by Joanna Parry, Unison
We recently ran an article about the Government’s consultation about Supporting Children at School with Medical Conditions. In it, we linked to concerns by Unison about who should be performing sometimes complex medical procedures that some children need in school to stay safe. You can read our article here
Yesterday the Government announced it had extended the deadline from May 1st to May 15th. This was because yet again, it had failed to get the Accessible versions — the Easy Read and the BSL— out in time. The credit for this can go, in large part, to our co-director Dr Sharon Smith, in her role for the Down’s Syndrome Association, for reminding the DfE about the equality duties.
Joanna Parry of the union, Unison, which represents thousands of teaching assistants and support staff, has written in more detail about their concerns over the proposals in the medical conditions consultation. If you haven’t yet responded, please read this, and our own article here to give you more information.
Why UNISON is raising concerns about draft Government guidance on medical conditions in schools by Joanna Parry
Every child has a right to an education and should be included as fully as possible in education and school life. Every child also has a right to receive NHS care and treatment that is appropriate to their needs and works across organisational boundaries, as enshrined in the NHS Constitution. Education and Health services must work together to enable these rights.
However, schools are increasingly delivering healthcare via their own staff, who are not health professionals. Across the country, school support staff are managing prescribed medication, administering controlled drugs and in some cases carrying out procedures such as catheterisation, tracheostomy care and enteral feeding.
The NHS is not routinely present in schools. The school steps in because it has to deal with the situation in front of them. The staff member agrees because they care about the child, even if they feel hugely anxious about doing so.
But questions remain:
- Where does “support” end and healthcare begin?
- Who is clinically accountable for decisions made during the school day?
- What happens when a child’s needs change or become more complex?
A grey area in legislation
This is the grey area at the heart of the Department for Education’s draft guidance, and it remains unresolved. It’s intended to strengthen support for children and young people. That aim is widely shared. But the detail raises serious concerns. Instead of clearly setting out how the NHS will meet children’s healthcare needs in schools, the guidance risks creating confusion about responsibility and shifting expectations onto schools.
This is about something fundamental: ensuring that children consistently receive the NHS care they need, while schools are not left to fill gaps in healthcare provision.
One of the most significant issues in the draft guidance is that it does not clearly set out the role of the NHS.
While references are made to “health professionals”, the guidance does not explain how NHS organisations will meet their statutory responsibilities for children’s healthcare in education settings. This distinction is important. Healthcare is not simply a matter of individual professionals providing advice or delegating tasks. It is a system responsibility, rooted in NHS commissioning, clinical oversight and accountability.
Without this clarity, there is a real risk that healthcare is presented as something schools are expected to organise, rather than a service children are entitled to receive.
Delegation of healthcare activities
The draft guidance states that delegated healthcare activities are “outside its scope”.
However, in practice, it still sets expectations that schools will manage and administer prescribed medication, including controlled drugs, and carry out healthcare activities as instructed by health professionals. These are clearly healthcare activities. Framing them as part of “support” provided by schools risks blurring the line between education and healthcare, and creates confusion about who is responsible.
This lack of clarity has real-world consequences for accountability, safety and workforce boundaries.
Individual healthcare plans sit at the centre of this issue. They are described as “non-clinical documents”. Yet they are expected to include detailed medical information, such as diagnoses, medication, treatment regimes, and monitoring requirements. The draft guidance suggests that schools should own, maintain and review these plans, despite their clinical content, with no mechanism for maintaining the integrity of clinical information or ensuring clinical oversight.
Even more responsibility shifted to schools
In practice, this risks shifting responsibility for healthcare onto schools, without clear legal or organisational arrangements to support that shift. It also risks embedding clinical decision-making within education-led processes, without appropriate NHS oversight.
UNISON’s position is straightforward: there must be a clear distinction between what schools are responsible for and what the NHS is responsible for.
The guidance should explicitly set out
- how NHS-commissioned services will meet children’s healthcare needs in schools,
- who is responsible for delivering healthcare and
- how clinical oversight and accountability will be maintained.
Without this, responsibility will continue to drift towards schools by default, rather than being properly resourced and delivered through the NHS. These issues affect whether children receive safe, consistent healthcare.
The implications are serious
If responsibilities are unclear:
- pupils may not receive the care they need and are entitled to
- families are left navigating a fragmented system
- school staff are placed in roles they are not trained or employed to undertake, and
- accountability for clinical decisions becomes blurred
There is also a wider system issue. Evidence increasingly shows that where NHS provision is limited, schools are expected to step in. This is not a sustainable or equitable solution.
Joint non-statutory guidance promised
The Department for Education, Department of Health and Social Care, and NHS England have committed to producing joint non-statutory guidance on how clinical healthcare activity is delivered in schools. Preceding this with statutory guidance before that work is complete risks creating further confusion.
