Time to write a prescription for change?

Paul Fisher finds professionals worried that the education of children in some hospitals is in need of intensive care. The education of sick children would seem to be in a healthier condition than ever before. What had been a discretionary service became a statutory duty under the 1993 Education Act, and the Act's somewhat vague command that local education authorities provide a "suitable education" was clarified by a subsequent Department for Education circular. That is the official line, at any rate.

"Sick children's education is in need of intensive care," is the slogan advertising a new report from the National Association for the Education of Sick Children. Its author, Kirsteen Tait, says: "The lack of specific funding has led to reductions in some areas. The new duties and guidance do not prescribe minimum standards, give no proper protection for sick children or their parents, and do not create much of a weapon for LEAs to secure central government funding."

Despite the Government's good intention that sick children should have their fair share of teaching, educational treatment is patchy. The NAESC report highlights many examples of bad practice: St Thomas's Hospital in Lambeth has no hospital-based teaching and Derbyshire's policy only provides for children expected to be in hospital for three weeks.

The report provides an impressively comprehensive picture of 116 LEAs and the 346 hospitals with regular child admissions. The directory's list of contacts and the area-by-area descriptions of entitlements will be an invaluable guide to parents and mainstream teachers. It should also create the pressure to right some local wrongs though the NAESC, a new charity which gained Nuffield and Gulbenkian money to fund its debut report, also intends to wield a national influence.

"There is a real danger the service could be destroyed by cuts," says Kirsteen Tait. The NAESC director, along with many hospital teachers, objects that the 1993 Act lumped disruptive pupils and truants in with sick children. The effect, she fears, could be that the service she represents will lose out to demands from more politically trendy supplicants.

Local government reorganisation could also be a threat and, she says, the potential ills could be avoided by the minimum standards listed in the panel below. That would force further quantifiable duties on LEAs which, in turn, might twist the arm of government to release more money.

The way a particular hospital education policy operates depends on health officials as well as LEAs. Some charge for classrooms, others don't; some give teachers parking spaces, others let them battle it out with parking wardens.

The NAESC report says: "Many hospital teachers have to teach in corners, share unsuitable or noisy rooms with consultants, volunteers and social workers, or are allocated rooms not big enough for more than one or two beds, or with doors not wide enough to take wheelchairs. These problems could be solved if hospital teachers were consulted at the planning stage."

Even in bureaucratically simpler days, sick children's education was organised in many different ways: there are hospital schools, only some of which are registered with special school status and delegated budgets; there are teaching services covering a number of hospitals and separate teaching units in single hospitals; there are full or part-time resident teachers, ad hoc tuition, or nothing at all.

Home tuition is even more muddled and the directory reveals everything from delegation of funds to mainstream schools to its ideal, in 29 LEAs, of hospital-based home tuition.

Muddle yields to mystery in a blur of funding arrangements. More specialised treatments mean more children attend hospitals away from their home towns. Yet their home LEAs have the legal responsibility to pay for an education over which they have no influence. Recoupment charges vary between Pounds 25 and Pounds 100 a day and there are allegations that some authorities with large hospitals in their boundaries profit by obfuscating the bills they deliver.

Enid Dunmall, of the National Standing Conference of Hospital Teachers ("now including home teachers as well", she says), thinks recoupment should be abolished and replaced with a central formula. Those within LEAs doubt the wisdom of this.

Jim Winter, Avon's principal education officer, wants to retain LEA involvement. "We're closer to the point of contact," he reasons. "If you apply a formula from Whitehall, you'd lose local flexibility and, for example, be unable to open the kind of adolescent psychiatric unit which we're starting here in Avon."

Ivor Widdison, of the Council of LEAs, says: "It's all part of the wider funding debate and we have no intention to divest ourselves of this responsibility. It is true that central government could create its own quango to dole the funds out, but do we really want another quango?" Kirsteen Tait says: "We need to see whether savings in local education budgets will affect hospitals disproportionately. The jury is out on this one." She has a DFE grant to monitor results of the new duties, and the NAESC study will be completed by October.

Education for Sick Children: directory of Current Provision in England and Wales, with a Commentary on the Problems and Issues costs Pounds 21 from NAESC, 18 Victoria Park Square, London E2 9PF. Tel: 081-980 8523

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