Many thousands of children in Scotland require medication just to get through the school day. Without it, the consequences can be severe and even potentially dangerous.

Being unable to take medication in school - or a failure to administer it properly - may make it impossible to attend and, even if they do, the chances are they will not get the most out of lessons and perhaps suffer indignities such as soiling their clothes.

Now a light is being shone on this underappreciated problem, with headteachers arguing that parents should have “key responsibility” for giving medication to their children because schools do not have the capacity to cope with increasing demand.

Primary school leaders body AHDS made its comments in a government consultation on long-awaited new guidance for supporting children’s diverse healthcare needs in school (bit.ly/HealthSchools). It calls on parents to play their part as the number of pupils with healthcare needs is increasing at the same time as school budgets and staffing are being cut.

“Parents must be seen as having the key responsibility for giving medication to their children as schools simply do not have staff to administer medicine, at specific times, for an increasing number of pupils,” says AHDS.

However, Iain Nisbet, a solicitor and education law consultant, told Tes Scotland that was “not good enough”. “How inclusive does that make the child’s school experience when they are effectively never away from parental supervision or oversight?” he asked.,

Nisbet stressed that, ultimately, the buck stopped with the education authority in catering for children’s health needs in school. He cited a case from 2013 when a seven-year-old with diabetes was out of school for two months because no one would administer his insulin. The family took the council to the additional support needs tribunal and won.

Crisis and confusion

Consultation responses to the new guidance lay bare confusion over who is responsible for looking after the “increasingly complex health needs” of pupils. The former children’s commissioner Tam Baillie - recently succeeded by Bruce Adamson - commented that the situation had not improved since his office published research four years ago, which found that more than a third of parents felt their child’s healthcare needs were not always met in school.

One charity, Action for Sick Children Scotland (ASCS), says in its consultation response that some children had been out of school for over a year because of a failure to agree how their healthcare needs would be met. Meanwhile, Baillie reports children being “left in soiled clothing [in school] as a result of no arrangements being in place to meet their needs”.

ASCS believes that children’s rights are being breached, including the right to an education; to the best possible medical care and to special care and education if the child is disabled.

The charity cites children who were unable to participate in PE due to chronic asthma, who have been forced to sit on the sidelines in their shorts and T-shirt in freezing gym halls in winter because teachers lacked the training to know that the cold can bring on asthma attacks.

Another pupil was constantly admitted to hospital with urine infections caused by having to lay her self-catheterising equipment out on the floor of the school toilet.

AHDS suggests that teachers should receive training during their initial teacher education on “more common needs”.

The new government guidance highlights five common medical conditions: diabetes, asthma, epilepsy, eczema and allergic reactions (including anaphylaxis).

Diabetes Scotland says there are 3,812 children and young people with Type 1 diabetes but care in school is “a postcode lottery”.

School nurses ‘a dying breed’

The charity says: “A lack of support in schools can lead to poorer control of the young person’s diabetes, requiring medical attention and even hospital admissions. Missed schooling and opportunities for socialisation are the result.”

The new government guidance advises that “the day-to-day responsibility of supporting the healthcare needs of children and young people in schools is likely to fall to education support staff or healthcare support staff”.

However, AHDS, children’s organisations and charities all point out that the financial pressure on local authorities has led to staffing cuts, with education support staff frequently in the firing line. School nurses are also a dying breed, they say.

A Tes Scotland investigation earlier this year revealed the number of additional support needs auxiliaries and care assistants had dropped from 6,023 in 2007 to 5,463 in 2016. Schools nurses and other medical staff numbers meanwhile more than halved over the same period, from 106 to 48, according to official figures.

The number of additional support needs teachers has also dropped. Official figures show only 2,896 specialist ASN teachers in the Scottish schools last year, a decline of 40 on the 2015 figure and a significant drop of more than 500 compared to 2009 when there were 3,402.

Generally, however, the organisations responding to the consultation welcomed the guidance, with many commenting it was long overdue. But further guidance was needed, according to Baillie, setting out exactly how “toileting and menstruation needs should be met in school.”

Welcome response

This call is echoed by Children in Scotland (CiS), which says its Enquire helpline for additional support for learning hears from parents “on a regular basis” who are going into school to administer medicine or to meet the healthcare or intimate care needs of their children.

“This affects their ability to enter, or remain in, the labour market. It also has negative impact on the child’s capacity to develop greater independence,” says CIS.

CiS calls for the guidance to make clear that there is a responsibility for healthcare needs of pupils to be met “in most cases by the school and not the parent”.

CiS, however, also says that the guidance needs to make clear the rights staff have to refuse to perform certain duties or to demand training.

AHDS, however, says it is “inappropriate to assume staff in schools have either the time, willingness or expertise to undertake healthcare duties”.

Stephen McCabe, children and young people spokesman for local authorities body Cosla, argued that reductions to local government budgets made it difficult to meet all children’s needs. Unfortunately cuts to local government budgets on the scale we have seen in the last two years always hit the most vulnerable,” he said.

A Scottish government spokeswoman said: “No child should be missing out on education owing to their healthcare needs. Ensuring children with significant health issues have the support they need requires careful planning and coordination - involving parents - and we expect health boards and education authorities to work together to ensure that children’s medical needs are properly supported.”

She added: “We have recently consulted on revised guidance for health boards, education authorities and schools to support them in this. We are in the process of considering the responses and will be publishing refreshed guidance later this year.”

@Emma_Seith