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Schools (Health Support) Bill

Volume 492: debated on Friday 8 May 2009

Second Reading

I beg to move, That the Bill be now read a Second time.

It has been a pleasure to witness the Bill that was considered before mine and deals with energy, energy supply and the environment receive a Second Reading. However, that is not my brief today.

I have had fruitful discussions with the Under-Secretary about this Bill and I have received reassurances, which I hope she will reiterate today. I pay tribute to the hon. Member for Basingstoke (Mrs. Miller), the Opposition spokesman, with whom I had discussions. I was treated very courteously and, with some reservations, she is sympathetic to the measure.

Nobody should interpret the Bill as an attack on education policies, teachers, head teachers and the staff who assist teachers or the medical profession. It should be seen as a way of tackling some of the concerns and problems that some children experience at school. I recognise from what the Under-Secretary has told me that much progress has been made, and I do not want to detract from that. Indeed, I am probably the last person who would want to do that.

Nevertheless, it is worth highlighting some of the problems that some children experience. I appreciate that the subject is broad, especially when we consider some of the illnesses and disabilities that many children experience. I have had quite a bit of co-operation from the Liberal Democrats. The other day, I attended a meeting of the all-party group on diabetes. Many parents were at that meeting. I listened not only to them, but to the children, and I heard about the problems that they were experiencing as a result of illnesses and disability, and equally about the concerns of the parents, who sometimes clash with the authorities over what their priorities are. For example, the education authority could have a totally different priority from, say, the health authority. There are certain elements in my Bill that would bring such authorities together.

The Prime Minister has had some difficulties this week, but he agreed at very short notice to meet one or two parents and some of the children. That is a side of the Prime Minister that the public do not often see. I am sure that the parents and the children appreciated the fact that he was taking an interest. In fact, if the House wants to know, he said to me, “Even Obama’s interested in this health area.”

Nevertheless, we need to get on. I am grateful for the opportunity to bring the issue of health support in schools before the House. I hope that the Bill will provide the impetus for those in all parts of the House to realise the importance of decent support for all children with long-term health conditions in schools. I hope that the Bill will enable the House to do something about that. My Bill would amend the Education and Inspections Act 2006, establish standards in schools for the support of children with specified health conditions and make provision for the inspection of such support. The 2006 Act places a duty on schools to promote pupil well-being. However, as it does not explicitly refer to the support of children with health conditions, their needs are not being met in many schools. Local authorities, primary care trusts and schools must work in partnership to ensure that all children receive the appropriate support that they need to live a full school life.

Let me pay tribute at the outset to the many organisations that support the Bill—in fact, some of them are represented in the Gallery. Their expertise has been crucial in bringing the Bill to the House. I am going to read their names out, because the public and the House do not always see the tremendous effort or the hours that they put in, sometimes voluntarily, in this case for the welfare of our school children. Those organisations include the Anaphylaxis Campaign, Asthma UK, the British Heart Foundation, the Children and Young People HIV Network, CLIC Sargent, Coeliac UK, the Cystic Fibrosis Trust, Diabetes UK, Epilepsy Action, Input, Juvenile Diabetes Research Foundation International, the National Centre for Young People with Epilepsy, National Voices, the Royal College of Nursing, TreeHouse, Scope, Sickle Cell and Young Stroke Survivors, the Stroke Association, the UK Children with Diabetes Advocacy Group, Vision 2020 UK and YoungMinds. In addition, I would like to express my appreciation for the hard work that my staff have done on the Bill, along with the organisations that I have named. They have shown tireless dedication to the cause and I appreciate their help.

I recently met a young constituent who was at Westminster as part of a lobby of Parliament by a leading health charity, Diabetes UK, on behalf of children. That lively young man enjoys, for the most part, a successful and fulfilling life at school, despite the challenge that type 1 diabetes poses. My constituent’s condition is well matched by a caring and well-informed family, excellent support from a local GP and outstanding care from the diabetes unit at the local hospital in Coventry. I do not doubt that the House is unanimous in its admiration for the thousands of medical professionals and families, such as those I have referred to, who support children with long-term health conditions across the UK.

That determined young man does not allow his condition to obstruct his education. My constituent and his family face the test of ensuring that the consistency with which they and their medical team treat his condition is matched by his school’s aspiration to ensure, in a holistic sense, that his educational well-being is guaranteed. In expressing that concern, I intend no criticism of my constituent’s school, as I think I have made clear. Chief among the school’s aspirations is excellence in primary education, and I hope that the House will join me in commending it and its peers for their unswerving desire to achieve that standard, which it reaches and surpasses.

I want to underline, however, that while many schools do provide excellent medical support for children with long-term conditions, that standard is not universally upheld. There is every reason to change that. I believe that the Government are genuine in their use of the maxim Every Child Matters. In an age when many strive for universal equality, it is crucial that Members of this House, and particularly of the Government, ensure that the desire for inclusion places children and young people at the forefront. My Front-Bench colleagues have sought to improve educational attainment and the quality of school life, and they have achieved much in doing so. The Schools (Health Support) Bill is aimed at promoting the universal equality that the whole House strives for, and offers practical steps to allow us to prove that every child matters.

My constituent’s struggle to obtain adequate health support is not unique. An estimated 20,000 children under 15 in the UK have type 1 diabetes, 83 per cent. of whom do not have good blood glucose control. In fact, the UK has the lowest number of children attaining good diabetes control in Europe. The struggle is not unique to children with diabetes. Across the UK, more that 1 million children go to school every day while braving the trials of a long-term medical condition. On average, two children in every classroom have asthma, and 57 per cent. of those children and their carers lack the confidence that someone would know what to do if they suffered an attack. A further 12,500 people suffer from sickle cell disease in the UK, yet only two out of the 107 local education authorities surveyed by the Economic and Social Research Council had written policies on the sickle cell disease in schools.

One in 10 children and young people between the ages of five and 16 have diagnosable mental health disorders. Children and young people with a disorder such as attention deficit hyperactivity disorder—ADHD—or a conduct disorder are more likely to be excluded from school. Exclusion in this context refers not only to physical exclusion but to social exclusion, because poorly managed mental health problems, as with any others, mark children out as different from their peers. In common with children with physical illnesses, many have problems accessing medication on school premises. Children who suffer from sickle cell disease also have an increased risk of experiencing a stroke, potentially at school.

These examples cover just a few conditions, but the problem of finding decent medical support in schools is endemic, and there is a raft of other long-term and chronic illnesses from which children and young people suffer. Decent school health support allays carers’ fears about the adequacy of support in the event of an emergency. It also allows children to participate fully in school life, meaning that they do not have to be excluded from activities that their peers take for granted, such as sport or school trips. Decent health support is vital if children are to reach their full potential. Without it, conditions such as diabetes can have an impact on a child’s cognitive functions and ability to learn. Decent health support means that inclusion need not be an illusion. For the cost of providing health support training to schools that do not have a policy in place, the benefit is multiplied many times over.

Let us imagine a child who needs to inject insulin up to four times a day, whose school does not have a health support policy in place. If they are unable to inject themselves, someone—a parent or guardian, perhaps—might have to make the journey to school at least once a day.

The hon. Gentleman is making a good case for his Bill and I agree with him about the problems that he alludes to. I recently went out with school nurses who were training teachers in how to administer adrenaline for a particular child who had various allergies and might suffer anaphylactic shock. This is an eminently sensible way of ensuring that teachers are on hand and trained in what to do in case of emergencies. I am told that because of the shortage and diminishing number of school nurses, they are no longer available in many schools to provide that sort of advice, which makes it difficult for certain children to go to those schools if they cannot be sure of receiving the necessary emergency treatment. Is the hon. Gentleman as concerned as I am about the shortage of school nurses?

