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The Parliamentary Under-Secretary of State for Education (Mr Edward Timpson)
It is a pleasure to serve under your chairmanship, Mr Leigh. I congratulate my hon. Friend the Member for Mid Derbyshire (Pauline Latham) on securing this extremely important debate. I welcome her constructive and well informed speech, as well as the not insignificant contribution of Rufus the bear, which unfortunately might not otherwise have gone down in the Hansard history.
I, too, have spoken in the past on children’s health conditions, and I understand and am very much aware of the challenges that affected children might have to face in school and outside it if they have a chronic condition such as diabetes, which affects one in 550 school-age children. We are not talking about an insignificant number of children. My hon. Friend also alluded to my being reasonably new to the great machinations of the Department for Education, but I shall endeavour to do my best to address all the points that she made. On anything I am not able to address today, I shall make every effort to fulfil my duty by engaging in correspondence with her, to ensure that she has all the answers for which she has posed questions.
I am acutely aware and conscious of the often draining impact on parents of a child with type 1 or type 2 diabetes. Day to day, they have to manage the condition, which is lifelong. It is important to recognise the huge contribution of parents to ensuring that their children have as happy and as normal a childhood as possible.
Without doubt, it is vital that children with diabetes are able lead the same full and active life as children without diabetes—there should be no discrimination, and the Equality Act 2010 makes it absolutely clear that that applies within schools. With proper support, children with diabetes should be able to participate fully in school life and to enjoy their time there along with their friends, not feeling left out in the way that my hon. Friend has described in some cases. For that reason, it is right to encourage schools to do all that they can to support pupils with medical needs, including diabetes.
Teachers have to consider many conditions when looking at the provision and support for children in school. Fortunately, there are many examples of schools excelling in doing precisely that. We expect schools, employers, staff, parents and local health services to work together in the interests of such children—very much as hon. Members have been encouraging them to do in today’s debate—to ensure that they are not disadvantaged at school. The 26,500 children affected by type 1 diabetes in the UK is a significant number, so the issue is of real importance to the families and teachers directly involved with those children’s lives.
As my hon. Friend pointed out, by necessity children diagnosed with type 1 diabetes must learn quickly how to manage their condition themselves: how to monitor their blood sugar; how to choose meals in the school dining room with an appropriate carbohydrate content; what precautions to take when they exercise and play sports; and how to manage their insulin infusions or to do their own injections, which they might have to do as many as four times a day. I have certainly seen that in my constituency, when visiting schools and learning about some of the conditions that children have to live with day to day and how responsibly many children are in facing up to the challenge.
Such a task is challenging for children or young people, and we cannot expect them to do it on their own, without the proper support. They need that support, and without it in place, it is all too easy for the children to be distracted from their learning and from feeling safe and happy at school—quite apart from the stigma that can be associated with the condition, as mentioned by hon. Members. It is also important that children with diabetes are not excluded from school trips or PE lessons due to a lack of understanding of the condition by their school. If that happens, the word must go out that that is not only unacceptable but ultimately discriminatory.
The first priority for any family with a diabetic child is to ensure that school staff and fellow pupils understand the condition and, in particular, what to look for should the child suffer low blood sugar or even a hypo. Safety must be the No. 1 priority. That is particularly important for the newly diagnosed and for very young children, who may find it more difficult to help themselves. The key to success is common sense.
Parents, staff and health professionals should work together, sharing information and agreeing responsibilities that reflect the personal requirements of the individual child. It is important that staff work together to ensure that, in every situation and at all times, someone at the school has the training and understanding of what is required if an episode occurs or an injection is required. They should ensure that protocols are agreed and followed and that the specific needs of individual pupils are fully addressed and accommodated. Access to medicine and appropriate snacks should always be allowed.
It is crucial for children with diabetes to control their condition well, because the long-term complications may be life-threatening, as my hon. Friend said—not to mention the massive cost to the health service of complications. Adequate support at school can affect a young person’s confidence in taking control of their condition at that vital early stage. It is also important that teachers are sensitive to the bullying that may result when a child lacks confidence or feels different because of their condition. I have come across that in my constituency.
Long-term medical conditions can impact negatively on academic attainment and pupils’ psychological well-being. That should provide a strong incentive for teachers when considering how to support pupils with diabetes. If they want to do what they are there to do—to get pupils to learn and to fulfil their academic potential—supporting them and helping them to control their diabetes is an important step in achieving that.
The good news is that there are many examples of effective practice throughout the education system. The vast majority of schools adequately manage pupils’ medical needs, and it is right that we trust them to do that and to make relationships work at local level. However, I am aware—this has been articulated further today—that some parents believe that schools do not do enough to help them and their children. Some employers—schools and local authorities—feel that they bear a significant risk if something goes wrong. Some staff, particularly support staff, feel that they are left to deal with children with inadequate or insufficient training, or are asked to carry out procedures they are not comfortable with. That remains a problem even today, but such feelings should be unnecessary and may lead to distress for the child concerned, their family and the school.
