A Guidance Document for Services Working with Children and Young People

Medicine Safetyand other health related topics

CONTENTSForeword 4Introduction 5

CHAPTER 11. Developing a Medicines Policy 71.1 Introducing a Policy 71.2 Prescribed Medicines 81.3 Controlled Drugs 81.4 Non-Prescription Medicines 91.5 Long-Term Medical Needs 91.6 Administering Medicines 101.7 Self-Management 101.8 Refusing Medicines 111.9 Record Keeping 111.10 Educational Visits 121.11 Sporting Activities 131.12 Home to School Transport 13

CHAPTER 22. Roles and Responsibilities 152.1 Parents 152.2 The Employer 162.3 The Governing Body 172.4 The Lead Adult 172.5 Teachers and Other Staff 182.6 Early Years Staff Giving

Medicines 182.7 Lancashire County Council 182.8 Primary Care and NHS Trusts 182.9 Health Services 192.10 Ofsted 19

CHAPTER 33. Dealing with Medicines Safely 213.1 Safety Management 213.2 Storing Medicines 213.3 Access to Medicines 213.4 Disposal of Medicines 213.5 Hygiene and Infection Control 223.6 Emergency Procedures 22

CHAPTER 44. Developing a Health Care Plan 234.1 Co-ordinating Information 234.2 Off-site Education or

Work Experience 244.3 Staff Training 244.4 Confidentiality 24

CHAPTER 55. Common Conditions –

Practical Advice 255.1 Asthma 255.2 Epilepsy 275.3 Diabetes 295.4 Anaphylaxis 305.5 Attention Deficit Hyperactivity

Disorder (ADHD) 325.6 Teenage Pregnancy 335.7 Good Practice Guide for Infection

Control – Hand Washing 35

5.8 MRSA – Methicillin ResistantStaphylococcus Aureus 36

5.9 Procedure for the Safe Useand Administration ofOxygen in Cylindersin Pre-School Settings 38

5.10 HIV 40

CHAPTER 66. Legal Framework 436.1 Introduction 436.2 General Background 436.3 Indemnity Policy 436.4 Action in Emergencies 446.5 Children and Young People

with Medical Needs 446.6 Access to Education and

Associated Services 446.7 Health and Safety 456.8 Staff administering medicines 456.9 Staff 'duty of care' 456.10 Admissions 466.11 The Law 466.12 SEN and Disability Act

(SENDA) 2001 466.13 Local Authority and Schools 466.14 Early Years Settings 466.15 Health and Safety at

Work Act 1974 476.16 Management of Health

and Safety atWork Regulations 1999 47

6.17 Control of SubstancesHazardous to HealthRegulations 2002 48

6.18 Misuse of Drugs Act 1971 486.19 Medicines Act 1968 486.20 The Education (School Premises)

Regulations 1999 486.21 National Standards for

under 8s day care andchildminding – Premises 49

6.22 The Education (IndependentSchools Standards)(England) Regulations 2003 49

6.23 Special Educational Needs –Education Act 1996 49

6.24 Care Standards Act 2000 49Schools 49Day Care Provision 50

CHAPTER 77. Related Documents 517.1 Early Years Settings 517.2 Schools 517.3 Department of Health

(including joint publications) 527.4 Ofsted 527.5 Useful Contacts 527.6 The Law 53

Foreword

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FOREWORDMost children and young people will have, atsome time, a medical condition which couldaffect their attendance or participation inactivities. This may be short-term, forinstance, completing a course of medication,or a more long-term condition, which, if notproperly managed, could limit their access toa particular setting and the activities that areon offer.

The aim of this guidance document is to helpsettings where children and young peopleattend; develop policies and procedures forthose who have either a short-term or long-term medical need and put into placeeffective management systems to supportthem in the setting.

Individual settings are encouraged to developtheir own medicines policy and maintain clearwritten (audited) records for supportingchildren and young people with medicalneeds, including, where necessary, individualhealth care plans and the safe managementof medicines.

This document replaces ‘ManagingMedicines in Schools’, which was producedin 2002; the document will be made availableelectronically via the schools’ portal and theinternet.

This guidance document has been producedby Lancashire County Council in consultationwith partners from the Primary Care Trusts,schools and support services. Many thanksmust be expressed to all those who haveparticipated in producing this guidancedocument.

It is intended that the guidance will bereviewed on an annual basis. Commentsregarding the document and its contents arewelcome and should be forwarded toPolicyDevelopment@ed.lancscc.gov.uk

Introduction

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INTRODUCTION

This document provides guidance forLancashire County Council, Primary CareTrusts, Schools, Early Years Settings, Privateand Voluntary Organisations which providedirect services to children and young people.

This guidance is commended to allorganisations listed above. It was writtenspecifically for services provided directly byLancashire County Council but it is not arequirement upon these services.

The guidance has been produced withreference to Managing Medicines in Schoolsand Early Years Settings (DoH, 2005) and theNational Service Framework for Children,Young People and Maternity Services,Standard 10 (DoH, 2004), Including Me,Managing Complex Health Needs in Schooland Early Years Settings (DfES 2005).

It is designed to assist in the:

• Review of current policies and procedureswhich involve children and young peoplewith medical needs in order to make surethat everyone, including parents andcarers, are clear about their respectiveroles;

• Putting in place effective managementsystems to help support individual childrenand young people with medical needs;

• Making sure that medicines are handledresponsibly;

• Ensuring that all staff are clear about whatto do in the event of a medical emergency.

Examples of a Health Care Plan and otherforms for recording medication which can beadapted to suit the child, young person andthe setting are available for download at:http://www.lancashire.gov.uk/education/pdf/pid1142/form_templates.doc

It is recognised that Health Care Plans andother documentation developed withinparticular settings, for example Primary CareTrusts, could be used in place of these.

The guidance is concerned with children andyoung people from birth to 19 years of agewho have identified health needs and, as aconsequence, require additional supportand/or care in order to:

• Maintain optimal health during the day ornight;

• Access the range of opportunities availableto them to the maximum extent.

This guidance has been written for thefollowing settings:

• All schools;• Children's Centres;• Sure Start local programmes;• Childminders;• Playgroups;• Nursery schools;• Any setting eligible to receive NurseryEducation Grant funding;

• Before and after school clubs;• Holiday play schemes;• Residential care homes;• Youth and community services.

NB: Throughout the document the genericterm "setting(s)" will be used to describe anyof the provisions shown above for Childrenand Young People.

The lead adult with overall responsibility in sucha setting will be referred to as the ‘Lead Adult’.

Where the term 'Parents' is used it should betaken as defined in Section 576 of theEducation Act 1996, to include any personwho is not a parent of a child but hasparental responsibility for or care of a child.

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CHAPTER 11. Developing a MedicinesPolicy

For ease of reading throughout thedocument the generic term "setting(s)" willbe used to describe any of the aboveprovision for Children and Young People.

The lead adult with overall responsibility insuch a setting will be referred to as the‘Lead Adult’.

Where the term 'Parents' is used it should betaken as defined in Section 576 of theEducation Act 1996, to include any personwho is not a parent of a child but hasparental responsibility for or care of a child.

1.1 Introducing a Policy

A clear policy understood and accepted bystaff, parents, children and young peopleprovides a sound basis for ensuring thatchildren and young people with medical needsreceive proper care and support in a setting.

The Lead Adult has the responsibility fordevising the policy. However, settings actingon behalf of the employer should developpolicies and procedures that draw on theemployer's overall policy but are amended fortheir particular provision. Policies should, asfar as possible, be developed in consultationwith the Lead Adult where they are not theemployer. All policies should be reviewedand updated on a regular basis.

Policies should aim to enable regularattendance. Formal systems and proceduresin respect of administering medicines,developed in partnership with parents andstaff, should back up the policy.

A policy needs to be clear to all staff, parentsand children. It could be included in theprospectus, or in other information forparents. A policy should cover:

• Procedures for managing prescriptionmedicines which need to be taken duringthe day;

• Procedures for managing prescriptionmedicines on trips and outings;

• A clear statement on the roles andresponsibilities of staff managingadministration of medicines, and foradministering or supervising theadministration of medicines;

• A statement of parental responsibilities inrespect of their child's medical needs

• The need for prior written agreement fromparents for any medicines to be given to achild or young person;

• The circumstances in which a child oryoung person may take any non-prescription medicines;

• The settings policy on assisting childrenand young people with long-term orcomplex medical needs;

• Children and young people carrying andtaking their medicines themselves;

• Staff training in dealing with medical need;• Record keeping;• Safe storage of medicines;• Access to the school's emergencyprocedures;

• Risk assessment and managementprocedures.

Whilst teachers and other school staff incharge of pupils have a common law duty toact as any reasonably prudent parent wouldto make sure that pupils are healthy and safeon school premises (and this might inexceptional circumstances extend toadministering medicine and/or taking actionin an emergency), school staff should not, asa general rule, administer medication withoutfirst receiving appropriate information and/ortraining (eg Support Staff may have specificduties to provide medical assistance as partof their contract and will have receivedappropriate training); whilst Section 3(5) ofthe Children Act provides protection toteachers acting reasonably in emergencysituations. First Aiders are not trainedgenerally as part of their first aid training toadminister medication.

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It is each parent's responsibility to ensure thattheir child is fit to attend school and anymedication required whilst the child is atschool should ideally be administered bythe parent.

1.2 Prescribed Medicines

Parents are responsible for supplying thesetting with adequate information regardingtheir child's condition and medication. Thisinformation must be in writing, signed andcurrent so that procedures for each individualchild or young person’s medication areknown. The information should be updatedannually at an agreed time, or earlier, ifmedication is altered by the child's GPor Consultant.

All items of medication should be delivereddirectly to the setting by parents or escortsemployed by the Authority. It is the parent'sresponsibility to inform the Lead Adult inwriting when the medication or the dosage ischanged or no longer required. It would beconsidered good practice if a transfer ofmedication book was available to be signedon arrival at the setting.

After the first receipt of medication at a settingadditional medication of the same maycontinue to be accepted without further notice,but any changes to the prescribed medicationor a change in medication, must be notified inwriting to the Lead Adult or acceptedAuthorised Person. ‘As required’ medication,for example, inhalers, will only be accepted ifthe above procedures have been followed. Arecord must be maintained of all medicationadministered to a child or young person.

Each item of medication must be delivered tothe Lead Adult or Authorised Person in asecure and labelled container as originallydispensed. It may be appropriate for the GPto prescribe a separate amount of medicationfor the settings use. This should benegotiated with the parent. Items ofmedication in unlabelled containers shouldbe returned to the parent. The settingshould never accept medicines that have

been taken out of the container asoriginally dispensed nor make changes todosages on parental instructions.

Medicines should only be taken to a settingwhen essential; that is where it would bedetrimental to a child or young person'shealth if the medicine were not administeredduring the settings 'day'. The setting shouldonly accept medicines that have beenprescribed by a doctor, dentist, nurseprescriber or pharmacist prescriber.Medicines should always be provided in theoriginal container as dispensed by apharmacist and include the prescriber'sinstructions for administration, the child'sname and date of dispensing.

It is helpful, where clinically appropriate, ifmedicines are prescribed in dose frequencieswhich enable it to be taken outside thesetting’s hours. Parents could beencouraged to ask the prescriber about this.It is to be noted that medicines that need tobe taken three times a day could be taken inthe morning, after attending the setting andat bedtime.

The Medicines Standard of the NationalService Framework (NSF) for Children1

recommends that a range of options areexplored including:

Prescribers consider the use of medicineswhich need to be administered only once ortwice a day (where appropriate) for childrenand young people so that they can be takenoutside the setting’s hours. Prescribersconsider providing two prescriptions, whereappropriate and practicable, for a child oryoung person's medicine: one for home andone for use in the setting, avoiding the needfor repackaging or re-labelling of medicinesby parents. Medication should never beaccepted if it has been repackaged orrelabelled by parents.

1.3 Controlled Drugs

The supply, possession and administration ofsome medicines are controlled by the Misuse

81 National Service Framework for Children and Young People and Maternity Services: Medicines for Children and Young People (Department of Health/DfES, 2004).http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4089102

DevelopingaMedicinesPolicy

of Drugs Act and its associated regulations(see Legal Framework). Some may beprescribed as medication for use by childrenand young people.

Once appropriate information and traininghas been received, any member of staff mayadminister a controlled drug to the child oryoung person for whom it has beenprescribed. Staff administering medicineshould do so in accordance with theprescriber's instructions.

A child or young person who has beenprescribed a controlled drug may legally haveit in their possession. However it would beconsidered good practice to have theprescribed controlled drugs stored in safecustody. However, children and youngpeople could access them for self-medicationif it is agreed that it is appropriate.The setting should keep controlled drugs in alocked non-portable container and onlynamed staff should have access. A recordshould be kept for audit and safety purposes.A controlled drug, as with all medicines,should be returned to the parent when nolonger required to arrange for safe disposal(by returning the unwanted supply to thelocal pharmacy). If this is not possible, itshould be returned to the dispensingpharmacist (details should be on the label).

Misuse of a controlled drug, such aspassing it to another child or young personfor use, is an offence. There should be anagreed process for tracking the activities ofcontrolled drugs and recognition that themisuse of controlled drugs is an offence.

1.4 Non-Prescription Medicines

Lancashire County Council (LCC) policy isthat of not accepting non-prescriptionmedication.

LCC as an organisation has a policy not toaccept non-prescribed medication. Thispolicy is commended to all MaintainedSchools in Lancashire. However it is theschools’ responsibility to agree its policy

regarding non-prescription medication. AllGoverning Bodies and school's seniormanagement teams should ensure that aproperly instigated and understoodprocedure, with clear written (audited)records, which include insurance andindemnification, is maintained and isavailable to be audited. Arrangements to thiseffect should be drawn up and included inthe school/early years' setting Health andSafety Policy and communicated to allconcerned including parents.

A young person under 16 should never begiven aspirin or medicines containingibuprofen unless prescribed by a doctor.

1.5 Long-Term Medical Needs

The parent is responsible for supplying thesetting with adequate information regardingtheir child's condition and medication. Thisinformation must be in writing, signed andcurrent so that procedures for each individualchild and young person's condition andmedication are known. It is recommendedthat each setting has a standard set of formsfor this purpose, examples of which can bedownloaded at:http://www.lancashire.gov.uk/education/pdf/pid1142/form_templates.doc

The information should be updated annuallyat an agreed time or earlier if medication isaltered by the GP or Consultant.

It is important to have sufficient informationabout the medical condition of any child oryoung person with long-term medical needs.If a child or young person's medical needsare inadequately supported, this may have asignificant impact on their experiences andthe way they function in a setting. Theimpact may be direct in that the conditionmay affect cognitive or physical abilities,behaviour or emotional state. Somemedicines may also affect learning, leadingto poor concentration or difficulties inremembering. The impact could also beindirect; perhaps disrupting access toeducation through unwanted effects of

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treatments or through the psychologicaleffects that serious or chronic illness ordisability may have on a child andtheir family.

The Special Educational Needs (SEN) Codeof Practice 2001 advises that a medicaldiagnosis or a disability does not necessarilyimply SEN. It is the child or young person'seducational needs, rather than a medicaldiagnosis, which must be considered2.

The setting would need to know about anyparticular needs before a child or youngperson is admitted, or when they first developa medical need. For children and youngpeople who attend hospital appointments ona regular basis, special arrangements mayalso be necessary. It is often helpful todevelop a written health care plan for suchchildren and young people, involving theparents and relevant health professionals.

This can include: details of a child or youngperson's condition, special requirement egdietary needs, pre-activity precautions andany side effects of the medicines, whatconstitutes an emergency, what action totake in an emergency, what not to do in theevent of an emergency, who to contact in anemergency, the role the staff can play.

Form 2 provides an example of a health careplan which settings may wish to use oradapt. This can be downloaded at:http://www.lancashire.gov.uk/education/pdf/pid1142/form_templates.doc

1.6 Administering Medicines

No child or young person under 16 shouldbe given medicines without their parent'swritten consent. Any member of staff givingmedicines to a child or young personshould check:

• The child or young person's name on themedicine container;

• Prescribed dose;• Expiry date;• Written instructions provided by the

prescriber on the label or container3 andwithin the medication packaging.