I believe we are all concerned about what the hon. Gentleman has outlined, but that is one of the reasons why health authorities and local authorities must, as I said earlier, sit down together to develop joint priorities. The other day I met a lady who had similar problems, and it was clear to me that the local authority viewed its priorities in one way while the health authority viewed them in quite another. As long as that continues, there will be problems; this is one issue that my Bill is designed to address—or to get the Government to address. While that division continues, we will never get a proper set of priorities for treating these illnesses. At the end of the day, as I am sure the hon. Gentleman knows, resources come into play here.

I warmly congratulate the hon. Gentleman on securing this Second Reading debate. I join him in paying tribute to charity organisations in his and my constituencies and throughout the country.

I would like to raise an issue touched on by my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton). I was recently dealing with a constituency issue relating to problems with the provision of Epipens for treating children allergic to nuts, for example, for anaphylactic shock. The key issues there were about resources and consistency of practice across the entire local education authority. Inevitably, there were resource implications. I am worried that in dealing with a whole load of illnesses and long-term conditions, the resource implications are going to be very significant. Does the hon. Gentleman have any definitive data on how many children and local education authorities are involved and what level of resources we are talking about?

I agree with the hon. Gentleman in general terms, but I shall come on to deal with the point later in my speech.

The parent or carer responsible for injecting the child may not be in employment and this responsibility can create a knock-on effect of financial burden to the whole family and beyond. Furthermore, children who are not supported in the management of their health condition are more likely to suffer from complications that can threaten their lives and place an increased burden on NHS services in primary and secondary care.

Health support in schools should be an integral part of medical support for young people. That is not to say that schools should be required to give comprehensive medical support rather than merely to augment the work done by medics and carers. The Royal College of Nursing advocates the use of school nursing in providing health support. It is simply not possible for a school nurse to be present for the event of any medical emergency or a health incident that might require any degree of support. School nurses have a vital part to play in health support, however, as they provide expertise that teachers cannot be expected to have. Conversely, in terms of health support, it is crucial that they are able to expand their mandate of health education to provide teachers with advice on how to handle situations that long-term conditions can give rise to.

The key element in the provision of health support is ensuring that teachers are able to teach while being aware of the health support that is a critical part of some of their pupils’ education. The current voluntary guidance is not working and implementation is patchy: while some schools provide fantastic support, others are failing their most vulnerable students. An explicit requirement is needed, backed up by effective regulation from Ofsted, to ensure that all schools meet the needs of all children with long-term conditions.

In closing, I hope that my Front-Bench colleagues will be able to offer some hope on school support to the charities and campaigners who have worked so tirelessly for this cause. I believe in my Bill. Finally, in response to the hon. Member for Peterborough (Mr. Jackson), I point out that there are roughly about 1 million children who, one way or the other, have a difficult medical condition.

I hope that the hon. Gentleman will forgive me for referring to the situation in my constituency, but linked to the specific issue of resources is that of children whose first language is not English. I have three schools where more than 95 per cent. of children do not have English as their first language. The resource implications for and the pressures on those schools are significant and they have not received recompense through ethnic minority achievement grant. In these straitened, less than benign economic times, how does he see the problem of children whose first language is not English? For instance, they may also have diabetes, which is prevalent in my constituency too.

I thank the hon. Gentleman for his intervention. To a certain extent, I sympathise with what he says. I am thinking about the parent tongues of those who go to a particular school in my constituency. They speak about 27 different languages and the school does a magnificent job. To take a step forward in dealing with the problem he outlined, we must start with, on the one hand, the Department of Health and the health authorities and, on the other, the Department for Children, Schools and Families and the education authorities, to see what their priorities are. Unless we can get a joint approach, we will always have these problems.

As I said earlier, some schools do well in relation to medical treatment for such children, but the situation is not the same across the country. Unless we can get some uniformity and agreement between the health authorities and the education authorities, we will not get the national cohesion to deal with those problems that we would like.

I have outlined the problems, and while I would not expect the Department for Children, Schools and Families to solve them all, one of my objectives today, and certainly one of the objectives of the voluntary organisations and the professional people who have put such a tremendous effort into this, is to highlight some of the difficulties experienced by those children and their parents.

We must bear in mind the fact that a family might contain only one breadwinner. If the family is of reasonable size, that one breadwinner might be required to go to the school to give three or four injections a day. That has a host of implications. By and large, we always try to encourage the family unit, whichever way it is defined, and the best way to start to address those problems is more and more to unite the family unit. Most of those in such families are affectionate towards one another and have a good home life, but if they begin to have medical and economic problems sitting on their doorstep, that can lead to a lot of tensions.

Those are the issues and the range of social problems that we want to address, and my Bill is a little step in the direction of trying to address them. Once again, I offer my appreciation of the support that I have had from Opposition Members such as the hon. Member for Basingstoke and from my hon. Friend the Under-Secretary. I am looking forward to her giving in her winding-up speech an indication of how we can take these matters forward.

I also appreciate the work done in this area by the Department for Children, Schools and Families. I am not criticising the teaching profession, headmasters or schools. I am trying to get a united approach across the country to deal with some of these problems, because if we are not careful, we could end up with a lottery. Hon. Members have heard that expression in relation to many fields where the service that people receive can depend on the area they live in.

I commend the immense amount of work that the hon. Member for Coventry, South (Mr. Cunningham) has done to bring the Bill to the House. I think everybody would agree that he has made an exceptionally strong case for the Bill, and I reiterate the thanks he gave to the many different organisations associated with children’s health that do so much behind the scenes to ensure that we are properly briefed on the issues that face families today. Those organisations include Diabetes UK, which made a comprehensive briefing available in advance of today’s debate.

Nothing is more important than our children’s health. When a woman finds out she is pregnant and when she has her child, one of the first things she wants to know is that the child is as healthy as can be. One of my children suffers from asthma and often has to medicate at school, and I am thankful for the support he gets from his teachers. However, parents who have to live with the day-to-day realities of a child with a long-term chronic condition want them to be able to participate in everyday life as best they can, and school is a pivotal part of every child’s life.

My hon. Friend the Member for Peterborough (Mr. Jackson) alluded to the fact that many children throughout the country have long-term conditions that affect not just their academic performance in school, but their ability to participate in other ways. Social exclusion can be a real problem for children with long-term conditions, and they have to be able to deal with it. The Bill highlights the importance of this issue, and I commend the hon. Member for Coventry, South for bringing it to the attention of the House.

The Bill also highlights the importance of local authorities and local primary care trusts working with schools to provide children living with long-term conditions such as autism, asthma, diabetes, epilepsy and anaphylaxis with the support they need. The Under-Secretary of State for Children, Schools and Families, the hon. Member for Portsmouth, North (Sarah McCarthy-Fry), and I recently spent a great deal of time on the Apprenticeships, Skills, Children and Learning Bill talking about how important such co-operative working is. She will doubtless draw the House’s attention to the new conditions within that Bill that will further help to enable co-operative working.

There are already significant obligations on PCTs, schools and local authorities to support children with long-term conditions. Indeed, since September 2007 schools have had a duty to promote the well-being of all pupils, including those with long-term conditions, under Every Child Matters. Children’s trust boards and young people’s plans are designed to provide the co-ordination between local authorities and PCTs that the hon. Member for Coventry, South rightly identified is too often lacking. Indeed, there are already measures in place in the Disability Discrimination Act 1995 to underline the importance of supporting children with long-term conditions.

Does my hon. Friend agree that one of the most vital aspects in the provision of care for children and young people that certainly should not be overlooked is respite care, particularly for autistic children, and especially when there is more than one such child in the family? Indeed, I have had constituency casework in that respect. Does my hon. Friend agree that the focus should continue to be on respite care, which is a Cinderella service for many local authorities?