We want relevant school staff to be competent in managing pupils’ health needs and to feel confident in doing so. Schools should ensure that staff understand the school’s responsibilities, have appropriate training and can access continuing support, which includes receiving advice from juvenile diabetes specialist nurses in local health services when they are present.
It is clear that the effective management of long-term conditions helps children to improve their academic attainment and enables children with additional health needs to be included in the wider life of the school. That is extremely important. Teachers have a responsibility to ensure that pupils with diabetes can fulfil their educational potential, and it is in everyone’s interest to learn about diabetes, how to manage emergencies and how to support pupils with diabetes. In many ways, that goes beyond the education system, and there is a much wider debate to be had about pupils’ understanding of what diabetes is and how it manifests itself not just in adults, but in children. If people are more aware of that, there may be greater potential for local collaboration to be more effective.
The Government have made it clear that they want to give schools maximum freedom to use their own professional judgment and to decide their own priorities. As my hon. Friend said, there is no legal duty on teaching staff to provide medical support, to administer medication or to supervise a pupil taking medication. There are no plans at this stage to change that. It is for individual schools to make decisions about the managing medicine policies and protocols, but they are funded to provide continuing professional development and training for staff, and it is their responsibility to ensure that such needs are met for children with diabetes.
It is right that schools should take responsibility for managing their own approach to medicines, and guidance is available to support them. We encourage local authorities and schools to adopt the guidance in the booklet, “Managing Medicines in Schools and Early Years Settings”, which was produced in 2005. Appropriately, it provides joint guidance from the Department for Education and Department of Health, and it explains the roles and responsibilities for administering medicines on school premises. The guidance aims to ensure that children with medical needs are effectively supported, and work is ongoing as we speak to review and update the guidance to make it fit and proper for the future. It also contains a template for a health care plan, which my hon. Friend discussed. There is no excuse for schools not putting such plans in place.
Schools can also make use of the excellent resources created by the Medical Conditions at School Partnership, of which Diabetes UK is an active and important member. I am sure that my hon. Friend is aware that its website holds specialist advice about pupils with type 1 diabetes to help schools and school health care professionals to support such pupils. There are also resources for holding diabetes awareness sessions that can be used by schools to inform and train staff in a format that is accurate, reliable, easy to use and well presented. Similarly, it is right to say that Diabetes UK has excellent online resources for schools to use.
My hon. Friend alluded to the Juvenile Diabetes Research Foundation, which launched a resource pack in September 2008. During the last school year, 2011-12, it sent packs to more than 2,000 primary schools. I believe that it is in the process this month of sending out similar packs to secondary schools. There is plenty of information, advice and guidance out there for schools to take on board.
Pauline Latham
On that specific point, I have spoken to JDRF and I intend to send packs to every primary and secondary school in my constituency, so that they will have no excuse for not knowing about the situation.
Mr Timpson
I suspect that that is music to the ears, and I commend my hon. Friend for taking that course of action. Perhaps other hon. Members should consider following suit, because there is clearly not only a need, but an appetite for that to be followed through across the education sector. I commend my hon. Friend for leading by example.
I do not believe that it is the task of central Government to provide specialist medical advice for schools. It is for the excellent third sector organisations, such as Diabetes UK and JDRF, which employ highly skilled medical practitioners and work closely with their members, to support and advise them on specific issues.
My hon. Friend mentioned the Essex protocol, which provides an excellent template for all local authorities and schools to use, or to adapt, to meet local circumstances. She cited inconsistent services and a postcode lottery of care in schools, and it goes without saying that that is totally unacceptable. I highly commend the protocol to those schools and local authorities that may be reviewing their own practices and are seeking a tried and tested model as a basis for improving their care of pupils with type 1 diabetes. I trust that many more schools will take it on.
I am pleased to report that from April 2012 paediatric diabetes services will attract a best-practice tariff payment of £3,189 per patient per year for every child or young person under 19 who attends a paediatric diabetes clinic, provided certain strict criteria are met. The best-practice tariff includes a requirement for 24-hour support and advice to be available to patients and their families. To ensure that the child receives the best care that they can offer, that will include additional contacts by the diabetes specialist team for check-ups, telephone contacts, school visits, e-mails, troubleshooting, advice, support and so on. Eight contacts per year are recommended as a minimum. I hope that my hon. Friend agrees that that is a new and significant incentive for local health services to provide additional support for young diabetic children.
The coalition Government place a sharp focus on robust standards across the education system and the highest quality of teaching, and rightly so. But if children are to enjoy and progress at school, it is vital that schools provide a secure and happy environment where they can focus on learning, and for children with diabetes that includes oversight of their well-being and safety. Parents also need, and should always have, the assurance that their child’s school provides a secure environment.
We all agree that we need to help pupils with diabetes to grow in confidence, independence and well-being. I do not support further Government intervention or legislation, which would be heavy-handed and unnecessary, but I believe that every child or young person with diabetes should have an individualised, evidence-based care plan with agreed review dates. All schools should aim to have those in place, and the Essex protocol is a good starting point.
I am grateful to my hon. Friend for raising this important issue. If I have not covered any matters in this short debate, I will endeavour to write to her, so that she has answers to all her questions.