Caring for patients' educational needs too

12th May 2006 at 01:00
Prolonged ill health is no barrier to receiving an education. Sue Leonard learns how Scotland's largest children's hospital provides lessons and how a secondary school with chronically ill pupils copes with their medical needs.

Eight-year-old Richard Neilson has just finished reading a book on dragonflies and is practising his "je" sounds. Across the table, another pupil is going through a maths worksheet.

The room is full of the normal teaching fare: a whiteboard, television and DVD player, a computer, lots of books and wall posters. It is the sort of scene you might expect to find in a typical school. However, the lesson is taking place in one of the smallest and most unusual classrooms in Scotland - at the Royal Hospital for Sick Children in Glasgow.

While at first sight Richard looks like any other pupil trying to concentrate, he is sitting in a wheelchair with both legs in plaster casts.

They are being kept apart by a pole.

Richard has Perthes' disease, a hip disorder which causes spasm, and he has been in hospital for a week and a half for treatment.

Yorkhill Hospital, as it is also known, treats children from all over Scotland, with illnesses ranging from heart disease to chronic common health conditions such as epilepsy and fatigue, as well as trauma injuries from road accidents. As a result, Glasgow City Council runs the country's largest hospital education service.

"It's just like normal school," says Richard, who is one of more than 400 patients who are taught at Scotland's largest children's hospital every year because they are too sick to go home. Some even sit Standard grade and Higher exams here.

Most of the pupil patients - around 65 per cent - come from outside Glasgow. Any school-aged child admitted for five days or more, like Richard, or those with recurring conditions, receives lessons, at the bedside or in classrooms if they are able to get out of bed. While numbers vary, they average around 50 on any given day.

The service is staffed by five primary teachers, covering the 5-14 curriculum, and six secondary teachers, who cover maths, English, science, social subjects, modern languages and information technology. There are also art and music specialists who each come in two days a week and a classroom assistant.

Children currently receive up to two hours of tuition a day due to accommodation difficulties - there are three small classrooms in different parts of the hospital - but there are plans to offer a full school day, for those well enough, when more space becomes available. The education team is negotiating with hospital officials about converting part of a disused ward to extend the school.

"In time children will have a full school day," says Peter Feeley, who heads the Hospital Education and Home Tuition Service, which also provides education at other centres for children with mental health problems and those with a history of truancy.

"The education here plays a vital role for children with prolonged chronic conditions," says Mr Feeley. "It gives them the opportunity to complete their education properly.

"As full-time an education as possible is very beneficial for the children here."

Mr Feeley, who retires this summer after 13 years in charge of sick children's education in Glasgow, hopes this will happen some time in the next six years, before a new children's hospital is built, probably at the Southern General Hospital.

"At the moment we spend mornings with the primary school children and afternoons with the secondary age children," he says. "We have a general policy of being as like an ordinary school as possible and in normal circumstances children go to school for a whole day. A lot depends on the accommodation."

David Caruthers, a primary teacher based at the hospital, and his colleagues liaise with the patients' schools so that they know which part of the curriculum to focus on and can be faxed worksheets and homework.

Parents are also encouraged to do work with their children outside the hospital lessons.

Small classes mean the teachers can get to know pupils well and the children benefit from the individual attention. When Glasgow-based children leave the hospital, home tuition is organised if they have to remain at home for four weeks or more to recover.

Although children have been taught in hospital for a long time, their right to an education when they are ill has only recently been enshrined in law. Under section 40 of the Standards in Scotland's Schools etc Act 2000, local authorities now have to make special arrangements for pupils to receive tuition outside school if they are deemed unable to attend due to prolonged ill health.

Figures from the Scottish Executive show that in 2004-05 855 children in Scotland received local authority education at home or in hospital because of long-term illness or through special arrangements put in place as a result of family illness.

Across Scotland, councils offer hospital and home tuition where they can or pay others, such as Glasgow City Council, to provide it. The type of service offered depends on where patients live and which hospital they use.

In Edinburgh, two secondary and two primary teachers provide lessons lasting about an hour at children's bedsides because there is no classroom.

At Aberdeen's children's hospital, one teacher provides lessons in a classroom or at the bedside, depending on the condition of patients. At Ninewells Hospital in Dundee, a part-time teacher runs lessons in the afternoon. So far this session she has worked with 51 pupils from six authorities. Home teaching staff are also recruited from the sick pupil's school; last year 17 pupils were taught at home for three to seven hours a week.

For children staying in hospital, away from home and friends, the sight of a teacher can be welcoming. Mr Caruthers says: "Even the most unenthusiastic children are keen to see the teacher because they get fed up and frightened in hospital and we are a familiar figure. If children have missed school, they often become anxious about what they have missed.

"It is massively different from working in schools but is very rewarding.

You build up a really good relationship with them," he says, but flexibility is key.

"A class teacher is able to focus on a specific stage and become a specialist. I have to teach four or five different stages every day."

The teacher also has to fit in with the medical needs of pupils. While teachers in a traditional school are in charge of their environment, in hospital they have to get used to teaching at bedsides against a background of ward activity, from nurses and doctors treating patients and interruptions for blood or other tests to relatives visiting and noise from TVs. The teacher may go to a pupil only to find that they have gone for an X-ray.

Mr Feeley points out the many benefits of job, particularly how well teachers get to know the children, but admits it has its own stresses.

"Sometimes children do not get better. You develop a personal bond with these children and it can be hard if they die. It does not happen that often but that is the reality."

Back in the classroom at Yorkhill Hospital, Richard is reading through a story he has made up about ghosts and appears to be enjoying the one-to-one attention from Mr Carruthers. This time next week he should be back at John Paul II Primary in Uddingston, North Lanarkshire, having barely missed any school work.

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