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Report: Safety and Inclusion of Children with Medical Conditions at School

The APPG for Diabetes and the APPG on Epilepsy held a joint evidence session at the House of Commons on Wednesday 1st of March 2017 into the safety and inclusion of children with medical conditions at school.

Evidence was heard from parents Louise Taylor, Sue James and Sara Milocco; Professor Helen Cross, from the Great Ormond Street Hospital; Professor Simon Dyson, from De Montfort University; and Thalie Martini, Chair of the Health Conditions in Schools Alliance. Written evidence and comments were also submitted by over 300 parents, children, schools and healthcare professionals.

The full report can be downloaded here.

The duty to support children with medical conditions is clearly not yet known, understood or implemented by enough schools.

It is not acceptable to expect individual parents to have to advocate and argue for their child’s rights. There is a greater role for the government and education bodies to play to ensure the law is adequately implemented and enforced and that children receive the necessary support.

Schools need to be better informed about what is expected of them, what adjustments are required, and then reassured that the procedures they have put in place are correct.

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Weekly diabetes parliamentary round-up

House of Commons Questions

School Milk – DH – Lucy Powell

Thu, 30 March 2017 | House of Commons – Written Answer

Asked by Lucy Powell (Manchester Central) To ask the Secretary of State for Health, what assessment he has made of the role of school and nursery milk in the Government’s Childhood Obesity Plan.

Asked by Lucy Powell (Manchester Central) To ask the Secretary of State for Health, what assessment he has made of the role of school and nursery milk in supporting the health of children in deprived communities.

Answered by: Nicola Blackwood Answered on: 30 March 2017

Where the school food standards apply, milk must be available during school hours and offered free to disadvantaged pupils, and free milk is also available to infants if served as part of their lunch.

As part of the Childhood Obesity Plan, the Government will publish and promote example menus for early year’s settings in England later this year. This will help settings to meet the latest Government dietary recommendations, including the consumption of milk and dairy products.


Health: Children – DH – Jonathan Ashworth

Thu, 30 March 2017 | House of Commons – Written Answer

Asked by Jonathan Ashworth (Leicester South) To ask the Secretary of State for Health, what data his Department and its agencies collect on the effect of childhood health on later life chances.

Answered by: Nicola Blackwood Answered on: 30 March 2017

Public Health England (PHE) track a number of indicators concerning health, wellbeing and behavioural and cognitive outcomes associated with life chances. This is via the Public Health Outcomes Framework and other profiles, in particular the child health profiles and the early years profiles.

These indicators include background factors, such as children in low income families, risk factors, (for example low birthweight at term), and protective factors including breastfeeding initiation. PHE also collect data on early years outcomes via the Ages and Stages questionnaire as well as later childhood outcomes.

There are also indicators on obesity, namely excess weight in four-five and 10-11 year olds. In terms of childhood health and life chances, obese children and adolescents are at an increased risk of developing various health problems (both physical and emotional /psychological), and are also more likely to become obese adults.

In addition, the Department funds longitudinal studies such as the millennium cohort study to track children through childhood and is supporting the roll-out of Routine Enquiry into Adverse Childhood Experiences. This will encourage people to disclose childhood adversity, which can lead to them getting the help they need sooner.


Department of Health – DH – Nic Dakin

Fri, 24 March 2017 | House of Commons – Written Answer

Asked by Nic Dakin (Scunthorpe) To ask the Secretary of State for Health, whether he plans to launch the Daily Mile nationwide in England.

Answered by: Nicola Blackwood Answered on: 24 March 2017

The Chief Medical Officer recommends that all children aged five-18 should get at least 60 minutes of moderate to vigorous physical activity each day.

The Government published a Childhood Obesity Plan for Action in August 2016, which can be accessed here:

https://www.gov.uk/government/publications/childhood-obesity-a-plan-for-action

This plan states that for all primary school children, at least 30 minutes of physical activity should be delivered in school every day through active break times, Physical Education, extra curricular clubs, active lessons or other sport and physical activity events. Schools have the freedom to decide how to meet this expectation and which programmes, such as The Daily Mile, they choose to adopt.


Primary Education: Sports – DfE – Mr Jim Cunningham

Mon, 27 March 2017 | House of Commons – Written Answer

Asked by Mr Jim Cunningham (Coventry South) To ask the Secretary of State for Education, what estimate her Department has made of the proportion of primary school children who do not receive a minimum of two hours of sport and PE activity each week; and if she will make a statement.

Answered by: Edward Timpson Answered on: 27 March 2017

The Department does not hold that information, as the Government does not set a target for how much curriculum time schools must dedicate to Physical Education (PE) or specify the sports and activities that must be taught in schools.

PE remains a compulsory subject at all four key stages in the national curriculum, and we have given schools the freedom to deliver a diverse and challenging PE curriculum that best suits the needs of their pupils.

The Chief Medical Officer has stated that children should be active for 60 minutes a day (of which 30 minutes should be during school time), and we are supporting this through a number of initiatives, including the primary PE and sport premium.

Since 2013, we have invested over £600 million to improve PE and school sport in primary schools through the primary PE and sport premium. In an independent evaluation, 84% of schools reported an increase in pupil engagement in PE during curricular time and in the levels of participation in extra-curricular activities. Research has also shown that primary schools are on average now delivering almost two hours of PE to pupils each week since the introduction of the premium.

But we know there is more to do, which is why we will also be doubling the premium from £160m to £320m per year from September 2017, using money raised by the sugar soft drinks industry levy.


