Learning Disability Today
Supporting professionals working in learning disability and autism services

Quality of medical care in special schools needs addressing in new SEND review

The standard of medical provision in special schools needs to be urgently addressed in the forthcoming SEND review, according to the Medicine in Specialist Schools Group.

It comes as special schools face a “postcode lottery” in the commissioning and delivery of services that provide medical and health care because they are entirely delegated to local authorities and their partner clinical commissioning groups.

The report in the TES looked at the national inconsistency in healthcare commissioning and found that children are at risk of harm as neither Ofsted nor the Care Quality Commission is tasked to review health and medical services when they are provided in these special schools.

Annual nursing needs assessments should be mandatory in specialist education settings

The Medicine in Specialist Schools (MiSS) was formed in 2019 to “give a voice to school leaders in specialist provision, who want to ensure that their pupils receive high-quality health and medical support while they are in school”.

It has six clear asks from the SEND review:

  • A NHS commissioning framework is required for children and young people with additional and complex health needs and disabilities when they are attending specialist education settings because of the cumulative clinical risk that is being managed there.
  • Annual nursing needs assessments should be mandatory in specialist education settings to inform commissioning and workforce planning by both NHS Trusts and schools.
  • Clarification of the legal status of clinical nursing care in specialist education settings is needed when it is outside the framework of NHS commissioning and funded directly from the school’s budget.
  • Delegation of clinical tasks by healthcare professionals to “support workers” in schools should require LAs to provide a robust delegation framework in line with forthcoming NICE guidelines.
  • Training provided to special school staff to carry out these “delegated clinical tasks” must fit with the Nursing and Midwifery Council’s professional standards and establish consistent expectations for this care across the country.
  • Ofsted and the Care Quality Commission (CQC) should explore how delivery of clinical nursing and paediatric therapy services in specialist education settings could be incorporated into the joint local area SEND inspection framework, so that commissioners of services and professionals working with the most vulnerable children can be held to account for the quality of care provided in these schools and settings.

Dominic Wall, a headteacher in Bradford and co-ordinator of the Medicine in Specialist Schools regional leaders network, told the TES that there is much that needs to be solved in the SEND review including mainstream failure and exclusion, long waits for EHCP assessment, the postcode lottery funding problem, and lack of specialist school places.

He added; “Meanwhile, with regards to ensuring that the health needs of our most vulnerable children are met, there is also much that must change.

Currently, the CQC has a duty in law to inspect health services when they are provided in residential special schools, but when those services are offered to children with the same needs in neighbouring day special schools, they do not have a remit.



Ahead of the publication of the SEND review, we want to understand what your priorities are in this area. If you work in, or adjacent to, SEND please complete this short survey, which will help us to understand the challenges of the sector. 

The results of this survey may also be used for a piece of thought-leadership on the topic. Everyone taking part in the survey will receive a copy of the findings report and be entered into a prize draw to win a £50 Amazon gift voucher.


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