Why attendance policies aren’t working for students with long-term health conditions

Lowering school absence levels has been a focus for the Labour government since it came to power. So far, the Department for Education has introduced measures such as giving every state school in England an AI-powered minimum attendance improvement target and setting a national attendance target of 94 per cent by 2028-29.

But there is a key group of students for whom the new attendance targets will be little help.

We estimate around three to four students in every classroom in the UK experience long-term physical health conditions such as diabetes, asthma and epilepsy, which can significantly affect their attendance, wellbeing and academic outcomes.

Despite this, our research has found that students with long-term health conditions are not currently having their needs adequately met at secondary school.

The research is part of the INSCHOOL project, which has been working with young people with health conditions to better understand their experiences of school life.

Difficulties for students with health conditions

During the project, the research team spoke to over 100 secondary school students aged 11-18 from Leeds Children’s Hospital via interviews and focus groups.

The accounts from these young people underpinned the development of a holistic school needs assessment, which was used to gather further information from 270 secondary school students with health conditions across the UK.

Participating students reported difficulties when they were absent from school. Our work found that 72 per cent of participating children said they had fallen behind on their school work, and 81 per cent said they had been left to catch up on missed work on their own.

They added that school staff often “hassle” them and their families to explain every absence, which is detrimental to the school-home relationship.

In addition, this cohort of students also report being negatively impacted by attendance incentives, with 72 per cent saying they missed out on attendance rewards because of their health.

One 11-year-old with a neuromuscular condition described the feelings associated with this: “What really upsets me is when school have reward days if you’ve got over 97 per cent...all the class has gone for pizza and you’re sat in the class and you’re like ‘It’s not my fault!’.”

However, the difficulties these children face go beyond attendance.

Supporting young people’s health needs

Over half of our sample said it wasn’t easy to take medications or use medical devices at school. This was due to difficulties with accessing these when needed, or due to feelings of embarrassment or awkwardness with doing so in visible areas of the school.

Just 25 per cent of participants said that school staff understood their health condition and the impact it had on them. Many gave examples of feeling they had unfairly gotten into trouble because of misunderstandings about their health needs and how they would like these to be managed.

For example, one 12-year-old with diabetes said: “I was just using my phone to scan myself and then [my teacher] said, ‘Is that your phone out? If that is your phone out, you’re going to get it confiscated’.”

A common cycle of experience was that a young person knows what is needed to manage their health, and when these needs are not met in school, they become frustrated.

Depending on the student, their response to this is usually to withdraw or to challenge. Either option reduces the chance of their needs being met in the short term, and lowers the chance that they will seek help in the future.

So, what do these findings mean for schools?

Shared fundamental needs

A key idea emerging from the INSCHOOL project is that no matter what specific condition young people have, they all share the same fundamental needs in their school lives.

They need to be supported to safely manage their health in school. They need a flexible and supportive system to help them keep up and catch up with schoolwork. They need to be listened to and included in healthcare planning within school. They need understanding and compassion for the challenges their health conditions present and to be supported to cope with these challenges.

It would therefore be beneficial for schools to think about health conditions as one cohort with shared fundamental needs. Rather than trying to learn everything about every condition, schools should adopt broad policies that address key needs, and use these to target resources and underpin staff training in a way that will benefit the greatest number of students with health conditions.

The key first step is identifying the students in your school with long-term health conditions. You should then assess their needs by having them and their parent or carer complete a holistic school needs assessment.

You can then use this to create an individual health care plan that is regularly reviewed to make sure it is working well for the student.

Rethinking attendance approaches

And when it comes to attendance, schools might need to completely rethink their approaches.

A 2023 review showed that existing policies and practices aiming to address attendance directly - such as offering attendance rewards - are very unlikely to be effective for this group. In fact, the INSCHOOL project shows these policies can adversely impact these students.

It is therefore better to address the holistic needs of this cohort, on the understanding that if we can better meet these needs, students will have a better school experience and improvements in attendance and attainment are likely to follow.

Dr Simon Pini is associate professor of child health research at the University of Leeds and leads the INSCHOOL project