Soft Drinks: Taxation – HM Treasury – Dr Sarah Wollaston

Fri, 24 March 2017 | House of Commons – Written Answer

Asked by Dr Sarah Wollaston (Totnes) To ask Mr Chancellor of the Exchequer, whether he has assessed the potential merits of using money raised through the Soft Drinks Industry Levy to extend the free school meals scheme to (a) nursery schools and (b) private nurseries; and if he will make a statement.

Asked by Dr Sarah Wollaston (Totnes) To ask Mr Chancellor of the Exchequer, what assessment he has made of the potential merits of using money raised from the Soft Drinks Industry Levy to support (a) nursery schools and (b) private nurseries in accessing the Children’s Food Trust accreditation scheme; and if he will make a statement.

Answered by: Jane Ellison Answered on: 24 March 2017 The Government has already confirmed that, in England, we will invest the £1 billion revenue we originally forecast from the Soft Drinks Industry Levy during this parliament in giving school-aged children a better and healthier future, including through doubling the primary school PE and sport premium and expanding school breakfast clubs. The Secretary of State for Education recently set out further details on this, including £415m for a new healthy pupils capital programme. The Department for Education will set out more detail in due course. Grouped Questions: 68234


MPs debate Preventing Avoidable Sight Loss

Tue, 28 March 2017 | Debate – Adjournment and General

NHS England had opted to allow vision services to be planned and delivered on a local rather than a national basis, MPs heard today.

Responding to a debate on preventing avoidable sight loss, Community Health and Care Minister David Mowat declared it “unacceptable” that 20 people a month were losing their sight due to preventable causes, and said that “we need to work collectively to address it”.

He also acknowledged the pressing character of this issue given the increasing elderly proportion of the population, discussing the significance of improving quality of life for the UK’s expanding population of seniors.

He pointed to the significance of other lifestyle factors, such as smoking and obesity, and noted the importance of the upcoming Tobacco Control Strategy, which would feature specific targets by age group, as well as the existing Obesity Strategy.

Mr Mowat welcomed the impact of the new diabetic eye disease screening programme, which had resulted in “significant progress” in preventing this problem. When it came to other causes, including cataracts, age-related macular degeneration and glaucoma, he also referenced the significance of free sight tests at school and for elderly or high-risk populations.

The minister emphasised that treatment was led by CCGs, and noted significant regional disparities which he said suggested local commissioners in areas with particularly high levels of preventable sight loss ought to take action. He flagged the Public Health Outcomes Framework as a good guide in this respect.

Mr Mowat said that NICE guidelines must militate against any rationing of treatment, and promised to investigate why CCGs were not requiring opticians to refer patients to GPs, who would in turn refer onwards to hospitals and opthalmologists.

Discussing Sustainability and Transformation Plans (STPs), he defended the fact that they did not all address avoidable sight loss by describing them as “a process, not an event”, and called on interested parties to continue lobbying local health leaders.

He also said that the same principles on waiting lists should apply to eye appointments as in other areas of NHS care.

Addressing calls for an eye strategy, he argued that this would not be a “panacea”, as shown by experience in Northern Ireland. “My preference is to work with NHS England and with Health Education England, if it is a question of getting more people into roles and all that goes with that”, he commented.

Responding for the Opposition, Shadow Community Health Minister Julie Cooper declared herself “shocked” at the lack of a national sight loss strategy, and called for health professionals to get better access to data; for local service provision; and for an emphasis on prevention. She also declared that STPs represented an “exciting opportunity” to address these issues.

Opening the debate, Conservative MP Nusrat Ghani highlighted her work on the APPG on Eye Health and Visual Impairment, as supported by the RNIB, and noted the statistic that half of sight loss could potentially be avoided.

She complained about the treatment of an individual who had initially been unable to secure the urgent medical attention she needed to preserve her sight, and lamented that NHS England “does not give eye health the profile it deserves”. She pointed out that sight loss was not subject to an NHS England strategy like those in place for hearing loss and dementia, and also expressed regret that the issue was not referenced in STPs.

She called for some “small changes to guidelines and legislation” such as allowing orthoptists to sign hospital eye service spectacle prescriptions, and pointed to the need for screening of children and efficient referral processes.


Health Committee – Government is missing important opportunities to tackle childhood obesity

Mon, 27 March 2017 | Commons Select Committee Press Release

27 March 2017

The Government needs to take more robust action to tackle the impact of deep discounting and price promotions on the sales of unhealthy food and drink, says the Health Committee in its follow up report into childhood obesity.

Given the amount of our food and drink that is purchased on discounts and promotions, the Committee is urging the Government to follow the evidence-based advice to create “a level playing field”. It was Industry representatives themselves, when giving evidence to the Committee, who explained that the current Government plans risk being undermined unless there is regulation. Retailers who act responsibly on discounting and promotions should not be put at a competitive disadvantage to those who do not.

The Government’s plan to tackle childhood obesity was published in August 2016. Although the Health Committee welcomes the measures the Government has announced on the sugary drinks levy, they are extremely disappointed that several key areas for action that could have made the strategy more effective have not been included.

Chair of the Health Committee, Dr Sarah Wollaston MP, says:

“We are extremely disappointed that the Government has rejected a number of our recommendations. These omissions mean that the current plan misses important opportunities to tackle childhood obesity. Vague statements about seeing how the current plan turns out are inadequate to the seriousness and urgency of this major public health challenge. The Government must set clear goals for reducing overall levels of childhood obesity as well as goals for reducing the unacceptable and widening levels of inequality.”

