
Children and young people who are experiencing challenges surrounding their health and wellbeing continue to have the same educational rights given to all children and young people to ‘adequate and efficient’ educational provision that is ‘directed towards the development of the personality, talents and mental and physical abilities of the child or young person to their fullest potential’ (The Education (Scotland) Act 1980; Standards in Scotland’s Schools Act 2000; and The Education (Scotland) Act 2016).
Full access to educational entitlements
Receiving full access to educational entitlements, including healthcare in school and additional support for learning if needed, enhances the ability of children and young people to benefit from their education and to improve their educational attainment. It assists children and young people to fulfil their potential, gain qualifications, and therefore improve their future life prospects. It also allows children and young people to learn and socialise with friends in schools, or to maintain contact through other support streams whilst in hospital, or other educational establishments, separate from their friends. This can reduce isolation and offer normality in what may be a stressful or traumatic time; and therefore, have a positive impact on their mental health and wellbeing. Participation in the holistic and individually focussed approaches of Scotland’s Curriculum for Excellence enhances children and young people’s resilience and capacity to self-manage their lives, including aspects surrounding their health.
Holistic and knowledgeable approaches
Holistic and knowledgeable approaches are particularly important, since many children and young people may experience both physical and mental health conditions, with one sometimes impacting upon the other. It is not uncommon, for instance, for children and young people who have had extended absence because of poor physical health, or who have experienced traumatic illnesses or injuries, to present with symptoms of anxiety and depression. They may experience difficulty attending school regularly, or at all. Some may become recognised as ‘school refusers’ or ‘poor attenders”. They may underachieve significantly in their educational outcomes, fall behind or as a last resort, drop out of education. A further issue is that disabled children with additional support needs have a higher risk of poor physical and mental health; this risk further increases for children and young people with complex disabilities.
A multidisciplinary approach
Findings from families, and health and education professionals recommend a multidisciplinary approach between families and health and education professionals to ensure that children and young people receive the necessary support required; this is highly important when waiting for assessment and diagnoses. During this time, the impact of health on education is often underestimated, and limited knowledge on the family’s situation may result in miscommunication and often unnecessary strain on already struggling families. The child, therefore, may not be receiving educational provision that equates with their statutory rights, in terms of quantity or quality, despite legislation and guidance defining and raising the awareness of their rights.
Some children and young people may experience periods in which they receive no education, whilst others have had to be withdrawn by their parents or carers because appropriate healthcare had not been made available in their educational establishment. This is illustrated in an Additional Support Needs Tribunal (Scotland) case, in which a young child with Type 1 diabetes was reported by his mother as not being adequately supported in the administration of insulin in school, after the teacher refused to continue the administration. The correct and timeous administration of insulin was necessary not only for his health and safety but also for his education and socialisation with his friends. The child was unable to attend school from December 2012 – March 2013. The Tribunal said that the Council had unlawfully discriminated for the period of the child’s absence from school.
Key barriers to children and young people with health conditions accessing their full educational rights
- The COVID-19 pandemic has caused enormous educational disruption to children and young people across Scotland. We know that during the pandemic education was not equally accessible, with digital exclusion and exam cancellation, which disproportionately affected groups of children and young people. The pandemic also led to a significant reduction in hospital services, where some children and young people may receive their education; this means that at an extreme view, their rights may have been compromised. Reports by the Scottish Parliament show that the demand for specialist services will increase as the longer-term impacts of the pandemic emerge, and is likely to remain a prominent issue in Scotland for the foreseeable future.
- Research emerging regarding the Cost-of-Living Crisis show that families with higher energy needs, such as larger families, or households where someone is disabled or has a long-term health condition are being severely impacted. It cannot be disputed the damage this crisis will have on children and young people’s physical and mental health, and the damage this consequently will have on their education in both the short-term and long-term. It is well known that children and families living in poverty suffer greater health and social inequalities, as well as larger negative impacts on educational outcomes and attainment. In the recent Tackling Health Inequalities in Scotland Report 2022 it states that “about 75,000 children went without food on a day during the past year.”
- The above report, further highlights the difficulty in lack of accessible nursery and childcare for those caring for disabled children, arguing that this has effectively excluded the families from accessing free childcare provision provided by the Scottish Government.