If in doubt about any procedure staff shouldnot administer the medicines but check withthe parents or a health professional beforetaking further action. If staff have any otherconcerns related to administering medicineto a particular child or young person, theissue should be discussed with the parent, ifappropriate, or with the appropriate healthprofessional that may be attached to thesetting.

All settings should complete and sign arecord each time they give medicine to achild or young person. Forms 5 and 6provide examples which settings may wish touse or adapt for this purpose. These can bedownloaded at:http://www.lancashire.gov.uk/education/pdf/pid1142/form_templates.docGood records help demonstrate that staffhave exercised a duty of care.

1.7 Self-Management

It is good practice to support and encouragechildren and young people, who are able, totake responsibility to manage their ownmedicines from a relatively early age. Theage at which they are ready to take care of,and be responsible for their own medicineswould vary. As children grow and developthey should be encouraged to participate indecisions about their medicines.

Older children with a long-term illness should,whenever possible, assume completeresponsibility under the supervision of theirparent. Children develop at different ratesand so the ability to take responsibility fortheir own medicines varies. This should beborne in mind when making a decision abouttransferring responsibility to a child or youngperson. There is no set age when thistransition should be made. There may becircumstances where it is not appropriate fora child or young person of any age to self-manage. Health professionals need toassess, with parents and children and

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2 SEN Code of Practice (DfES/0581/2001) paragraphs 7:64-7:67.http://publications.teachernet.gov.uk/default.aspx?PageFunction=productdetails&PageMode=publications&ProductId=DfES+0581+2001

3 It is to be noted that adrenaline pens include manufacturer's instructions.

DevelopingaMedicinesPolicy

young people, the appropriate time to makethis transition.

If a child or young person can take theirmedicines themselves, staff may only need tosupervise. The policy should say whether achild or young person may carry andadminister (where appropriate) their ownmedicines, bearing in mind the safety ofother children and young people and medicaladvice from the prescriber, in respect of theindividual child or young person. Form 7provides examples which settings may wishto use or adapt for this purpose and can bedownloaded at:http://www.lancashire.gov.uk/education/pdf/pid1142/form_templates.doc

Where children and young people have beenprescribed controlled drugs, staff need to beaware that these should be kept in safecustody. However, children and youngpeople could access them for self-medicationif it is agreed that it is appropriate.

1.8 Refusing Medicines

If a child or young person refuses to takemedicine, staff should not force them to do so,but should note this in the records and followagreed procedures. The procedures mayeither be set out in the policy or in anindividual health care plan. Parents should beinformed of the refusal on the same day. If arefusal to take medicines results in anemergency, the setting's emergencyprocedures should be followed as writtendown in the child or young person’s care plan.

1.9 Record Keeping

Parents should tell the setting about themedicines that their child needs to take andprovide details of any changes to theprescription or the support required.However, staff should make sure that thisinformation is the same as that provided bythe prescriber.

Medicines should always be provided in theoriginal container as dispensed by apharmacist and include the prescriber'sinstructions. In all cases it is necessary tocheck that written details include:• Name of child or young person;• Name of medicine;• Dose;• Method of administration;• Time/frequency of administration;• Expiry date;• Date of dispensing.

Staff should check that any details providedby parents, or in particular cases by apaediatrician or specialist nurse, areconsistent with the instructions on thecontainer. Form 3 provides examples whichsettings may wish to use or adapt for thispurpose and can be downloaded at:http://www.lancashire.gov.uk/education/pdf/pid1142/form_templates.doc

Form 4 provides examples which settingsmay wish to choose or adapt to confirm, withthe parents, that a member of staff willadminister medicine to their child. This formcan be downloaded at:http://www.lancashire.gov.uk/education/pdf/pid1142/form_templates.doc

All early years settings must keep writtenrecords of all medicines administered tochildren, and make sure that parents sign therecord book to acknowledge the entry.

Although there is no similar legal requirementfor the setting to keep records of medicinesgiven to children and young people, it isgood practice to do so. Records offerprotection to staff and proof that they havefollowed agreed procedures. Some settingskeep a logbook for this. Forms 5 and 6provide examples which settings may use forthis purpose or adapt for medicine recordsheets. These forms can be downloaded at:http://www.lancashire.gov.uk/education/pdf/pid1142/form_templates.doc

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1.10 Educational Visits

It is essential that when planning aneducational visit, the school can demonstratethat it has taken all reasonable steps and hasundertaken reasonable adjustments to tryand ensure that the visit is accessible tochildren and young people with disabilitiesand/or medical needs.

Schools must also ensure that when includedin an outdoor visit a child or young person isnot put at a substantial disadvantage. Thesefactors may include: the time and effort thatmight need to be expended by adisabled/medical needs child; theinconvenience, indignity or discomfort adisabled/medical needs child might suffer;the loss of opportunity or the diminishedprogress that a disabled/medical needs childmay make in comparison with his or herpeers who are not disabled or havemedical needs.

Lancashire County Council has in place anEducational Visits Policy and Guidelineswhich was written to comply with Health andSafety at Work law. The document, theaccompanying Forms and Appendices, setsout the safety policy for off-site EducationalVisits, participation in adventurous outdooractivities, and the arrangements for theimplementation of the Policy.

All schools/services have received hardcopies of the Policy and Guidelines but themost up to date version is available on thewebsite:https://lccsecure.lancashire.gov.uk/education/data/edintact

Lancashire County Council is the employer inthe following schools/services and they havebeen directed to implement thearrangements in their Educational VisitsPolicy and Guidelines:

• Community schools, community specialschools, voluntary controlled schools,maintained nursery schools and short stayschools;

• Lancashire Young People's Service;• Lancashire Outdoor Education Service.

The legal responsibilities of Governing Bodiesfor Voluntary Aided and Foundation Schoolsare set out in the DfES document ‘Health andSafety: Responsibilities and Powers’. Forthose Voluntary Aided and FoundationSchools that are covered by the LCC’sinsurance arrangements, the Policy andGuidelines are a mandatory requirement.

In respect of individual cases where there areconcerns, schools should seek advice fromthe technical advisers (details below).However:

• It is essential that the school discusses theproposed visit and planning process withthe parents and (wherever possible) thechild or young person as early as possible;

• The risk assessment should cover thespecific issues of the child or youngperson. Reasonable adjustments should bemade and alternative activities may need tobe considered. If it is a Type B visit, theForm 1B (Application to the Authority forApproval) and Form 5 (Risk Assessment)should clearly show that the child(ren) havebeen fully considered in the planningprocess and that any necessary reasonableadjustments have been made; These formscan be downloaded at:http://www.lancashire.gov.uk/education/pdf/pid1142/form_templates.doc

• The staff and volunteers on the visit mustbe fully briefed and particularly if there areany adjustments to the programme for thechild(ren) that have any SEN or medicalneeds. Schools should use the relevantplanning forms (Form 2A for Type A visitsand Form 2B for Type B visits); Theseforms can be downloaded at:http://www.lancashire.gov.uk/education/pdf/pid1142/form_templates.doc

• Advice about activities or venues can beobtained from the appropriate technicaladviser (Nursery, Primary and SpecialSchools - 01772 532805, SecondarySchools - 01772 532783 or 01772 531224);

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• Any disputes with parents should bereferred to the Legal Adviser for Schools inthe County Secretary and Solicitor’s Group(01772 533321).

Lancashire County Council is the employer inthe following:

• Community schools, community specialschools, voluntary controlled schools,maintained nursery schools and short stayschools;

• Integrated Youth Support Service;• Lancashire Outdoor Education.

Further information on Educational Visits andthe Disability Discrimination Act, 1995 can befound in Appendix 18 of this Policy:https://lccsecure.lancashire.gov.uk/education/data/edintact

If staff are concerned whether they canprovide for a child or young person's safety,or the safety of other children and youngpeople on a visit, they should seek parentviews and medical advice from the SchoolHealth Service or the child or young person'sGP. See DfES guidance on planningeducational visits4.

The National standards for under 8s day careand childminding mean that the registeredperson must take positive steps to promotesafety on outings.

1.11 Sporting Activities

Most children and young people with medicalconditions can participate in physicalactivities and extra-curricular sport. Thereshould be sufficient flexibility for all childrenand young people to follow in waysappropriate to their own abilities. For many,physical activity can benefit their overallsocial, mental and physical health andwellbeing. Any restrictions on a child oryoung person's ability to participate in PEshould be recorded in their individual HealthCare plan. All adults should be aware ofissues of privacy and dignity for children andyoung people with particular needs.

Some children and young people may needto take precautionary measures before orduring exercise, and may also need to beallowed immediate access to their medicinessuch as asthma inhalers. Staff supervisingsporting activities should consider whetherrisk assessments are necessary for somechildren and young people, be aware ofrelevant medical conditions and anypreventative medicine that may need to betaken and emergency procedures.

1.12 Home to School Transport

Lancashire County Council arranges home toschool transport where legally required to doso. It must make sure that children andyoung people are safe during the journey.Most children and young people with medicalneeds do not require supervision on schooltransport, but should provide appropriatetrained escorts should they consider itnecessary5. Guidance should be soughtfrom the child or young person's GP orpaediatrician.

Drivers and escorts should know what to doin the case of a medical emergency. Theyshould never administer medication; however,some passenger assistants may have beenspecially trained to clear tracheotomy tubes.Drivers and passenger assistants should fullyunderstand what procedures and protocolsto follow and they should be clear about theirroles, responsibilities and liabilities.

Where children and young people have life-threatening conditions, specific Health CarePlans should be carried on vehicles. Schoolswould be well placed to advise the CountyCouncil and its transport contractors ofparticular issues for individual children.Individual transport Health Care Plans willneed input from parents and the responsiblemedical practitioner for the child concerned.The Care Plans should specify the steps tobe taken to support the normal care of thechild as well as the appropriate responses toemergency situations. All drivers and escortsshould have basic first aid training.Additionally, trained escorts may be required

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4 Health and Safety of Pupils on Educational Visits: a good practice guide (DfES, 1998) http://www.hse.gov.uk/education/visits.htm

5 Please refer to 'Good Practice Guidelines for further information around this service.http://lccintranet/education/education_standards_and_inclusion_group/reports/pdf/home_to_school_travel.pdf

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to support some children and young peoplewith complex medical needs. These can behealthcare professionals or escorts trainedby them.

Some children and young people are at riskof severe allergic reactions. Risks can beminimised by not allowing anyone to eat onvehicles. As noted above, all escorts shouldhave basic first aid training and should betrained in the use of an adrenaline pen foremergencies where appropriate.

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RolesandResponsibilities

CHAPTER 22. Roles and Responsibilities

Responsibility for Child Safety

For ease of reading throughout thedocument the generic term "setting(s)" willbe used to describe any of the aboveprovision for Children and Young People.

The lead adult with overall responsibility insuch a setting will be referred to the‘Lead Adult’.

Where the term 'Parents' is used it should betaken as defined in Section 576 of theEducation Act 1996, to include any personwho is not a parent of a child but hasparental responsibility for or care of a child.

It is important that responsibility for childsafety is clearly defined and that each personinvolved with children with medical needs isaware of what is expected of them. Closeco-operation between the setting, parents’,health professionals and other agencies willhelp provide a suitably supportiveenvironment for children and young peoplewith medical needs.

Children and young people with medicalneeds have the same rights of admission toschool as other children, and cannotgenerally be excluded from school formedical reasons. Where a child or youngperson's presence at a setting represents aserious risk to the health or safety of othersthe Lead Adult may send the child or youngperson home that day, after consultation withthe parents. This is not exclusion and mayneed to be done for medical reasons.

2.1 Parents

Parents, as defined in Section 576 of theEducation Act 1996, include any person whois not a parent of a child but has parentalresponsibility for, or care of, a child. In thiscontext, the phrase 'care of the child' includes

any person who is involved in the full-timecare of a child or young person on a settledbasis, such as a foster parent, but excludesbaby sitters, child minders, nannies andschool staff.

It only requires one parent to agree to orrequest that medicines are administered. Asa matter of practicality, it is likely that this willbe the parent with whom the setting has day-to-day contact. Where parents disagree overmedical support, the disagreement must beresolved by the courts. The setting shouldcontinue to administer the medicine in linewith the consent given and in accordancewith the prescriber's instructions, unless anduntil a court decides otherwise.

It is important that professionals understandwho has parental responsibility for a child.The Children Act 1989 introduced theconcept of parental responsibility. The Actuses the phrase ‘parental responsibility’ tosum up the collection of rights, duties,powers, responsibilities and authority that aparent has by law, in respect of a child. Inthe event of family breakdown, such asseparation or divorce, both parents willnormally retain parental responsibility for thechild or young person and the duty on bothparents to continue to play a full part in thechild or young person's upbringing will notdiminish. In relation to unmarried parents,only the mother will have parentalresponsibility unless the father has acquired itin accordance with the Children Act 1989.Where a court makes a residence order infavour of a person who is not a parent of thechild or young person, for example agrandparent, that person will have parentalresponsibility for the child for the duration ofthe Order.

If a child is 'looked after' by LancashireCounty Council, the child or young personmay either be on a Care Order or beVoluntarily Accommodated. A Care Orderplaces a child in the care of LancashireCounty Council and gives them parentalresponsibility for the child. LancashireCounty Council will have the power to

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determine the extent to which thisresponsibility will continue to be shared withthe parents. Lancashire County Council mayalso accommodate a child or young personunder voluntary arrangements with the child'sparents. In these circumstances the parentswill retain parental responsibility acting, so faras possible, as partners of LancashireCounty Council. Where a child is looked afterby Lancashire County Council day-to-dayresponsibility may be with foster parents,residential care workers or guardians.

Parents should be given the opportunity toprovide the Lead Adult of the setting withsufficient information about their child'smedical needs if treatment or special care isneeded. They should, jointly, with the LeadAdult, reach agreement on the setting’s rolein supporting their child's medical needs, inaccordance with the employer's policy.Ideally, the Lead Adult should always seekparental agreement before passing oninformation about their child's health to otherstaff. Sharing information is important if staffand parents are to ensure the best care for achild or young person.

Some parents may have difficultyunderstanding or supporting their child'smedical condition themselves. Local healthservices can often provide additionalassistance in these circumstances.

2.2 The Employer

Under the Health and Safety at Work Act1974, employers, including LancashireCounty Council and school GoverningBodies, must have a health and safetypolicy6. This should incorporate managingthe administration of medicines andsupporting children with complex healthneeds, which will support the setting indeveloping their own operational policies andprocedures.

Lancashire County Council health and safetypolicies and procedures are commended toall Maintained Schools in Lancashire. InCommunity, Community Special and

Voluntary Controlled Schools, the employer isthe County Council. The Governing Body isthe employer in Voluntary Aided Schools andFoundation Schools.For all Maintained Schools (Community,Community Special and Voluntary ControlledSchools, Voluntary Aided and FoundationSchools) covered by the County CouncilInsurance arrangements7, the school'sGoverning Body should follow the health andsafety policies and procedures produced byLancashire County Council.

In the event of legal action over an allegationof negligence the employer, rather than theemployee, is likely to be held responsible.Governing Bodies should therefore makesure that their insurance arrangementsprovide full cover in respect of actions whichcould be taken by staff in the course of theiremployment. It is the employer'sresponsibility to make sure that properprocedures are in place; and that staff areaware of the procedures and fully trained.Keeping accurate records is essential in suchcases. Employers should support staff touse their best endeavours at all times,particularly in emergencies. In general, theconsequences of taking no action are likelyto be more serious than those of trying toassist in an emergency.

Staff in a school or in an early years settingwill be directly employed by LancashireCounty Council or Governing Body, asemployer. However, some care or health staffmay be employed by a local health trust orpossibly through the voluntary sector. Insuch circumstances, appropriate sharedmanagement arrangements should beagreed between the relevant agencies.