I thank my hon. Friend for reminding us of that important service, which can be a lifeline for many families and can often help to ensure that they can continue to cope when they have particularly difficult and stressful situations to deal with. He is right to say that it is a Cinderella service, and that we should ensure that it continues to get the support it deserves. The Bill deals with the question of how difficult it is to get such services to work together, and without the support that my hon. Friend mentioned other things can easily start to fall to pieces.

It is important to remember that schools have a legal duty under the Disability Discrimination Act to children with long-term conditions. The Act’s definition of “disabled” is drawn very broadly and covers everybody with

“a physical or mental impairment which has a substantial and long-term adverse effect on his”

or her

“ability to carry out normal day-to-day activities.”

It would seem there is no apparent shortage of legislation, so why are parents and children still struggling to cope in the way the hon. Member for Coventry, South has already outlined, which has left him feeling that it is absolutely imperative that he introduce this Bill today?

There is an abundance of fine words in existing legislation, but a sharp contrast becomes apparent when one looks at the availability of medical and specialist support in some areas, which leaves too many children—especially those with diabetes—finding it difficult to manage their conditions effectively. Two years ago, the Government produced a report highlighting the fact that our system of support for children coping with diabetes lagged behind European systems. Children with diabetes faced a postcode lottery, with many having good access to support, but many not. Indeed, according to the Government’s report, one in 10 young people with diabetes did not have a consultant with specialist expertise in diabetes, and nurses providing the type of specialist support that such children need, such as advice on diet and other matters, were stretched thin, with case loads well in excess of the Royal College of Nursing’s recommended levels. That left 84 per cent. of diabetics aged under 16 with poor or very poor control of their condition.

My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) has already done a great deal of work on these matters, and I commend him for the commitment he has shown to children’s health issues during his years in Parliament. He has highlighted the critical role played by school nurses in providing a vital connection between health, education and children’s well-being, linking school and home. They can identify precisely the types of vulnerable young people we are talking about today and help them to cope by providing support in school. However, a written answer from the Under-Secretary of State for Health, the hon. Member for Brentford and Isleworth (Ann Keen), published on 22 April, graphically shows that the Government are well behind schedule in delivering on their promise to have at least one full-time, year-round, qualified school nurse working with each cluster of primary and secondary schools. The shortfall of more than 1,000 school nurses nationwide is significant because it is specifically cited by head teachers as one of the key barriers to enabling schools to support children with long-term health conditions.

Children are finding it difficult to cope and there is a shortage of school nurses: it is little wonder that teachers and schools feel ill equipped to provide for children who need support either to get through the day or to medicate themselves during the day. The inconsistency in the availability of professional support on the ground and in our schools, the lack of training for school staff, and the growing fear among teachers about the threat of litigation if they administer treatment and things go wrong, perhaps through no fault of their own, are all factors that must be considered alongside the Bill’s provisions. Conservative Members certainly support the intention behind the Bill of enabling children to get the education and the opportunities they need at school, but we recognise the importance of ensuring that we have on the ground professional support for teachers. Only in that way can the school outcomes that we want for all children be achieved. All the issues have to be debated in more detail than today’s debate allows.

Children do get the support we want them to have in areas where local authorities and primary care trusts work together to support schools and to put in place the practical measures that are needed. Areas such as Birmingham already have successful plans to support children with long-term conditions. In Birmingham, when a child is diagnosed with diabetes or any other condition, the PCT promptly goes into schools to provide the relevant training to class teachers and other key staff, and written guidance and training materials are provided to the school. The city council provides insurance cover for all staff, which is dependent on their receiving training from a health care professional. That helps to overcome some of the fears of litigation that I think hon. Members will have come across in their constituencies, which can put a barrier in the way of teachers helping in the way that they want to. There are other examples of that type of practice up and down the country. I hope that in Committee Members will look further at how the good practice of authorities such as Birmingham can be made more widespread across the country.

Again, I commend the hon. Member for Coventry, South for introducing the Bill. I wish the Bill well, and offer it support from the Conservative Front Bench, with the caveats that I mentioned. I hope that in Committee the issues can be dealt with in more detail, and that further provisions can be put in place, so that children who have some of the most difficult conditions to deal with are encouraged to excel and achieve their potential in school.

First, may I congratulate my hon. Friend the Member for Coventry, South (Mr. Cunningham) on the Bill? It is well worth while, and he is getting support from across the House. He put the case for the Bill, and pointed out the problems faced by some children in some schools, but the hon. Member for Basingstoke (Mrs. Miller) has just mentioned some examples of good practice. Not every school is failing, but some children in some schools have problems.

My hon. Friend the Member for Coventry, South, mentioned the evidence brought to us by Diabetes UK and a range of other organisations. One thing struck me when I looked at the evidence. Of course there are medical needs, and there are cases where it would be very helpful if people, including teachers in school, were aware of those needs and could perhaps make sure that a child got treatment and took their medication and so on. However, it is not just medical needs that matter. Examples were pointed out of children being excluded from lessons or extra-curricular activities, sometimes because of a misunderstanding about their conditions and the long-term problems that they had to deal with. There were examples of children having to eat alone if they had specific food requirements. It struck me, when looking at that evidence, that one could over-emphasise the medical aspects. There are social and other aspects, too. In some cases, what is needed is understanding of, and training about, social needs as well as medical needs.

The Bill extends the general duty already on schools to support pupil well-being, and makes specific requirements relating to health. I understand the concerns that have been expressed by one or two Opposition Members about not wanting to place on schools too-onerous requirements that would have major resource implications, whether financial or in terms of human resources. I think that we are all conscious of that; we have to be reasonable about what we expect a school to do, given its resources.

My hon. Friend the Member for Coventry, South, who opened the debate, and the hon. Member for Basingstoke pointed to what can be done if not only schools but primary care trusts and local authorities are involved, and if we get the right levels of co-operation. It is not just a case of saying to a school, “Here, get on with this”, when it does not have the help and support that it needs from other organisations, particularly PCTs.

In some cases, understanding is missing; I will refer in a bit of detail to one specific condition. I have spent a lot of time in my years in the House dealing with issues to do with HIV. Schools may have to deal with that long-term condition if a pupil has an HIV infection. The situation is quite complex. It raises issues not so much about treatment as about confidentiality, for instance. The Bill would require a school’s governing body to have a policy about how a condition should be dealt with, and appropriate training would go a long way towards dealing with some of the problems that children currently have to face.

Does the hon. Gentleman share my concern about the growing number of children being turned away from primary and secondary schools because they have HIV? That shows a lack of understanding not only of the children’s condition, but of the law.

Absolutely. I shall give one or two examples of that. There is indeed ignorance of the law. As the hon. Lady pointed out, the Disability Discrimination Act 2005, which applies to schools, specifically refers to HIV. Under the terms of the Act, someone should be regarded as disabled from the point at which infection occurs. By ignoring that, a school might well be breaking the law. The difficulty for many parents would be how to get the law enforced. They may not even be aware of the provisions of the Disability Discrimination Act.

A further problem in relation to HIV is that of confidentiality and disclosure. HIV is not a notifiable condition. It is up to the person living with HIV whether they choose to disclose the fact that they have HIV. There is no requirement to disclose the condition. Parents of children with HIV are unsure what they should or should not do. HIV is a condition that, we know, attracts stigma and discrimination, so a parent may wonder whether to disclose their child’s condition and what the consequences might be for the child.

There are examples where that has gone badly wrong, so there is a clear case for much better guidance to be given to schools on how they should deal with children with HIV. If my hon. Friend’s Bill went through, a school would be required to have an appropriate policy.

I pay tribute to all the work that the hon. Gentleman has done through the years campaigning on HIV/AIDS. We have national clinical frameworks, within which there is leeway for local authorities and various agencies to respond appropriately to the needs of their area. One of the possible criticisms of the Bill is that it takes an overly generalised approach. In some respects it may be said that it undermines the existing general duty on local education authorities and the NHS to provide the services that they are already providing to children with long-term conditions.