The Committee also calls on the Government to ensure that manufacturers pass on the cost of the levy to ensure that there is a price differential at the point of sale between high- and low- or no-sugar drinks. The Committee feels that this would enhance the effect of the levy in encouraging low or no sugar choices and that failure to pass on the levy would result in consumers having to cross subsidise high-sugar products.

The Committee has welcomed the tiered levy and recognises that this has already started to drive reformulation and further recommends that it be extended to include milk-based drinks with added sugar.

The report welcomes the Government’s positive response to the Committee’s recommendation that the proceeds of the soft drinks industry levy should be directed towards measures to improve children’s health including through increasing access to school sports and to breakfast clubs. The Committee will follow up how the income from the levy is distributed, including the ways in which this can help to reduce the inequalities arising from childhood obesity.

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Report: Industry action on obesity and Type 2 diabetes

The APPG for Diabetes held an evidence session at the House of Commons on Wednesday 18th of January 2017 into industry initiatives to take action on sugar.

Evidence was heard from Mark Saxon, Head of Public Affairs at Coca Cola UK, Will Blomefield, Head of UK Government Relationship at Tesco, Tim Rycroft, Corporate Affairs Director at the Food and Drink Federation (FDF) and Michelle Norman, Head of External Affairs and Dr. Caroline Saunders, Head of Nutrition at Lucozade Ribena Suntory. Written evidence was also submitted to this inquiry by PepsiCo.

The full report can be downloaded here.

As much of the success of the Childhood Obesity Plan depends on the industry’s initiatives, witnesses were clear that there are big limits to what they would be able to do unilaterally. How this will impact the accomplishment of the plan remains to be seen.

The APPG for Diabetes will continue to monitor and comment on this very important area of policy. The next meeting on this topic will be held in October, one year from the Childhood Obesity Plan.

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Next APPG meeting: The Future of Inpatient Diabetes Care

In April the APPG for Diabetes will have a meeting on The Future of Inpatient Diabetes Care, Wednesday, 19 April 2017, 5-6:30pm, House of Commons.

Speakers will include:

  • Lesley Doherty, patient voice;
  • Gerry Rayman, Lead of the National Diabetes Inpatient Audit;
  • Dr Mayank Patel, Consultant Diabetologist for the University Hospital of Southampton;
  • Dr Kath Higgins, Consultant in Diabetes Medicine for the University Hospital of Leicester;
  • Prof Mike Sampson, Chair, JBDS
  • Dr Partha Kar, Associate National Clinical Director, Diabetes, NHS England.

Read the full agenda here: APPG for Diabetes Meeting Agenda 19 of April


One in six hospital beds are occupied by a person with diabetes. Because of poor management and a lack of training for staff about how to care for people with diabetes, a large number of these patients develop complications whilst in hospital that can lead to a longer length of stay.

There are however areas of improvement and many examples of good practice to learn from. The latest National Diabetes Inpatient Audit (NaDIA) report has pointed to reductions in the incidence of hypoglycemic episodes and the development of foot ulcers. However, medication errors are still common and there is a need to improve staffing levels and patient experiences.

How can we make sure that these examples of good practice are shared more widely? What measures should hospitals adopt to improve the experience of people with diabetes in hospital? And crucially, what is the future of inpatient diabetes care?

The APPG will hear from healthcare professionals and care providers on the challenges remaining and innovations that have the potential to improve inpatient diabetes care.


If you would like to attend, please RSVP by emailing diabetes-appg@outlook.com. Due to limits on room capacity, please note that admittance will be on a first come, first served and one organisation, one person basis.


Call for evidence: If you have an opinion, case study or best practice to share, please contribute to our report and send in a written submission to diabetes-appg@outlook.com until midnight April 16.

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The invisible battle of children with medical conditions and their families

On Wednesday 1 March, the All-Party Parliamentary Group for Diabetes and the All-Party Parliamentary Group for Epilepsy had a joint meeting to hear from parents, researchers, campaigners and healthcare professionals on the Safety and Inclusion of Children with Medical Conditions at School.

The meeting was co-chaired by Keith Vaz MP and Caroline Ansell MP, with the illustrious presence of Liz McInnes MP, George Howarth MP, Victoria Atkins MP, Andy Slaughter MP, Andrew Selous MP, Kevin Hollinrake MP and Baroness Bakewell of Hardington Mandeville.

Powerful testimonies were heard from the speakers and the audience on the challenges facing children with medical conditions at school. The Children and Families Act 2014 included a statutory duty requiring all schools in England to make the right arrangements to support children with medical conditions. However, as the evidence heard showed, the duty is not being implemented effectively, leaving over a million children with medical conditions at risk. The evidence collected will be part of a report.

Read the full minutes here: Minutes for the meeting on the Safety and Inclusion of Children with Medical Conditions at School


1.  Louise Taylor, parent

Louise, parent of a child with Type 1 diabetes, spoke of an unfortunate incident her daughter experienced. Her daughter suffered a dangerous hypoglycaemic attack during a cycling proficiency test. The school’s staff had not checked to make sure her daughter had her ‘hypo kit’ with her, and instead made her walk back to the school. When she finally arrived back to school, she was in a poor state and the school did not know how to help her.

“It is a parent’s worst nightmare to get a call from a school saying their child is seriously ill and they do not know how to help her”, shared Louise. Gladly, Louise was able to go to school to her daughter’s aid. It took a long time to get her daughter’s blood sugars back to a safe level. Not only it was an awful physical experience for her daughter, it was also embarrassing and traumatic. Her daughter is now scared of doing things she enjoys, like sports and extra-curricular activities.