The employer is responsible for making surethat staff have appropriate training to supportchildren and young people with medicalneeds. Employers should also ensure thatthere are appropriate systems for sharinginformation about a child or young person’smedical needs in each setting for which theyare responsible. Employers should satisfythemselves that training has given staff

16

6 Health and Safety: Responsibilities and Powers (DfES/0803/2001) includes information on responsibilities for health and safety in schoolswww.teachernet.gov.uk/_doc/4017/Responsibilites%20and%20Powers.doc

7 Insurance –A guide for schools (DfES/0256/2003) http://www.dfes.gov.uk/valueformoney/index.cfm?action=GoodPractice.Default&ContentID=22

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sufficient understanding, confidence andexpertise, and that arrangements are in placeto update training on a regular basis. Ahealth care professional should providewritten confirmation of proficiency in anymedical procedure.

Primary Care Trusts have the discretion tomake resources available for any necessarytraining. Consideration should also be givenin arranging training for staff in themanagement of medicines and policiesabout administration of medicines. Thisshould be arranged in conjunction with localhealth services or other health professionals.

2.3 The Governing Body

Governing Bodies are responsible for settingthe strategic direction of the school. Thisincludes the establishment, monitoring andevaluation of policies. All schools shouldhave a policy for medicines. In developing apolicy the Governing Body must have regardto the views of the parents. It is thereforerecommended that they consult with parents,and healthcare professionals.Individual schools should develop policies tocover the needs of their own school. Thepolicies should reflect those of their employer.The Governing Body has generalresponsibility for all of the school's policieseven when it is not the employer. TheGoverning Body will generally want to takeaccount of the views of the Head Teacher,staff and parents in developing a policy onassisting children and young people withmedical needs.

2.4 The Lead Adult

The Lead Adult is responsible for putting theemployer's policy into practice and fordeveloping detailed procedures. Day-to-daydecisions will normally fall to the Lead Adultor to whosoever they delegate this to, as setout in their policy.

Although the employer must ensure that staffreceive proper support and training wherenecessary, equally, there is a contractual duty

on the Lead Adult to ensure that their staffreceive the training. As the manager of staffit is likely to be the Lead Adult who will agreewhen and how such training takes place.

The Lead Adult should make sure that allparents and staff are aware of the policy andprocedures for dealing with medical needs.The Lead Adult should also make sure thatthe appropriate systems for informationsharing are followed. The policy shouldmake it clear that parents should keep theirchildren at home when they are acutelyunwell. The policy should also cover theapproach to taking medicines in a setting.The Lead Adult and the Governing Body ofschools should ensure that the policy andprocedures are compatible and consistentwith any registered day care operatedeither by them or an external provider ontheir premises.

For a child or young person with medicalneeds, the Lead Adult will need to agree withthe parents exactly what support can beprovided. Where parents expectationsappear unreasonable, the Lead Adult shouldseek advice from the school nurse or doctor,the child's GP or other medical advisers and,if appropriate, the employer. In early yearssettings advice is more likely to be providedby a health visitor.

If staff follow documented procedures, thenthe employer's public liability insurance willapply if a parent should make a complaint.The Lead Adult should ask the employer toprovide written confirmation of the insurancecover for staff who provide specific medicalsupport. Registered persons are requiredto carry public liability insurance for daycare provision.

Criteria under the National standards forunder 8s day care make it clear that day careproviders should have a clearly understoodpolicy on the administration of medicines. Ifthe administration of prescription medicinesrequires technical or medical knowledge thenindividual training should be provided to stafffrom a qualified health professional. Training

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is specific to the individual child concerned.Ofsted's guidance on this standard sets outthe issues that providers need to thinkthrough in determining the policy. In thesecases contact should be made with theappropriate health service, school nurse orhealth visitor.

2.5 Teachers and Other Staff

Some staff may be naturally concerned forthe health and safety of a child or youngperson with a medical condition, particularly ifit is potentially life threatening. Staff withchildren and young people with medicalneeds in their class or group should beinformed about the nature of the condition,and when and where they may need extraattention. The child or young person'sparents and health professionals shouldprovide this information.

All staff should be aware of the likelihood ofan emergency arising and what action to takeif one occurs. Back up cover should bearranged for when the member of staffresponsible is absent or unavailable. Atdifferent times of the day other staff may beresponsible for children, such as lunchtimesupervisors. It is important that they are alsoprovided with training and advice.

Many voluntary organisations specialising inparticular medical conditions provide adviceand/or information advising staff on how tosupport children.

A Health Care Plan may reveal the need forsome staff to have further information about amedical condition or specific training inadministering a particular type of medicine orin dealing with emergencies. Staff should notgive medicines without appropriate trainingfrom health professionals. When staff agreeto assist a child with medical needs, theemployer should arrange appropriate trainingin collaboration with local health services.Local health services will also be able toadvise on further training needs. In everyarea there will be access to training, inaccordance with the provisions of the

National Service Framework for Children,Young People and Maternity Services, byhealth professionals for all conditions and toall settings.

2.6 Early Years Staff GivingMedicines

For registered day care, the conditions ofemployment are individual to each setting. Itis therefore for the registered person toarrange who should administer medicineswithin a setting, either on a voluntary basis oras part of a contract of employment.

2.7 Lancashire County Council

In Community Special and VoluntaryControlled Schools and Community NurserySchools, Lancashire County Council, as theemployer, is responsible for all health andsafety matters. For Lancashire CountyCouncil day nurseries, out of school clubs(including open access schemes), holidayclubs and play schemes the registeredperson, which may be Lancashire CountyCouncil itself, is responsible for all health andsafety matters.

Lancashire County Council, as the employer,provides a general policy framework to guidesettings in developing their own policies onsupporting children and young people withmedical needs drawn up in consultation withlocal Primary Care Trusts.

2.8 Primary Care and NHS Trusts

Primary Care Trusts (PCTs) have a statutoryduty to purchase services to meet localneeds. PCTs and National Health Service(NHS) Trusts may provide these services.PCTs, Lancashire County Council andsettings should work in co-operation todetermine need, plan and co-ordinateeffective local provision within the resourcesavailable.

PCTs must ensure that there is a medicalofficer with specific responsibility for childrenwith special educational needs (SEN)8. Some

188 SEN Code of Practice (DfES/0581/2001) paragraphs 10:24 – 10:26.http://www.child-disability.co.uk/pdf/SEN%20Code%20of%20Practice%20DfES-0581-2001_main.pdf

RolesandResponsibilities

of these children may have medical needs.PCTs and NHS Trusts, usually through theschool health service, may provide adviceand training for staff in providing for a child'smedical needs.

2.9 Health Services

The nature and scope of local health servicesto settings varies between Health Trusts.They can provide advice on health issues tochildren, parents, staff within the setting, andthe Local Authority. The main health contactfor schools is likely to be a school nurse,whilst early years settings usually link with ahealth visitor. The school health service mayalso provide guidance on medical conditions.

Most settings will have contact with the healthservice through a school nurse, health visitor orcommunity paediatrician. The school nurse,health visitor or community paediatricianshould help the setting draw up individualHealth Care Plans for children and youngpeople with medical needs, and may be ableto supplement information already provided byparents and the child or young person'sGeneral Practitioner. The school nurse, healthvisitor or community paediatrician may also beable to advise on training for staff onadministering medicines, or take responsibilityfor other aspects of support.

Every child and young person should beregistered with a GP, who work as part of aprimary health care team. Parents usuallyregister their child with a local GP practice. AGP owes a duty of confidentiality to patients,and so any exchange of information betweena GP and a setting should normally be withthe consent of the child or young person, ifappropriate, or the parent. Usually consentwill be given, as it is in the best interests ofthe child or young person for their medicalneeds to be understood by staff. The GPmay share this information directly or via theappropriate health professional.

Many other health professionals may takepart in the care of children with medical

needs. Often a community paediatrician willbe involved. These doctors are specialists inchildren's health, with special expertise inchildhood disability, chronic illness and itsimpact in the setting. They may be directlyinvolved in the care of the child, or provideadvice to the settings in liaison with the otherhealth professionals looking after the child.

Most NHS Trusts with school health serviceshave pharmacists. They can providepharmaceutical advice to the setting. Somework closely with local authority educationdepartments and give advice on themanagement of medicines within settings.This could involve helping to prepare policiesrelated to medicines in the setting and thetraining of staff. In particular, they canadvise on the storage, handling and disposalof medicines.

Some children and young people withmedical needs receive dedicated supportfrom specialist nurses or communitychildren's nurses, for instance a children'soncology nurse. These nurses often work aspart of a NHS Trust or PCT and work closelywith the primary health care team. They canprovide advice on the medical needs of anindividual child, particularly when a medicalcondition has just been diagnosed and thechild is adjusting to new routines.

2.10 Ofsted

During an inspection Ofsted will check that daycare providers have adequate policies andprocedures in place regarding theadministration and storage of medicines.Regulations require that parents give theirconsent to medicines being given to their childand that the provider keeps written records.

During school inspections Ofsted inspectorsmust evaluate and report on how wellschools ensure pupils' care, welfare, healthand safety. Ofsted will look to see whether'administration’ of medicines follows clearprocedures9 and assess steps are taken toprovide children and young people with a

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9 Ofsted Inspecting schools – Handbook for inspecting nursery and primary schools; http://www.archive.official-documents.co.uk/document/ofsted/inspect/primary/30107.htmInspecting schools – Handbook for inspecting secondary schools, http://www.archive.official-documents.co.uk/document/ofsted/inspect/secondary/29503.htmInspecting schools – Handbook for inspecting special schools and pupil referral units http://www.archive.official-documents.co.uk/document/ofsted/inspect/special/29502.htm (all Ofsted 2003). These include judgements about the care, welfare, health and safety of pupils.

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safe environment, including the safe storageand use of medicines.The Commission for Social Care Inspection(CSCI) has a regular programme ofinspections for care homes and other typesof residential establishments such as specialresidential and boarding schools10 .

2010 Ofsted Inspection Guidance Document – LEA Framework 2004 – Support for health and safety, welfare and child protection (Ofsted, 2004).

http://www.ofsted.gov.uk/assets/3491.doc

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CHAPTER 33. Dealing with Medicines Safely

For ease of reading throughout thedocument the generic term "setting(s)" willbe used to describe any of the aboveprovision for Children and Young People.The lead adult with overall responsibility insuch a setting will be referred to as the‘Lead Adult’.

Where the term 'Parents' is used it should betaken as defined in Section 576 of theEducation Act 1996, to include any personwho is not a parent of a child but hasparental responsibility for or care of a child.

3.1 Safety Management

All medicines may be harmful to anyone forwhom they are not appropriate. Where asetting agrees to administer any medicinesthe employer must ensure that the risks tothe health of others are properly controlled.This duty is set out in the Control ofSubstances Hazardous to Health Regulations2002 (COSHH).

3.2 Storing Medicines

Large volumes of medicines should not bestored. Staff should only store, supervise andadminister medicine that has beenprescribed for an individual child or youngperson. Medicines should be stored strictlyin accordance with product instructions(paying particular note to temperature) and inthe original container in which dispensed.Staff should ensure that the suppliedcontainer is clearly labelled with the name ofthe child, the name and dose of the medicineand the frequency of administration; asdispensed by a pharmacist in accordancewith the prescriber's instructions. Where achild or young person needs two or moreprescribed medicines; each should be keptin a separate container. Non-healthcare staffshould never transfer medicines from theiroriginal containers.

Children and young people should knowwhere their own medicines are stored andwho holds the key. The Lead Adult isresponsible for making sure that medicinesare stored safely. All emergency medicines,such as asthma inhalers and adrenalinepens, should be readily available to the childor young person and should not be lockedaway. Many settings allow children andyoung people to carry their own inhalers.Other non-emergency medicines shouldgenerally be kept in a secure place notaccessible to children and young people.Criteria under the ‘National standards forunder 8s day care’ require medicines to bestored in their original containers, clearlylabelled and inaccessible to children.

Some medicines need to be refrigerated. Theycan be kept in a refrigerator containing foodbut should be in an airtight container andclearly labelled. There should be restrictedaccess to a refrigerator holding medicines.

Local pharmacists can give advice aboutstoring medicines.

3.3 Access to Medicines

Children and young people need to haveimmediate access to their medicines whenrequired. The setting may want to makespecial access arrangements for emergencymedicines that it keeps. However, it is alsoimportant to make sure that medicines areonly accessible to those for whom they areprescribed. This should be considered aspart of the policy about children and youngpeople carrying their own medicines.

3.4 Disposal of Medicines

Staff should not dispose of medicines.Parents are responsible for ensuring thatdate-expired medicines are returned to apharmacy for safe disposal. They shouldalso collect medicines held at the end ofeach term. If parents do not collect allmedicines, they should be taken to a localpharmacy for safe disposal.

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Sharps boxes should always be used for thedisposal of needles. Sharps boxes can beobtained by parents on prescription from thechild's GP or paediatrician. Collection anddisposal of the boxes should be arrangedwith either Lancashire County Council’sEnvironmental Services or the PCT; alternativearrangements can also be made with privatecontractors if necessary.

3.5 Hygiene and Infection Control

All staff should be familiar with normalprecautions for avoiding infection and followbasic hygiene procedures11. Please refer toChapter 5, 'Hand Washing and InfectionControl'. Staff should have access toprotective disposable gloves and take carewhen dealing with spillages of blood or otherbody fluids and disposing of dressings orequipment. Ofsted guidance provides anextensive list of issues that early yearsproviders should consider in making suresettings are hygienic.

3.6 Emergency Procedures

As part of general risk managementprocesses all settings should havearrangements in place for dealing withemergency situations. This could be part ofthe school's first aid policy and provision12.Other children and young people shouldknow what to do in the event of anemergency, such as telling a member of staff.All staff should know how to call theemergency services. Guidance on calling anambulance is provided in Form 1 whichprovides an example which settings maywish to use or adapt for this purpose. Thisform can be downloaded at:http://www.lancashire.gov.uk/education/pdf/pid1142/form_templates.doc

All staff should know who is responsible forcarrying out emergency procedures in theevent of need. A member of staff shouldalways accompany a child or young persontaken to hospital by ambulance, and shouldstay until the parent arrives. At hospital it is

the health professionals who are responsiblefor any decisions on medical treatment whenparents are not available.

Staff should never take children to hospital intheir own car; it is safer to call an ambulance.The National standards require early yearssettings to ensure that contingencyarrangements are in place to cover suchemergencies.

Individual Health Care Plans should includeinstructions as to how to manage a child inan emergency, and identify who has theresponsibility in an emergency, for example ifthere is an incident in the playground alunchtime supervisor would need to be veryclear of their role.

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11 Guidance on infection control in schools and nurseries:http://www.hpa.org.uk/infections/topics_az/schools/schools_guidelines_2006.pdf. (Department of Health/Department for Education and Employment/Public HealthLaboratory Service, 1999)

12 Guidance on First Aid for Schools: a good practice guide (DfES, 1998). http://www.teachernet.gov.uk/_doc/4421/GFAS.pdf.

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CHAPTER 44. Developing a Health Care Plan

Purpose of a Health Care Plan

For ease of reading throughout thedocument the generic term "setting(s)" willbe used to describe any of the aboveprovision for Children and Young People.

The lead adult with overall responsibility insuch a setting will be referred to the‘Lead Adult’.

Where the term 'Parents' is used it should betaken as defined in Section 576 of theEducation Act 1996, to include any personwho is not a parent of a child but hasparental responsibility for or care of a child.

The main purpose of an individual HealthCare Plan for a child or young person withmedical needs is to identify the level ofsupport that is needed. Not all children andyoung people who have medical needs willrequire an individual plan; a writtenagreement with parents may be all that isnecessary. Forms 3 and Form 4 provideexamples which settings may wish to use oradapt for this purpose. These forms can bedownloaded at:http://www.lancashire.gov.uk/education/pdf/pid1142/form_templates.doc

An individual Health Care Plan clarifies forstaff, parents and the child or young personthe help that can be provided. It is importantfor staff to be guided by the child or youngperson's GP, paediatrician, or otherappropriate health professional. Staff shouldagree with parents and the appropriate healthprofessional, how often they should jointlyreview the health care plan. It is sensible todo this at least once a year, but muchdepends on the nature of the child or youngperson's particular needs; some would needreviewing more frequently.

