letting the team down or we are not putting children first

14 School staff are increasingly being expected to take on more and more pupils with very significant health needs with less and less support from the health services. They are expected in some cases to do as much as a trained nurse would with minimal training and support

15 Employment and deployment If you provide health care support to pupils, how was this agreed? The duties are specified in my contract of employment I volunteered/agreed to take on these duties and am paid extra to do so I volunteered/agreed to take on these additional duties but am not paid any extra I feel that I was forced into taking on these additional duties for my employer 21.6% 7.1% 53.2% 18.1%

16 School policy and insurance 24.8% support staff did not know if their school had a policy regarding the management of medicines and health care procedures 82.6% did not know if tasks were covered by their employer s insurance policy I worry about our insurance should anything go wrong and don t feel that we would be protected, and worry whether we would be cut adrift should anything happen

17 Other issues of concern Cuts to local authority budgets = overstretched school nurse workforce and lack of training for support staff School nurses have been actively encouraged to become health visitors and posts not replaced Rapid increase in academies = challenges for local authorities to retain oversight of health needs in schools

18 RCN and UNISON called for urgent action All children with health needs to have an up-to-date care plan All staff who provide care to receive specific training Appropriate staffing levels with remuneration reflecting responsibilities Clear policies for managing medicines and health care procedures.

19 RCN/UNISON joint statement Produced to assist all schools, local authorities, health professionals and schools staff to work in partnership to ensure children s needs are met Aims to improve understanding of roles, responsibilities, training and governance required

20 Employers and school leaders Clear policy on management of healthcare support which is understood by staff, parents and pupils Individual care plan drawn up for each child Adequate insurance cover in place, with appropriate assurance given to staff Specific, accredited training for staff on a named-child basis, refreshed at least once a year Match staff with sufficient training and pay to the specific needs of children

21 School nurses Devise individual care plans with young person and parent/carer specifying when they should be reviewed Provide training to identified support staff on a named-child basis Ensure that adequate supervision is in place for identified support staff Assist with risk assessments where required

22 School support staff Only undertake tasks where they are clearly defined, feel competent, have completed approved training and are fully indemnified Maintain a thorough knowledge of guidelines in their school Deliver care and undertake procedures according to guidelines Know who to contact in an emergency

23 What are the barriers to achieving best practice? All children with health needs to have an up-to-date care plan All staff who provide care to receive specific training and appropriate supervision Appropriate staffing levels with remuneration reflecting responsibilities Clear policies for managing medicines and health care procedures

24 Related work Department for Education working group awaiting new guidance Health Conditions in Schools Alliance lobbying re. Children and Families Bill Encouraging schools to take action on issues identified in survey/statement Possible re-survey with RCN Literature for members

25 Supporting literature RCN and UNISON survey 2012: Supporting pupils with health needs in schools RCN and UNISON joint statement: Providing support for children and young people with health needs in schools RCN report: The RCN s UK position on school nursing RCN report: Managing Children with Health Care Needs Delegation of clinical procedures, training and accountability issues

26 Supporting pupils with healthcare needs in schools Joanna Coates Education & Children s Services, UNISON j.coates@unison.co.uk