Showing posts with label school nurse wales. Show all posts
Showing posts with label school nurse wales. Show all posts

Supporting Learners with Medical Needs in Wales

Supporting Learners with Medical Needs in Wales

A practical guide for ALN families on health plans, school duties, and your rights

Children and young people with medical needs are protected under Welsh education law and the Additional Learning Needs system.

Schools have clear duties to support learners with healthcare needs, whether those needs are short-term, long-term, fluctuating, mental health-related, or linked to neurodevelopmental conditions.

This guide explains what schools must provide, how Individual Healthcare Plans work, and how education and health services are expected to work together to keep children safe and included.

It also includes guidance for electively home-educated families, children with chronic illness, and those experiencing slow post-viral recovery.

1. What counts as a medical need in Wales?

A medical need is any physical or mental health condition that affects a child’s ability to:

  • access education

  • attend regularly

  • remain safe in school

This includes, but is not limited to:

  • asthma

  • ADHD medication needs

  • epilepsy

  • diabetes

  • chronic fatigue or post-viral symptoms

  • anxiety or panic attacks

  • gastrointestinal conditions

  • feeding or hydration difficulties

  • allergies and anaphylaxis

  • Long Covid

  • mobility or continence needs

  • mental health conditions

  • medication that must be given during the school day

Medical needs do not need to meet a diagnostic threshold.
If a condition affects safety, access or attendance, it counts.

Welsh Government reference:
Schools must follow Supporting Learners with Healthcare Needs (statutory guidance).

https://www.gov.wales/supporting-learners-healthcare-needs

2. When a school must create an Individual Healthcare Plan

Welsh Government guidance requires an Individual Healthcare Plan (IHP) when:

  • a child has a long term or complex medical condition

  • medication must be given in school

  • emergency procedures are required

  • a condition affects attendance

  • a condition affects participation in learning

  • adjustments, rest breaks or safety planning are needed

  • symptoms fluctuate or are invisible

  • a child cannot reliably self-manage symptoms, hydration or energy

Schools cannot refuse to create a plan because they are busy, because a condition is described as anxiety, or because a child appears to be coping or masking.

If a medical condition affects safety or access to education, a plan is required.

3. What should be in a good Individual Healthcare Plan?

A strong IHP should include:

  • a clear description of the condition

  • signs and symptoms to watch for

  • known triggers and how to reduce them

  • baseline information on energy, eating, drinking and regulation

  • emergency procedures

  • medication details, including dose, timing and storage

  • who is trained to deliver care

  • rest breaks and sensory needs

  • hydration or nutrition strategies

  • when parents should be contacted

  • when the child is too unwell for school

  • steps for return after illness

  • who is responsible for daily checks

  • an agreed communication system

  • reasonable adjustments during lessons, movement and breaks

The plan should be written with full parental involvement and reviewed at least annually, or sooner if the child’s condition changes.

4. Schools must involve the right people

An Individual Healthcare Plan should be written with input from:

  • the parent or carer

  • the school nurse

  • GP or specialist team where appropriate

  • the school ALNCo

  • pastoral or wellbeing staff

  • the child or young person, where possible

Schools must not write a health plan in isolation without consulting healthcare professionals.

If a child has an Individual Development Plan (IDP), the IHP should sit alongside it and inform ALN provision.

5. Medication in school: your rights

Schools must:

  • store medication safely

  • train staff to administer it

  • keep clear records

  • allow children to carry inhalers where appropriate

  • make reasonable adjustments for sensory needs around medication

  • support hydration and food needs linked to medication side effects

Schools cannot require a parent to attend daily to administer medication unless this is by parental choice.

6. When medical needs affect attendance

Where a condition causes fatigue, pain, anxiety, dysregulation or difficulty managing a full school day, families may request:

  • a reduced timetable

  • a phased reintegration plan

  • temporary home tuition

  • rest breaks or quiet spaces

  • adjusted start or finish times

  • a review of the IDP

If a child is too unwell to attend long term, families may request:

  • medical needs tuition

  • Education Otherwise Than At School (EOTAS) where attendance becomes medically impossible

Parents are not required to provide repeated GP notes. Schools must accept parental explanation unless there is a clear safeguarding concern.

