Children with Additional Health Needs: Provision of ‘Health’ Funding for Mainstream Schools and Early Years Settings in Hertfordshire.

The school age population includes many children with additional health needs. By way of illustration, in a typical school-age population of 1000 children:

  • There will be approximately 80 children with asthma[1]
  • Approximately fifteen children will have a peanut allergy[2]
  • Between three and five children will have epilepsy[3]
  • Between one and two children will have type 1 diabetes[4]

In September 2014, the Department of Education published statutory guidance for school governors setting out a range of responsibilities arising as a result of the SEND reforms: web page also provides links to a set of templates and resources intended to support schools in meeting the needs of pupils with additional health needs.The guidance was further updated in December 2015.

The revised guidance states (paragraphs numbered as per text):

“(5) The governing body must ensure that arrangements are in place to support pupils with medical conditions. In doing so they should ensure that such children can access and enjoy the same opportunities at school as any other child.

(12)Governing bodies should ensure that the school’s policy covers the role of individual healthcare plans, and who is responsible for their development, in supporting pupils at school with medical conditions.

(15)The governing body should ensure that the school’s policy clearly identifies the roles and responsibilities of all those involved in the arrangements they make to support pupils at school with medical conditions.”

For any child with additional health needs schools/early years settings should consider whether the child would benefit from the creation of a Health Care Plan. The school is responsible for making the decision as to whether a Health Care Plan should be created and for writing/updating that Plan. The school will be supported in this endeavour by the child’s parents and health care staff such as the school nurse or community children’s nurse.

Many children with Health Care Plans will actually require very little in the way of additional health care support in orderfor thechild’s health needs to be met within schools and early years settings. For many such children school staff will be provided with training/advice by a health care professional who knows the child – school nurses, community children’s nurse, Children's Community Trainers (Training High), therapist or specialist nurse - (usually supported by parents). Following the provision of this training/advice, the child’s ongoing health care needs can often be fully met by school staff. The School Nursing teams in Hertfordshire have developed a suite of documents which are intended to assist schools in supporting children with epilepsy, anaphylaxis, asthma and sickle cell disease. These can be accessed on The Grid at

When school/early years staff might be required to undertake specific additional care for the child, moreformal training may be provided – for instance in the administration of nebuliser therapy for a child with asthma or to administer emergency rescue medication for a child with epilepsy. In most instances, even when a small additional time commitment is required of the school, the undertaking of such clinical care does not require the provision of additional funding to the school.

For some children a higher level of health intervention is required, sometimes to undertake particular clinical care procedures. Where this care involves a regular and predictable time commitment on the part of the school, a request may be made to the local Clinical Commissioning Group (Herts Valley CCG and East and North Hertfordshire CCG) to provide funding to allow for a member of the school staff to undertake specific clinical care in order to support the child’s attendance. This funding is only available for children who are registered with a Hertfordshire General Practitioner. Any such request will require the completion of a joint assessment by the school and an appropriate health professional. The recommendations from this assessment will be presented to the Hertfordshire Schools Health Funding Panel. Copy of Panel referral paperwork is attached as appendices A/B.

In addition to the provision of funding, any necessary training for school-employed staff will be provided by NHS clinicians, usually members of the Community and Specialist Children’s Nursing Teams.

Summary of Panel Process.

The Hertfordshire Schools Health Funding Panel – meets on a monthly basis throughout the year. This Panel is responsible for making decisions in respect of the provision of funding for schools. This process is as follows:

  1. The School/Early Years Setting initially discusses the child’s additional health needs with the designated School Nurse (or Health Visitor for an Early Years Setting).
  1. Full details of the pupil’s additional health care needs should be incorporated in a Health Care Plan. Consideration might be given at this stage to the establishment of a Team Around the Child/Team Around the Family approach to supporting the child’s additional needs in school.
  1. Due to the complexity of the child’s need he/she may already be known to the Community Children’s Nursing Teams who can provide more information on the child’s individual health needs.
  1. If further advice is required at this stage, the School, School Nurseor Health Visitor should contact Mark Whiting– West Hertfordshire ( – 01923 470662) or Jo Collins – North/East Hertfordshire ( - 01438288366).
  1. An application should be made to the Hertfordshire Schools Health Funding Panel. The Application form (to be completed and submitted to the Panel by the school) must be counter-signed by an appropriate health professional or the application will not be considered.
  1. Application considered at next available Panel. The health professionalwho supported the school in completing the Application mayattend Panel in order to provide supplementary advice in support of the request for funding.
  1. Panel decision communicated in writing to school by Chair of Panel within two weeks of Panel and copied to Health Professional that has supported the application.
  1. If funding is approved, this will usually be for a maximum of one year and this will then be subject to annual re-application/review (to be held in May/June of each subsequent year). Schools will be contacted in advance of the review Panel and will be invited to apply for further funding.
  1. If funding is approved, the school/early years setting will be asked to submit invoices termly in arrears for care provided to the child during the preceding academic term.
  1. In addition to the provision of funding, any necessary training for school-employed staff will be provided by NHS clinicians, usually members of the Community and Specialist Children’s Nursing Teams. This will be arranged directly between the NHS clinician and the school/early years setting.