The schools did not have a medical conditions policy in place, and did not know it needed one, by law. When the right procedures are in place, school staff can understand their responsibility in keeping children safe and how to do it. Situations like the one experienced by Louise’s daughter can then be avoided. Without it, children with medical conditions are put in unnecessary danger.

Louise also researched her local area to see how many schools had a medical conditions policy. She found that no school was even aware the duty existed. Because of it, Louise started a petition online to call on government to raise awareness and compliance to the law. She met her MP Andy Slaughter at the meeting and together they plan to raise awareness to the duty in their local area.


2.  Sue James, parent

Sue’ son suffers from chronic migraines, Postural Tachycardia Syndrome, Chronic Fatigue Syndrome and Vitamin D Deficiency. This makes her son’s autonomic nervous system malfunction, giving him dizziness, constant migraines and potentially fainting.

“Schools did not understand his conditions”, said Sue. Her son was not allowed to work in the school’s quiet room because he was told it was not suitable for him. When ill, her son is made to walk four blocks until the first aid room, which puts him at risk of accidents. Once, he was made to walk back home without her knowledge. When she asked for a wheelchair her son could use, the schools’ Headteacher advised her son not to use one, saying it “would not look cool”. When raising a complaint, the school deputy disregarded her son’s condition by stating that when she has a headache she takes over the counter medication and is fine the next day. Sue’s son has had a constant headache for 51 months.

Sue was told her son should only come to school when he is fit for work, and if he could not function in a normal classroom without support he could not attend school.

Despite being rated ‘good’ by OFSTED, the school did not have a medical conditions policy nor an individual healthcare plan in place, to the knowledge of the local authority. It was only implemented after Sue pushed for one. But still, the school refused to hear Sue and the healthcare professional’s suggestions for the plan. “There is a lack of understanding and communication”, said Sue.

Eventually, Sue had to take her son out from school per advisement of the Chronic Fatigue Syndrome team at hospital, as functioning without support in a mainstream school was too much for his health.


3.  Sara Milocco, parent

Sara’s daughter has coeliac disease and needs to follow a gluten free diet to avoid pain, vomiting, lethargy, emotional distress and, in the long term, cancer and osteoporosis. She had been trying to get the school to provide her daughter with gluten free food for years, but never received a response. When the duty came to force, she used it as a leverage to start a conversation, but still faced overwhelming resistance.

“The school still did not see coeliac disease as a medical condition and did not feel they had the obligation and responsibility to support my daughter at school”, said Sara. Even when she tried to compromise and offered to contribute with meals for her daughter, her help was denied as it would isolate the other students who might also want homed cooked meals. Sara’s concerns about the understanding of the catering staff and the risks of contamination were continuously dismissed.

In 2016, her daughter was given a full plate of pasta by the school and assured it was gluten free. It was not, and her daughter vomited it two hours later and had to be sent home in pain. Later, for simplicity, the school subjected her daughter to eat jacket potatoes and beans every day, which is far from a healthy balanced meal. As a result, her daughter’s well-being, concentration and growth was impacted. Sara was advised by her daughter’s doctor to withdraw her daughter from school meals, as her daughter had not grown in height or weight for six months.

“There is a lack of appropriate training, willingness to listen and care”, said Sara. She had to step up her complaints in order to be heard, but it still became her responsibility to raise awareness among school staff on gluten and the risks of contamination. It took Sara’s time, understanding and commitment to make any change happen. “What about parents who do not have the ability or time to bring a similar campaign forward?” she asks, wondering if their children do not deserve the same support. To this date, her daughter’s school still does not have a medical conditions policy in place, despite being rated as ‘outstanding’ by OFSTED.


After the parents spoke, Caroline Ansell MP stated there is a clear lack of compassion and understanding for the needs of children with medical conditions and thanked the parents for sharing their ongoing battles to get their children the support they need in school. She raised the issue of responsibility and asked if any of the parents had contacted their respective Governors. All parents had, none received a positive response. Caroline Ansell MP also empathized with the speakers and raised the issue of how parents can appear “too demanding” when all they want is their right.

George Howarth MP shared his concern about the psychological impact poor care and discrimination can have on children with medical conditions, saying there is a need to address the issue of bullying.


4.  Professor Helen Cross, Great Ormond Street Hospital

Helen started by explaining epilepsy is a condition which is characterised by recurrent seizures. Approximately two thirds of people with epilepsy have their seizures controlled by medication. She said in childhood, epilepsy is more common than diabetes, and there is still an element of stigma attached to epilepsy as many people are unaware of how the condition can affect young people.

“Parents may be aware of difficulties their children are experiencing at school, but many teachers are unaware what they are going through”, said Helen. As a solution, Helen said there is a need to raise awareness in schools and every school should have a medical conditions policy in place.

She explained how children with medical conditions may not want to be labelled at school, such as having photo charts on the wall or needing to go to a specific place if they have a seizure, so it is important to communicate with the parent and the child when building an Individual Healthcare Plan. Helen explained how this may not seem a priority if a young person’s seizures are under control, but Epilepsy may still be affecting their learning. “Every child needs an Individual Healthcare Plan”, said Helen.

Helen also spoke about the need for paediatric specialist nurses and their importance in providing a link for the young person by going into schools. She mentioned how the school nursing provision has unfortunately been reduced. She also called for the need for psychological support, as this is affects many young people with epilepsy, as well as other medical conditions.

