Managing Pupils Healthcare Needs

The managing pupils healthcare needs policy is a statutory policy for schools to support pupils with healthcare needs and ensure minimal disruption to their education.

A model policy has been developed by Denbighshire Education and Children’s Services with schools and partners which school governing bodies can adopt, or they must produce their own in line with Welsh Government Statutory Guidance.

View the model Managing Pupils Healthcare Needs policy

Case Studies

Below are some examples of how the managing healthcare needs policy has been used to support some pupils. Click on pupil A, B or C to find out more.

Pupil A

Pupil A is aged 10 in a local mainstream primary school. He has recently been diagnosed as having type 1 diabetes and requires monitoring of his blood sugar levels at regular intervals during the school day. The specialist nurse for diabetes has been involved in his care and in conjunction with his family has produced a medical healthcare plan.

His diabetes is not yet under control and is affected by a variety of factors such as diet and exercise. Therefore this pupil will require a school-based health plan in order to capture his additional needs and support him across the day.

Pupil B

Pupil B is aged 9 and has a history of well-controlled asthma. She has been prescribed a reliever inhaler and the parent/carer have completed appendix (consent form) for school to supervise pupil B’s use of the inhaler as required. The school used appendix 3 and gave consideration to the impact of the condition in the school environment and determined that a plan was not needed at this time. (Note the kept a written record that this was done). However, the school were aware that this may alter and have a review procedure in place to monitor her healthcare needs and their impact on her school day.

Pupil C

Pupil C is in secondary school. He has mild cerebal palsy for which he uses a rolator around the school building and has a wheelchair for longer trips outside of school. He requires no medication at home or during the school day and has little involvement from health professionals other than his physio appointments and annual checks. He has no medical healthcare plan. His mobility issues do however have an impact on his school day and need to be formally recognised within a school-based individual healthcare plan so that his safety can be ensured travelling around the school and that all contact staff are aware of his additional needs.

More information 

Click on a heading below to find out more information 

Pain killers

Following extensive consultation with legal and health colleagues we have made the following conclusion that schools should not hold their own supply of paracetamol (or any pain killer) to administer to pupils

This decision is based on the fact that the risks to the safety of the child and the school staff far outweigh the benefits. The main points are listed below:

Any member of school staff taking on the responsibility to administer the school supply of paracetamol would be making clinical decisions with regard to the medical need of the child.  They will be having to correctly diagnose, prescribe and administer the correct dose of paracetamol to the child (the dose of paracetamol needs to be changed for low weight children – this would mean that the staff would have to determine whether the child is low weight).

  • Any member of staff administering the school supply of paracetamol would have to determine that it is safe for the child to do so: Is the medical status that the school holds about the child still accurate?  What other medication is the child taking?  When was the child’s last dose of paracetamol?  How many paracetamol have been taken in the last 24 hours / what other pain killers have been taken in the last 24 hours?  Has the child consumed any alcohol (or other legal/illegal substances in the last 24 hours)?
  • By administering a pain killer to a pupil, schools are potentially masking the signs and symptoms of another underlying medical illness in a child.
  • The school is placing themselves at risk especially if a child / parent is not truthful in the information that they provide about the child (i.e. consumption of other drugs or alcohol, medical condition etc).
  • We have been given reports of Denbighshire pupils stockpiling on pain killers in school with the intent of self-harm.  For example taking paracetamol from school staff and friends.

Alternative procedures could be:  a) unwell children to go home;  b) parents to bring painkiller to school and administer to their child.

For the purpose of this policy, what is the definition of health?

Many learners will have a short-term healthcare need at some point. With appropriate support they should be able to regularly attend and take part in most activities. However, some learners may have significant or long-term healthcare needs affecting their cognitive or physical abilities, their behaviour or their emotional state, which may require additional support.

For more information, see page 4, paragraph 3 of Supporting learners with healthcare needs

Which staff should read and understand the policy?

All staff. We recommend that you include this as part of your induction for all new staff and supply staff.

See policy, section 11.

What is the role of the teachers and support staff in managing healthcare needs of pupils?

Any staff member within the education setting may be asked to provide support to pupils with healthcare needs, including assisting or supervising the administration of medicines. This role is entirely voluntary.