Staff should judge each child's needsindividually as children and young peoplevary in their ability to cope with poor health ora particular medical condition.

Developing a Health Care Plan should not beonerous, although each plan will containdifferent levels of detail according to the needof the individual child or young person. Form2 provides an example which settings maywish to use or adapt for this purpose. Thisform can be downloaded at:http://www.lancashire.gov.uk/education/pdf/pid1142/form_templates.doc

In addition to input from the school healthservice, the child's GP or other health careprofessionals (depending on the level ofsupport the child needs), those who mayneed to contribute to a health care planinclude:

• The Lead Adult;• The parent;• The child or young person (if appropriate);• Early Years Practitioner, class teacher(primary schools), form tutor, head of year,pastoral staff, learning mentors;

• Care assistant or support staff;• Staff who are trained to administermedicines;

• Staff who are trained in emergencyprocedures.

Early years settings should be aware thatparents may provide them with a copy oftheir Family Service Plan, a feature of theEarly Support Family Pack13. Whilst the planwill be extremely helpful in terms ofunderstanding the wider picture of the child'sneeds and services provided, it should nottake the place of an individual Health CarePlan devised by a health professional andsigned by the same professional, the parentsand the setting or indeed the record of achild's medicines(s).

4.1 Co-ordinating Information

Co-ordinating and sharing information on anindividual child or young person with medical

2313 Early Support Family Pack (DfES, 2004) http://www.earlysupport.org.uk/modResourcesLibrary/HtmlRenderer/Familypack.html

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needs, particularly in secondary schools, canbe difficult. The Lead Adult should decidewhich member of staff has specificresponsibility for this role. This person canbe a first contact for parents and staff, andliaise with external agencies.

Staff who may need to deal with anemergency will need to know about a child oryoung person's medical needs. The LeadAdult should make sure that supply staffknow about any medical needs.

4.2 Off-site Education orWork Experience

Schools are responsible for ensuring, underan employer's overall policy, that workexperience placements are suitable for ayoung person with a particular medicalcondition. Schools are also responsible for ayoung person with medical needs who, aspart of Key Stage 4 provision, are educatedoff-site through another provider such as thevoluntary sector, E2E training provider orFurther Education College. Schools shouldconsider whether it is necessary to carry outa risk assessment before a young person iseducated off-site or has work experience.

Schools have a primary duty of care for childrenand young people and have a responsibility toassess the general suitability of all off-siteprovision including college and workplacements. This includes responsibility for anoverall risk assessment of the activity, includingissues such as travel to and from theplacement and supervision during non-teachingtime or breaks and lunch hours. This does notconflict with the responsibility of the college oremployer to undertake a risk assessment toidentify significant risks and necessary controlmeasures when pupils below the minimumschool leaving age are on site.

Schools should refer to guidance fromDCSF14, the Health and Safety Executive andthe Learning and Skills Council forprogrammes that they are funding (egIncreased Flexibility Programme). Generally

schools should undertake an overall riskassessment of the whole activity and schoolsor placement organisers should visit theworkplace to assess its general suitability.Responsibility for risk assessment remainwith the employer or the college. Wherestudents have special medical needs theschool will need to ensure that such riskassessments take into account those needs.Parents, children and young people mustgive their permission before relevant medicalinformation is shared on a confidential basiswith employers.

4.3 Staff Training

A Health Care Plan may reveal the need forsome staff to have further information about amedical condition or specific training inadministering a particular type of medicine orin dealing with emergencies. Staff should notgive medicines without appropriate trainingfrom health professionals. When staff agree toassist a child or young person with medicalneeds, the employer should arrangeappropriate training in collaboration with theappropriate health service such as thecommunity paediatrician, school nurse, healthvisitor, or other appropriately trained healthprofessional. They will also be able to adviseon further training needs. In every area therewill be access to training, in accordance withthe provisions of the National ServiceFramework for Children, Young People andMaternity Services15, by health professionalsfor all conditions and to all settings.

4.4 Confidentiality

The Lead Adult and members of staff shouldalways treat medical informationconfidentially. The Lead Adult should agreewith the child or young person whereappropriate, or otherwise the parent, whoelse should have access to records andother information about a child or youngperson. If information is withheld from staffthey should not generally be held responsibleif they act incorrectly in giving medicalassistance but otherwise in good faith.

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14 Health and Safety Executive http://www.hse.gov.uk/

15 National Service Framework for Children, Young People and Maternity Serviceshttp://www.dh.gov.uk/en/Healthcare/NationalServiceFrameworks/Children/DH_4089111

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CHAPTER 55. Common Conditions –Practical Advice

The guidance notes provide basicinformation which has relevance for thesupport of children and young people withmedical needs in situations where 'locoparentis' applies. Where the term 'Parents' isused it should be taken as defined in Section576 of the Education Act 1996, to include anyperson who is not a parent of a child but hasparental responsibility for or care of a child.

The information provided is not exhaustiveand it is important that the needs of childrenand young people are assessed on anindividual basis. Further details about any ofthe conditions in this section should besought in the first instance from theappropriate health professional such as thecommunity paediatrician, school nurse,health visitor, diabetic nurse, epilepsy nurseor other appropriately trained professional.

From April 2004 training for first-aiders inearly year's settings must include recognisingand responding appropriately to theemergency needs of babies and children withchronic medical conditions.

The medical conditions covered in thissection are:

5.1 Asthma;5.2 Epilepsy;5.3 Diabetes;5.4 Anaphylaxis;5.5 Attention Deficit Hyperactivity Disorder

(ADHD);5.6 Teenage Pregnancy;5.7 Hand Washing and Infection Control;5.8 MRSA;5.9 The use of Oxygen in Settings.5.10 HIV

For further information, help line details on allof the above please refer to the appendix.

Help and advice for schools on developing adrug education policy is available from theTeacher Adviser for Drug, Alcohol andTobacco Education.Telephone number 01257 226900

Public Health Contact Details

5.1 Asthma

What is Asthma?

Children and young people with asthma haveairways which narrow due to a reaction tovarious triggers. The triggers vary betweenindividuals but the most common onesinclude grass pollen, animal fur, house dust-mites, cold air and viral infections. Exerciseand stress can also cause an asthma attack.

Medicine and Control

Advice should be sought from the appropriatehealth professional such as the GP, communitypaediatrician, school nurse, health visitor orthe asthma nurse. There are two main types ofmedicines used to treat asthma, relievers, andpreventers. Usually relievers will only need tobe used during the day.

Relievers (blue inhalers) are medicines takenimmediately to relieve asthma symptoms andare taken immediately to relieve the onsetand/or during an asthma attack. They aresometimes taken before exercise.

Preventers (brown, red, orange and purpleinhalers, sometimes tablets) are usually usedin the morning and/or evening.For young children and some children andyoung people with disabilities a spacerdevice (with or without a mask) may be usedto dispense the medicine.

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Area Telephone Number

Central Lancashire 01772 644400

East Lancashire 01282 610250

North Lancashire 01524 519333

Lancashire and CumbriaPublic Health Network

01772 644483

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Children and young people with asthmaneed to have immediate access to theirreliever inhalers when they need them.

Children and young people who are able touse their inhalers themselves should beallowed to carry them with them. If they aretoo young or immature to take personalresponsibility for their inhaler the personacting in loco parentis should ensure that it isstored in a safe but readily accessible place,clearly marked with the child or youngperson's name. Inhalers should always beavailable during physical education, sportsactivities and educational visits.It is important that inhalers prescribed forone child are not used to treat another;medication is only to be used by theperson it has been prescribed for.

For those children and young people withsevere asthma a spare inhaler may beprescribed to be kept in the setting. Spareinhalers must be clearly labelled with nameand expiry date and stored in a lockedcupboard. It is the parents’ responsibility toensure that any medication retained in thesetting is within its expiry date.

The most common signs of an asthma attackinclude:

• Coughing;• Wheezing;• Being short of breath;• Feeling of a tight chest;• Being unusually quiet or having difficultytalking.

When a child or young person has an asthmaattack they should be treated according totheir individual Health Care Plan or asthmacard as previously agreed.

An ambulance should be called if:

• The symptoms do not improve sufficientlyin 5 to 10 minutes;

• The child is too breathless to speak;• The child is becoming exhausted;• The child looks blue.

The child or young person suffering theattack may become distressed and anxiousand in severe attacks the skin and lips mayturn blue. Not everyone will present with allof these symptoms.

It is important to consider that children andyoung people will verbalise their symptoms inlanguage appropriate to their development.

Individual Procedures

It is the parent's responsibility to arrangeregular reviews with the relevant health careprofessional and to ensure that a copy of themanagement plan is available to the setting.It is important to agree, in partnership withparents, how to recognise when their child'sasthma is worse and what action should betaken.

It is the parents’ responsibility to arrangeregular asthma reviews with the relevanthealthcare professionals and ensure that acopy of the management plan is available tothe setting.

Children and young people with asthmashould participate in all aspects of the settingday, which include physical activity. Relieverinhalers should be carried on all off-siteactivities. Some may need to take theirreliever medication before any physicalexertion. As with any person warm-upactivities are essential before sudden activityespecially in cold weather. Particular caremay be necessary in cold or wet weather.

Reluctance to participate in physical activityshould be discussed with parents staff andthe child. However children and youngpeople should not be forced to participate ifthey feel unwell.

Children and young people with asthma mayat some time have some sleep disturbancesdue to night symptoms. This may affect theirconcentration and may also result in non-attendance. Such issues should bediscussed with the parents as appropriate.

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All settings should have an asthma policythat is an integral part of the whole settings’policy on medicines and medical needs.

All staff, particularly PE teachers, should havetraining or be provided with information aboutasthma once a year to support theirknowledge about asthma symptoms,medicines, and their delivery and what to doif a child has an asthma attack.

5.2 Epilepsy

What is Epilepsy?

Children and young people with epilepsyhave repeated seizures sometimes called fits,turns, blackouts and convulsions and canhappen to anyone at any time. A seizure is aclinical event in which there is a suddendisturbance of neurological functions, usuallyin association with an abnormal or excessiveneuronal discharge. Epilepsy is a veryindividual condition and affects male andfemales equally.

Seizures can take many different forms and awide range of terms may be used to describethe particular seizure pattern that individualsexperience.

Partial SeizureNot all seizures involve loss ofconsciousness. A person may remainconscious with symptoms ranging from thetwitching or jerking of a limb to experiencingstrange tastes or sensations such as pinsand needles.

Complex Partial SeizureWhere consciousness is affected; a child oryoung person may appear confused, wanderaround and be unaware of theirsurroundings. They could also behave inunusual ways such as plucking at clothes,fiddling with objects or making mumblingsounds and chewing movements. They maynot respond if spoken to. Afterwards, theymay have little or no memory of the seizure.

Generalised – Tonic, Colonic SeizureIn some cases a child or young person maylose consciousness. Such seizures mightstart with a person crying out, then themuscles becoming stiff and rigid. Theperson may fall down. This may be followedby jerking movements as muscles relax andtighten rhythmically. During a seizurebreathing may become difficult and thechild's colour may change to a pale blue orgrey colour around the mouth. Some maybite their tongue or cheek and may beincontinent.

After a seizure the chid or young person mayfeel tired, be confused, have a headache andneed time to rest or sleep. Recovery timesvary. Some may feel better after a fewminutes while others may need to sleep forseveral hours.

Absence SeizureAnother type of seizure involves a loss ofconsciousness for a few seconds. A personmay appear 'blank' or 'staring', sometimeswith fluttering of the eyelids. Such absenceseizures can be so subtle that they may gounnoticed. They might be mistaken fordaydreaming or not paying attention in class.If such seizures happen frequently they couldbe a cause of deteriorating academicperformance.

Parents and health care professionals shouldprovide information to the setting to beincorporated into the individual health careplan.

Details which should be recorded on theHealth Care Plan should include:

• Any factors which might possibly haveacted as a trigger to the seizure, forexample, visual/auditory stimulation,emotion (anxiety, upset);

• Any unusual 'feelings' reported by the childor young person prior to the seizure;

• Parts of the body demonstrating seizureactivity, for example limbs or facialmuscles;

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• The timing of the seizure – when ithappened and how long it lasted for;

• Whether the child or young person lostconsciousness;

• Whether the child or young person becameincontinent.

If a child or young person experiences aseizure in a setting, details should berecorded and communicated to parents.This will help parents to give more accurateinformation on seizures and seizurefrequency to the child or young person'sspecialist.

Medicine and Control

Advice should be sought from the appropriatehealth professional such as the GP, communitypaediatrician, school nurse, health visitor orthe epilepsy nurse. The majority of childrenand young people with epilepsy take anti-epileptic medicines to stop or reduce theirseizures. Any medication which is required ina setting must be stored according to thepolicy for the safe storage of medicines.

Triggers such as anxiety, stress, tiredness orbeing unwell may increase a child's chanceof having a seizure. Flashing or flickeringlights and some geometric shapes orpatterns can also trigger seizures. This iscalled photosensitivity. It is very rare. Mostchildren and young people with epilepsy canuse computers and watch television withoutproblems; but should not sit too close to thecomputer screen or television; advise shouldbe sought from parents.

Children and young people with epilepsyshould be included in all activities. Extra caremay be needed in some areas such asswimming or working in science laboratories.Concerns about safety should be discussedwith the child, parents as part of the HealthCare Plan.

It is important that all staff in settings areaware of the child or young persons’condition and of how to react should theyexperience a seizure.

Individual Procedures

It is the parents’ responsibility to arrangeregular reviews with the relevant health careprofessional and to ensure that a copy of themanagement plan is available to the setting.During a seizure it is important to ensure thatthe person is safe, putting something softunder the person’s head during a convulsiveseizure will help to protect it. Movementsshould not be restricted and the seizureshould be allowed to take its course.Nothing should be placed in the person'smouth.

After a convulsive seizure the person shouldbe placed in the recovery position and stayedwith until they are fully recovered.Most seizures last for a few seconds orminutes, and stop of their own accord.Some may be prone to longer seizures or toone seizure after another one which mayrequire rectal Diazepam, also a liquid solutionMidazolam may be prescribed by the healthprofessional which is administered orally orintra-nasally.

Advice and guidance regarding trainingand administration of medication shouldbe sought from the appropriate healthprofessional such as the communitypaediatrician, school nurse, health visitor,or GP.

Staff should protect the dignity of the personas far as possible, even in emergencies. Thecriteria under the National standards forunder 8s day care requires the registeredperson to ensure the privacy of children whenintimate care is being given.

An ambulance should be called during aconvulsive seizure if:

• It is the child or young person's firstseizure;

• The child or young person has injuredthemselves badly;

• They have problems breathing after aseizure;

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• A seizure lasts longer than the period setout in the child's Health Care Plan;

• A seizure lasts for five minutes if you do notknow how long they usually last for thatchild or young person;

• There are repeated seizures, unless this isusual for the child as set out in the child oryoung person’s Health Care Plan.

The above information should be an integralpart of the setting's emergency proceduresbut should also relate specifically to the childor young person’s individual Health CarePlan. The Health Care Plan should clearlyidentify the type or types of seizures,including seizure descriptions, possibletriggers and whether emergency interventionmay be required.

5.3 Diabetes

What is Diabetes?

Diabetes is a condition where the level ofglucose (sugar) in the blood rises due to thebody being unable to use it properly. Normallythe amount of glucose is controlled by thehormone insulin. Children and young peoplewith diabetes have lost either the ability toproduce insulin or produce insulin effectively.

Type 1 Diabetes - the person is unable toproduce enough insulin or no insulin at all andwill require daily insulin injections, to monitortheir blood glucose level and to eat regularlyaccording to their personal dietary plan.