Finally, Helen brought up the need to maintain support for children in secondary school. Many secondary schools find that issues affecting young people with medical conditions have not previously been recognised at primary school. She explained how this has a knock-on impact on young people, with some of them being recommended for fewer GCSEs or none. “Children with medical conditions need support at whatever time the condition is recognised”, she said.


5.  Simon Dyson, Professor of Applied Sociology at De Montfort University

Simon Dyson is part of a team of researchers at De Montfort University who report on the experiences of young people with sickle cell disorders (SCD) in the education system. SCD is a complex condition with major symptoms including strokes, silent strokes, chronic pain and acute painful crises. His team surveyed local authorities in England, pupils living with SCD and schools attended by young people with SCD.

He started by sharing some of the experiences he collected showing how children with SCD are not being cared for adequately at school. “In an academy school in England, a young girl with SCD was having a severe painful crisis and was rolling around on the floor in agony while other children film her on their mobile phones. The teacher did not intervene”, said Simon. A majority of children with SCD are prevented from going to the toilet when needed, about half reported not being permitted to drink water, and about a third are made to take unsuitable exercise. Simon explained all of these could trigger a severe sickle cell painful crisis, and all could have been avoided.

To make matters worse, a third of children said they have been called lazy when in fact they are tired from their anaemia. Moreover, parents are being threatened with fines for missed schooling when it is schools who are failing in their duty to include young children with medical conditions and help them catch up on missed work. “Lack of knowledge leads schools to misunderstand children’s accounts and make simple, but dangerous mistakes”, said Simon.

Simon explained how there is a need to raise awareness of the full implications of a condition, not just acknowledging its existence, as awareness without understanding allows children with SCD to became targets of bullying and discrimination. Even so, Simon shared there is evidence that raising teacher awareness is important, it was insufficient to make the difference in school experience. “Teachers are often overloaded and stressed and they need to be supported”, said Simon. It was only a background policy that was able change the social environment of the school and promote school inclusion, detailing procedures in a way that does not require teachers to be specialists of every condition.

However, results from Simon’s research has found that less than 10% of schools had such a policy in place. Furthermore, Simon shed light to the issue of accountability. In his research, only about 13% of local authorities contacted could state how many children under their jurisdiction had an individual healthcare plan or knew how many children with SCD they had in their schools. “At this level, SCD as a potential issue affecting pupils is relatively invisible in education policy terms”, said Simon. He declared OFSTED must be instructed to assess quality of inclusion of pupils with medical conditions as part of school inspections.


Liz McInnes MP agreed with speakers on the importance of supporting children with medical conditions at school, and raised the issue of school nurses. She questioned if this could be the solution to the problem. Simon Dyson responded that, at the moment, there is only about one school nurse for five schools. While it would be helpful to have more nurses, he said “a whole school change is needed”. Schools must change culture to fully include children with medical conditions, must change procedures to prevent them from becoming ill, and every staff should be prepared to help in case of an emergency.


6.  Thalie Martini, Diabetes UK Make the Grade Delivery Manager

Thalie is the chair of the Health Conditions in School Alliance, a group of over 30 organisations working together for the rights of children with medical conditions at school. She talked about how good care and inclusion in school ensures these children are safe and can achieve their academic potential. “Good care can be achieved when clear overarching procedures and policies are in place in schools”, said Thalie. She explained how the new duty in England has the potential to make a significant difference to the lives of over a million children with medical conditions. The problem is that the duty is not being implemented correctly.

She summarized the evidence from the meeting and how it resonates with the evidence collected by the Alliance. Parents from across health conditions are concerned for their child’s safety due to their necessary day to day management, fear their child will be excluded or put at a disadvantage because of their condition, and worry about school staff not being properly informed to know what to do to prevent their child becoming ill or excluded, or help in case of an emergency.

Thalie shared the results of two Freedom of Information (FOI) investigations conducted by the Alliance. In 2015 and in 2017 less than 12% of schools demonstrated statutory arrangements were in place to support children with medical conditions. As the causes for the poor implementation, the Alliance found that ‘lack of confidence’ and ‘fear of not knowing what to do’ were the main issues declared by schools. While most might be aware of the legislation, they do not understand it and know what is required of them. “There is limited support for schools”, said Thalie, “and it is unclear how the Department of Education is supporting them”. She shared how, through her experience with Diabetes UK Make the Grade Campaign, when schools have the tools to implement the duty correctly good care happens. “Schools need to be informed and supported to implement the duty”, said Thalie.

The issue of accountability was again brought up, with Thalie saying there is also a “limited monitoring of implementation”. Thalie shared the results surveys and investigations conducted by the Alliance, showing that less than 1% of Local Authorities check that schools have implemented the duty and only 27% of schools say OFSTED checked for their medical conditions policies in the last inspection. At this point, the struggles of children with medical conditions and their families remain invisible. “Implementation of the duty must be routinely monitored”, said Thalie. While the statutory guidance states that “inspectors must consider how well a school meets the needs of the full range of pupils, including those with medical conditions”, the OFSTED’s inspection handbook does not reference the statutory guidance.

As a solution, Thalie stated the Department of Education must take action to raise awareness of what is required in schools, and OFSTED must ensure inspectors are trained and equipped to routinely check schools’ medical conditions policies at inspections.


Caroline Ansell MP commented how it is positive to remember good care in school exists, and the importance of sharing good practice between schools. She said to be glad to hear there is a “blueprint” for solving the problems parents had shared. Kevin Hollinrake MP and Andrew Selous MP talked about the importance of raising awareness with schools of good practice and their statutory duty, suggesting a MP toolkit could be helpful to make sure that schools understand their obligations.


