Children and Families Bill

Lord Kennedy of Southwark Excerpts

Wednesday 29th January 2014 Lords Chamber

Moved by

[Lord Kennedy of Southwark]

57C: Clause 81, page 57, line 16, at end insert—
“(7) In preparing and implementing individual health care plans and following the guidance issued by the Secretary of State, local authorities, clinical commissioning groups and governing bodies must work together in fulfilling their functions under this Act.”

[Lord Kennedy of Southwark (Lab)]

My Lords, I am grateful to the Minister and his officials for the time that they have given to me, my noble friend Lady Young, many of the staff at Diabetes UK and many others. I draw noble Lords’ attention to my entry in the register of Members’ interests: I am the chair of a small council at Diabetes UK.

I very much welcome the decision that the noble Lord, Lord Nash, and the Government made to include in the Bill a duty on schools to make arrangements for children with health conditions. I am genuinely grateful for that; it is a hugely positive step, and one that we hope will ensure that children with medical conditions get the support and help that they need to thrive at school. The draft guidance sets out many things that schools must do to ensure that children with medical conditions can take part in all parts of school life and give them the best possible chance of reaching their academic potential while staying safe and healthy. The draft guidance also acknowledges the different roles that CCGs, local authorities, schools, nurses, GPs and providers of health services have in ensuring that children with medical conditions get the support that they need to be in school. School nurses have several key roles in helping schools to meet the needs of children with medical conditions.

For many children with medical conditions, their specialist nurse often fulfils this role. Without this medical expertise, schools would not be in a position properly to support children with medical conditions, from awareness training about a condition right up to full training about a child’s condition, the administration of medicine and the use of equipment. While these responsibilities are included in the draft guidance, there remains no requirement in the Bill for local authorities or CCGs to fulfil their roles. That is why I have tabled Amendment 57C. It is essential that schools know that they can rely on their local authority, CCG and local health services to provide the expertise and training their staff will need.

The problems people report to many of the charities in the Health Conditions in Schools Alliance suggest that there will be an initial increase in requests for training as schools improve their support. We do not want to see some schools left without the training and skills their staff need.

We are already aware that there have been many occasions when schools have asked for training and the local authority or the local health service has not been able to provide it. The draft guidance refers to the NHS Act 2006 and Section 10 of the Children Act 2004, but these are general duties rather than ones that specifically meet the very particular needs that schools will have in securing the training they need for their staff. Has the Minister considered the possibility that some schools will not be able to access the training and expertise their staff need? If local authorities and CCGs cannot or will not provide the training and skills they need, will the Minister clarify what the next step is for a school in that situation?

When considering this point, it is important that we face up to some of the realities. We know that there are roughly 1,300 fully qualified school nurses. The average school nurse already looks after around 10 primary schools and two secondary schools. Even if the number of school nurses were to increase, it would take several years, and the duty needs to start to make a difference this September.

At the moment, we know that for more complex needs it is often the specialist nurse who organises training, helps to produce the individual healthcare plan and advises how much support each child requires. If the duty is to make an impact, the roles of the specialist nurse, school nurses and the local authorities that commission them and other healthcare professionals are vital. How will the crucial role of healthcare professionals, local authorities and CCGs in making sure that things improve in school for children with health conditions be communicated to them?

The indicative draft makes it very clear just how important an individual healthcare plan is. An individual healthcare plan draws together the thoughts of the school, a healthcare professional, pupils and parents. It makes clear how the condition might affect the pupil, sets out the medicine and equipment they need, and details the management of their condition, who should be trained, the level of support needed, what to do in emergencies and who is responsible for doing what. It is also tailored specifically to each child or young person with a medical condition. Yet the indicative draft guidance also states that not all children with a medical condition will need an individual healthcare plan. The Health Conditions in Schools Alliance has said that it cannot envisage a situation in which a child with a medical condition would not need an individual healthcare plan. Even in circumstances where the pupil manages the condition themselves and is rarely affected by it, it is worth noting in an individual healthcare plan that the condition exists, the medicine the pupil takes to control it and what to do in an emergency. As it stands, the guidance gives schools an opportunity to opt out of delivering individual healthcare plans. It also raises the question: who makes this decision? We do not want a situation where someone is making arbitrary judgments on who does and does not get an individual healthcare plan.

The draft guidance makes very clear the role of the governing body in fulfilling the duty, both in agreeing policies and in making sure that they are delivered. Paragraph 10 of the guidance covers renewing policies regularly, which is very welcome. It would be strengthened further if it was made clear that governing bodies should audit the support the school provides for children with health conditions so that they know their medical condition and put it into policy, and ensure that any individual healthcare plans are delivered.

Many charities have recognised the complaint that some children’s individual healthcare plans are not followed. Making sure that the school fulfils what has been agreed will contribute to ensuring that children get the support they need. Again, I thank the Minister for what he has addressed on this subject so far, and I am pleased with what has been achieved to date. If he could respond to the questions I have asked, I would be very grateful, and if he could give some clarity on these last few points, I think we will be able to make real progress here.

--- Later in debate ---

As I have said, we will be testing all these points during public consultation. We will of course consider carefully all comments that we receive. We plan to launch the consultation next week and would be grateful for comments from noble Lords on this before finalising the guidance for schools to use from September this year. It is my view that the right drivers and incentives are now in place to ensure we achieve our objectives on this important issue. Culture change is never easy and does not happen overnight but I believe that on this issue we are all united and behind the same goal. As the new duty is implemented, we will keep the arrangements under regular review. I hope that that is sufficient to reassure noble Lords and I urge the noble Lord, Lord Kennedy, to withdraw his amendment.

[Lord Kennedy of Southwark]

My Lords, I thank the noble Lord very much for his response. I still have one or two concerns. The opt-out is an issue, as is the issue about what governing bodies and schools do. I accept his kind offer to meet with officials, which I will do in the next few days. Other noble Lords may want to come with me. There are one or two small things that can be ironed out. Having said that, I am very grateful for what the noble Lord has done up to now and I beg leave to withdraw the amendment.

Amendment 57C withdrawn.