Type 2 Diabetes - there is insufficient insulinfor the person's needs or the insulin is notworking properly. This is usually treated bydiet and exercise alone, but may requiresome medication.

Medicine and Control

Diabetes, for the majority of children andyoung people, is controlled by injections ofinsulin each day. Most young children will beon a twice a day insulin regime of a longeracting insulin, these will usually beadministered early morning and later in the

evening time. If an injection is required whistthe person is in a setting then it may benecessary for an adult to administer theinjection. Older children may be on multipleinjections, and others may be controlled onan insulin pump. Most children and youngpeople can manage their own injections, inwhich case supervision may be required andalso a suitable private place to carry it out.

Children and young people with diabetesmay also need to ensure that their bloodglucose levels remain stable and may checktheir levels by taking a small sample of bloodand check this in their monitor. They mayneed to do this before meal times, beforeexercise or more regularly if their insulinneeds adjusting. The majority of childrenand young people will be able to carry thisout themselves and will need a suitableprivate place to do so. However, youngerchildren may need adult supervision to carryout the test and/or interpret test results.

Increasingly, children and young people aretaught to count their carbohydrate intake andadjust their insulin accordingly. This meansthat they have a daily dose of long-actinginsulin at home, usually at bedtime; and theninsulin with breakfast, lunch and the eveningmeal, and before substantial snacks. Theperson is taught how much insulin to givewith each meal, depending on the amount ofcarbohydrate eaten. They may or may notneed to test blood sugar prior to the meal todetermine how much insulin to give. Diabeticspecialists would only implement this type ofregime when they are confident that the childor young person is competent. The child oryoung person is then responsible for theinjections and the regime would be set out inthe individual Health Care Plan.

Children and young people with diabetesneed to be allowed to eat regularly during theday. This may include eating snacks duringthe day time or prior to exercise. Settingsmay need to make special arrangements forchildren and young people with diabetes ifmeal times are staggered/if a meal or snackis missed or after strenuous activity, the

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person may experience a hypoglycaemicepisode (a hypo) during which blood glucoselevels fall too low. Staff in charge of PE orother physical activity sessions should beaware of the need for children and youngpeople with diabetes to have glucose tabletsor a sugary drink to hand.

The issue of close communication betweenparents’ with the settings is fundamental tothe care of children and young people withdiabetes, as many aspects of growth anddevelopment will have an impact on theirdiabetes control.

Individual Procedures

It is the parents’ responsibility to arrangeregular reviews with the relevant health careprofessionals and ensure that a copy of themanagement plan is available to the schoolor setting.

Each child or young person may experiencedifferent symptoms and this should bediscussed when drawing up a Health CarePlan.

All staff should be aware that the followingsymptoms, either individually or combined,may be indicators of low blood sugar – ahypoglycaemic reaction (hypo) in a child oryoung person with diabetes.

• Hunger;• Sweating;• Drowsiness;• Pallor;• Glazed eyes;• Shaking or trembling;• Lack of concentration;• Irritability;• Headache.

If a child or young person has ahypoglycaemic reaction it is very importantthey are not left alone and that a fast actingsugar, such as glucose tablets, a glucoserich gel, or a sugary drink is brought to theperson and given immediately. Slower actingstarchy food, such as a sandwich or two

biscuits and a glass of milk, should be givenonce the child has recovered, some 10-15minutes later.

An ambulance should be called if:

• The child or young person's recovery takeslonger than 10-15 minutes;

• The child or young person becomesunconscious.

Some children and young people mayexperience hyperglycaemia (high glucoselevel) and have a greater than usual need togo to the toilet or to drink. Tiredness andweight loss may indicate poor diabeticcontrol, and staff should let parents’ know ifthis is the case. If the child or young personis unwell, vomiting or has diarrhoea this canlead to dehydration. If the child or youngperson is giving off a smell of pear drops oracetone this may be a sign of ketosis anddehydration and will need urgent medicalattention.

5.4 Anaphylaxis

What is Anaphylaxis?

Anaphylaxis is an acute, severe allergicreaction requiring immediate medicalattention. It usually occurs within seconds orminutes of exposure but on rare occasionsmay happen after a few hours.

Common triggers include peanuts, tree nuts,sesame, eggs, cow's milk, fish, certain fruitssuch as kiwifruit, and also penicillin, latex andthe venom of stinging insects (such as bees,wasps or hornets).

The most severe form of allergic reaction isanaphylactic shock, when the blood pressurefalls dramatically and the person losesconsciousness. This is rare among youngchildren below teenage years. Morecommonly among young children there maybe swelling in the throat, which can restrictthe air supply, or severe asthma. Anysymptoms affecting the breathing areserious.

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Less severe symptoms may include tinglingor itching in the mouth, hives anywhere onthe body, generalised flushing of the skin orabdominal cramps, nausea and vomiting.Even where mild symptoms are present, theperson should be watched carefully, as it maybe the start of a more severe reaction.

Medicine and Control

It is the parents’ responsibility to arrangeregular reviews with the relevant health careprofessional and to ensure that a copy of themanagement plan is available to the setting.Treatments for anaphylactic reactions includeantihistamines, adrenaline inhalers, and forthe more severe allergic reaction an injectionof adrenaline (also known as epinephrine).This is delivered in a pre loaded device,known as an Epipen with the correct dose ofadrenaline and is prescribed on an individualbasis. The devices are available in twostrengths - adult and junior.

Should a severe allergic reaction occur theadrenaline injection should be administeredinto the muscle of the upper outer thigh eitherdirectly or through light clothing.In some areas school nurses have receivedspecialist training to further support staff,children and young people who may sufferfrom severe allergic reactions which resultin an anaphylactic episode.Examples of Health Care Plans which can beadapted to suit the child or setting can bedownloaded from:http://www.lancashire.gov.uk/education/pdf/pid1142/form_templates.docIt is recognised that Health Care Plansdeveloped within particular PCT's or settingscould be used.

An Ambulance Should Always be Called

Where a child or young person requiresmedical support in a setting on account ofanaphylactic reactions, staff will have toagree to administer medicine in anemergency. Training for this will need to beprovided by local health service.

Staff that volunteer to be trained in the use ofthese devices can be reassured that they aresimple to administer. Adrenaline injectors,given in accordance with the manufacturer'sinstructions are a well understood and safedelivery mechanism. It is not possible tooverdose using an Epipen as it only containsa single dose. In cases of doubt it is betterto give the injection than to hold back.

The decision on how many adrenalinedevices the setting should hold and where tostore them, has to be decided on anindividual basis between the Lead Adult, theparents and the medical staff involved. Themedication should be readily accessible inaccordance with health and safety policies.

Where children and young people areconsidered to be sufficiently responsible tocarry their emergency treatment on theirperson, there should always be a spareEpipen kept according to health and safetypolicies which is accessible to all staff. Inlarge establishments or split sites, it is oftenquicker to use an Epipen which is with theperson rather than taking time to collect onefrom a central location.

It is important that staff in settings areaware of the child or young person'scondition and where medication is kept incase of emergencies.

Day-to-day policy measures are needed forfood management; awareness of the child oryoung person's needs in relation to the menu,individual meal requirements and snacks inthe setting; this will help minimise the risk ofan allergic reaction. It is important that thecatering manager is fully aware of the child oryoung person's individual requirements.When new kitchen staff are employed it isimportant that they are also made aware ofany individual needs.

A Health Care Plan should be agreed by theparents’, child or young person, the settingand the appropriate health care professional.

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Important issues specific to anaphylaxis to becovered within the Health Care Plan include:

• Anaphylaxis – what may trigger it;• What to do in an emergency;• Prescribed medicine;• Food management;• Precautionary measures.

Children and young people who are at risk ofsevere allergic reactions are not ill in theusual sense except that if they come intocontact with a certain food or substance, theymay become very unwell. It is important thatthese children and young people are notstigmatised or made to feel different. It isimportant, too, to allay parents’ fears byreassuring them that prompt and efficientaction will be taken in accordance withmedical advice and guidance.

Anaphylaxis is manageable. With soundprecautionary measures and support fromthe staff, the child or young person's life maycontinue as normal for all concerned.

5.5 Attention Deficit HyperactivityDisorder (ADHD)

What is Attention Deficit HyperactivityDisorder?

Attention deficit hyperactivity disorder (ADHD)is a neurobiological disorder caused by animbalance of some of the neuro-transmittersin the brain. It is normally used to describechildren and young people who have threemain kinds of problems:

• Overactive behaviour (hyperactivity);• Impulsive behaviour;• Difficulty in paying attention anddistractibility.

Some children and young people havesignificant problems in concentration andattention, but they are not necessarilyoveractive or impulsive. They are sometimesdescribed as having Attention Deficit Disorder(ADD) rather than ADHD. Children withADHD have a short attention span, find it

hard to concentrate and have difficultylearning new skills. Children and youngpeople with ADHD are often misunderstoodand frequent criticism of their behaviour canlead to poor self-image and other emotionaland behavioural difficulties. Many childrenwith ADHD are more likely to have learningdifficulties.

Problems with ADHD are not confined to thesetting but will affect the child or youngpersons’ behaviour at home and in thecommunity.It is the parents’ responsibility to arrangeregular reviews with the relevant health careprofessional and to ensure that a copy of themanagement plan is available to the setting.

Medicine and Control

When a child or young person has beendiagnosed with ADHD or is displayingbehaviours characteristically associated withADHD, staff in the setting could adapt theenvironment to one which would benefit thechild or young person. For example:

• Set short, achievable tasks/targets and giveimmediate rewards when the task/targethas been achieved;

• Use large type, and provide only one ortwo examples per page. Avoid illustrationswhich are not relevant to the task;

• Using checklists and outlining the task tobe completed for example, homeworkcharts;

• Keep rules clear and simple;• Use attention and praise to reward positivebehaviour;

• Give the child or young person specialresponsibilities so that their peers can seethem in a positive light.

Children and young people diagnosed ashaving ADHD will have an individualtreatment programme. This is most likely toinclude a behaviour management/supportprogramme which can be shared betweenhome and the setting. Management of thechild or young person's difficulties should beshared between the home, the setting and

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support service including the relevanthealth service.

In more severe cases of ADHD medicationmay also be prescribed such asMethylphenidate or Dexedrine. It is importantto work out exactly how this will be takenwhilst the child or young person is away fromhome or attending a setting. Staff are notobliged to administer medication, but if theydo so they must have clear instructions fromthe appropriate health professional.

In the first few weeks after prescription, if thedosage of Methylphenidate is adjusted atanytime it is essential that regularcommunication between home and thesetting takes place on the effects of the drugon the person's behaviour. The settingshould be informed immediately of anychange to the dosage pattern.

Likely side effects include:

• Loss of appetite with or without a stomachupset. This tends to resolve itself within amonth of starting treatment;

• Headaches;• Sleepiness. The child or young person’ssleep pattern may be disturbed for a shortperiod of time;

• Aggravation of existing tics, particularly ofthe head and neck muscles.

It is important that the setting takes note ofany side effects and inform the parents at theend of the day.

5.6 Teenage Pregnancy

Information for schools regarding healthand safety arrangements for pregnant pupils

Health and Safety cannot be used as areason for asking a pregnant pupil to stopattending school.

Pregnancy should not be equated with illhealth, but the health and safety implicationsmust be addressed.

Best practice may be for pregnant pupils toattend school for as long as possible or foralternative arrangements to be made, suchas attendance at a Lancashire EducationMedical Service (LEMS) teaching centre.

Schools may wish to carry out a specific riskassessment in conjunction with the pupil andher parents, if appropriate, and any resultingrisks should be managed. Schools may wishto review the risk assessment ascircumstances change or during differentstages of the pregnancy and after the birth ofthe child.

In essence, a risk assessment for apregnant pupil should be the same as forany pregnant member of the schoolcommunity, such as teachers, welfare staff,support staff, supervisors, etc.

Attached is a flowchart for schools to helpthem identify risks and so develop a riskassessment suitable for use in school. Therisk assessment, with its list of potential risks,is by no means exhaustive in its scope, butschools may wish to use it as a baselinedocument to adapt and customise to suittheir individual school's needs.

Flexibility, compromise and common sensecan avoid most risks and schools mayidentify others that have not been highlighted.Most school age pregnancies can beaccommodated without too much adjustmentand remaining in the home school offers thepregnant pupil the best chance of avoidingsocial exclusion and of fulfilling theiracademic potential.

Please note it is the responsibility of theschool to produce a risk assessment if theyfeel it is appropriate. If a more detailed riskassessment is required, the Pregnancy andParenthood Service (PPS) can be contactedfor advice and assistance. Please contactthe PPS Manager, or the Learning Mentorattached to your school. Contact details arelisted below:

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Health and safety guideline for pregnantpupils in school and attending LEMS

Rational

Health and Safety issues should not be usedas a reason for asking a pregnant pupil tostop attending school. However, some pupilsin advanced pregnancy (24+ weeks) andafter birth (up to 12 weeks) choose to attendLEMS.

For those who choose to remain in school,however, the following guidelines may behelpful in supporting the Health and Safety ofpregnant pupils and their babies.

GuidelinesMovement

• Ensure pregnant pupils have sufficient timeto move around school at change oflessons and at the start and end of theteaching day.

• If pregnant pupils have to use stairs, allowextra time and ensure handrails are secure.Use lift if available.

Fatigue

• If heavy books/bags have to be carried,ensure a 'buddy' is on hand to help.

• Allow short breaks during lessons ifnecessary, especially if the pregnant pupilhas been sitting in one place for sometime.

• Be aware that new mothers will have had abroken night's sleep and may be tired.

Comfort

• Ensure the pregnant pupil has acomfortable seat which gives support tothe back and allows ease of egress.

• Provide writing surfaces at an appropriateheight to accommodate 'bumps'.

Facilities

• Allow pregnant pupils free access to toiletfacilities and appreciate that some youngwomen experience nausea and sickness.

• Ensure pregnant/breastfeeding pupils haveunrestricted access to drinking water tominimise the risk of dehydration andreduction of breast milk.

Subjects

• Afford some 'time out' to pregnant pupilswho may be affected by conditions inspecific lessons eg use of VDU, fumes inscience lessons, materials and equipmentin practical lessons such as art and PE.

Emotional

• Be aware that pregnant pupils may havemore pressing immediate concerns thanschoolwork as the birth approaches and somay need longer to complete tasks.

• Teenage mothers have a higher rate ofpost-natal depression than older mothersand so may need extra emotional supporton their return to school after birth.

• Breastfeeding mothers may need supportand understanding to maintain their milkflow once they return to school.

Conclusion

School staff may be experienced insupporting colleagues and/or school ageparents and parents-to-be, but should a girlgo into labour at school, parents should beinformed immediately and 999 should becalled for an ambulance.

In essence, pregnant pupils should betreated in the same way as a pregnantmember of staff would be.

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Area Telephone Number

PPS Manager 01257 517212

Hyndburn, Ribble Valley& Rossendale 07717 543845

Chorley &West Lancashire 07887 831593

Burnley & Pendle 07887 831555

Lancaster, Morecambe& Wyre 07887 831554

Preston, South Ribble& Fylde 07789 927918

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LEMS staff are experienced in supportingschool age parents and parents-to-be, butshould a girl go into labour at a centre,parents should be informed immediately and999 should be called for an ambulance.

You may identify other potential hazards inyour school and take appropriate action.

5.7 Good Practice Guidelinesfor Infection Control – HandWashing

Young children in particular are prone tocatching various infections. There are manypotential sources of infection within the homeand other settings and the main causes arelikely to be as follows:

• Other children or adults;• Domestic and farm animals;• Contaminated or uncooked food;• Contaminated water.

Infections can be transmitted in a variety ofways – by touch, consuming contaminatedfood or water, or by airborne transmission.However the main transfer of potentiallyunpleasant and hazardous infections within asetting can be simply and effectivelycontrolled by the establishment of goodhygiene procedures. A number of strategiesare likely to be involved in this respectincluding advice on cleaning, heating, andthe use of disinfectants. The single mosteffective weapon against infection ishand washing.