If you wish to discuss any elements of the above advice, then please contact Mark Whiting, Consultant Nurse, Children’s Community and Specialist Nursing – – 01923470662.

Appendix A.

Date as postmark/email /

Peace Children’s Centre

Peace Prospect
Watford
Herts
WD17 3EW
Tel: 01923 470662
Fax: 01923 470618

To:

/ Headteacher/SENCo/InCo,
Hertfordshire Schools,

Dear Colleague,

Re: Hertfordshire Clinical Commissioning Groups - Funding for children with additional health needs.

I write in order to advise you of the new process for the provision of funding by NHS funding for children with an identified additional health need who are attending a Hertfordshire School in line with DOH ‘Supporting Children with Medical Needs in Schools’ September 2014 and the new SEND reforms.

If you wish to request the provision of funding for the above named child you should complete the attached form “Request for Initial Health Funding or Renewal of Health Funding (Hertfordshire Clinical Commissioning Groups)” – all sections of the form must be completed and it should be returned to me at your earliest convenience

You will note that the form requires the signature of an appropriate health professional who will also be able to assist you in completing the form. In most instances this will be either your school’s allocated school nurse, or alternatively a member of the local Community Children’s Nursing Team. You may wish to discuss with the child’s parents in order to identify the health professional who best knows the child.

All requests for funding will be considered at a funding review Panel. Panels are held each month and once a funding request has been considered, I will write to youwithin 14 days in order to advise you of the outcome and, if supported by Panel, the arrangements for payment to the school of any agreed funding. The health professional who has supported the school in completing the request for funding will be invited to contribute to the discussion at the Panel and will receive a copy of the care agreed.

I trust that this letter is self-explanatory, but if you wish to discuss this with me, then please do not hesitate to contact me.

Yours sincerely,

Mark Whiting,

Consultant Nurse,

Children’s Community and Specialist Nursing

Appendix B

Request for Initial Health Funding or Renewal of Health Funding (Hertfordshire Clinical Commissioning Groups)

NURSING ASSESSMENT OF HEALTH INTERVENTION PROVIDED AT SCHOOL BY LEARNING SUPPORT STAFF

Child’s Name: / Date of Birth:
Name of School: / School Contact Telephone Number:
School Address/Postcode: / Name/Job Title for contact at the School:
GP, if known: / NHS No:
Lead Professional?
Details of package of care requested from the Hertfordshire Clinical Commissioning Groups including frequency, predictability and specific nature of health interventions for which health funding is being requested.
Name and designation of health care professional completing/supporting this assessment:
Date of assessment:
Signature of health professional:
Please provide details overleaf of a typical day for the child at school. (If interventions are unpredictable eg. Epilepsy please give an outline of total interventions in week).
Please append with this assessment form copies of any recent and relevant documentation e.g. notes of TAC meeting, medical letters etc.

Activities to be performed by staff in school

Activity / Activities performed by (which member of staff) / Training required
Yes/No
0830
0900
0930
1000
1030
1100
1130
1200
1230
1300
1330
1400
1430
1500
1530
1600
Total number of hours of ‘health’ intervention at school per day
Hourly rate of funding* - funding will not be awarded unless this information is provided. / £

In completing this document you should bear in mind the advice provided in the recently issued Hertfordshire document ‘Guidance for Medical Needs in Mainstream Schools’ a copy of which should be available in school. This can also be accessed on ‘The Grid’

[1]One in eleven children in the UK have asthma

[2] Peanut allergy now affects around 1 in 70 children in the UK. This is reflected ina documented increase in admission rates of children with very severe (anaphylactic reactions. (accessed 26.07.2012)

[3] In the UK, there are an estimated 60,000 children under 18 with epilepsy

[4]The current estimate of prevalence of Type 1 diabetes in children in the UK is one per 700–1,000. This gives a total population of 25,000 under-25s with Type 1 diabetes. That means that local authorities and primary care trusts (PCTs) can expect between 100 and 150 children with diabetes to live in their area. The peak age for diagnosis is between 10 and 14 years of age.