I am not entirely sure I understand the point that the hon. Gentleman is making. I can see that there may well be differences in the incidence of a particular condition. HIV is an obvious example. In London particularly, there is a relatively high incidence, but there are rural areas where the incidence is extremely low, so it is much more likely that a school in London might have to deal with a child who has HIV than a school in, say, rural Devon. That does not mean that that could not happen in rural Devon. It is not rocket science to draw up some fairly simple, clear guidelines about how a school ought to approach the issue.

Let me give some examples of what can happen to children. A child attending a nursery school attached to a primary school in Middlesex was due to start in the reception class in September, and the child’s mother asked the head teacher if the school had any policy on informing parents in the event of, say, an outbreak of chickenpox. The head teacher asked why, and the mother explained that her daughter had an auto-immune problem, HIV. That information was then spread around the school and the head teacher told the mother that all the teachers had concerns about teaching her child, and that the dinner ladies would have to be told in case the child had an accident. The mother tried to explain that no one was at risk simply by being in the same room as her child, and eventually the head teacher said, “Look, you really ought to take the child to another school, and don’t tell them that your daughter has HIV. Just enrol her without telling them.” That is a perfect example of a complete lack of understanding. We are not asking the school to be able to treat someone with HIV; we are asking it to have some understanding about what it means.

Another case concerned a child transferring from a primary to a secondary school just last year. The primary school knew about the child’s HIV status and passed that information on to the secondary schools without asking for the parents’ consent, and the secondary schools then said that they wanted to inform all sorts of people in the school about the child’s status.

Those are the sorts of things that can happen when people within a school are not aware of how they should deal with a child with HIV. That is one specific condition, but I could quote a range of examples. I do not suggest that such problems arise in every school, but they do arise, and too frequently. If there was training, if there was some understanding, if there was a policy within schools of just how a child with such a condition should be dealt with, we would avoid these problems. That is where I see the value in the Bill. Yes, I understand the resource implications and that we might have to think through carefully how we bring in some of the provisions, what conditions are covered, and whether the condition would require a school nurse to be available before the school could be expected to deal with the problem.

The hon. Gentleman is being very generous in giving way. He makes a powerful commentary on the importance of understanding long-term illnesses and conditions such as HIV in schools. Does he therefore share my concern that that understanding is in no way helped when we have such a massive shortfall in the number of school nurses throughout the country who would be providing the professional advice, support and training that he so eloquently advocates?

There is a problem. We do need more school nurses, and I do not think that any hon. Member would disagree that we should be trying to fill that gap and provide more school nurses. That is why we need to think through how the Bill will be implemented and what conditions may be included, perhaps initially and then later. But that should not blind us to the notion that better training and information could help, and that where there are examples of good practice, as the hon. Lady mentioned in her speech with regard to the PCT and what is being done in Birmingham, they could be built on in other parts of the country. That would certainly help.

My hon. Friend the Member for Coventry, South has done an excellent job in bringing the Bill to the House, I hope that it will be allowed to make progress, and I look forward to hearing the Minister’s comments in reply to the debate.

I shall give a cautious welcome to the Bill. The hon. Member for Coventry, South (Mr. Cunningham) is to be commended on his work, on his collaboration with the charity and voluntary sectors and on his generous cross-party tributes to my hon. Friends on the Front Bench and to other Members.

In the Bill, there is much that any sensible, caring and community-minded Member would support. Schools would be required to produce and implement medical conditions policies and upgrade their current guidance, and every child would have an individual health care plan. We consider those proposals to be sensible, but I have a concern about the Bill, although I add the caveat that we support its intent. The Bill involves the head and the heart, and our heart is with it, because there is a demonstrable need for such policies. The hon. Gentleman kindly provided the national figure of about 1 million for those children and families who are affected by a serious medical condition, so something needs to be done. Indeed, there is an argument—a slightly tangential argument—that the Government should have introduced their own Bill, rather than rely on one of their Back Benchers.

My concern is with the element of compulsion, and perhaps I did not make that clear to the hon. Member for Walthamstow (Mr. Gerrard). We must not disregard best practice locally between local NHS trusts and local education authorities in carrying forward national clinical framework policies on, for example, diabetes. My constituency has a high prevalence of several long-term conditions—diabetes being one, chronic, obstructive pulmonary disease and asthma being others. We do not know why, but asthma affects a large number of young people. In my constituency, in particular, it affects the 12 per cent. of people who have a south Asian background.

We must not lose sight of the wider context, particularly when the issue comes back, as it often does, to funding and resources. Respite care, as I said to my hon. Friend the Member for Basingstoke (Mrs. Miller) is a big issue, and it is difficult to provide adequate daily and weekly respite care for parents and guardians of children with long-term conditions. No local education authority will ever say that it has sufficient provision and resources to carry out that work.

The Bill also relates to mental health—an issue identified by the charities to which the hon. Member for Coventry, South referred. However, of itself, mental health is a major issue and a growing problem for children and young people, and I am not entirely sure that the national clinical frameworks are yet able to cope with it. On a recent visit to my local district general hospital, one problem that clinical staff identified was the lack of provision at weekends and out of hours for teenagers and young people with mental health problems.

Litigation is also a consideration. I talked earlier, when intervening on the hon. Gentleman, who was very generous with interventions, about anaphylactic shock, allergies and Epipens. The bureaucracy and problem in providing a consistent policy across my local education authority for a relatively small number of children with such problems, which are obviously life threatening, demonstrated to me how complicated the issue is, particularly its resource implications for training and skills, let alone its legal implications.

My hon. Friend brings to mind a visit that I made recently to Chatham and an organisation called The Place2Be, which operates in a local school with children who, as a result of incidents in their lives, are vulnerable to mental health problems. Does he agree that that is one example of the many schools throughout the country which already go above and beyond what is expected and try to fill the gap—particularly in mental health services—that exists due to a lack of provision by local primary care trusts?

My hon. Friend makes a pertinent and astute point, which is worth reinforcing. For the avoidance of doubt, I should make it clear that I am not implying that through his laudable Bill the hon. Member for Coventry, South is undermining the work already being done. However, in many respects there are exemplars of how to deal with children with long-term conditions.

That brings me to another issue on which we need a joined-up policy. I hope that I am not being unfair to the hon. Gentleman, but I do not think that his Bill takes it into account. I am thinking of children with conditions who are carers themselves. In this country, we have still not given sufficient attention to the issue of young carers. To give them their due, the Government have moved forward on local provision for carers, but we should not forget about the issue.

My hon. Friend the Member for Basingstoke wisely alluded to school nurses. In many local education authorities, the delivery of that service is undermined by a lack of people—mainly women, but also men—who put themselves forward for the important role of school nurse. The role is similar to that of a district nurse, and it is vital for delivering first-class medical and clinical care and education into the community.

Earlier, I mentioned the pressures in some local schools with diverse populations. In many parts of the country, mainly in urban areas, many children come into school without being able to speak English; the hon. Gentleman will have instances of the same thing in Coventry. Yesterday, I was talking to someone I know whose wife is a teaching assistant. Virtually her whole day is taken up in giving one-to-one tuition to a little Bulgarian boy. That is fine, but think of the resource implications if we intend to impose the regulatory framework that the Bill would involve, and how that would affect schools across the country. It would be very resource-intensive. If the Bill goes into Committee, I would be interested in whether we could conduct an impact assessment and ascertain the likely cost and the resource drain on local authorities. The aim is laudable, but we live in difficult times. I suspect that it would be a big ask to make schools such as some in my constituency—schools with structural issues of demography and population—deliver the level of service, which is consistent across the country, involved with that aim.

