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What the doctor ordered;School Management

No one will accept responsibility for administering medication to children in school. Fiona MacLeod reports.

Caring for a sick child is a worry for any parent, but for a teacher faced with a pupil needing medical treatment, the issues are particularly complicated.

Just where does a teacher's responsibility lie when a child in his or her care has a condition that could require life-saving medical intervention? And from a parent's point of view, who within the school building will act should something happen to a child?

Teachers may be happy to stick a plaster on a grazed knee, but to be prepared to administer rectal diazepam to an epileptic child is quite another matter. And for the whole spectrum of ailments and illnesses in between, the issues for teachers are no more clear cut.

The debate came to the fore with the alarming increase in asthma among school-age children, as well as the headline-hitting cases of anaphylactic shock brought on by allergy to peanuts or eggs.

But while it is clear that the responsibility for child health lies with local health authorities, the practicalities of how that should be administered during the school day have still not been settled.

Education authorities have laid down procedures for parents and teachers to follow, should a child need to take medicine during the school day, but teachers are under no legal or contractual obligation to administer medicines.

In the absence of any nationally laid down guidelines, practices vary enormously throughout the country. The result is sometimes contradictory advice, causing confusion among teachers and alarm in parents.

"The administration of medicines within schools has become increasingly an issue in recent years," says Charles Muir, assistant director of education at Aberdeen City Council. "This authority, alongside Aberdeenshire, works closely with Grampian Healthcare Trust to discuss the whole area. We meet every six weeks to monitor and review our schools' medical services.

"We look at the role and remit of school nurses and have set up protocols for dealing with a number of conditions. Guidelines on the administration of medicines are issued to each school and we aim for a partnership between the parent, the school and the child."

While this may represent best practice, the Aberdeen councils have got to that point through their own efforts. Teachers and education departments across the country are frustrated by the lack of guidance from the Scottish Office. A national working party invited draft guidelines from the Association of Directors of Education in Scotland. After a further meeting in which the directors tried to resolve the lack of progress, a report was promised for January 1997. Nothing has been heard on the issue since then.

Jon Mager, assistant director of education at Aberdeen City Council involved in special educational needs, where the administration of invasive medicines is a particularly acute issue, says: "We are extremely concerned about the lack of progress on this matter. Parents, children and professionals involved need the backing of clear national guidelines on this extremely sensitive issue."

He points out that medical treatments are evolving at such a rate that teachers are being confronted with new dilemmas all the time.

"A number of children now have gastrostemy tubes. This is a relatively new development and there were very few around five years ago. Now Aberdeen has more than 20 children with them.

"Invasive medicine has really brought this issue to the fore. If something goes wrong, parents and staff want to know that there is someone available who knows what to do.

"The debate is all about whether this comes under the care of the child or medical treatment."

Enquiries at the Scottish Office recently about any national guidelines at first drew a blank. The education department had no knowledge of any such proposal; surely it was the health department's concern? A request there met with the ball being lobbed back to the education department. Eventually a Scottish Office spokesman was able to report that the project had been abandoned "due to the complexities of the issue".

Without national guidelines, practice in schools will depend on the education authority's commitment, and advice from the unions. In one Edinburgh primary school, this means that no teacher below management level will administer any drug or medical assistance whatsoever - everything is passed to the head or deputy. Schools under Glasgow City Council stick firmly to the extensive written guidance inherited from the former Strathclyde region.

This requires written instruction from parents and health boards for all medicines that may involve teaching staff. Paracetamol is the only pain-relieving non-prescribed medicine that can be given to children, but only to those over the age of 12. Primary school children with a headache or other pain requiring an analgesic should be sent home after contacting parents. Letters are sent to all new parents spelling out how the individual school deals with medicines.

Union advice to teachers is extremely cautious. Guidelines drawn up last year by the Educational Institute of Scotland state that teachers should only administer drugs or medicines to pupils if they are happy to volunteer to do so.

It also urges teachers only to volunteer to cover for the emergency administration of a drug in a "potentially life-threatening situation". Certificated training should be given, as well as formal legal indemnity.

In addition, any supervision of the routine taking of medicine should only be agreed to by the teacher with the written consent of both parent and the education authority. The Health Education Board for Scotland also recommends that teachers who agree to administer invasive medicines such as rectal diazepam should be accompanied by another teacher.

The difficulty remains in situations where staff are asked to administer medicines and they feel unwilling, because of the responsibility, to volunteer. "In most circumstances our staff are positive and professional and do volunteer, but they do not like this situation," says Mager. "We would all prefer clear guidelines to be handed out nationally and resolved into local policies. Then everyone would be clear about this difficult issue."

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