- The legislation and guidance cited are lengthy and complex documents. While Enquire produces succinct and lucid summaries of these documents, a full understanding of children and young people’s rights can only be grasped from perusal of the documents themselves, which takes a considerable amount of time and resource.
- It is of our opinion and expertise, and from speaking with the families that we work with, that some Education Authority Officers, and school staff (whether of local authority or independent) appear to have insufficient awareness of the educational rights of their pupils with health conditions, of the laws underpinning those rights, of Scottish Government guidance, or of their own responsibility to deliver and facilitate individually appropriate educational provision and healthcare in, or out, of school. An example of this is The European Association for Children in Hospital (EACH Charter) with Article 7 stating ‘Children shall have full opportunity for play, recreation and education suited to their age and condition and shall be in an environment designed, furnished, staffed and equipped to meet their needs.’
- This insufficiency extends to many parents, carers, children, and young people themselves, who may not know what to ask of the Education Authority and school. Equally, other families with greater awareness may, understandably, be too preoccupied with their children and young people’s health and wellbeing to enter a lengthy struggle for their educational rights.
- The concepts of ‘ill health’, ‘long-term’, or ‘chronic conditions’ are rarely mentioned in important educational documentation; with many documents in desperate need of an inclusive update to correlate guidance for the current crisis. The Supporting Children’s Learning: Draft Code of Practice (3rd Edition) 2017, Technical Guidance to Schools in Scotland 2014 (in relation to the Equality Act 2010), and Initial Teacher Education Content Analysis (2017), make little reference to additional support needs and/ or disability. The Initial Teacher Education document highlights that during some PGDE Secondary Programmes, some spent as little as 13 contact hours dedicating teaching time to health and wellbeing. With the endless Scottish Government documentation promoting the improvement of children’s health and wellbeing, it is disappointing, but not surprising, that education teams have insufficient knowledge surrounding children’s educational rights. This lack of connection can lead to the impression that mental or physical health conditions and healthcare needs are primarily matters for families and medical professionals and have little to do with schools and their staff. This in turn can lead to some children and young people with very significant challenges to their health and wellbeing failing to access the rights in education to which they are fully entitled under the criteria used to identify children and young people who have Additional Support Needs or are Disabled.
- Significant disparities also exist between the various Education Authorities and their linking Health Boards in the educational provision and arrangements made and, in the services, offered to children and young people with health conditions. These disparities are evident both when children and young people are in school and when they are absent for a prolonged period, or frequently for shorter periods, due to ill health. Within each Education Authority the approaches taken by individual schools may vary, and further disparities exist in the attitudes and practices of the spectrum of staff working within individual schools. Children and young people with health issues are effectively subject to a postcode lottery, with some faring very well indeed and too many others being ill-served and deprived of their rights.
- Thus, with evidence of some children and young people’s educational rights being neglected and the national picture showing such disparities across Education Authorities and schools, it appears that there has been insufficient focus on children and young people with health-related issues by Authorities’ Quality Improvement Officers and by His Majesty’s Inspectorate.
- The need for additional and joint training for both education and health staff is evident, at initial professional education and in-service levels, although pressures, both on time for further training and on programme content, are already overwhelming.
- There is evidence nationally of falling numbers of qualified learning support, specialist teachers and of classroom and school assistants. These staff may work with primary class teachers and secondary subject teachers in supporting pupils with additional support needs of all kinds, including those that are health-related and who may require healthcare in school and/or support for their learning. The increasing numbers of reported pupils with additional support needs appear to reflect an increase in numbers but they may also reflect the pressure on school resources, both human and material, in the current economic climate. The benefit of an increase here, may reflect the deeper societal understanding we have gained in the last decade of additional support needs.
Summary statistics
Summary Statistics for Schools in Scotland 2020 and 2021 and statistics noted in the Report of the May 2017 meeting of the Scottish Parliament’s Education and Skills Committee and include:
Numbers of Pupils with Additional Support Needs in Scottish Schools | 2010 | 69,587 (10.3%) |
2016 | 170,329 (24.9%) | |
2017 | 183,491 (26.6%) | |
2020 | 226,838 (32.3%) | |
2021 | 232,753 (33%) | |
Numbers of Additional Support for Learning Teachers | 2010 | 3,518 |
2016 | 2,990 | |
2017 | 2,838 |