7. What happens for electively home-educated children?

Health support does not end with deregistration.

Electively home-educated children continue to have access to:

  • school nursing services

  • vaccinations

  • health checks

  • continence services

  • paediatric referrals

  • long-term condition monitoring

Families can contact their local health board directly.

8. When you should request a review or change of plan

Request an urgent IHP review if:

  • Symptoms worsen or fluctuate

  • medication changes

  • attendance drops

  • fatigue or sensory overwhelm increases

  • the child cannot regulate without breaks

  • staff say they cannot meet health needs

Request an IDP review if:

  • medical needs impact learning

  • health and education provision need alignment

  • reduced timetables become prolonged

  • anxiety or EBSA develops due to health

If attendance becomes medically impossible, request EOTAS consideration.

9. Where to find the official Welsh Government guidance

The statutory duties are set out in:

Supporting Learners with Healthcare Needs (Welsh Government)

This document is essential for families and professionals.

10. Disclaimer and safety notice

Learn Without Limits CIC provides general information about education rights and public guidance. We do not provide clinical or legal advice.

If your child is unwell, seek appropriate medical support.

  • NHS Wales 111 for non-emergency advice

  • Your GP for ongoing or worsening symptoms

  • Call 999 immediately if a child has difficulty breathing, seizures, severe drowsiness, chest pain, dehydration symptoms, or any sign of serious illness

Always trust your judgement and use the appropriate service.

11. Coming later this month

We will publish a two-part series:

Long Covid in Welsh children

These posts explore slow recovery, post-viral fatigue, school anxiety, pacing and support for ALN learners, building directly on the issues raised here.

We will also be hosting an online session for parents to support our Long Covid series in early March, and you can book a place via our website here https://learnwithoutlimitscic.org/events.en.html

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This Blog is the official publication for Learn without Limits CIC 
https://learnwithoutlimitscic.org/

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Attendance Guidance for Families in Wales

 



When your child is too unwell to attend school and what the system should do instead

For many families, attendance stops being a routine school matter and becomes a source of constant anxiety.

Parents are warned about attendance percentages, penalty notices, and court action. What is often missing from these conversations is a basic but crucial point:

Attendance law does not override a child’s health.

Welsh Government guidance is clear that where health affects attendance, the response should be supportive, flexible and planned. It should not be punitive.

This article explains what parents are expected to do, what they are not required to do, and how families can push back safely when pressure is being applied inappropriately.

Do parents need a doctor’s note every time a child is off sick?

No.

There is no requirement in Wales for parents to obtain a GP or medical note for every illness related absence.

Welsh Government attendance definitions confirm that illness is an authorised absence where a satisfactory explanation has been provided by the parent. GP practices are not expected to provide letters for routine sickness, and parents are not required to seek medical appointments purely to justify absence.

Medical evidence can take many forms and GP notes are not the default expectation.

Key point: Schools should not require medical evidence as a condition of authorising absence where illness is genuine and explained. If a school intends to mark illness as unauthorised, it should tell parents this and explain why.

Suggested parent wording:

“Please record today’s absence as illness. I am providing a satisfactory explanation. If you intend to mark this as unauthorised, please confirm in writing and explain what evidence you require.”

What about fluctuating conditions and sporadic attendance?

Many children live with health conditions that do not follow a predictable pattern. This includes:

  • chronic fatigue and pain conditions

  • mental health difficulties

  • neurodevelopmental burnout

  • post-viral illness, including Long Covid

Welsh Government guidance on supporting learners with healthcare needs exists specifically because some learners cannot reliably access education in the usual way. It recognises that health conditions may fluctuate, worsen after activity, and affect attendance inconsistently.

This means:

  • a child coping one week does not prove capacity the next

  • uneven attendance does not equal avoidance

  • pressure to push through can worsen outcomes

Attendance affected by healthcare needs should trigger planning and flexibility, not assumptions of non-compliance.

Suggested parent wording:

“Our child has healthcare needs that affect capacity. We are asking for a planned approach to access and support, not assumptions based on short periods of improvement.”