7.  Group Discussion

After each of the panel speakers spoke, Keith Vaz MP opened the floor for questions and many guests shared their personal experiences with the group.

One example was Emma Williams, parent of a child with both Type 1 diabetes and coeliac disease. She faced an uphill battle to convince her school the duty was statutory, but even after adopting it her school refuses to follow the agreed healthcare plan. As a result, the school failed to call an ambulance when her son suffered a dangerous hypoglycaemic attack. Moreover, her son is excluded from attending after school clubs and is continuously discriminated against. Her councillor arranged for someone from the Local Authority to go into school, but Emma could not input into the report or respond to the school’s allegations. The report goes as far as stating that drinking water can prevent a hypoglycaemic attack, when it cannot. The school’s governors’ suggested she moved her son to another school and claimed, in writing, his presence is “detrimental to all other 209 pupils”. Emma contacted the Department of Education, who advised the school was in the wrong, but said Emma would need to resolve the matter for herself with the school. She contacted Ofsted, who advised her they do not deal with individual child’s issues.

Emma’s despair in trying to guarantee her son’s safety and inclusion, something he is entitled to by right, is exemplar of why action must be taken to make sure the duty is adequately implemented in schools.


Next meeting

Keith Vaz MP thanked all speakers for their evidence. He reiterated the need to raise accountability and ensured both APPGs would continue to take this matter forward.

The next APPG for Diabetes meeting will take place on Wednesday, 19 April 2017 and will focus on the Improving Inpatient Care: Challenges and Best Practices. Please email diabetes-appg@outlook.com if you would like to attend.

Article

Weekly diabetes parliamentary round-up

House of Commons Questions

Hypertension – DH – Jim Shannon

Fri, 10 February 2017 | House of Commons – Written Answer

Asked by Jim Shannon (Strangford) To ask the Secretary of State for Health, what recent steps the NHS has taken to tackle trends in blood pressure related complaints among people in their 50s.

Answered by: Nicola Blackwood Answered on: 10 February 2017

In 2016, NHS RightCare published its Cardiovascular disease (CVD) prevention optimal value pathway, which outlines best practice care pathways to help improve CVD prevention, including opportunities to better detect, diagnose and control cases of high blood pressure. The pathway can be viewed here:

https://www.england.nhs.uk/rightcare/intel/cfv/cvd-pathway/

NHS England’s National Clinical Director for Cardiovascular Disease Prevention launched a new resource for clinical commissioning groups and general practitioners (GPs) ‘Blood Pressure – How Can We Do Better?’ It was developed by GPs, nurses and pharmacists working with partners including NHS England, Public Health England, the British Heart Foundation, the Stroke Association and the Royal College of General Practitioners. It can be accessed at:

https://www.bhf.org.uk/bp-how-can-we-do-better

NHS England is a member of the Blood Pressure System Leadership Board, established by Public Health England, to help drive improvements in the prevention, detection and management of high blood pressure.

The NHS Health Check is a national programme that aims to prevent heart disease, stroke, diabetes and kidney disease, and raise awareness of dementia both across the population and within high risk and vulnerable groups. Between April 2013 and September 2016, 4.9 million people have benefitted from a blood pressure check as part of their NHS Health Check. Evaluation of the programme demonstrated that one case of hypertension is diagnosed in every 27 people receiving a check.


Diabetes: Health Education – DH – Jim Shannon

Wed, 8 February 2017 | House of Commons – Written Answer

Asked by Jim Shannon (Strangford) To ask the Secretary of State for Health, what steps his Department is taking to reduce the number of people diagnosed with diabetes.

Answered by: Nicola Blackwood Answered on: 08 February 2017

The National Health Service Diabetes Prevention Programme (NHS DPP) is a joint commitment from NHS England, Public Health England and Diabetes United Kingdom, to deliver at scale evidence based behavioural interventions for individuals identified as being at high risk of developing type 2 diabetes.

The NHS DPP operates through a national framework of providers able to deliver a nine month structured programme of behaviour and lifestyle interventions, tailored to personal need. Local health economies select their preferred provider and work with them to ensure the content responds to the needs of the local population demographics, and to generate the referrals. The intervention is group based behavioural coaching, includes advice on the risks of diabetes and support to achieve personal goals related to a healthy weight, nutrition and reaching the Chief Medical Officer’s recommended levels of physical activity.

The NHS DPP supports people to take control of their own health to reduce the risk of developing type 2 diabetes. Eligible individuals have a raised blood sugar associated with risk factors such as age, ethnicity or high Body Mass Index.

To the end of November 2016 13,383 at risk individuals had been referred to the NHS Diabetes Prevention Programme. By 2020 up to 100,000 individuals per year will be able to access the service.


NHS: Standards – DH – Mr Kevan Jones

Mon, 6 February 2017 | House of Commons – Written Answer

Asked by Mr Kevan Jones (North Durham) To ask the Secretary of State for Health, what guidance his Department issues to clinical commissioning groups on implementation of quality statements made by NICE published in Quality Standards.

Answered by: Nicola Blackwood Answered on: 06 February 2017

The Department has not issued any guidance to clinical commissioning groups (CCGs) on implementation of National Institute for Health and Care Excellence (NICE) quality standards.