Hand Washing

• Hand washing is a simple procedurewhich, if carried out correctly, contributessignificantly to the control of infection.However, it is often neglected or carried outineffectively. Hands should be wetthoroughly with water before applying soap.All surfaces of both hands should bevigorously massaged with the lather,remembering to pay particular attention tothe finger tips, thumbs and between thefingers as these areas are frequentlymissed;

• Make sure all the soap is rinsed off underrunning water and then dry the handsthoroughly;

• Always cover any cuts with waterproofplasters;

• Wherever possible apply hand cream asthis product protects hands and helps toprevent dryness and cracking;

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Hazard Risk RiskLevel Action

Crowded corridorsand stairs Injury, fall High

Change lessons5 minutes early,use lift if available

Carrying bags Back strain Medium Provide locker,buddy

Toilets lockedduring lessons

Sickness,bladderincontinence

Medium Provide accessto toilet facilities

Sitting in oneplace too long

Back strain,cramp Medium

Allow movementand providesupportivefurniture

Restricted accessto drinking water

Dehydrationand reductionin breast milk

High Provide drinkingwater

Uniform nolonger fits Discomfort Low Negotiate

suitable clothing

Fatigue Strain, poorconcentration Medium Timetable

negotiations

Science Fumes Low Sensible seating

Specific Risk Assessment

NO

YES

NO

Has arisk beenidentified?

MakeNecessaryadjustments

Monitor&

Review

Action 1Can actionsbe taken or

changes madeto significantlyreduce risk?

Can therisk be

removed?

RemoveRisk

Action 2Offer SuitableAlternatives

NO

YES YES

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• The hands normally have a 'resident'population of micro-organisms. Otherorganisms (germs) are picked up duringevery-day activities, and these are termed'transient' organisms;

• Many infection control problems arecaused by these transient organisms;

• Hand washing should remove thesetransient organisms before they aretransferred to another person or to asusceptible area on the same person;

• The potential chain of infection is broken byeffective hand hygiene.

Good Practice

• Fingernails should be kept clean and short;• Ideally jewellery should not be worn;• Breaks anywhere on the skin should becovered with a waterproof dressing;

• Medical advice should be sought for skindamage by other agents eg. Eczema.

Hands Should Be Washed and Dried:

• After visiting the toilet;• Before handling food;• When hands are visibly soiled;• Before a clean procedure;• After a dirty procedure, even if gloves areworn;

• Between care episodes for an individualperson.

5.8 MRSA – Methicillin ResistantStaphylococcus Aureus

Staphylococcus Aureus is a commonbacteria and at any one time approximatelyone third of the population, adults andchildren, is colonised with the bacteria. Thismeans that the organism lives harmlessly ona person's skin or in the nose and normallydoes not cause any infection beyond theoccasional mild skin irritations. Theseinfections are easily treated by antibiotics.

However some strains of StaphylococcusAureus bacteria are resistant to the morecommon antibiotics and these strains arereferred to under the general heading of MRSA.

Who is at Risk from MRSA?

MRSA can only be detected by laboratorytests and as it normally does not cause anysymptoms most people will never know ifthey are colonised with MRSA. MRSA maycause problems if it infects persons withsurgical wounds, catheters, or drips whichallows bacteria to enter the body. Cautionalso needs to be exercised in instanceswhere a person with MRSA may come intoclose contact with another person who has aseverely reduced resistance to infection, forinstance a person who is immuno-supressed,eg a person receiving treatment for cancer, orwho have an immuno-deficient conditions egHIV. Further advice should be sought fromthe local Community Infection Control Nurseor Public Health Department in suchcircumstances. However, it is always worthbearing in mind that although MRSA is foundnot only in hospitals but also in nursing andresidential homes and in the community atlarge, it usually only causes problems tovulnerable patients in the hospital setting.

Can MRSA be Treated?

A limited number of antibiotics are stilleffective against MRSA infections but theycan cause quite severe side effects. That iswhy in the UK the focus of intervention tendsto be on prevention and control. The majorityof individuals with MRSA will be colonisedrather that infected and so antibiotictreatment would not be necessary.

Prevention and Control

As with most infections, MRSA is mainlytransferred by touch and so attention to goodhygiene procedures and to effectivehandwashing techniques remain the mosteffective ways in which to prevent MRSA fromspreading. All staff and children and youngpeople in settings should be encouraged towash their hands:

• After using the toilet;• After handling any soiled linen, nappies, ordressings;

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• After touching animals;• When their hands appear dirty.

No special cleaning methods are requiredand ordinary soap is just as effective asanti-bacterial brands provided that handsare washed and dried thoroughly.

If basic hygiene precautions are followed aperson with MRSA is not a risk to others,including babies and pregnant women.Good hygiene procedures in a setting areimportant to prevent the spread of allpotentially infectious bacteria, not just MRSA.Cutlery, toys teaching and play materials,toilet areas and changing beds do not needto be subject to any additional hygieneprecautions or procedures beyond thesettings usual cleaning regime because theyhave been used by children and youngpeople know to be colonised with MRSA.

Points of Guidance for Staff

• Cuts, sores and surgical wounds in staffand children and young people should becovered by a waterproof dressing toprevent infection;

• If blood or other body fluids have to becleaned up, a disposable apron anddisposable gloves should be worn andpaper towels used. All of these itemsshould then be placed in plastic bags anddisposed of safely and hygienically;

• Staff who have Eczema or Psoriasis shouldnot perform any intimate care procedureson children and young people with MRSA;

• Children and young people with MRSA donot need to be taught separately fromothers or kept in any form of isolation withinthe setting;

• Children and young people with MRSAshould be allowed to participate in out-of-school activities and visits, again with goodhygiene procedures being undertakenwhen necessary.

MSRA Guidelines for the Portage Servicein Lancashire

Basic infection control measures are requiredto minimise the spread of MRSA;these include:

• Disposable plastic aprons must be wornand discarded after each visit;

• All fresh cuts/abrasions that are less than24 hours old should be covered by animpermeable dressing (if in doubt weardisposable latex gloves);

• Hands must be washed and driedthoroughly after each visit. If the portageworker is in any doubt about handwashingfacilities available, then the hands may bewashed and dried again beforecommencing work with the next client. Itmay be necessary to take soap and towelto the visit;

• All rings with stones, watches and braceletsmust be removed or covered during clientcontact. This is necessary to enableeffective handwashing. If you wear awedding ring wash underneath it;

• Equipment/toys specifically kept for achild's usage must be washed and driedthoroughly before putting back into generaluse. Ordinary detergent and water issufficient for this;

• Soft toys and wooden toys without coatingsshould not be used. Plastic toys that areeasily cleaned are preferable. If a specificitem/toy is required that does not meet thiscriteria it may be used for that child but notput back into general use afterwards;

• Staff with Eczema or Psoriasis should seekfurther advice before attending to childrenwith know MRSA colonisation (See below).

Swabbing

Repeated swabs will not normally be requiredfrom the affected child, however, there maybe specific incidences when these may berequested, eg if the child is to be admittedinto hospital.

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In the Home

When basic good hygiene practices arefollowed, individuals with MRSA are not atrisk to others including members of theirfamily (including babies, children andpregnant women), visitors or portage staff.Good hygiene is important to prevent thespread of all infections not just MRSA.

Help and Advice

To find out more or to get specific advice youshould contact the Lancashire Early YearsSEN service, Area Manager or you localHealth Protection Agency who has beenappointed to give infection control advice inthe community.

5.9 Procedure for the Safe Useand Administration of Oxygen inCylinders in Pre-School Settings

The following procedures outline the safetymeasures that must be followed whenoxygen cylinders are present on anypremises maintained by Lancashire CountyCouncil registered as eligible for NurseryEducation Grant Funding or Ofsted registeredas premises suitable for the provision ofchildcare anywhere else where LancashireEarly Years SEN Services employees arerequired to work, (referred to as a setting) inorder that Lancashire County Council and itsemployees can fulfil their responsibilitiesunder Health and Safety Legislation.

Oxygen is a colourless and odourless gaswhich is slightly heavier than air. In the eventof a leak, oxygen is initially likely to be foundclose to ground level.

The presence of oxygen cylinders canincrease the risk of fire, for although oxygenitself does to burn; it may support and

accelerate combustion, and may causesubstances to ignite more easily and to burnmore fiercely.

It is important that no-one is allowed tosmoke in any area where an oxygencylinder is either stored or in use. Thiswould include home settings when EarlyYears SEN Staff are present.

Storage of Cylinders

Oxygen cylinders should only be held at asetting's premises in agreed cases whereoxygen is required for medical purposes byspecific service users as part of an agreedmulti-disciplinary plan. The plan should bereviewed regularly and details recorded onthe individual service user's file/care plan.The file/care plan must be led and signed byan appropriate medical professional. Staffmust receive training from an appropriatemedical professional and must havedocuments to show that they have beendeemed competent by that professional toadminister and oversee the use of oxygen.

If oxygen is to be stored at the setting,supplies should be kept at the lowestpossible levels ie do not store spares.Oxygen will normally be supplied in small twolitre cylinders.

Once there is no further requirement foroxygen to be available at a given location,arrangements should be made via thesupplier for any cylinders to be removed assoon as possible. Such a decision will be asa result of medical advice.

Oxygen Cylinders Should:

• Be stored in a dry, reasonably wellventilated area, but under cover, not in theopen;

• Be stored in a locked area which should beclearly marked with an oxygen symbol as awarning of the contents and the need forcaution;

• Be considered as a fire risk as the contentsare stored under pressure, which increases

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Contact Telephone Number

Health ProtectionAgency,Lancashire& Cumbria HealthProtection Unit

01257 246450

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the risk of explosions in case of a fire. Thesetting must inform their insurer that theyare using and/or storing oxygen on site;

• Be kept away from highly flammableliquids, readily combustible materials andsources of heat and ignition;

• Not be exposed to extremes oftemperature;

• Not be allowed to become rusty or dirty. Ifthis happens, arrangements should bemade for the cylinders to be exchanged assoon as possible;

• Not be repainted or have their markingsobscured or labels removed.

During use, care should be taken to ensurethat an oxygen cylinder does not fall over andbecome damaged. Cylinders which areequipped with carrying devices or stands tokeep them upright should be stored in thesedevices. If no device or stand is supplied,the cylinder should be stored and used on aflat stable surface

Cylinders should NOT be carried around aroom as a child plays.

A manual handling assessment should becarried out to determine the safest methodfor moving cylinders. For example a cylindertrolley may be required, depending upon thesize of the cylinder and the distance it has tobe moved. The findings of the riskassessment should be brought to theattention of anyone who may have to movethe cylinder.

Administration of Oxygen

Before a child can be accommodated in asetting it is ESSENTIAL that a full care plan isdrawn up by a relevant health professional,eg community paediatrician, GP, schoolnurse, health visitor, specialist nurse orhospital consultant; in conjunction with thechild's parents and the setting.

The care plan should include:

• The child's details and medical needs;• The level of flow that is required;

• The frequency that oxygen needs to beadministered;

• Detailed checking and counter signingprocedures;

• Any maintenance procedures;• Details of emergency procedures shouldthe equipment fails or the child becomes ill;

• Details of provision should it be necessaryto admit a child to hospital;

• Details of emergency contacts for parents.

Under no circumstances shouldinstructions for the administration ofoxygen be accepted solely from parents.

Oxygen must only be administered to a childas prescribed eg at the times and for theduration stated on the written documentationsupplied by the health contact. The detailsmust match any instruction provided by thepharmacist who has supplied the cylinder. Ifthe oxygen is dependent on staff observationof a child's condition, the limits of staffresponsibility has to be clearly stated in thecare plan along with the action that is neededshould these limits be passed.

Oxygen should only be administered to achild when it is supplied through a 'fixed' or'set' delivery device eg the attachment to theoxygen supply will normally have a numberedor 'step' delivery. Also as a safeguard, twomembers of staff should witness thenumbered setting of the regulator when theoxygen cylinder is switched on.

Administration of oxygen must not be basedupon the need for staff observation of achild's condition, or upon the request of achild or parent.

Storage, administrative and recordingsystems relating to oxygen on the premisesshould be treated in the same way as anyother medicine. Members of staff, who maybe required to administer oxygen to a childas part of their duties, must be shown how todo so properly by the pharmacist supplyingthe cylinder or by the appropriate healthprofessional. Where the administration ofoxygen is a recognised part of staff duties,

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they will be covered under Lancashire CountyCouncil’s insurance arrangements.

Emergencies

Leaks

Any leakage of oxygen from a cylinder willusually be evident by a hissing noise. Staffshould be aware that leaks commonly occurat points where attachments are connectedto the cylinder.

It is important to observe absolute cleanlinesswhen handling oxygen cylinders, as thetransfer of grease to the connections couldcause a serious fire in the event of a leak.

Never use any kind of sealing or jointingcompound to cure a suspected leak, or usesticky tape of any kind on a cylinder.

Never attempt to repair any cylinder, otherthan gentle tightening of joints orattachments as necessary as shown intraining.

In the event of a leak, turn the cylinder valveoff. Follow the procedures as written in thecare plan regarding the failure of oxygensupply.

If the cylinder is thought to be unsafe, do notattempt to use it. If this is not possible, clearthe area of others and seek assistance. Anycylinder found to be leaking should beremoved to a safe area, marked accordinglyand the supplier contacted with a requestthat it is removed as soon as possible.

Fire

The presence of oxygen cylinders mayincrease the risk of fire at an establishmentby supporting the combustion of othermaterials, or posing a risk of explosion if acylinder is exposed to heat or damage in theevent of a fire.Storage of oxygen should be noted in theFire Risk Assessment and be brought to theattention of the Fire Officer.

Cylinders should be kept away from allsources of ignition, particularly during use.

Smoking should not be allowed in the sameroom as oxygen cylinders, either duringstorage or use.

In the event of a fire, any oxygen cylindersshould be removed from the premises, if it issafe to do so. If the cylinder is in use, itshould be turned off before making anyattempts to remove it.

Staff should follow the prescribed fireevacuation procedures for the establishment.

Training

All staff should be made aware of any oxygencylinders located on site; the child for whomthey are required; the location of thecylinders; and safety measures for their useand storage in accordance with theseprocedures.

A copy of the BOC Gases leaflet entitled'Oxygen in the Home' (May 2000 edition)should be available at the establishment andthe contents brought to the attention of allstaff.

Any queries relating to these proceduresmust be brought to the attention of theLancashire Early Years SEN service, LineManager or Area Manager and whereappropriate the Health and Safety Unit ontelephone number 01772 535355 as soon aspossible.

5.10 HIV

What is HIV?

HIV = human immune-deficiency virus.

HIV in Children and Young People

The vast majority of HIV-infected children andyoung people in this country have acquiredHIV infection through mother to childtransmission. Infection may pass from the

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mother to the unborn child in the wombduring pregnancy, during delivery of the babyor after birth through breastfeeding. Infantsinfected through mother to child transmissionshow few symptoms of acute HIV infection inthe first weeks of life, but progression toserious disease or death is rapid, and up to25% of these infants will progress to seriousdisease or death by their first birthday.

How is HIV Spread?

HIV infection is spread by blood-to-bloodcontact with an infected person’s blood.Certain other body fluids may also beinfectious eg semen, vaginal secretions andbreast milk.

The Main Routes of Infection Are:

• By sexual intercourse with an infectedperson without a condom;

• By sharing blood-contaminated needles orother equipment for injection drug use;

• From an infected mother to her baby duringpregnancy, whilst giving birth or throughbreastfeeding.

Other Less Common Routes by with theInfection may be Spread are:

• Through a blood transfusion in a countrywhere blood donations are not screenedfor HIV (all blood donations in the UK arescreened for HIV);

• By invasive medical/dental treatmentabroad using non-sterileinstruments/needles;

• By tattooing, cosmetic piercing (eg ear andbody piercing) or acupuncture withunsterilised needles or equipment;

• By sharing razors and toothbrushes (Whichmay be contaminated with blood) with aninfected person.