Is there a percentage absence rate that triggers enforcement?

There is no legal attendance percentage at which fines or court action automatically apply.

In practice, attendance below 90 percent is often labelled persistent absence. This is a monitoring category, not an enforcement threshold. It is used to identify learners who may need additional support, not to mandate punishment.

Attendance figures must always be interpreted in context, particularly where illness or disability is involved.

What is the role of the school nurse and why are they important?

School nurses in Wales are Specialist Community Public Health Nurses working under the Healthy Child Wales Programme. Their role is not limited to vaccinations.

They support physical and emotional health, identify barriers to education, work with families and schools, and contribute to planning where health affects learning.

They are one of the few professionals whose remit explicitly bridges health and education.

School nurse involvement can be particularly valuable when:

  • attendance is affected by health

  • conditions fluctuate or are misunderstood

  • schools focus solely on attendance figures

  • families are being pressured without health being properly considered

Parents do not need school permission to request school nurse involvement.

Suggested parent wording:

“I am requesting input from the school nursing service, as Welsh Government describes school nursing as assessing and monitoring health needs and working with families to promote wellbeing.”

The school nurse is also very useful where a child requires ongoing healthcare support. They can help draw up an Individual Health Care Plan (IHCP/IHP) to support chronic healthcare needs while a child is attending school. This can include continence support, medication, or other day-to-day health requirements.

You can find out more about what an Individual Health Care Plan is, and how it differs from the much better known Individual Development Plan (IDP), here:
https://learnwithoutlimitscic.blogspot.com/2026/01/idp-vs-ihp-in-wales.html

What if an Education Welfare Officer becomes involved?

Education Welfare Officers are not intended to be enforcement-only roles.

Where health is the reason for absence, it is reasonable to expect a support-first approach. Parents are entitled to request that healthcare needs are considered before escalation.

Parents can also request communication in writing and ask for meetings to include health professionals.

Suggested parent wording:

“Our child’s absences relate to healthcare needs. Before any enforcement action is considered, please confirm what support and planning steps have been taken to ensure access to education.”

Penalty notices and enforcement as a last resort

Penalty notices exist, but Welsh Government guidance frames them as one option among several interventions. Decision-makers are expected to have regard to the guidance and follow it unless there is good reason to depart.

This reinforces an important principle: enforcement should not be the first response, particularly where health needs are clearly in play.

Being encouraged to deregister because of attendance

Some families report being advised that deregistration would “solve” attendance problems where a child is too unwell to attend school.

It is important to be clear:

Deregistration is a parental choice.
It should not be presented as a response to health related absence.

Welsh Government guidance is built around access, planning and working together. Families are entitled to expect consideration of:

  • authorised absence

  • healthcare informed planning

  • reasonable adjustments

  • alternative provision where attendance is not currently suitable

Suggested parent wording:

“We are not seeking deregistration. We are asking how education can be accessed appropriately while healthcare needs are managed, in line with Welsh Government guidance.”

When does EOTAS become relevant?

Education Otherwise Than At School (EOTAS) may be appropriate where:

  • a child cannot reasonably attend school due to health

  • attendance pressure worsens their condition

  • school-based adjustments have not resolved access

EOTAS is a lawful education route, not a failure by parents.

If you need more information about EOTAS and whether it might be applicable to your situtation, then part 1 of our 5-part EOTAS series can be found here:- https://learnwithoutlimitscic.blogspot.com/2025/12/eotas-in-wales-part-1.html

What Welsh Government guidance consistently supports

Across attendance guidance, healthcare needs frameworks and school nursing policy, the message is consistent:

  • illness can be an authorised absence

  • attendance must be interpreted in context

  • support should precede enforcement

  • health and education must work together

Parents are not expected to compromise a child’s health to meet attendance targets.

If you are reading this as a parent

If you are exhausted, frightened or feeling pressured, please hear this clearly:

Protecting your child’s health is responsible parenting. It is not neglect.

Coming next

Later this month we will publish a two-part series on Long Covid and education in Wales, building directly on the issues raised here.

Sources and references (Welsh Government unless stated)

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