5.27 Joint Protocol between Health Services & Schools in respect of the management of pupil absence from school when medical reasons are cited
1. Context & Aims
1.1. The aim of this Protocol is to provide advice in respect of the management of pupil absence from school. The Protocol aims to clarify information sharing arrangements between health professionals and schools in Norfolk to promote the health and well-being of school children in relation to the management of sickness absence and to reduce unnecessary attendances at GP surgeries and inappropriate requests for medical information.
1.2. This protocol has been devised in response to the findings of Norfolk Safeguarding Children Partnership Serious Case Review: Case P (2016). A recommendation from the Review was for NSCB to commission the development of a protocol and associated guidance for best practice in managing absences from school reported by parents to be for health-related reasons. Case P is a complex case, but the existence of medical evidence appears to have been a key driver influencing the decision not to proceed with more formal legal action to address the child’s chronic poor school attendance. The Review identified that a considered discussion about the parentally-asserted versus professionally-provided medical evidence to support school absence would have clarified that there was a need to better understand the way in which the child’s family operated and the needs of the child.
1.3. The protocol has been updated following consultation with representatives from the Local Medical Committee (LMC), Named GPs for Safeguarding Children, 5-19 Healthy Child Programme (formerly known as the School Nursing Service), Norfolk Practices Data Protection Officer and Norfolk County Council Medical Needs Service and Attendance Service.
2.1. Nationally, illness is the most common reason provided for pupil absence. In the academic year 2018-2019, illness accounted for 52.6% of all pupil absence and 79.1% of pupil enrolments had missed at least one session due to illness. . There is much research that shows a strong correlation between high attendance and high attainment for all children. Department for Education research indicates that even missing a short amount of time from school can reduce every pupil’s chance of securing the grades they are capable of achieving .
3. Consent & Information Sharing
3.1. Timely and appropriate sharing of information between education and health services is important in meeting the needs of the child when reported illness is impacting on school attendance. This may be more pertinent if the child is in receipt of Free School Meals [FSM], and/or has a special educational need. Pupils eligible for and claiming FSM are at greater risk of non-attendance, with a persistent absence rate of 22.8% compared to non-FSM pupils at 8.3%. For pupils with a SEN statement or education healthcare [EHC] plan, the persistent absence rate in 2018-2019 was 24.6% (compared to 9% for pupils with no identified SEN.
3.2. Confidential information can only be shared with the consent of a person with parental responsibility for that child, or the young person themselves if over 16. Information sharing between health professionals and referring schools will be proportionate and in negotiation with the parent/carer and child.
4. Managing Pupil Absences for Medical Reasons
4.1. At all stages, schools should consider the impact on the child, wider context and case history and follow early help and safeguarding processes as applicable. If school attendance improves, monitoring and appropriate support should continue. All school staff have a key role in early identification, intervention, and support for children. Where there are concerns regarding a pupil’s unsatisfactory attendance, interventions should be implemented by the school at the earliest opportunity to try to improve the situation and to support the child appropriately.
4.2. School attendance Guidance for maintained schools, academies, independent schools and local authorities (July 2019) states that, Schools should advise parents to notify them on the first day the child is unable to attend due to illness. Schools should authorise absences due to illness unless they have genuine cause for concern about the veracity of an illness. If the authenticity of illness is in doubt, schools can request parents to provide medical evidence to support illness. Schools can record the absence as unauthorised if not satisfied of the authenticity of the illness but should advise parents of their intention. Schools are advised not to request medical evidence unnecessarily. Medical evidence can take the form of prescriptions, appointment cards, etc. rather than doctors’ notes.
Schools should not routinely be asking parents/carers to obtain appointment cards for the sole purpose of providing medical evidence for absence. An appointment card does not confirm that a child attended the appointment. When considering medical evidence provided in the form of appointment cards and prescriptions, schools should review the evidence available to consider whether the evidence specifically confirms or makes comment upon a diagnosed condition that would explain the level of absence. Schools should also consider whether pupil absence is indicative of wider concerns and the implications for the child’s health, development, and well-being, thinking beyond the medical issues presented by parents/carers.
4.3. Authorised absence means that the school has either given approval in advance for a pupil of compulsory school age to be away or has accepted an explanation offered afterwards as justification for absence. If schools are unsure how to code absence due to health needs, colleagues can contact the LA attendance service on email@example.com or by telephone at 01603 223681.