HIV Infection is Not Spread by SocialContact or Daily Activities such as:-

Coughing, sneezing, hugging, kissing,holding hands, or sharing bathrooms,swimming pools, toilets, food, cups, cutleryand crockery.

Implications for Settings

There is no obligation on parents, childrenand young people to disclose a diagnosis ofHIV, nor is there any obligation for anyone toinform their employer of their HIV status.

It may be the case however that the person incharge of a setting may have to be informed;this may be if the child or young person isfrequently absent due to the need to attendhospital appointments, or if medication hasto be administered whilst the child or youngperson is attending the setting.

Those who are made aware should be strictlyconfined to those who need to know in orderto ensure the proper care and any additionalpastoral or educational support can beprovided. Information should not bedisclosed to or within settings solely on thebasis that it might help protect those involvedin the care or treatment of a child or youngperson with HIV infection.

The HIV status of any individual shouldonly be disclosed with the informedconsent of the individual concerned.

Disclosure

Disclosure concerning children and youngpeople or adults may come about through avariety of sources, eg• Child or young person and/or family;• Playground or community gossip;• Media attention.

The confidentiality policy should be followedat all times. The safety and well-being of theindividual are paramount.

Under the Disability Discrimination Act 1995,schools have a duty not to discriminateagainst students on grounds relating to adisability in admissions, education andassociated services, and exclusions fromschools (see paragraphs 2.11-2.12 fordiscussion of HIV and disability).

In exceptional circumstances, where a childor young persons behaviour is thought to

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pose a serious risk of infection to others,disclosure of the child or young persons HIVstatus may be warranted (eg if a child oryoung person is deliberately trying to harmother children by activities involving the directexchange of fresh blood).

Links to Guidance Document:

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4093509

Protection Against Infection

Standard hygiene precautions should be inuse to protect against all infections. It is arequirement under COSHH for riskassessments to be undertaken in all settingsto assess the risk and to control andminimise the risk of infection.

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CHAPTER 66. Legal Framework

For ease of reading throughout thedocument the generic term "setting(s)" willbe used to describe any of the aboveprovision for Children and Young People.

The lead adult with overall responsibility insuch a setting will be referred to as the‘Lead Adult’.

Where the term 'Parents' is used it should betaken as defined in Section 576 of theEducation Act 1996, to include any personwho is not a parent of a child but hasparental responsibility for or care of a child.

6.1 Introduction

This section sets out the legal framework forsettings and the local authority in themanagement of medicines.

It summarises:

• The main legal provisions that affectLancashire County Council and settings'responsibilities for managing a child oryoung persons medical needs;

• The main legal provisions that affect earlyyears settings' responsibilities for managinga child's medical needs.

It is to be noted that this section does notconstitute an authoritative legal interpretationof the provisions of any enactments,regulations or common law – that isexclusively a matter for the courts. It remainsfor the Local Authority and the setting todevelop their policies in the light of theirstatutory responsibilities and their ownassessment of local needs and resources.

6.2 General Background

Where the Lancashire County Council acts ‘inloco parentis’ for any child or young person,procedures need to be in place for the

administration of medication and to supportthe child or young person with medicalneeds. However, whilst all staff have a dutyto take reasonable care for the health andsafety of children and young people insettings there is no contractual requirementfor staff to administer medication or supportchildren and young people who have medicalneeds. Where staff do agree to participate inthese duties it is important to recognise thattheir participation is of a voluntary nature.

Nevertheless, it is advisable for all settings tohave in place up-to-date policies andprocedures on the administration ofmedication and on the support of childrenand young people who have medical needs.All staff need to be made aware of thesettings policies and procedures by the LeadAdult. In some cases the contracts for non-teaching staff or teaching assistants mayinclude references to the administration ofmedication and/or the undertaking of medicalprocedures. These contracts will, of course,be agreed on an individual basis.

Staff who work in children's social caresettings are required to adhere to theChildren's Social Care policies andprocedures.

6.3 Indemnity Policy (Applies tothose employed by LancashireCounty Council only)

All staff, including non-teaching staff, who areinvolved in the administration of medicationand in the support of children and youngpeople with medical needs, should be awareof Lancshire County Council's policy onindemnity. This policy is quoted in its entiretybelow.

If a member of staff administers medicationto a child or young person, or undertakes amedical procedure to support that child oryoung person and, as a result expenses,liability, loss, claim or proceedings arise, theCounty Council as employer will indemnifythe member of staff provided the followingconditions apply:

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• The member of staff is an employee ofLancashire County Council.

• The medication/procedure areadministered by the member of staff in thecourse of or ancillary to their employmentwith Lancashire County Council.

• The member of staff follows:

(i) these procedures;

(ii) the setting’s policy;

(iii) the procedure outlined in the individualchild or young person's Health Care Planand directions received through training inthe appropriate procedures.

• The expenses, liability, loss, claim orproceedings are not directly or indirectlycaused by and do not arise from fraud,dishonesty or a criminal offence committedby the member of staff.

NOTES: This indemnity is to be readtogether with the indemnity given tomembers and officers which was approvedby Lancashire Full Council on 26 May 2005.

Exceptionally, this indemnity has beenextended by the County Council to apply tomembers of staff in all schools maintained bythe County Council including those who areemployees of the governing body of theschool rather than the County Council.

6.4 Action in Emergencies

Any individual can take action to preserve lifeprovided that the action is carried out with thebest of intentions and is performed in goodfaith. In law this is recognised as the issue ofnecessity and is used as a defence(successfully) for example in cases whereblood transfusions may be given in lifethreatening situations against the religiouswishes of the individual or the individual'sparents/carers.

In failing to act in an emergency situationa teacher or other member of school staffmay be found to be in breach of thestatutory duty of care.

6.5 Children and Young Peoplewith Medical Needs

Children and young people with medicalneeds have the same rights of admission to asetting as others. Most children and youngpeople will at some time have short-termmedical needs, perhaps entailing finishing acourse of medicine such as antibiotics.Some, however, have longer term medicalneeds and may require medicines on a long-term basis to keep them well, for examplechildren or young people with well-controlledepilepsy.

Others may require medicines in particularcircumstances, such as those with severeallergies who may need an adrenalineinjection. Children and young people withsevere asthma may have a need for dailyinhalers and additional doses during anattack.

Most children and young people with medicalneeds can attend a setting regularly and takepart in normal activities, sometimes withsome support. However, staff may need totake extra care in supervising some activitiesto make sure that these children and youngpeople, and others, are not put at risk.

An individual Health Care Plan can help staffidentify the necessary safety measures tosupport children and young people withmedical needs and ensure that they andothers are not put at risk. Detailed advice onhow to develop a Health Care Plan is set outin Chapter 4.

6.6 Access to Education andAssociated Services

Some children and young people withmedical needs are protected fromdiscrimination under the DisabilityDiscrimination Act (DDA) 1995. The DDA

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defines a person as having a disability if theyhave a physical or mental impairment whichhas a substantial and long-term adverseeffect on their abilities to carry out normalday-to-day activities.

Under Part 4 of the DDA, responsible bodiesfor schools (including nursery schools) mustnot discriminate against disabled childrenand young people in relation to their accessto education and associated services – abroad term that covers all aspects of schoollife including school trips and school clubsand activities16. Schools should be makingreasonable adjustments for disabled childrenand young people including those withmedical needs at different times of their life;and for the individual disabled child or youngperson in their practices and procedures andin their policies.

Early years settings not constituted asschools, including childminders and otherprivate, voluntary and statutory provision arecovered by Part 3 of the DDA. Part 3 dutiescover the refusal to provide a service, offeringa lower standard of service or offering aservice on worse terms to a disabled child oryoung person17. This includes disabledchildren and young people with medicalneeds. Like schools, Early Years Settingsshould be making reasonable adjustments fordisabled children and young people includingthose with medical needs. However, unlikeschools, the reasonable adjustments by EarlyYears' Settings will include alterations to thephysical environment as they are not coveredby the Part 4 planning duties.

6.7 Health and Safety

Lancashire County Council schools andGoverning Bodies are responsible for thehealth and safety of children and youngpeople in their care. The legal framework forschools dealing with the health and safety ofall their pupils derives from health and safetylegislation. The law imposes duties onemployers. Primary Care Trusts (PCTs) and

NHS Trusts also have legal responsibilities forthe health of residents in their area.The Registered Person in Early YearsSettings, which can legally be a managementgroup rather than an individual, is responsiblefor the health and safety of the children intheir care. The legal framework for registeredearly years settings is derived from bothhealth and safety legislation and the Nationalstandards for under 8s day care.18

6.8 Staff administering medicine

There is no legal or contractual duty on staffto administer medicine or supervise a child oryoung person taking it. The only exceptionsare set out in the paragraph below. Supportstaff may have specific duties to providemedical assistance as part of their contract.Of course, swift action needs to be taken byany member of staff to assist any child oryoung person in an emergency. Employersshould ensure that their insurance policiesprovide appropriate cover.

6.9 Staff 'Duty of Care'

Anyone caring for children and young peopleincluding teachers, other school staff and daycare staff in charge of children have acommon law duty of care to act like anyreasonably prudent parent. Staff need tomake sure that children and young people arehealthy and safe. In exceptionalcircumstances the duty of care could extendto administering medicine and/or taking actionin an emergency. This duty also extends tostaff leading activities that take place off site,such as visits, outings or field trips.

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16 The Code of Practice for Schools – DDA 1995: Part 4 (Disability Rights Commission, 2002) explains the duties: schools have and shows responsible bodies howthey might meet the duties that apply to them. http://83.137.212.42/sitearchive/DRC/the_law/legislation__codes__regulation/codes_of_practice.html

17 The Disability Rights Commission (DRC) has issued a Code of Practice covering Rights of Access to Goods, Facilities, Services and Premises, under Part 3 of the DDA. 5

18 National standards for under 8s day care and childminding – Childminding (DCSF/0649/2003); Creches (DfES/0650/2003); Full day care (DfES/0651/2003); Out ofschool care (DfES/0652/2003); Sessional care (DCSF/0653/2003)

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6.10 Admissions 19 20

Children and young people with medicalneeds have the same rights of admission toschool as other children and young people,and cannot generally be excluded from schoolfor medical reasons. In certain circumstances,eg where there is a risk to health and safety ofstaff or other pupils, children can be removedfrom school for medical reasons. This,however, is not exclusion.

6.11 The Law

Legislation, notably the Education Act 1996,the Disability Discrimination Act 1995, theCare Standards Act 2000 and the MedicinesAct 1968 are also relevant to settings indealing with children and young people'smedical needs. The following paragraphsoutline the provisions of these Acts that arerelevant to the health and safety of childrenattending early years settings and schools.

6.12 SEN and Disability Act(SENDA) 2001

The SEN and Disability Act (SENDA) 2001amended Part 5 of the Education Act 1996making changes to the existing legislation, inparticular strengthening the right of childrenand young people with SEN to be educatedin mainstream schools.

Schools and early years settings are bothrequired to take 'reasonable steps' to meetthe needs of disabled children and youngpeople.

6.13 Local Authority and Schools

SENDA also amended Part 4 of the DisabilityDiscrimination Act (DDA) 1995 bringingaccess to education within the remit of theDDA, making it unlawful for schools andLocal Authorities to discriminate againstdisabled pupils for a reason relating to theirdisability, without justification. This mightinclude some children and young people withmedical needs.

Part 4 duties apply to all schools; private orstate maintained, mainstream or special andthose early years settings constituted asschools.

Some medical conditions may be classed asa disability. The responsible body of a schoolwill need to consider what arrangements canreasonably be made to help support a pupil(or prospective pupil) who has a disability.The Disability Rights Commission hasproduced a Code of Practice for Schools.Advice and training from local healthprofessionals will help schools when lookingat what arrangements they can reasonablymake to support a pupil with a disability.

Schools are not, however, required to provideauxiliary aids or services or to make changesto physical features. Instead, schools andthe Local Authority are under a duty to planstrategically to increase access, over time, toschools. This duty includes planning toincrease access to the school premises, tothe curriculum and providing written materialin alternative formats to ensure accessibility.

Part 4 duties cover discrimination inadmissions, the provision of education andassociated services and exclusions.

The reasonable adjustments duty in Part 4includes provision of:

• Auxiliary aids and services;• Making physical alterations to buildings(from October 2004).

6.14 Early Years Settings

Early years settings, not constituted asschools, must comply with Part 3 of the DDA;this includes day nurseries, family centres,pre-schools, playgroups and childminders(including those in a childminding network).The duties cover the refusal to provide aservice, offering a lower standard of serviceor offering a service on worse terms to adisabled child.

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19 School Admission Code of Practice (DfES/0031/2003). http://www.dfes.gov.uk/sacode/

20 Improving Attendance & Behaviour: Guidance on Exclusion from Schools and Pupil Referral Units (DfES/0354/2004)http://www.behaviour4learning.ac.uk/viewarticle2.aspx?contentId=10612

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Under Parts 3 and 4 of the DDA all settingsare required not to treat a disabled child 'lessfavourably' than any other child for a reasonrelating to their disability. There maysometimes be justification for less favourabletreatment, but it may not be possible to justifyif there is a reasonable adjustment that mighthave been made but was not.

6.15 Health and Safety at WorkAct 1974

http://www.healthandsafety.co.uk/haswa.htm

The Health and Safety at Work Act (HSWA)1974 places duties on employers for thehealth and safety of their employees andanyone else on the premises. This coversthe head teacher and teachers, non-teachingstaff, children and visitors.21

Who the employer is depends on the typeof school:

• For community schools, community specialschools, voluntary controlled schools,maintained nursery schools and pupilreferral units the employer is the LancashireCounty Council;

• For foundation schools, foundation specialschools and voluntary-aided schools theemployer is the governing body;

• For academies and city technologycolleges the employer is the governingbody;

• For non-maintained special schools theemployer is the trustees;

• For other independent schools theemployer is usually the governing body,proprietor or trustees.

The employer for registered day care willdepend on the way it has been set up.Settings may be run by private individuals,charities, voluntary committees,Lancashire County Council, SchoolGovernors, the proprietor or the trustees insome independent schools, and companiesthat provide day care as an additionalservice to customers (eg crèches in shops orsports clubs).

The employer of staff at the setting must doall that is reasonably practicable to ensurethe health, safety and welfare of employees.The employer must also make sure thatothers, such as pupils and visitors, are notput at risk. The main actions employers musttake under the Health and Safety at Work etcAct are to:

• Prepare a written Health and Safety policy;• Make sure that staff are aware of the policyand their responsibilities within that policy;

• Make arrangements to implement thepolicy;

• Make sure that appropriate safetymeasures are in place;

• Make sure that staff are properly trainedand receive guidance on theirresponsibilities as employees.

Most settings will at some time have childrenon roll with medical needs. The responsibilityof the employer is to make sure that safetymeasures cover the needs of all children atthe setting.

6.16 Management of Health andSafety at Work Regulations 1999

The Management of Health and Safety atWork Regulations 1999, made under theHSWA, require employers of staff at a schoolor early years setting to:

• Make an assessment of the risks ofactivities;

• Introduce measures to control these risks;• Tell their employees about these measures.

The National standards for day care settingsmake it clear that the registered person mustcomply with all relevant health and safetylegislation. Registered persons in Early YearsSettings are also required under the Nationalstandards to take positive steps to promotesafety. Supporting criteria under the safetystandard includes undertaking riskassessments.

4721 Health and Safety: Responsibilities and Powers (DfES/0803/ 2001) http://www.teachernet.gov.uk/_doc/4017/Responsibilites%20and%20Powers.doc

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HSWA and the Management of Health andSafety at Work Regulations 1999 also applyto employees. Employees must:

• Take reasonable care of their own andothers' health and safety;

• Co-operate with their employers;• Carry out activities in accordance withtraining and instructions;

• Inform the employer of any serious risk.

