A single parent wants his asthmatic daughter enrolled in the large primary you teach in. But none of the staff wants to be responsible for the medication she needs. She is too young to take responsibility herself, so your joint refusal means you are effectively excluding her from your school.

An imaginary scenario, perhaps, but increasing numbers of children with medical conditions are applying for places in mainstream schools. And, say voluntary organisations, provision for them is patchy.

A survey by the National Asthma Campaign in 1999, for example, found that despite official guidelines on social inclusion, “there was still much to be done to make schools safe for children with asthma”.

This condition affects four or five children in most classrooms - and the number is increasing. But almost two-thirds of the teachers and special needs co-ordinators questioned by the campaign believed their school had no policy on asthma, and nearly one-third of parents of children with asthma said their child’s teacher did not sufficiently understand the problem.

Other voluntary organisations are concerned that lack of information, training and support for teachers is stopping schools from accepting children with medical needs and from the children taking part in school life as fully as they could.

Headteacher Tim Hughes realised just how varied provision for such pupils can be when his daughter was refused admission to a reception class in a Birmingham school because of her peanut allergy, but was willingly accepted at a school nearby. As a parent he wanted his daughter to have all the opportunities of mainstream schooling, but as a head he understands why schools might back away from accepting children with life-threatening conditions. “They’re frightened. It’s a big responsibility. You’re potentially being asked to act to save a child’s life.”

So what are schools obliged to do, what support do they receive and what are parents entitled to expect?

The Department for Education and Employment and the Department of Health, have issued guidance in DfEE Circular 1496. This says that children with medical needs should be encouraged to take part in school life as fully as possible. They “have the same rights of admission to school as other children, and cannot generally be excluded from school for medical reasons”. Where necessary, it says, schools should draw up individual health care plans. This may mean a teacher or member of the support staff taking responsibility for any drug administration.

The Health and Safety at Work Act 1974 requires employers to assess risks and make sure their staff receive the necessary training. A child with particular medical needs may be more at risk than others, and this has to be accounted for in the school’s health and safety procedures.

But if the child needs medication during the day, responsibilities are divided. “Parents are responsible for their child’s medication. The head is normally responsible for deciding whether the school can assist a pupil who needs medication,” says the circular.

“There is no legal or contractual duty on school staff to administer medicine or supervise a pupil taking it. This is a voluntary role.” Moreover, if an injection is needed, it should be administered only by “an appropriate practitioner”, according to the Medicines Act 1968, or by someone who “must act in accordance with the practitioner’s directions”.

But in an emergency teachers have a common-law duty to “act as a reasonably prudent parent would” and, the guidance says, this might extend to administering medicines “in exceptional circumstances”.

A child with medical needs who also has a learning difficulty can expect support from the local health authority under the 1993 Education Act. But this can be refused if the authority considers the help “unnecessary” or “not reasonable in the light of the resources available”.

Teacher unions are understandably cautious when their members are asked to take on responsibilities for children who may suddenly become a medical emergency.

“Teachers are now more aware of the dangers they place themselves in by being caring,” says Olwyn Gunn, education secretary for the National Association of Schoolmasters Union of Women Teachers. She says staff could be put in a difficult position if they felt under pressure to carry out procedures for which they had not been trained.

A spokeswoman for the National Union of Teachers agrees that administering medication can leave teachers open to accusations of causing harm or child abuse. Moreover, the teacher has a duty of care to the whole class and cannot be too occupied with one child. The union’s advice to members is not to volunteer to administer medication unless they are confident about the training they have been offered.

Tim Hughes (who contributed to circular 1496) says that although children are still being refused places on medical grounds, it is becoming less common. Teachers want to support children, he believes, but they must be confident they will be properly supported so that the training “becomes a safety net rather than something to be terrified of. Good multi-agency working and open doors are crucial.”

Fear of taking responsibility in an emergency may discourage schools from admitting children with medical needs, but more and more children are suffering from chronic conditions. Five years ago, for example, between 10 and 20 children in Birmingham schools had been diagnosed with anaphylaxis (acute allergic reaction); now there are 400.

The local education authority was so concerned about the number of pupils with medical needs that it started a programme with the local health authority to train staff in 500 schools.

Chris Rumney is one of two nurses doing the training. She believes it is important to train all staff, including midday supervisors, and to work with the meals service to avoid foods that may contain allergens. Since 1995, she and her colleague have trained staff to recognise symptoms of common conditions, such as asthma, diabetes, epilepsy and anaphylaxis, and have helped develop care programmes for individual children by liaising between parents, schools and health professionals.

They have also helped schools with policy documents. Working with the ambulance service, they drew up authority-wide basic guidelines to ensure that paramedics who are called to the school have vehicle access, can get through the security system and have someone to guide them to the emergency. And they devised a medicines policy following an increase in the number of children with attention deficit hyper-activity disorder (ADHD) who need medication during the day.

At first, the unions were reluctant to add to teachers’ responsibilities, but the LEA has taken out insurance to indemnify staff who follow the agreed procedures. And Chris Rumney believes that staff who do nothing in an emergency are at greater legal risk than those who follow the guidelines.

Devon LEA - working with the National Asthma Campaign and drug company GlaxoWellcome - has launched a project to train school nurses to boost teachers’ and pupils’ knowledge and understanding of asthma. The LEA provided materials and developed a policy that schools can adapt, while GlaxoWellcome lent a trainer, sponsored a school video competition and supported extra training for the nurses.

Voluntary organisations can also support schools. Among others, the National Asthma Campaign, Diabetes UK, the British Epilepsy Association and the Anaphylaxis Campaign supply school packs with information. The NAC estimates that it takes about 10 hours to put an effective asthma policy in place.

Although DfEE circular 1496 summarises guidance for schools, some of the voluntary organisations believe it does not go far enough. Diabetes UK would like the rights and responsibilities of parents and schools clarified in a single, easily accessible document. Chris Rumney believes initial teacher training should include training on dealing with the most common medical conditions teachers are likely to encounter. All teachers would then have a basic knowledge which could be regularly updated.

There are implications for other educational institutions. Chris Rumney’s work is extending into nurseries and pre-school play groups, and after-school and breakfast clubs. The present cohort of children with medical needs will soon be moving into further and higher education. Although they will be old enough to take much of the responsibility for themselves, these institutions will need to be geared up to accept them.

Department for Education and Employment: www.dfee.gov.ukBritish Epilepsy Association: www.epilepsy.org.uk Tel: 0113 210 8800.Anaphylaxis Campaign: www.anaphylaxis.org.uk Tel: 01252 542 029.Diabetes UK: www.diabetes.org.uk Tel: 020 7323 1531.National Asthma Campaign: www.asthma.org.uk Tel: 020 7226 2260