NHS England has advised that NICE guidance, including quality standards, is built into advice provided to commissioners on specific clinical areas of work as appropriate. For example, the End of Life Commissioning Toolkit, published April 2016, supports delivery of the NICE Quality Standard on end of life care in adults and is published at:

https://www.england.nhs.uk/wp-content/uploads/2016/04/nhsiq-comms-eolc-tlkit-.pdf

In addition, as part of the current Diabetes Treatment and Care transformation funding bidding process, part of the scoring criteria for bids includes consideration of the degree to which the proposed developments will be compliant with NICE guidance, including relevant quality standards.

NICE has advised that it provides support and resources to help CCGs work with and use quality standards. This includes the development of formal indicators related to quality standards to measure the quality of care at CCG level, visits from the NICE field team of implementation consultants, a forward plan of topics, including likely resource implications, tools to support measurement against the standards and databases of shared learning examples about the experience of others working with quality standards and levels of uptake of these standards.


Obesity: Children – DH – Andrew Rosindell

Wed, 8 February 2017 | House of Commons – Written Answer

Asked by Andrew Rosindell (Romford) To ask the Secretary of State for Health, what steps his Department is taking to educate parents on child obesity.

Answered by: Nicola Blackwood Answered on: 08 February 2017

Tackling childhood obesity is a priority for this government as set out in the Childhood Obesity Action Plan (2016), and providing information to parents is an important part of our strategy.

Change4Life is Public Health England’s (PHE) flagship campaign to help families and children in England to eat well, and move more. In January 2017 Change4Life launched the Be Food Smart campaign, which provides practical information to parents on the sugar, salt and saturated fat content of everyday food and drink.

PHE is also responsible for the National Child Measurement Programme (NCMP). PHE provides guidance to local authorities on how to meet their statutory requirement to weigh and measure every child attending state school in reception and Year 6. PHE recommends that parents are provided with information about the programme and a feedback letter reporting the results. The template materials provided for local tailoring include information about maintaining a healthy weight and links to NCMP pages on the Change4Life website.

The Change4Life website can be viewed here:

https://www.nhs.uk/change4life-beta/be-food-smart


Soft Drinks: Taxation – HM Treasury – Mr Laurence Robertson

Fri, 3 February 2017 | House of Commons – Written Answer

Asked by Mr Laurence Robertson (Tewkesbury) To ask Mr Chancellor of the Exchequer, what criteria he is using to determine which soft drinks will be subject to the soft drinks industry levy announced in the Budget 2016.

Asked by Mr Laurence Robertson (Tewkesbury) To ask Mr Chancellor of the Exchequer, what estimate he has made of the potential revenue to the Exchequer from the proposed soft drinks industry levy.

Asked by Mr Laurence Robertson (Tewkesbury) To ask Mr Chancellor of the Exchequer, what recent assessment he has made of the possible negative effect on businesses of the proposed soft drinks industry levy.

Answered by: Jane Ellison Answered on: 03 February 2017

As announced at Budget 2016, the levy will apply to added sugar soft drinks with total sugars above 5 grams per 100 millilitres.

The Government consulted on the detail of the soft drinks industry levy last year. In December 2016, we published our formal response to the consultation, alongside draft Finance Bill legislation, setting out further detail on the scope of the levy and those drinks included.

As for every Finance Bill measure, HM Revenue and Customs published a Tax Impact Information Note which included an updated impact assessment.

The Office for Budget Responsibility has estimated that the levy will raise £520m in the first year, £500 million in the second year, falling to £455m in the third year as more producers reformulate. These estimates are sensitive to the speed of reformulation.

Article

Weekly diabetes parliamentary round-up

House of Commons Questions

Churchill, J – PMQs – Type 2 diabetes research

Wed, 1 February 2017 | House of Commons – Oral Question

Jo Churchill (Bury St Edmunds) (Con) This week the Danish drug firm Novo Nordisk invested £115 million in the UK to further research into type 2 diabetes. Will the Prime Minister join me in welcoming that investment as well as the academics and scientists involved, many of whom are from the EU and around the world and will appreciate the assurance she gave earlier? Will she also work with me to ensure that any innovations and new treatments get to patients as quickly as possible?

The Prime Minister As my hon. Friend will probably understand, I recognise this issue particularly personally, although I am a type 1 diabetic rather than type 2. Any investment in diabetes research is to be welcomed, and when new solutions and support for diabetics are found, it is important that they get to people as quickly as possible. A significant number of people in this country suffer from type 2 diabetes, and the figures show that there is a great risk that the number will increase significantly in the coming years. We need to do all that we can not only to prevent people from becoming type 2 diabetics in the first place, but to support those who have that condition so that people suffer from fewer complications and are able to manage their lives.


Older People: Health Education – DH – Jim Shannon

Tue, 31 January 2017 | House of Commons – Written Answer

Asked by Jim Shannon (Strangford) To ask the Secretary of State for Health, what recent steps his Department has taken to issue guidance on how people aged 50 years and older might reduce the risk of their suffering strokes and heart attacks.

Answered by: David Mowat Answered on: 31 January 2017

The Department does not plan to issue any guidance on this matter.