In some cases children and young peoplewith medical needs may be more at risk thanother children. Staff may need to takeadditional steps to safeguard the health andsafety of such children. In a few casesindividual procedures may be needed. Theemployer is responsible for making sure thatall relevant staff know about and are, ifnecessary, trained to provide any additionalsupport these children require.

6.17 Control of SubstancesHazardous to Health Regulations2002

The Control of Substances Hazardous toHealth Regulations 2002 (COSHH) requiresemployers to control exposures to hazardoussubstances to protect both employees andothers. Some medicines may be harmful toanyone for whom they are not prescribed.Where a school or setting agrees toadminister this type of medicine the employermust ensure that the risks to the health ofstaff and others are properly controlled.

Legislation, notably the Education Act 1996http://www.opsi.gov.uk/ACTS/acts1996/ukpga_19960056_en_1The Disability Discrimination Act 1995http://www.opsi.gov.uk/acts/acts1995/ukpga_19950050_en_1The Care Standards Act 2000http://www.opsi.gov.uk/acts/acts2000/en/ukpgaen_20000014_en_1and the Medicines Act 1968http://www.opsi.gov.uk/si/si1989/Uksi_19890192_en_1.htmare also relevant to settings in dealing withchildren's medical needs.

6.18 Misuse of Drugs Act 1971and associated regulations

The supply, administration, possession andstorage of certain drugs are controlled by theMisuse of Drugs Act 1971 and associatedregulations. This is of relevance to settingsbecause they may have a child or youngperson that has been prescribed a controlleddrug. The Misuse of Drugs Regulations 2001allows ‘any person’ to administer the drugslisted in the Regulations.

6.19 Medicines Act 1968

The Medicines Act 1968 specifies the waythat medicines are prescribed, supplied andadministered within the UK and placesrestrictions on dealings with medicinalproducts, including their administration.Anyone may administer a prescribedmedicine, with consent, to a third party, solong as it is in accordance with theprescriber's instructions. This indicates that amedicine may only be administered to theperson for whom it has been prescribed,labelled and supplied; and that no-one otherthan the prescriber may vary the dose anddirections for administration.

The administration of prescription-onlymedicine by injection may be done by anyperson but must be in accordance withdirections made available by a doctor,dentist, nurse prescriber or pharmacistprescriber in respect of a named patient.

6.20 The Education (SchoolPremises) Regulations 1999 22

The Education (School Premises) Regulations1999 require every school to have a roomappropriate and readily available for use formedical or dental examination and treatmentand for the caring of sick or injured pupils. Itmust contain a washbasin and be reasonablynear a water closet. It must not be teachingaccommodation. If this room is used forother purposes as well as for medicalaccommodation, the body responsible mustconsider whether dual use is satisfactory or

4822 Standards for School Premises (DFEE/0029/2000) http://www.opsi.gov.uk/si/si1999/19990002.htm

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has unreasonable implications for itsmain purpose.

The responsibility for providing these facilitiesin all maintained schools rests with the LocalAuthority.

6.21 National Standards forunder 8s day care andchildminding – Premises

The National standards do not require daycare settings to have a separate first aidroom but they do cover the promotion ofgood health and taking positive steps toprevent the spread of infection. Suchsettings should also have one washbasin forevery ten children over two years of age.

The National standards also require premisesto be safe, secure and suitable for theirpurpose. They must provide adequate spacein an appropriate location, be welcoming tochildren and offer all the necessary facilitiesfor a range of activities that promote theirdevelopment. Supporting criteria under thestandard includes space standards, outdoorplay areas, toilets, staff facilities, kitchens andlaundry facilities. The standards do notrequire settings to have a separate first aidroom but they do cover the promotion ofgood health and taking positive steps toprevent the spread of infection.

6.22 The Education(Independent SchoolsStandards) (England)Regulations 2003

The Education (Independent SchoolsStandards) (England) Regulations 2003require that independent schools have andimplement a satisfactory policy on First Aidand have appropriate facilities for pupils inaccordance with the Education (SchoolPremises) Regulations 1999.

6.23 Special Educational Needs– Education Act 1996

Section 312 of the Education Act 1996 sets

out that a child has special educationalneeds if he has a learning difficulty that callsfor special educational provision to be madefor him. Children with medical needs will notnecessarily have special educational needs(SEN). For those who do, schools shouldrefer to the DCSF SEN guidance.

Section 322 of the Education Act 1996requires that local health services mustprovide help to the Local Authority (LA) for achild with SEN (which may include medicalneeds), unless the health services considerthat the help is not necessary to enable theLA to carry out its duties or that it would notbe reasonable to give such help in the light ofthe resources available to the local healthservices to carry out their other statutoryduties. This applies whether or not a childattends a special school. Help from localhealth services could include providing adviceand training for staff in procedures to dealwith a child's medical needs if that child wouldotherwise have limited access to education.Local Authorities, schools and early years'settings should work together, in closepartnership with parents, to ensure propersupport for children with medical needs.

6.24 Care Standards Act 2000

Schools

Residential special schools are required toregister with the Commission for Social CareInspection (CSCI) and are subject to therequirements set out in the Children's HomesRegulations 2001. In respect of medicines,this is set out in Regulation 21 and places aduty on the registered person to make'suitable arrangements for the recording,handling, safekeeping, safe administrationand disposal of medicines'. The Departmentof Health has also published NationalMinimum Standards (NMS) that set outguidance of how the Regulations may be met(Standard 13).

CSCI also works in conjunction with Ofsted tomonitor health and social welfare in boardingschools. There are also NMS for boardingschools although such schools are not

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subject to Regulations under the CareStandards Act.

Day Care Provision

The Children Act 1989 was amended by theCare Standards Act 2000 by the introductionof Part XA. In accordance with 79B in PartXA of the Children Act, the Office forStandards in Education (Ofsted) registers daycare provision (day nurseries, crèches, out ofschool clubs and pre-school provision) andchildminders. As regulator, Ofsted ensuresthat those who provide day care orchildminding services are suitable and thatthe requirements set out in the Nationalstandards for under 8s day care andchildminding are met. The registered personin early years settings in the private andvoluntary sectors must meet the requirementsof the national standards for under 8s daycare and childminding.The National standards for under 8s day careand childminding require that the RegisteredPerson in an early years setting promotes thegood health of children and takes positivesteps to prevent the spread of infection andappropriate measures when they are ill(Standard 7).

The criteria for this standard sets out that theregistered person has a clear policy,understood by all staff and discussed withparents, regarding the administration ofmedicines. If the administration ofprescription medicine requirestechnical/medical knowledge then individualtraining must be provided for staff from aqualified health professional and that trainingmust be specific to the individual child oryoung person concerned.

There is a requirement in the Nationalstandards for under 8s day care andchildminding that the registered person musttake positive steps to promote safety withinthe setting and on outings and ensure properprecautions are taken to prevent accidents(Standard 6).

For day care settings, the criteria sets outthat the Registered Person must takereasonable steps to ensure that hazards tochildren on the premises, both inside andoutside, are minimised and is aware of, andcomplies with, health and safety regulations.Staff must be trained to have anunderstanding of health and safetyrequirements for the environment in whichthey work.

The national standards do not override theneed for providers to comply with otherlegislation such as that covering health andsafety, food hygiene and so on.

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CHAPTER 77. Related Documents

DfES unpriced documents can be orderedfrom DfES Publications,Tel: 0845 6022260.Email: dfes@prolog.uk.com.Please quote the publication reference whenordering.

7.1 Early Years Settings

Disability Discrimination Act 1995 – Code ofPractice – Rights of Access – Goods,Facilities, Services and Premises (DisabilityRights Commission, 2002). Price: £13.95Order: The Stationery Office Tel: 0870 6005522 DRC Code of Practice webpage:www.drc-gb.org/the law/practice. asp

Early Support Family Support Pack and EarlySupport Professional Guidance (DfES, 2004).Ref: ESPP1. Website:www.earlysupport.org.uk

Including Me – Managing Complex HealthNeeds in Schools and Early Years Settings(Council for Disabled Children, due forpublication in summer 2005). Council forDisabled Children. Tel: (020) 7843 1900.

National standards for under 8s day care andchildminding – (DfES/DWP, 2003) –Childminding Ref: DfES/0649/2003.Créches Ref: DfES/0650/2003.Full day care Ref: DfES/0651/2003.Out of school care Ref: DfES/0652/2003.Sessional care Ref: DfES/0653/2003.http://www.surestart.gov.uk/improvingquality/ensuringquality/inspectionandregulation/

7.2 Schools

Code of Practice for Schools – DisabilityDiscrimination Act 1995: Part 4 (DisabilityRights Commission, 2002). Ref: COPSHwww.drc-gb.org/thelaw/practice.asp

Order: Disability Rights Commission Tel:08457 622 633Drugs: Guidance for Schools (DfES, 2004)Ref: DfES/0092/2004www.teachernet.gov.uk/drugs/

Guidance on First Aid for Schools: a goodpractice guide (DfES, 1998)Ref: GFAS98. www.teachernet.gov.uk/firstaid

Health and Safety: Responsibilities andPowers (DfES, 2001)Ref: DfES/0803/2001.www.teachernet.gov.uk/responsibilities/

Health and Safety of Pupils on EducationVisits: a good practice guide (DfES, 1998)Ref: HSPVhttp://www.teachernet.gov.uk/wholeschool/healthandsafety/visits/

Also three part supplement:Part 1 – Standards for LEAs in OverseeingEducational Visits (DfES, 2002)Ref: DfES/0564/2002;Part 2 – Standards for Adventure (DfES,2002) Ref: DfES/0565/2002;Part 3 – Handbook for Group Leaders (DfES,2002) Ref: DfES/0566/2002.

Home to school travel for pupils requiringspecial arrangements (DfES, 2004)Ref: LEA/0261/2004www.teachernet.gov.uk/wholeschool/sen/sentransport/

Improving Attendance and Behaviour:Guidance on Exclusion from Schools andPupil Referral Units (DfES, 2004) Ref:DfES/0354/2004http://www.teachernet.gov.uk/management/resourcesfinanceandbuilding/schoolbuildings/schooldesign/Pupil_Referral_Units/

Insurance – A guide for schools (DfES, 2003)Ref: DfES/0256/2003www.teachernet.gov.uk/management/atoz/i/insurance/index.cfm?code=keyd

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RelatedDocuments

School Admissions Code of Practice (DfES,2003)Ref: DfES/0031/2003www.dfes.gov.uk/sacode/

Special Educational Needs Code of Practice(DfES, 2001)Ref: DfES/0581/2001www.teachernet.gov.uk/teachinginengland/detail.cfm?id=390

Standards for School Premises (DfEE, 2000)Ref: DFEE/0029/2000www.teachernet.gov.uk/sbregulatoryinformation

Work Related Learning and the Law (DfES,2004)Ref: DfES/0475/2004http://publications.teachernet.gov.uk/default.aspx?PageFunction=productdetails&PageMode=publications&ProductId=DFES-0340-2006&

7.3 Department of Health(including joint publications)

Guidance on infection control in schools andnurseries (Department of Health/Departmentfor Education and Employment/Public HealthLaboratory Service, 1999) Download onlyfrom: Wired for Health at:www.wiredforhealth.gov.uk/

National Service Framework for Children andYoung People and Maternity Services:Medicines and Children and Young Peoplewebsite: www.dh.gov.uk/healthtopics(Click on Children's Services). Order: DHPublications Tel: 08701 555 455

7.4 Ofsted

Inspecting schools – Handbook forinspecting nursery and primary schools Ref:HMI 1359. Inspecting schools – Handbookfor inspecting secondary schools Ref: HMI1360. Inspecting schools – Handbook forinspecting special schools and pupil referralunitsRef: HMI 1361. All Ofsted 2003. Priced.

Order: The Stationery Office Tel: 0870 6005522 or view online athttp://www.ofsted.gov.uk/

LEA Framework 2004 – Support for healthand safety, welfare and child protection(Ofsted, 2004)http://www.ofsted.gov.uk/portal/site/Internet/menuitem.eace3f09a603f6d9c3172a8a08c08a0c/?vgnextoid=4f4ac30f8636c010VgnVCM1000003507640aRCRD

7.5 Useful Contacts

Allergy UKAllergy Help Line: (01322) 619864Website: www.allergyfoundation.com

The Anaphylaxis CampaignHelpline: (01252) 542029Website: www.anaphylaxis.org.uk andwww.allergyinschools.co.uk

Association for Spina Bifida andHydrocephalusTel: (01733) 555988 (9 am to 5 pm)Website: www.asbah.org

Asthma UK (formerly the National AsthmaCampaign)Adviceline: 08457 01 02 03(Mon-Fri 9 am to 5 pm)Website: www.asthma.org.uk

Council for Disabled ChildrenTel: (020) 7843 1900Website: www.ncb.org.uk/cdc/

Contact a FamilyHelpline: 0808 808 3555Website: www.cafamily.org.uk

Cystic Fibrosis TrustTel: (020) 8464 7211(Out of hours: (020) 8464 0623)Website: www.cftrust.org.ukDiabetes UKCareline: 0845 1202960(Weekdays 9 am to 5 pm)Website: www.diabetes.org.uk

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Department for Education and SkillsTel: 0870 000 2288Website: www.dfes.gov.uk

Department of HealthTel: (020) 7210 4850Website: www.dh.gov.uk

Disability Rights Commission (DRC)DRC helpline: 08457 622633Textphone: 08457 622 644Fax: 08457 778878Website: www.drc-gb.org

Epilepsy ActionFree phone Helpline: 0808 800 5050(Monday – Thursday 9 am to 4.30 pm, Friday9 am to 4 pm)Website: www.epilepsy.org.uk

Health and Safety Executive (HSE)HSE Infoline: 08701 545500(Mon-Fri 8 am-6 pm)Website: www.hse.gov.uk

Health Education TrustTel: (01789) 773915Website: www.healthedtrust.com

Hyperactive Children's Support GroupTel: (01243) 551313Website: www.hacsg.org.uk

MENCAPTelephone: (020) 7454 0454Website: www.mencap.org.uk

National Eczema SocietyHelpline: 0870 241 3604(Mon-Fri 8 am to 8 pm)Website: www.eczema.org

National Society for EpilepsyHelpline: (01494) 601400(Mon-Fri 10 am to 4 pm)Website: www.epilepsynse.org.uk

Psoriasis AssociationTel: 0845 676 0076 (Mon-Thurs 9.15 am to4.45 pm Fri 9.15 am to 16.15 pm)Website: www.psoriasis-association.org.uk/

Sure StartTel: 0870 000 2288Website: www.surestart.gov.ukYou can download this publication or ordercopies online at:www.teachernet.gov.uk/publicationsSearch using ref: 1448-2005DCL-EN.

7.6 The Law

SEN and Disability Act 2001http://www.opsi.gov.uk/ACTS/acts2001/ukpga_20010010_en_1

Health and Safety at Work etc Act 1974http://www.hse.gov.uk/legislation/hswa.pdf

The Management of Health and Safety atWork Regulations 1999http://www.opsi.gov.uk/si/si1999/19993242.htm

Control of Substances Hazardous to HealthRegulations 2002http://www.opsi.gov.uk/si/si2002/20022677.htm

Misuse of Drugs Act 1971http://www.ukcia.org/pollaw/lawlibrary/misuseofdrugsact1971.phpAnd associated regulations Medicines Act1968http://www.the-shipman-inquiry.org.uk/4r_page.asp?id=3116

The Education (School Premises) Regulations1999http://www.england-legislation.hmso.gov.uk/si/si1999/99000202.htm

The Education (Independent SchoolsStandards) (England) Regulations 2003http://www.opsi.gov.uk/si/si2003/20031910.htm

National Standards for under 8s day care andchildminding – Premiseshttp://www.opsi.gov.uk/si/si2003/20031996.htm

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RelatedDocuments

Special Educational Needs – Education Act1996http://www.opsi.gov.uk/ACTS/acts1996/ukpga_19960056_en_1

Care Standards Act 2000http://www.opsi.gov.uk/acts/acts2000/en/ukpgaen_20000014_en_1

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