I shall conclude. We all welcome the Bill and the chance to debate what has rightly been described as the situation of invisible children, who are often overlooked and pushed to the side in mainstream schooling. While I am at it, I should pay tribute to some of the superb schools in my constituency that look after children in these situations. Middleton primary school in Bretton has a unit for deaf children, and Jack Hunt secondary school also looks after deaf children.

It is right that we should have this debate. These children have a right to the best education, irrespective of their long-term conditions, and we have the responsibility to deliver it. At the same time, however, we should recognise existing best practice and not lightly dismiss the revenue costs that might fall on local education authorities. With those caveats, I congratulate the hon. Member for Coventry, South. I hope that the Minister has some good news for him in her remarks.

I, too, congratulate my hon. Friend the Member for Coventry, South (Mr. Cunningham) on his speech and on his promotion of this excellent Bill. I hope that the Government’s response will recognise the need for the proposals within it.

My principal reason for speaking in the debate is to highlight the courage and determination of one of my constituents, Sophia Loizia. Sophia is 17 and now a sixth-former, but a year ago, during her GCSEs, she was diagnosed with Hodgkin’s lymphoma. Thankfully, she is now in remission and in good health, but she has had one of the toughest years imaginable for a young person. Earlier this week, she attended the lobby, which many other hon. Members will have attended, organised by the coalition of charities that has been alluded to. She was one of five young people who went to Downing street to petition the Prime Minister in support of my hon. Friend’s Bill.

I do not intend to say anything more about what are intensely personal matters, as well as matters of public interest, save that I was so impressed not only by how highly intelligent Sophia was but how extraordinarily mature. It occurred to me that the fact that younger children, or those who may not have the same levels of accomplishment, have to suffer and go through serious medical conditions, as well as trying to cope with their education and the other pressures concerned, highlights the need for provisions such as this Bill. Thankfully, childhood cancer is relatively rare, although I pay tribute to the work that CLIC Sargent does in supporting children who have cancer.

A condition that is not rare—indeed, it affects up to one in 10 or 11 young people—is childhood asthma. I should perhaps declare an interest in that, many years ago now, I missed at least two years of mainstream schooling through asthma. I attended a special school and then went back into mainstream schooling. At that time, in the 1960s, there would have been no real understanding within mainstream schooling of the needs of children with medical conditions. I should underline that both the schools I attended were absolutely excellent. I should also say in passing that both—Chartfield school in Putney and Peterborough school in Fulham—have been closed by Tory councils in the past three years, despite vigorous campaigns to keep them open.

This week, on 5 May, we had world asthma day. Also this week, Asthma UK, one of the supporters of the Bill, launched its report, “Missing Out”, which specifically concerns the effect that asthma has on schoolchildren. I was shocked to find that 40 years on, 50 per cent. of children with asthma say that they have problems joining in lessons and going on school trips, and three quarters say that they have problems joining in sporting activities. Medication for asthma has improved hugely over the past 40 years, and it is amazing that children—up to two in every class nowadays—can still be restricted in that way.

The third condition to which I want to draw attention affects children on the autistic spectrum. That, too, is recognised far more than it would have been several years ago as a condition that affects very large numbers of children, many of whom will be in mainstream schooling. Again drawing from personal experience, my godson attended a superb school for autistic spectrum children, Queensmill school in Fulham. As a consequence of the excellent education there he was able to go into mainstream schooling, and his experience has been unfailingly good. Despite what we have heard about the need for more resources, that is partly because of the level of resources that the Government have put into both special needs schools and teaching assistants and support for mainstream schools. Largely, however, it is due to individual teachers who, although they had no experience or knowledge of autism, went and found out about it so that they could deal with autistic spectrum children.

That additional burden should not be put on individual teachers without support, because the general experience of parents of autistic spectrum children is that they do not have a good time in mainstream schooling. I wonder whether that is partly because it is regarded more as a behavioural than a medical condition, and because teaching professionals who would not presume to know about the treatment of medical conditions think that they know how to deal with children on the autistic spectrum. In fact, they need just as much support on that as on other matters.

I respect the hon. Gentleman’s position, which comes from personal knowledge and experience. On provision for autistic children, is there not an unfortunate choice for many parents to make between a lower level of care locally, particularly respite care, and out-of-borough or out-of-county provision? That might be just as good, but it restricts their access to their children, which is detrimental to family life.

This is an all-party debate and I do not want to introduce party politics into it, but a lot of this goes back to resources. In my experience, it is difficult to get Conservative councils in London to provide sufficient resources for special needs children, which is an expensive area of provision and easy to cut. It has been shown over the past 10 years that there is a need for commitment to that. However, I take the hon. Gentleman’s point. There is something of a postcode lottery, as provision is different in different parts of the country and even of the capital. The more that can be done to maintain support for children on the autistic spectrum in mainstream schooling, the better it will be, although there is clearly also a need for special needs education for those with more severe conditions.

I do not wish to take up a lot of time, but I have mentioned these slightly anecdotal matters because they show that for a large number of children—we have heard that it is 1 million across the UK—there are serious daily problems. I emphasise that we are talking about not special treatment but equitable treatment. It is about enabling children who have medical conditions and health problems to get the same level of education as children who do not. Some of the examples that I have given illustrate the fact that problems often occur when children move out of special needs education into mainstream schooling, which we all welcome, or when children who have been out of school for a long period come back following medical treatment.

The solutions are quite common-sense in a way, such as informing both teachers and pupils about the need to consider the problems that individual children have. I am sure that many teachers ensure that that happens as part of their pastoral care, as is suggested by my own experience as a governor of a sixth-form college with a strong pastoral tradition. However, there are also examples of crass behaviour, such as a teacher saying a child returning after a long absence for medical reasons, “Well, you’ve got no excuse for not catching up with your work now”, or fellow pupils who were friends in the past feeling awkward or in extreme cases indulging in bullying.

It simply requires people who understand the conditions to sit down with their staff and pupils and explain them, so that the children who return to school do not have constantly to explain to every teacher and pupil the nature of their condition and their continuing symptoms and needs. In almost every case, there will be continuing treatment—medication, chemotherapy and so on—that needs to be administered, and continuing frailty. Children inevitably go back to mainstream education before they are fully recovered.

Opposition Members have suggested that the Bill might involve too many resources or be too bureaucratic. I think that it is a light touch measure, which focuses on two or three principal needs for information and training and on a substantial number of children—not a small minority—in schools throughout the UK, who need such support and help.

I am pleased that the measure has support from all parties; I hope that it also has Government support.

I commend the hon. Member for Coventry, South (Mr. Cunningham) for introducing the measure. I approach the debate not only as a Member of Parliament, but as one very conscious of my role—I suspect that other colleagues also play such a role—as chair of governors of a local primary school as well as trustee of a city academy. The subject of the Bill has been a real issue for us and I have had occasion to discuss it with fellow governors and our head teacher.

It is clearly right to pay the Bill serious attention when 22 organisations form a coalition and ask us to support it. As constituency Members of Parliament in England—I say “England” advisedly; it is an England measure—we have all been involved with some of those organisations. I put on record their names: the Anaphylaxis Campaign, Asthma UK, the British Heart Foundation, the Children and Young People HIV Network, CLIC Sargent, Coeliac UK, the Cystic Fibrosis Trust, Diabetes UK, Epilepsy Action, Input, Juvenile Diabetes Research Foundation International, the Multiple Sclerosis Society, the National Centre for Young People with Epilepsy, National Voices, the Royal College of Nursing, TreeHouse—which is the national charity for autism education—Scope, Sickle Cell and Young Stroke Survivors, the Stroke Association, the UK Children with Diabetes Advocacy Group, Vision 2020 UK and YoungMinds.

Those organisations represent young people—some also represent adults—with 16 different conditions, which are not uncommon in many schools in this country. Four of the organisations lobbying today are concerned with children with diabetes. Indeed, Diabetes UK has led the campaign. This municipal year, the mayor of Southwark has chosen that organisation as her charity. She suffers from diabetes and has done good work to raise funds and increase the profile of the needs of those with diabetes. I know colleagues in the House who have also done such work because they, too, are sufferers.