The education setting should ensure staff:

  • Fully understand the education setting’s healthcare needs policies and arrangements.
  • Are aware of which pupils have more serious or chronic healthcare needs, and, where appropriate, are familiar with these learners’ IHPs. This includes knowing how to communicate with parents and what the triggers for contacting them are, such as when the pupil is unwell, refuses to take medication or refuses certain activities because of their healthcare needs.
  • Are aware of the signs, symptoms and triggers of common life-threatening medical conditions and know what to do in an emergency. This includes knowing who the first aiders are and seeking their assistance if a medical emergency takes place.
  • Fully understand the education setting’s emergency procedures and be prepared to act in an emergency.
  • Ask and listen to the views of pupils and their parents/carers, which should be taken into consideration when putting support in place.
  • Ensure pupils (or their friends) know who to tell if they feel ill, need support or changes to support.
  • Listen to concerns of pupils if they feel ill at any point and consider the need fo medical assistance (especially in the case of reported breathing difficulties).
  • Make sure pupils with healthcare needs are not excluded from activities they wish to take part in without a clear evidence-based reason, including any external trips/visits. This includes ensuring pupils have access to their medication and that an appropriately trained member of staff is present to assist where required.
  • Are aware of bullying issues and emotional well-being regarding pupils with healthcare needs, and are prepared to intervene in line with the education setting’s policy.
  • Are aware that healthcare needs can impact on a pupil’s ability to learn and provide extra help when needed.
  • Support pupils who have been absent and assist them with catching up on missed work ‒ this may involve working with parents and specialist services.
  • Keep parents informed of how the healthcare need is affecting the pupils in the education setting. This may include reporting any deterioration, concerns or changes to pupil or staff routines.
What is the role of the pupil and parent/carer in managing their healthcare needs?

It is vital that pupils and parents/carers are actively involved in the planning of support and management of healthcare needs. They should:

  • Receive updates regarding healthcare issues/changes that occur within the education setting;
  • Be involved in the creation, development and review of an IHP (if any). The parent/carer and pupil may be best placed to provide information about how their healthcare needs affect them. They should be fully involved in discussions about how the pupil’s healthcare needs will be met in the education setting, and contribute to the development of, and compliance with, their IHP;
  • Provide the education setting with sufficient and up-to-date information about healthcare needs, including any guidance regarding the administration of medicines and/or treatment from healthcare professionals. Where appropriate, pupils should be encouraged and enabled to manage their own healthcare needs;
  • Inform the education setting of any changes such as type of medication, dosage or method of administration;
  • Provide relevant in-date medicines, correctly labelled, with written dosage and administration instructions;
  • Ensure a nominated adult is contactable at all times and all necessary forms are completed and signed;
  • Inform the education setting if their child has/had an infectious disease or condition while in attendance.

See policy, 2.1.2 

What are the differences between a school-based individual healthcare plan (IHP) and a medical healthcare plan from a health professional?

School based Individual Healthcare Plan (IHP):

This plan is instigated by the school when it is identified that a pupil has a healthcare need (appendix 3 of the policy). This is a plan for the care of the individual pupil whilst in school and may include input from a health professional and a medical healthcare plan.

Medical Healthcare Plan:

This is a healthcare plan provided by a health professional.

See point 1.1.4.

Do we have to have a school-based individual healthcare plan (IHP) for every medical condition, even if they have a medical healthcare plan from a health professional?

As long as all aspects of your school policy (including appendix 3) have been carefully considered and the medical healthcare plan from the health professional covers the needs of the pupil concerned in the school environment, then you may not require the school based IHP.

Good practice suggests that you should record that you have reviewed your policy requirements for this pupil and accepted the medical healthcare plan to keep the pupil safe in school at that moment in time.

Please note that all healthcare plans whether medical or school based are subject to regular review, as agreed and noted in the pupil’s plan.

If you have any questions in relation to the pupil’s healthcare needs, please contact the appropriate health professional.

See point 1.1.4. 

Examples of medical conditions that might require an individual healthcare plan (IHP) or medical healthcare plan.

There is no definitive answer to this question. The healthcare needs of every pupil should be addressed on a case by case basis giving consideration to the impact of their condition in the school environment. There will be some children who have a healthcare need that can be managed without a plan.

Please see answer to question 5.

Can we use asthma individual healthcare plans or protocols based on templates provided by Asthma UK?

Yes. You will need to check with your school / specialist nurse that the plan is current and that it is the most up to date version.

Note: this can also apply to other medical conditions.