A significant amount of work is being taken across NHS England and Public Health England (PHE) in relation to reducing risk of heart attack and stroke, including:

– PHE’s role in addressing cardiovascular disease (CVD) is set out in Action on cardiovascular disease: getting serious about prevention which is available at the following link and includes guidance in the form of resources and support that PHE provides to help tackle CVD prevention:

https://www.gov.uk/government/publications/cardiovascular-disease-getting-serious-about-prevention

– PHE and partners have published an updated version of the Heart Age Tool, which is designed to help people understand their heart health and cardiovascular risk factors;

– PHE supports local authorities with delivering the NHS Health Check programme, tackling the leading risk factors that contribute to preventable death and disability with the potential reach of 15 million eligible people in England, and issues regularly updated best practice guidance to help aid the implementation of the programme;

– Rolling out the NHS Diabetes Prevention Programme across England, offering intensive behaviour change support to individuals identified as at high risk of diabetes – a major cause of heart attack and stroke; and

– PHE also manages campaigns specifically targeting the over 50s including the Be Clear on Cancer campaign to raise awareness of respiratory symptoms, including breathlessness, which can be a symptom of heart disease and the Act FAST campaign to raise awareness of the signs of a stroke and encourage people to call 999 immediately, so that those experiencing a stroke get to hospital as soon as possible.


Diabetes: Health Education – DH – Keith Vaz

Fri, 27 January 2017 | House of Commons – Written Answer

Asked by Keith Vaz (Leicester East) To ask the Secretary of State for Health, which clinical commissioning groups (CCGs) have received funding under the NHS Diabetes Prevention Programme; and how much funding each of those CCGs received.

Answered by: Nicola Blackwood Answered on: 27 January 2017

In 2016/17, NHS England funded local health economies with a total of £1,474,500 to support implementation activities and costs relating to the NHS Diabetes Prevention Programme (NHS DPP). Health economies are partnerships of clinical commissioning groups and local authorities.

NHS England has also nationally commissioned the NHS DPP behavioural interventions that are provided to local health economies.


School Milk – DfE – Julie Elliott

Fri, 27 January 2017 | House of Commons – Written Answer

Asked by Julie Elliott (Sunderland Central) To ask the Secretary of State for Education, what plans her Department has to encourage greater uptake of free milk in schools and nurseries.

Answered by: Edward Timpson Answered on: 27 January 2017

The government wants pupils to be healthy and well nourished. We already encourage the consumption of dairy products as part of a balanced diet through school funding, legislation and guidance.

Schools must provide free milk to all disadvantaged pupils when it is served during the school day as required by free school meals and milk legislation. Free milk is also provided to pupils in reception, year 1 and 2 when served as part of universal infant free school meals provision. To improve uptake, we are exploring what opportunities exist in the longer term to make the free school meals registration processes more efficient.

The School Food Standards provide the legislative framework to ensure schools provide children with healthy food and drink options, which includes a requirement to make milk available at least once during the school day. As part of our work on the childhood obesity plan we will be promoting these standards to those academies and free schools where they do not already apply.

Department of Health spending on the Nursery Milk Scheme has doubled since 2007/08. The Scheme provides 1/3 pint (189ml) of milk per day to children under the age of five attending childminders or private and local authority nurseries for at least two hours a day. In addition, the EU School Milk Scheme provides subsidised milk to school children and plays a valuable role in encouraging the consumption of dairy products and contributing to the development of healthy eating habits from an early age.


Soft Drinks: Taxation – HM Treasury – Mr Laurence Robertson

Fri, 3 February 2017 | House of Commons – Written Answer

  1. Asked by Mr Laurence Robertson (Tewkesbury) To ask Mr Chancellor of the Exchequer, what criteria he is using to determine which soft drinks will be subject to the soft drinks industry levy announced in the Budget 2016.
  2. Asked by Mr Laurence Robertson (Tewkesbury) To ask Mr Chancellor of the Exchequer, what estimate he has made of the potential revenue to the Exchequer from the proposed soft drinks industry levy.
  3. Asked by Mr Laurence Robertson (Tewkesbury) To ask Mr Chancellor of the Exchequer, what recent assessment he has made of the possible negative effect on businesses of the proposed soft drinks industry levy.

Answered by: Jane Ellison Answered on: 03 February 2017

As announced at Budget 2016, the levy will apply to added sugar soft drinks with total sugars above 5 grams per 100 millilitres.

The Government consulted on the detail of the soft drinks industry levy last year. In December 2016, we published our formal response to the consultation, alongside draft Finance Bill legislation, setting out further detail on the scope of the levy and those drinks included.

As for every Finance Bill measure, HM Revenue and Customs published a Tax Impact Information Note which included an updated impact assessment.

The Office for Budget Responsibility has estimated that the levy will raise £520m in the first year, £500 million in the second year, falling to £455m in the third year as more producers reformulate. These estimates are sensitive to the speed of reformulation.


Exercise: Children – DfE – Maggie Throup

Thu, 2 February 2017 | House of Commons – Written Answer

Asked by Maggie Throup (Erewash) To ask the Secretary of State for Education, if she will make it her policy to ring-fence a proportion of the revenue raised from the sugar levy to support the least active children to exercise more.

Answered by: Edward Timpson Answered on: 02 February 2017

We want all pupils to be healthy and active. Since 2013, we have invested over £600 million of ring-fenced funding to improve PE and sport in primary schools through the Primary PE and Sport premium. Evidence indicates that the funding is having a major impact, with 84% of schools reporting an increase in pupil engagement in PE during curricular time and in the levels of participation in extra-curricular activities.

Schools have the freedom to decide how best to use the funding based on the needs of their pupils, and the evidence indicates that the majority of schools are already targeting some of their funding at the least active pupils within their schools.

But we know that there is more to do, which is we have committed to using revenue from the soft drinks industry levy to double the primary PE and sport premium to £320 million a year from September 2017. This will enable schools to make further improvements to the quality and breadth of their PE and sport provision.