Two organisations in the list specifically deal with epilepsy. That triggered in my mind a realisation of the importance of the obligation on schools to ensure that there is a proper understanding of and response to people with such conditions. When I was at secondary school, somebody had an epileptic fit in front of me. I had never seen an epileptic fit before. For the first minute or so, I had no idea how to respond. I did not even register logically what was happening. That showed me the importance of preparedness among staff and pupils to deal with those conditions. I stress “and pupils”, because they need to know that it is not unusual, and should not be a problem for them, that one of their school colleagues might have a condition that needs help. Nearly everybody at school needs help, be it be emotional, psychological, mental or physical help. Schools will be better places and the quality of education and opportunity there will be better if they and all their members—the governors, the teaching staff, the non-teaching staff, those who come into schools and the pupils—know how to deal with those issues.

I want to signal how important the work done by the associations that I have mentioned is, by referring to three of them, one of which—the Multiple Sclerosis Society—is based on my constituency. I have had good involvement with the Multiple Sclerosis Society, which is led by Robert Meadowcroft, whom I have known for many years. A former member of my staff works for the Multiple Sclerosis Society now. We all know what fantastic work the society does in raising consciousness and awareness, increasingly through young people sharing their experiences, ensuring, as happened with the lobby here, not only that adults or workers come to lobby us, but that the people who live that life come to see us, and not only in our constituencies and surgeries, at meetings and in our communities, but here, too.

Also in my borough, although not in my constituency, is Sickle Cell and Young Stroke Survivors. Sickle cell disease is a condition that disproportionately affects those from Afro-Caribbean communities. I have the privilege of representing the local authority with the largest African community in Britain, and the issue is relevant to that community, as it is to people from black and other communities. Finally, there is Scope, for which, again, a former member of my staff works. Those examples indicate how good and effective those organisations are. Through the medium of the Bill, they have come to us to say, “Please see if you”—Parliament—“will agree to this very simple change in the law.”

That leads me to my next point, which is to commend the hon. Member for Coventry, South for producing a superbly short Bill. Private Member’s Bills are much easier for the House to deal with if they are short. The title of the Bill is short. There is also a good, robust view about when it should come into effect, namely within two months of the day on which it is passed. That is unusually refreshing, because normally the start date for legislation is way down the track. Clause 2 says that Ofsted should consider how schools deal with the issues covered in the Bill as part of its inspections.

The key to the Bill is clause 1, which would impose on schools’ governing bodies the obligation to produce and implement a medical conditions policy, which would have two components. Proposed new section 38(11) of the Education and Inspections Act 2006 says that the policy should set out

“the means by which records of the specified health conditions of children at the school are to be recorded and maintained”


“the preparation of an individual healthcare plan for each child”.

Clause 1 would also require the training of staff to enable them to respond, which would include not just teaching staff, but teaching assistants, the people in the kitchens and so on. There are also other things, which, to be honest, are incidental, including an obligation on NHS bodies, local authorities and primary care trusts to co-operate.

The hon. Gentleman has also been in wise in saying that at this stage he does not want to specify which health conditions would be covered, which he is leaving to Ministers. That is both a good thing about the Bill and a weakness, because until a Minister did that, the Bill would have no substance or import. There is no obligation on Ministers to do that by a certain date, so I guess there would have to be an amendment in Committee to change that.

Obviously, I cannot predict the outcome today, but I would have thought that if the Bill reached Committee, that would be the stage at which to thrash those issues out. After all, that is why we have a Committee stage.

I am absolutely comfortable with that reply. That was also my assumption. The Government will have to respond and say what they think, and they will have to show a willingness to define those conditions. I simply want to put on record that the Bill depends on having a list of those conditions. That might not be so easy to achieve, as there are many very common conditions, and some very rare ones. One would have to find a way of writing such a list.

Since I have been in the House, there have been many debates about whether it is better to have special schools, mainstream schools with specialist provision, or mainstream schools that can take everyone, whatever their needs. We need to be careful not to imply that the only schools that should exist are mainstream schools. I have never taken that view, although some colleagues do. I know from visiting schools in my constituency that there are mainstream schools that have a fantastic ability to meet the special needs of their children, either specifically or generally. I can think of two examples. Snowfields primary school, near London bridge, has a unit for dealing with children with autism which is hugely valued and recommended. The other is a relatively modern primary school in Rotherhithe, Alfred Salter school, which I think the Minister visited recently. It is a really good, well-led school with provision for children with physical disabilities and the capacity to deal with children with hearing impairments, and so on. It was built, and works, as a school that caters for those needs.

There are also really good special schools. For them, the provisions in the Bill are already par for the course. Nothing needs to be added to their obligations. Again, there are two pre-eminently good examples in my constituency. Spa school is a Bermondsey school for children and young people with autism. It is a really great, friendly, successful, high-achieving school. Cherry Garden school deals with children with considerable physical and other educational needs. Happily, it is about to get a hugely well-earned new school building, for which the head has been waiting for a long time. My most moving moment at a school play was last Christmas at that school. Every pupil took part, no matter what their physical or other disability might be, yet it was absolutely the most moving experience.

There are some fantastically good schools, but the Bill is really about the others, like the school of which I am chair of the governors. It is a mainstream school, but it may also be attended by children with epilepsy, sickle cell, diabetes, a mental health problem or whatever.

Theoretically, a group of schools with different specialities could take a cluster approach by pooling their specialist provision.

Yes, of course that is right.

I am sure that the Minister will advocate caution, and that is also my position and that of my hon. Friend the Member for Yeovil (Mr. Laws), who speaks for us on education. I am not seeking to block the Bill today; nor would my colleagues wish to do so. We are cautious, however, about whether the Bill as it stands represents the right way to go, and I want to set out our reasons for that.

Every primary school is already required to adopt a huge number of policies. The primary school of which I am chair of the governors has just reviewed all its policies, and one extremely experienced governor has kindly volunteered to rewrite them, so that none of them takes up more than two sides of paper—ideally, we want to get them down to one side—so that they are simple to read. There are a massive number of policies.

The hon. Member for Coventry, South will know from experience in his constituency, as I do from my own, that the legislation that this place passes has placed huge burdens on the governing bodies of schools, whether in relation to admissions policies, which we have just had to revise, or to others that we bring into force. Some provisions have a huge impact. Schools have rightly been challenged by the Disability Discrimination Act 1995, and they have sought to respond to it. We thus need to be careful not to embark on a policy that is burdensome rather than of benefit. We need to discover whether the objective could be achieved in a different way, by guidance rather than by a policy with an obligation. That is the question I have in mind, and I shall be interested to hear the Minister’s response to it.

I come to the debate with some slight indirect pride because the St. James primary school in Bermondsey has just had its Ofsted report and been judged outstanding. I have no doubt that that is due to the leadership of the head, who was appointed a few years ago, and all her staff team, to whom I pay tribute. This is an absolutely fantastic small school with 210 places in Jamaica road near Bermondsey tube station. What being on the governing body of that school has taught me—I joined it on purpose so that I can never be accused of failing to have my feet on the ground, as it were, when it comes to how things work on the ground—is that every child really does matter. “Every Child Matters” is a Government phrase—originally Lord Laming’s initiative and it has rightly been implemented—and it is important to look at every child separately in respect of academic and social achievement. A good school should automatically seek to have a pastoral care regime and a social care regime for every child. It should be the responsibility of the school, because it takes the place of parents, to look after every single child.

