There would be an outcry if the health service told the mother of a very sick child to take him home because it did not have the money or staff to cope with his condition. And if that child were allowed to deteriorate at home until he was so ill that he needed a pound;1,700-a-day critical-care bed, questions would almost certainly be raised about why he had not been treated in the first place.
Strange it is, then, that something similar happens without protest every day in the world of education. Children as young as four are excluded - often from more than one school - and are stuck at home until a place can be found for them at a special unit - and later in their lives, all too often at a young offenders' institution.
Figures published in July revealed that 6,320 pupils aged seven and under were given fixed-term exclusions in 200910, many of them more than once as the total number of exclusions was 13,060. There were also 220 permanent exclusions of children aged seven or under after schools said they could not cope with their behaviour.
The vast majority of these cases involved violent, aggressive and anti- social behaviour not normally associated with children at an age when most still believe in fairies and Father Christmas. Of the 620 permanent exclusions of children aged 11 and under, 90 were for assaulting another child and 180 for assaulting an adult, according to Department for Education figures. Verbal abuse and threatening behaviour against another child led to 30 permanent exclusions, and against an adult a further 70; sexual misconduct led to 10; damage 10 and persistent disruptive behaviour 190.
It is hard not to feel sympathy for the schools that have to take such drastic action. Teachers with a class of 30 pupils, or even 20, can hardly be expected to cope with children, however tiny, who throw chairs and tables at them, pull their hair or scratch them on the face. While the disruptive children take the lion's share of attention, other pupils miss out.
But what of the children? Is their own home really the place where they will recover? Across the country a growing number of schools are convinced that it is not and have set up "nurture" groups in which children most in need of attention are taught by specially trained staff in groups of eight to 12 in more relaxed, family-style surroundings for part of the day. Usually they join their classes for the start and end of the day, and for activities they can cope with.
While inappropriate behaviour and the inability to mix socially are sometimes found to be linked to a medical condition, nurture groups are set up primarily to help children who have suffered a trauma or faced neglect or violence in the home. Sometimes the cause can be traced back to family bereavement, marriage breakdown or a mother's postnatal depression. In other cases, children come from homes where there is alcoholism, drug abuse or domestic violence.
There are now around 1,500 nurture groups at schools in the UK and they claim some stunning successes. In one instance, a violent boy who had attacked teachers and other children traumatised the staff looking after him even further when he tried to hang himself in front of them. He was moved to another primary that adopts the nurture-group approach and within a year his behaviour and self-confidence had improved so much that he was able to rejoin mainstream classes.
Teachers have cited the case of the six-year-old who stripped off his clothes to check he was still there after his mother had told him he was such a bad little boy that he did not exist, and of the girl who thought she was ugly and would not believe that photographs of what she called "that pretty girl" were really of her. Both children made huge strides in their nurture groups and were later reintegrated into mainstream classes.
Nurture groups were first introduced in Hackney, east London, in 1970 by educational psychologist Marjorie Boxall. She was a proponent of attachment theory, which stresses the importance of children forming secure and happy relationships in their early years. A typical nurture group will eat breakfast together in homely surroundings that usually include soft chairs and toys. Children are accepted for what they are, not punished or criticised. They are taught the behaviour that is expected of them and are rewarded at every stage to encourage them. It is an approach much like the one a parent might take with a toddler who has limited skills to express himself and has not yet learnt to distinguish right from wrong or how to behave socially with others.
The expectation is that when the children have learnt to behave socially within the small group, they will be able to re-join their mainstream classes.
Last month, the nurture-group approach received a huge accolade from Ofsted, which reported that this form of intervention was having a "highly significant and far-reaching" effect on the behaviour of children who might otherwise be at risk of exclusion. Ofsted's report, based on visits to 29 schools and 379 pupils in nurture groups, said the approach was giving children the skills they needed to remain in education and saving them from permanent exclusion.
But while new groups are being set up, others are closing or running reduced hours as the Government's spending cuts hit school budgets. A survey by the umbrella organisation the Nurture Group Network (NGN) found that 87 of the groups have closed and others are under threat.
When schools return from the summer break, new Government guidelines on tackling poor behaviour will be in place and the Education Bill going through Parliament will extend schools' powers of search and prevent exclusion appeals panels from sending children back to those that excluded them.
Teachers generally welcome the extra powers, but Anne Marie Carrie, chief executive of children's charity Barnardo's, wants to see far more emphasis on helping and supporting pupils. "Clearly, managing challenging and disruptive behaviour in schools is essential. But very vulnerable children who are persistently disruptive often have problems at home which means they need extra help to manage their behaviour," she says.
"Repeatedly excluding a child is ineffectual and does little to improve their behaviour. For this reason, the `tough discipline' approach currently being recommended by the Government is misguided."
Clare Clarke, the head of Tottenhall Infant School in Enfield, north London, says her school does not exclude pupils. Sometimes the child needs to stay in the nurture group - called Rainbow - for four or five terms and other support is sought for them through social services or the educational psychology service, she says. Most of these children, however, re-join their mainstream classes within one to three terms. Rainbow has 10 places, with two of them usually left free for emergencies, such as the arrival of refugees from war-torn parts of the world. "One day a little boy's mother died overnight. He was eating mud, ripping up and defacing things. Rainbow gave him space and time to help him work through the trauma," Ms Clarke explains.
