In this article
100 years ago, the main health problems occurring in children were infectious diseases. Nowadays, however, the main burden of disease is chronic conditions. Some statistics suggest that between 13% and 27% of children are affected by a chronic condition that affects their lives. This might be a physical condition, asthma, obesity, or even a learning or behavioural problem. According to the National Institute for Health and Care Excellence (NICE), some 1.7 million children in England alone have long-term health conditions.
Of these children, those with the most complex needs or the most at-risk children will have an Individual Healthcare Plan (IHP). This is different from an Educational, Health and Care Plan (EHCP) but children may have both.
What is an individual healthcare plan?
When a child who has a medical condition attends school, it can be a worrying time for their parents. This is down to the fact that these children will require care, support or medicines while they’re in school in order to keep them healthy. Some may need interventions or monitoring too.
As with all conditions, a child’s health can also change over time—often unpredictably—which often means absences. It is important for parents to feel confident to leave their children in the care of school staff.
Besides the medical needs of the child, there are often associated emotional and social implications. Children might have low mood or anxiety due to their differences or conditions. Absences might mean they are not as well integrated with peers.
For these reasons, an Individual Healthcare Plan (IHP) can be extremely important. This outlines the care provided in detail so that parents and children feel reassured about their child’s needs being met in school.
The IHP is a collaborative plan that clarifies a child’s care and medical needs. It will outline daily medical care as well as emergency information. These plans are also useful in supporting conversations about the child’s needs for inclusion in school.
The plan will be graduated. This means there will be needs met by universal provision, some by targeted provision, and others by specialist provision.
In some cases, where there are special educational needs (SEN), a child may also have an Education, Health and Care Plan (EHCP) to bring together the varying needs of the child and outline the provision for their education.
Individual healthcare plans should be easily accessible by anyone who might need to refer to them but they should also be confidential. The detail required will be dependent upon the medical conditions and the support required.
What the law says
The Children and Families Act 2014 (Section 100) means schools have a duty to support pupils with medical conditions. This aims to make sure that these young people are adequately supported so they can remain healthy, take part fully in school life and can achieve their full potential.
Who is an individual healthcare plan for?
Not all children who have a diagnosed medical condition will require an IHP. However, these are typically required for those who have conditions that affect their wellbeing. Even when children can manage their condition themselves (in the case of diabetes or asthma, for instance), an IHP might be required.
This document can be used for any child who might need additional support, planning for or care. It can be suggested by a parent, a school or a healthcare professional.
These plans are different from Education Health and Care Plans as they can be put into place straight away when a health need is first identified. There is no statutory process and they can be reviewed as soon as care or support needs change. This is different from EHCPs, which require planned reviews and evidenced-based input from external agencies. Essentially, IHPs are more timely.
How should you prepare an individual healthcare plan?
An IHP can be initiated by a parent, a member of school staff or a medical practitioner who is involved in the child’s care. The plan should be developed with a collaborative approach from all involved parties. Examples of people involved include:
- School nurse
- Headteacher or SENDCO (special educational needs coordinator)
- The child’s paediatrician or specialists (this could be a consultant, paediatrician, physiotherapist, speech and language specialist, occupational therapist, etc.)
- The child
The aim of the plan should be to outline the steps the school will take to help their pupil manage their health condition. It should help the child to overcome barriers and access a full education. It will also outline how other services can be integrated to work with the child at school if this is necessary.
The responsibility of writing the plan and implementing it is on the school but all parties should be involved. If special educational needs are identified, an EHCP should also be drawn up. The IHP can be integrated with this or linked to it, if appropriate.
If a child is attending school after a period of alternative provision (e.g., home education) or hospital education, the school should consult education providers and the local authority to ensure successful integration.
Healthcare professional input
Healthcare professionals will provide any information needed about the child’s medical needs and potential difficulties they may face. School nursing teams will be best placed to advise on how the medical needs can be met and whether or not staff will need support to meet these or training. This is to ensure safety is considered for all.
The role of school staff
The SENDCO or a senior member of school staff is likely to be the one coordinating the plan. They will likely hold a review of the child’s needs and consult with medical professionals to make sure that treatments and interventions are delivered safely and correctly.
Other staff, including support staff, pastoral staff, teaching assistants and class teachers, will be able to contribute as they’re likely to recognise a range of situations on how the child’s medical needs might impact their experience of education.