In law, the decision whether to authorise absence rests with the Headteacher of a school or a person designated with this responsibility by the Headteacher. In cases where attendance does not improve and no clear medical evidence is available to support a child’s absences from school and parents fail to engage with a school-led Attendance Support Panel and/or fail to give consent for a referral to the 5-19 Healthy Child Programme (formerly School Nursing Service), schools are advised to carefully consider whether to authorise further absences and to instigate the ‘fast-track’ process (Education Fast-track to attendance process).
4.4. Most minor illnesses are self-limiting and do not require contact with a General Practitioner or a medical certificate. Medical certification for short term illness is not appropriate and should not be requested as standard school policy.
4.5. Where a child has an emerging a pattern of non-attendance, and parents/carers are stating that this is due to ill health, schools should discuss the reasons for absence with the child’s parent/carer. If up to date medical evidence (e.g. post-surgery or via a specialist service) is available, then the school does not need to use the Joint Protocol. Where the reasons for such absence are unclear however, and no other health care professionals are involved it is appropriate to seek consent from parents and make a referral to the 5-19 Healthy Child Programme team. This must be done by calling the Just One Number on 0300 300 0123. Referrals can only be made by telephone.
While statutory guidance states that ‘LAs should […] arrange provision as soon as it is clear that an absence will last more than 15 days’, early intervention is preferable and can prevent further disruption to a child’s education. It is recommended therefore, that schools contact the Just One Number (with consent) in the early stages of an attendance issue where health reasons are cited, (and no other health services are involved).
The HCP 5-19 team can help the family access appropriate support and share relevant information with the referrer as required.
For young people (11-19) there is also a confidential text messaging service: Chat Health 07480 635060.
More information is available via the Just One Norfolk website: 5-19 Healthy Child Programme.
School-led Attendance Support Panels are also recommended as an appropriate early intervention strategy.
4.6. Where a pupil has a verified and chronic health condition, the school should provide appropriate support in line with Supporting pupils with medical conditions at school and Norfolk County Council policies via the Medical Needs Service. The school should consider whether an Individual Healthcare Plan is appropriate.
4.7. The guidance and flow chart provided at Appendix 1 are intended to support schools to manage medical reasons for absence effectively.
4.8. In cases where a parent or carer continues to cite medical reasons for absence, schools should ask a person with parental responsibility (or the young person if over 16) to sign a consent form giving the school permission to liaise with the child’s healthcare professional. A consent form is attached in Appendix 2. This request may be made either before or as part of a fast-track attendance process but a call to the Just One Number 0300 123 0300 (see above) should have been made or offered before this action is taken.
When a formal request is made, health professionals can provide factual information to schools, with the parents’/carers’ informed consent. Forms for making these requests have been designed to standardise the medical information requested and received to help the school determine whether non-attendance cases have valid medical reasons to explain persistent absence. Schools should complete the form provided in Appendix 3; health professionals complete the form in Appendix 4.
General Practices may claim following the completion of reports through the collaborative arrangements. This is done via the CCG in the same way as claims for similar work such as medicals for potential foster carers and is monitored by the CCG.
6.1. It is important for schools and health professionals to have a clear and consistent approach in managing medical absences and making and responding to requests for medical information. This document provides a model for schools to manage sickness absence and promote good school attendance.
7. Supporting Guidance:
- Ensuring a good education for children who cannot attend school because of health needs Statutory guidance for local authorities; January 2013
- Just One Norfolk Healthy Child Programme Services 5-19
- Norfolk County Council Medical Needs Service policies and forms
- Public Health England has issued Health protection in schools and other childcare facilities advice on infection control. The guidance provides advice on:
- preventing the spread of infections
- how long to keep children away from school
- infections such as athlete’s foot, flu, German measles, head lice, impetigo, TB
- which diseases to vaccinate for
- School attendance Guidance for maintained schools, academies, independent schools and local authorities (July 2019)
- Supporting pupils with medical conditions at school; December 2015
- Appendix 1 – 2021 Joint Protocol Flow chart for schools
- Appendix 2 – 2021 Joint Protocol Flow chart for health professionals to initiate contact with schools
- Appendix 3 – 2021 Joint Protocol Consent Form
- Appendix 4 – 2021 Joint Protocol School information form
- Appendix 5 – 2021 Joint Protocol Health professional information form
- Downloadable version – 2021 Joint Protocol for managing school absence where health reasons are cited
This Joint Protocol was updated September 2021.
Review date: July 2022