The last question I pose—it is a rhetorical one—is whether all this is sufficient, as it were, and whether it is an obligation. It is also a question of whether Ofsted, when it inspects, should have to check whether what is in the Bill all actually happens. I have not done the necessary evidential research—not even into all the schools in Southwark, let alone around the whole country—to know what the Minister will have more access to than me, which is the extent to which all this is already good practice and already happening. We need an intelligent debate about what the evidence shows.

One thing I do know is that it is imperative that under the compulsory state schools system, any youngsters going to primary or secondary school with asthma, which can be very debilitating, or with a heart condition, which can make them much less alert and agile for long parts of the day, or with cancer or HIV, must be given the same dignity, respect, value and opportunity as everybody else. That is what the Bill is about. That is why I commend the Bill’s initiative; I will listen with interest to the Minister’s advice on whether this is the best way to achieve the objective that we share, or whether we need to find other ways in the minutes ahead. If the Bill goes to Committee, my colleagues will happily participate and work on the agenda that the hon. Member for Coventry, South and the 22 organisations have set us.

I congratulate the hon. Member for Coventry, South (Mr. Cunningham) on producing a Bill that is modest in size, but whose intention is far-ranging. There have been too many problems in our schools when it comes to dealing with children who suffer from certain types of conditions.

I am going to speak specifically about dyslexia and dyspraxia this morning, although they were not in the list that the hon. Gentleman set out in introducing the Bill. I fully appreciate, of course, that it was not an all-inclusive list and that there was no intention for the Bill to exclude children suffering from such conditions.

I assure the hon. Gentleman and the organisation that he speaks for that there was certainly no deliberate attempt to exclude them in any way whatever.

I am grateful for that clarification.

Young people and children with dyslexia and, in particular, dyspraxia, face significant problems. In the latter case, far too many people lack understanding of the condition. I recall that 20 years ago, staggeringly, there were local education authorities that did not recognise or accept the condition of dyslexia. Consequently, no help was provided for children suffering from that condition and they were written off as troublemakers—children who could not be bothered to get into the work ethic and do their lessons. People did not appreciate that there was no lack of will to learn among those children. Because of their condition, they found learning extremely difficult, and because their condition was unrecognised, no help was provided. They became deeply frustrated, which could lead to behavioural problems or lack of interest in learning.

Writing those people off as troublemakers was unforgivable, but, fortunately, great strides have been made in the last 20 years. The condition is recognised and people fully appreciate that specialist help and attention have to be provided to such children to help them to get a fair and decent deal to enable them to learn like other children in their class and minimise any disruption that they might cause to those other children. However, there is still a problem with dyspraxia because of the lack of knowledge and understanding of the problem. I fear that too many children in our schools might, to varying degrees, be affected by dyspraxia where it goes unrecognised—which means that help cannot be provided—simply because of the lack of knowledge among too many teachers that it is a problem. That is why I particularly welcome the Bill providing for

“training for school staff to support the implementation of individual healthcare plans.”

With that training and the acquisition of skills, there would be greater opportunity for teaching staff to recognise and identify the problem, so children could be set in the right direction to seek the appropriate help, and schools and teachers, working with medical practitioners, could plan a proper scheme to help those children.

There is a problem, however. I do not know, and will not know until I hear the Minister’s speech, whether the Government want to give the Bill a fair wind so that it has the opportunity to be considered in Committee and possibly reach the statute book during this parliamentary year. I do not know what will happen, but if the Bill does not succeed during this Session, for whatever reason, I will make a plea to the Minister.

The intentions behind the Bill are admirable and necessary to improve upon an existing situation. We all, as constituency Members of Parliament, have experience of parents trying to get their children statemented so that their problems and needs can be identified and provided for. All constituency MPs experience during their parliamentary career the frustration of the time-consuming problems that can be involved in getting a statement in the first place. Once a statement has been prepared and a course of action and help identified, it can be difficult to ensure that that assistance is provided. That will continue even if the Bill, by some quirk, does not become law.

If the Bill does not become an Act of Parliament, I shall urge the Minister to ensure that her Department works determinedly and channels its efforts to improve the existing situation, drawing on a number of the attributes identified in the Bill to ensure that children who, medically and through no fault of their own, have a disadvantage in life that impacts on their ability to learn get a fairer and better deal so that they can compete with their peers in the classroom to get the finest education that this country can provide for its next generation.

I congratulate my hon. Friend the Member for Coventry, South (Mr. Cunningham) on his success in the ballot and on introducing this Bill. I know that he feels passionately about this topic and that he is speaking on behalf of many young people with health needs and their parents. We are aware that the availability of good-quality support at school for children with long-term medical conditions is a major issue that needs to be addressed. I am grateful to him for introducing this Bill and for rightly highlighting the very real barriers that these children face. It is a tribute to his commitment that we are here debating this issue today.

We have heard from Members today many examples of schools that are not delivering the support that children need, and many Members raised particular instances in their constituencies. My hon. Friend the Member for Walthamstow (Mr. Gerrard) drew our attention to the very real difficulties faced by children with HIV. My hon. Friend the Member for Ealing, Acton and Shepherd’s Bush (Mr. Slaughter) spoke eloquently about a constituent of his with childhood cancer. The hon. Member for North Southwark and Bermondsey (Simon Hughes) told us about problems affecting children in his constituency with sickle cell anaemia, and the hon. Member for West Chelmsford (Mr. Burns) told us about difficulties in his constituency with children with dyslexia and dyspraxia.

We completely support the Bill’s underlying intention to improve support at school for children’s health needs. However, I have some concerns about whether having a legal duty on schools at this stage will actually deliver the best outcome for these children. We want schools to work together with us on this matter, and I hope to be able to explain to my hon. Friend the Member for Coventry, South and to the House how I believe we can achieve the better outcomes we all want through other means, and to set out what we have done and will do. His Bill has given me the opportunity to do that.

We know that many schools are already providing very good support to pupils where it is needed. The hon. Members for Basingstoke (Mrs. Miller) and for Peterborough (Mr. Jackson) gave examples of places they had visited and schools they knew about where that excellent support was being given. However, such examples of good practice are not uniform across the country, and where schools are not doing well, it can be for a range of reasons, such as lack of knowledge about such conditions, misconceptions or fear about what offering support would involve, lack of appropriate training, or concerns about possible litigation, as was mentioned. There may well be other barriers, and we need to find out what they are.

A legal requirement on schools to have a medical conditions policy now would be a bit like putting the cart before the horse: we need to understand the barriers before imposing such a duty. At this stage, it could be strongly resisted by schools and teachers as an additional and unreasonable burden. I do not want to force teaching or support staff to take on responsibility for administering medicines where they may not be qualified or confident to do so. I would rather work with schools to identify barriers and find ways to overcome them, and to bring them with us.

Does the Minister not think that one of the other, most notable barriers is the Government’s failure to deliver on their promises in respect of school nurses? We are, after all, still 1,000 school nurses short of the target that the Government themselves set.

Of course we want to see more school nurses, but there has been a 38 per cent. increase in their number between 2004 and 2007. However, we recognise that we need to go further.

Although having a policy is important, it will not in itself guarantee better provision. The proof is in the implementation, and the way to improve provision is to identify the barriers that prevent schools from supporting these pupils, to share good practice, to increase awareness and to reassure schools about what is involved.

As has been mentioned, schools already have a statutory duty to promote the well-being of their pupils. Well-being is defined as the five Every Child Matters outcomes, one of which is being healthy and staying safe. We recently consulted on guidance on what this means in practice, and I want to assure my hon. Friend the Member for Coventry, South and the House that we will ensure that the final guidance includes specific reference to the importance of schools considering the health requirements of their pupils, particularly those with long-term health conditions, as part of this duty.