Schools should be encouraged to seek advice from external agencies like educational psychology, learning inclusion teams, specialists like hearing or visual impairment teams, attendance teams like Educational Welfare Officers, the SEND inclusion team and any other third-sector help like Scope.
The role of the child and parents
The child themselves is often the one that is best placed to describe their needs and how their medical problems affect them. The pupil should be involved in discussions and contribute to the plan. This is particularly vital when children are in adolescence and preparing to advocate for themselves and manage their medical needs in their adult lives.
The parents will also have a keen understanding of their child’s day-to-day needs and the specifics of their condition—in some cases, more than the medical professionals themselves—so it’s important to listen to their views and ideas.
What is the process for developing an individual healthcare plan?
Just as medical needs are very individual, so too are IHPs and their implementation. Generally speaking, however, there is a common set of steps in the process to developing a plan:
- Informing the school: The child’s parents or healthcare professionals will inform the child’s school of a newly diagnosed condition or when a child has a diagnosed condition and is moving schools. The school will also be informed in advance of any return to education following a time out due to hospital admissions, for example.
- Meeting: There will be an initial meeting to discuss any medical needs and support the child will require. This will likely be done with the SENDCO and there will typically be a member of staff assigned to the pupil to provide their support.
- Meeting to outline whether an IHP is needed: There will likely be a further meeting that includes key school staff as well as the parents, child and healthcare professionals (or their written evidence) to decide whether or not an IHP is needed.
- Developing the plan: If a plan is agreed, it will be developed in partnership with appropriate professionals. The SENDCO is likely to be the one coordinating and writing the plan.
- Identifying training needs: The written plan will outline any training needs for school staff. The training will be organised as appropriate.
- The plan will be circulated and implemented.
- The plan will be reviewed when a condition changes or otherwise annually.
If training of school staff is required, this will be outlined in the plan. For instance, training might be needed for diabetes, intimate care, stoma care, etc. and should be organised for as soon as possible.
Healthcare professionals will be able to lead on the level and type of training needed and how it can be found. The training needs to ensure that all involved staff are confident and competent in dealing with the medical needs of the children in their care. This should also be kept up to date.
Having a first-aid certificate is not enough for dealing with specific medical conditions in children. The school should have a policy outlining staff proficiency in providing medication or medical care. There should also be whole-school awareness as appropriate too.
Finally, the school should embed preventative and emergency procedures so staff are able to act quickly and recognise when there is a problem.
Any member of staff in the school could be asked to support pupils who have medical conditions. This includes administering or supervising medicine intake. However, administering medicines isn’t part of the professional duties of a teacher, which needs to be considered.
What should an individual healthcare plan include?
A child with a medical condition should have the same access to opportunities within school as any other child.
When deciding what to include in an IHP, there are lots of things to consider. Plans might include some of the following information:
- Basic details about the child, including their name, date of birth, year, class, and a photo if possible.
- The name and a description of the medical condition. This should be explained in enough detail to be accurate but also in simple terms so that non-medical professionals have an understanding of it.
- The condition’s triggers if there are any.
- The symptoms and signs of the condition.
- What medications the child needs. This needs to include the dose, frequency or administration and storage instructions as well as any possible side effects.
- What treatments or tests a child might need at school, e.g., blood sugar monitoring for diabetes, physiotherapy for cystic fibrosis, etc.
- Specific support the child needs and individual staff responsibilities. This might be emotional support, rest periods, extra time to catch up on missed learning, travel time to get to lessons, etc. It might also be attendance support, dietary support, or support with specific activities.
- Information about monitoring arrangements for children self-managing their condition and medication or procedures. This should also detail cover information should the key worker be unavailable.
- Details on who needs to have access to the plan.
- The details on written permission for medication administration by staff.
- Details on school activities or trips outside of the normal school day.
- Risk assessments.
- Information on what to do in an emergency, like who to contact and what to do.
- The child’s views.
How can an individual healthcare plan be used?
The IHP is used to support the child throughout their education and can be reviewed whenever medical needs change or every year. The plan can also be used to support transitions between different settings. Members of staff can use the plan to inform planning and risk assessments for activities.
Should staffing change in the school, it will also be necessary to share the plan with new staff.
Final thoughts on individual healthcare plans
An IHP is a crucial document that needs to be planned carefully to ensure the health, safety and wellbeing of the pupil involved. It should be reviewed as and when necessary, or otherwise annually, and needs to consider the views of the child at the centre. Schools are encouraged to seek external support to ensure the needs of the child are being met and that their education is not suffering as a result of their medical condition.