Rainbow runs to between pound;60,000 and pound;70,000 a year to cover the cost of an experienced teacher and a classroom assistant. "It is incredibly cost- effective when you think about what would otherwise happen to the children. Without a shadow of doubt, these are children who would be excluded if they had to be taught in mainstream classes. They head-butt, bite, kick, swear, throw things. They are angry, but not at us. It is their way of saying, `Please help me.' We teach them to articulate their feelings," says Ms Clare.
"You need to be inclusive and believe that every child has a right to be in school. If you exclude a child, they will be shunted to another school. They are only four or five - they are not out to deliberately hurt people.
"Marjorie Boxall said we must nurture these children because they have missed out on nurture in the family. If there has been no key person to value the child, the child has a hostile view of the world out there. We help them to build up relationships and trust people again."
But are parents offended by the idea that their children need nurturing that they have not had at home? Ms Clare says only one parent has voiced strong objections. "We always invite the parent in, and when we sit down and have a discussion about the child's early experiences, they begin to trust you and tell you things that have happened in their lives," she says. "Very often we see not only the child begin to flourish - with clean shoes and shiny hair - but the parents begin to take more pride in themselves as they grow in self-esteem and confidence with their children."
Ms Clare's school was praised for its emphasis on reintegrating the children back into class. The Rainbow children join their classes for activities that they enjoy, such as PE or singing, and are gradually eased back into other lessons. Here, Ofsted also cited the liaison between classroom teachers and the Rainbow staff to ensure the children did not fall behind with the curriculum.
Inspectors said the highlight of their visit was when former members of the Rainbow group returned from their new educational settings to speak to them. "I feel like a president coming back on a state visit," said one former pupil. "I feel honoured to have had a time in Rainbow. I used to be angry and unhappy and it saved me."
The positive Ofsted report has given nurture groups a boost, but there are tough times ahead as local authorities and headteachers struggle with reduced budgets. Irene Grant, the national director of the NGN, says successive studies and reports have identified early intervention as the key to success in this area. Cutting the modest funding needed to run the groups will cost the country far more in the long run when troubled children turn into aggressive teenagers, anti-social adults and parents who cannot give their own children the security they lack, she warns.
New discipline measures in the Education Bill 2011
- Staff powers of search extended to items banned by the school and articles that they reasonably suspect have been, or are likely to be, used to commit an offence or cause personal injury or damage to property.
- Appeal panels abolished and replaced by review panels that will not have the power to force a school to reinstate an excluded pupil.
- Repeal of the requirement to give 24 hours' notice of detention to a parent, allowing schools to issue same-day detentions.
- Repeal of duty to enter into behaviour and attendance partnerships with other schools.
- Anonymity for teachers accused of misconduct against a pupil until the teacher is charged or the Secretary of State publishes information about an investigation or decision in a disciplinary case.
Revised behaviour guidelines
- Schools should not have a "no touch" policy. It is often necessary or desirable for a teacher to touch a child (dealing with accidents or teaching musical instruments).
- Teachers have a legal power to use reasonable force - for example, to remove a pupil who is disrupting a lesson or to prevent a child leaving a classroom.
- Heads can search for an extended list of items, including alcohol, illegal drugs and stolen property.
- Heads have the power to discipline pupils who misbehave outside the school premises and outside school hours.
Case study: from aggression to nativity's `absolute joy'
Cheryl first started being aggressive and hitting out at other children in the nursery. Both her parents were addicted to drugs and she was living with her grandmother.
When she moved into the infant classes, aged five, her behaviour deteriorated. She was biting, scratching, nipping and pushing for no reason. She would attack adults and other pupils every day. As a result, she was suspended from school.
Her grandmother was desperate for help and it was agreed that Cheryl would go into the nurture group and that home and school would keep daily diaries to keep in touch.
Her behaviour changed in the small group. She was extremely quiet and scarcely spoke. She would come into the room, sit down and clasp her hands on the table in front of her, only nodding and shaking her head in response to questions.
The teachers insisted she said the minimum of "yes" or "no" and built up her responses slowly. When she became violent with others, she was taken to a quiet corner to talk through what had happened. Very often she did not know why she had done it. The child she attacked was brought in so that Cheryl could apologise.
"The one positive thing in her first term in the group was that she did not bite anyone," her teacher said. "She still nipped other children or pushed them, but these incidents were fewer in number. She stopped attacking adults in the playground when they spoke to her. She still screamed `No!' at them when she was asked to do things and could be heard swearing at playtime.
"Then she started to say she did not want to come to the nurture group and wanted to stay in the class - probably because she did not want to follow the rules of the group and face the consequence of her behaviour. We started a treasure box for each child so that the children gained treasures for a variety of things. This proved to be a big success. She loved counting her treasures with us and working out how many more she needed to win a prize."
After three terms in the group, her behaviour had improved so much that she was able to join a mainstream class for part of the day and performed in the nativity play.
"She showed absolute joy at taking part. She now had an environment where she knew what to expect each day and she felt safe," the teacher said.
Photo credit: Chris James