See policy, point 4.4.7.

What training is needed for school staff including those who have specific responsibility for administering medications? How are costs met?

All staff (including temporary and supply) must be made aware of your Managing Healthcare Needs Policy, common conditions in the school (to ensure recognition of symptoms and understand where to seek appropriate assistance) and staff roles in carrying out healthcare arrangements.  For example this could be part of staff induction, staff meeting, staff handbook.  

The governing body should ensure that staff that volunteer or that are contracted to manage healthcare needs of pupils have access to the appropriate training and guidance. 

Schools should always ensure that the appropriate training is given to all contact staff to meet the healthcare needs of the pupils in their care.  This can be discussed with the relevant health professional.

Training can be provided by health professionals OR if the governing body decide to engage alternative providers, the cost must be met by the school budget.

Schools should be aware of their health and safety requirements in terms of trained first aid staff and ratios. The Health and Safety Department can be contacted on: 01824 712502 or email:

Who is responsible for training?

The governing body and headteacher are responsible for ensuring that the appropriate training is provided for all staff to meet the healthcare needs of the pupils. This will be addressed in consultation with the appropriate health professional.

See point 1.2.5 and see section 11.

What training and support is available from health professionals; and can training be delivered by cluster?

We are currently working with health professionals to provide training in a time efficient manner. In the meantime each school can contact their school nurse and has been provided with contact details for the specialist nursing team.

How should medication be transported and handed over to school?

Schools will discuss with parents/carers how the medication will be transported to school and this will be reflected in the consent form (appendix 2).

See policy, point 13.2.2 and appendix 2.

What do we do if a child has a healthcare need and attends a childcare provider before or after school?

This should be addressed on a case by case basis and will depend on the nature of the childcare provider. It should be agreed with the parent/carer and outlined in appendix 2 or 3. It should be noted that any childcare provider should have their own healthcare arrangements in place for the pupil.

The school should have a robust handover procedure and document this in appendix 2 or 3 as appropriate.

How do CSSIW requirements tie in with the managing healthcare needs policy?

The model managing healthcare needs policy applies to maintained nursery, primary, secondary and special schools, and pupil referral units (PRUs). Advice for non-maintained settings should be sought from CSSIW directly.

Can we share the school-based individual healthcare plan (IHP), the medical healthcare plan or record of medication with other healthcare professionals?

Yes you can as long as parent/carer consent has been obtained e.g. via appendix 2 or 3. However, in the case of the medical healthcare plan separate written consent would be required from the parent/carer.

What if we are not clear about the medication that has been administered to a child before school?

No medication should be administered to a pupil without prior written consent from a parent/carer through the completion of appendix 2.

If in doubt, you must never administer the medication, unless it is following an agreed emergency procedure.

Do we have an intimate care policy?

The local authority are currently developing a model policy to recommend to schools.

A child has returned to school mid-morning form the doctors with prescribed medication. All consent forms have been completed in school. Is the school at risk when administering the first dose?

Yes. Caution should be observed. We recommend as a rule that the first dose should be administered at home; except in the case of prescribed emergency medication (e.g. asthma inhaler).

Emergency salbutamol inhalers in schools

View guidance on the use of emergency salbutamol inhalers in schools in Wales.

Emergency adrenaline auto-injectors in schools

View guidance on the use of emergency adrenaline auto-injectors in schools in Wales.

Choose Pharmacy – Common Ailments Service

The ‘Choose Pharmacy – Common Ailments Service’ is being implemented by some Pharmacies in Conwy and Denbighshire. The scheme allows pharmacists to issue treatment to patients for a list of minor ailments . In some cases the treatment will be a Medication. This medication will be labelled in the same way as it would be if it had been prescribed by a GP or a Nurse Practitioner. 

If a parent/carer has taken up this process and a pupil requires treatment/a dose in school, if appropriate, schools can choose to accept such request, but must follow the procedures as set out in the managing healthcare needs policy and complete the relevant paperwork as per all prescribed medication (e.g. appendix 2 for consent and appendix 5 for recording administration).

On some occasions, a GP, Nurse Practitioner or Pharmacist will suggest that patients purchase over the counter medication (as this is cheaper than prescribing). For example: hayfever eye drops. Again, if appropriate schools can choose to accept such request, but must follow the procedures as set out above.

Find out more about the Choose Pharmacy – Common Ailments Service