But there is still an opportunity to get this right. Clear, joined-up guidance could reinforce children’s rights to NHS healthcare, provide clarity for schools and staff, and ensure that healthcare is delivered within appropriate clinical governance frameworks.
This should be incorporated into the Government’s proposed SEND reforms, which are worryingly quiet on how the clinical health needs of children and young people should consistently be met in education settings. That said, the SEND proposals are at least jointly badged by the Department for Education and the Department for Health and Social Care. So why isn’t this guidance for schools on supporting children with medical conditions similarly jointly owned?
Schools need clarity and clear boundaries
UNISON is calling for clarity. The final guidance should clearly set out the role of the NHS in meeting children’s healthcare needs in schools, make clear who is responsible for delivering healthcare and ensure that healthcare is provided within NHS-commissioned services, with appropriate clinical oversight.
Every child with a medical condition has a right to appropriate healthcare. Every school staff member has a right to clear boundaries and safe working expectations. And every family deserves confidence that the system is working as it should.
Right now, the lines are needlessly blurred. This guidance is an opportunity to draw them clearly—but that requires political will.
A coalition of unions is calling for a needs-led, NHS-commissioned service for all schools, particularly as policy moves towards more inclusive mainstream education.
As the introduction says, this consultation on the draft guidance is now open until 15th May 2026.
If you are a school staff member, parent or professional working with children and young people, you can help highlight these issues by responding. For more information, contact education@unison.co.uk
The consultation links
A repeat of the consultation links:
- Initial page
- Consultation document
- Draft statutory guidance – Supporting children and young people with medical conditions and allergy
- Equalities Impact Assessment
- Answer the consultation here
- Draft statutory guidance – Easy read version 1.9 MB (PDF document)
- Supporting Children and Young People With Medical Conditions and Allergies – BSL version
- Supporting Pupils with Medical Conditions at School Government Consultation – BSL version
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Also read:
- Beyond EHCPs: Why Inclusion Needs More Than a Document
- The Unacceptable Truth: 20 SEND legal rights at risk from the Government’s SEND reforms
- How health and family support systems are failing children starting school
- WEBINAR RECORDING! The implications for children’s legal rights to EHCPs and EOTAS of the Government’s SEND proposals
- When things go right: Shining a light on SEND Practitioners making a positive impact [Giveaway!]
- From suspicion to support: why the Government’s child protection reforms matter for disabled children
- Have your say on the future of transport for disabled children and young people
- Unison voices major concerns over SEND reform health plans for sick and disabled children out of school in the EOTAS consultation
- Top Tips for the EOTAS & EHCP consultation: Protect your child’s rights to statutory SEND support
- Navigating constraints: Why a former PCF chair thinks the current model is missing the mark for families
- Dear Secretary of State for Education, Lucy Powell: an Open Letter from Special Needs Jungle and SEND legal charity SOS!SEN
- Research: Disabled young people define inclusive education as “learning in the place that’s right for them”
Key Content
- Unison voices major concerns over SEND reform health plans for sick and disabled children out of school in the EOTAS consultation
- Allergy Guidance issued—but wider medical conditions guidance back for more work
- Philippa Stobbs OBE: Reform plans must have a clear line of sight from children and young people with SEND to better outcomes.
- ARFID: Avoidant/Restrictive Food Intake Disorder is much more than just “fussy eating”
- Draft medical conditions guidance raises “serious concerns” says union, over shift in clinical responsibilities to schools
- DfE backtracks over consulting on planned SEND legal changes. Parents MUST respond to the consultation to say Not in Our Name!
- Consultation: Supporting pupils with medical conditions at school. What’s new, what’s missing and what you need to know
- Leaking poorly thought-through plans and cuts to SEND rights will only end in tiers
- “We are living on a knife-edge” SENDCo research sounds the alarm about the high cost of mainstream inclusion
- Why the Government’s “SEND conversation” fell flat with parents: It’s failing to learn from voices of past experience
- Down Syndrome Act Guidance Consultation: Why you should care (even if you don’t have Down’s syndrome)
- Living with PoTS: Understanding Postural Orthostatic Tachycardia syndrome and how schools can help
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She is a rare disease & chronic pain patient advocate with Ehlers Danlos syndrome.
- The Unacceptable Truth: 20 SEND legal rights at risk from the Government’s SEND reforms - September 9, 2026
- Dear Secretary of State for Education, Lucy Powell: an Open Letter from Special Needs Jungle and SEND legal charity SOS!SEN - August 4, 2026
- Research: Disabled young people define inclusive education as “learning in the place that’s right for them” - July 30, 2026
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