On the provisions in the Bill regarding consulting parents and their children on individual health plans, we certainly agree and are addressing that issue in the child health strategy. The strategy sets out the plans for universal, targeted and specialist support across three life stages—early years and pregnancy, school-age children and young people—as well as the additional support for children and young people in need of acute or ongoing health care. It also sets out how the delivery system can be supported in implementing the recommendations, and in particular how the range of services in contact with children and young people can work better and with families to achieve common aims. A specific commitment is included to ensure that by 2010 all children with complex health needs have individual care plans to support co-ordinated care.

Published alongside the strategy is “Securing better health for children and young people through world class commissioning”—a guide that will support commissioners in delivering the vision set out in the strategy. Commissioning is key to providing local services and to accommodating the individual respective elements of individual care plans: one size cannot fit all.

That individualised approach, while working with the surrounding services, is central to how we perceive the future of schools. We are developing a White Paper that sets out our vision for the 21st century school, which will offer a genuinely personalised learning experience for all its pupils, including those with medical conditions. Our aim is that 21st century schools will inspire young people and engage parents, carers and the local community in the life of the school. They will work closely with other local children’s services to overcome the barriers to learning that pupils may face and to stretch and challenge the most able learners.

Our child health strategy encompasses the Government’s long-term vision of a 21st century children’s health service aimed at improving the health and well-being of all children, with a specific focus on children with disabilities. With schools, GP practices, hospitals, Sure Start children’s centres, the voluntary sector and Government all playing their part in support of families, we want to ensure that every child has a healthy start in life and a brighter future.

The Bill proposes placing a duty on NHS bodies to co-operate with school governing bodies. The concept of such co-operation is not new. Section 26 of the Health Act 1999 imposed a duty on NHS bodies to co-operate with each other, and section 22 of the National Health Service Act 1977 created a duty of co-operation between NHS bodies and local authorities, but of course that is just a general duty, where co-operation means sensible working together to ensure that the public are served to best effect.

We go further, as the hon. Member for Basingstoke mentioned, in the Apprenticeships, Skills, Children and Learning Bill, which received its Third Reading in this House on Tuesday and is now on its way to the other place. That legislation will make schools a statutory relevant partner in their local children’s trust, with primary care trusts and others, and require them to work in partnership with other local agencies to improve children’s well-being. They will be represented on the children’s trust board and contribute to the preparation and monitoring of the local children and young people’s plan. All relevant partners of the children’s trust will be able to pool their budgets to commission or deliver more integrated and effective services, which better match the needs of each child, young person or family.

Those changes will lead to much greater co-operation between services and facilitate easier access by schools to the services they need to support their pupils. I put on record here that we will make specific reference in our guidance to the need for partners to consider what is needed locally to support schools in managing children with medical conditions.

Clause 2 refers to inspection and monitoring. Inspectors already draw on evidence in a range of plans in place for individual children, including care plans for children who are looked after, education plans for children with special educational needs, and health care plans. Those plans identify any specific provision the children need to ensure that they are able to access education effective; they also ensure that appropriate measures have been put in place to protect the children’s well-being. Many of the plans include statements relating to children’s health, and inspectors will have access to them and to the views of pupils, parents and staff on how pupils’ needs are being met.

As I said earlier, in our final guidance on how schools should meet their statutory duty to promote children’s well-being we will include specific reference to considering the health requirements of pupils, and we will develop strong, school-level indicators that, taken together, measure a school’s contribution to pupil well-being. We will ask Ofsted to reflect those indicators when it designs the cycle of inspection starting in 2009.

Further accountability will be delivered through our proposed school report card. We have been consulting on what that report card might look like. We believe that it will make the school accountability system better able to recognise the full range of each school’s achievements, not just attainment. It will complement and sit alongside Ofsted inspection reports, and it is intended to be clear, powerful and easily understood by school governors, parents and the public. We are consulting on what categories of performance would be included on the report card. Attainment, of course, is one category—we do not want to lose sight of that—but we want to include things like pupil progression, how good a school is at narrowing attainment gaps for pupils from disadvantaged backgrounds and, crucially for this debate, how effective schools are at delivering wider outcomes, such as children’s well-being.

Does the Minister envisage that the report card would specifically say whether each pupil had a condition, and address the question of how the school was responding to it?

The report card will be much broader than that. We are looking to introduce a document that can be read by the public and by all parents. It would not go into that much detail. However, the Ofsted report would sit alongside it, and that, of course, would go into much greater detail. We also intend the views that parents and pupils hold about the school to form part of the school report card. That will give schools a powerful incentive to recognise parental concerns, which could well include concerns about children’s health needs and how well the school addresses them.

Once again, I am extremely grateful to my hon. Friend the Member for Coventry, South for introducing the Bill. It gives me an opportunity to set out the fact that in our recently published child health strategy, we announced that we will update our current guidance, “Managing Medicines in Schools and Early Years Settings”. That will be crucial to giving school staff the confidence that they need, and getting the buy-in from those schools that, for whatever reason, are giving children with health needs the support that they deserve.

The revised guidance will include clear statements of what is expected from those involved in supporting pupils with medical conditions, such as schools and primary care trusts. We first need to understand and address the barriers that schools face when it comes to providing necessary support, and we need to identify how those barriers can be overcome. We will work with the expert organisations, including Diabetes UK, and with schools and school staff, to identify the barriers and the best way to address them. Alongside revising that guidance, we have made a commitment to an awareness-raising campaign. The aim of the campaign will be to raise the profile of the issue in schools, promote consistent good practice across the country, and enable schools to cultivate a positive support ethos.

The Department for Children, Schools and Families is setting up a stakeholder group to help review and revise the guidance and provide recommendations for the awareness campaign. The group will comprise officials from the Department of Health and from DCSF, the main stakeholders and the lobby groups, and school and head-teacher representatives. Parents of children with long-term conditions will possibly be represented, too.

Once again I congratulate my hon. Friend the Member for Coventry, South on introducing the Bill. As I said at the outset, I fully support the intentions behind the Bill, but I hope that I have been able to explain why I do not think that legislating for a legal duty is the right thing to do at this time. I hope that I have been able to demonstrate how we can deliver the outcomes that we all want through the new legislation and guidance in the Apprenticeships, Skills, Children and Learning Bill, and through the measures outlined in the recently published child health strategy and the guidance that will underpin it. That includes, of course, our commitment to working with all interested parties and stakeholders to update the “Managing Medicines in Schools and Early Years Settings” guidance. That, together with accountability mechanisms such as the comprehensive area assessment of local authorities, Ofsted inspection of schools and the proposed new school report card, will deliver the outcomes that my hon. Friend envisaged in his Bill.

We want to bring schools along with us, not by coercion through a legal duty, but by working together to make best practice common practice. We want to work with all stakeholders—PCTs, schools, local authorities, disability charities, parents and children themselves—to ensure the very best outcomes for all children with health needs in schools.

With the leave of the House, may I say that we have had an interesting debate today, with many good contributions exploring the Bill, whether hon. Members agreed with it or not. During the debate I became conscious of the danger that my Bill would pile more legislation on teachers. It was pointed out earlier that much legislation these days affects teachers, and it was not the intention of my Bill to impose a greater burden on them.

The Minister has honoured the commitments that she gave me in private conversations, so I do not intend to pursue my Bill. Given that my hon. Friend has made a number of concessions and that considerable progress has been made, campaigners have achieved quite a lot today. They have forced the House to have a good debate on the issues, and they have gained considerably from what the Minister said. If they read Hansard, they will see exactly what they have achieved.

My role was merely to bring the Bill before the House. More important for campaigners and for the House is that the assurances given by the Government today are followed through. If they are not, I assure my hon. Friend that I shall be one of the first to remind her.

Once again, I thank all the campaigners involved and Members on both Opposition Front Benches. Members of the Opposition parties have treated me very courteously, as have my colleagues. A number of hon. Members were unable to be present today. That is understandable, as Friday is a constituency day and Members have heavy commitments.

I beg to ask leave to withdraw the motion.

Motion, by leave, withdrawn.