Written evidence from UNISON (SEN 489)

 

Education Committee

Solving the SEND crisis

 

UNISON is a trade union representing around 250,000 school support staff across all school settings including primary, secondary and special schools, along with alternative provision. We are submitting evidence because our members working in schools often play a key part in the school life and education of SEND pupils, particularly teaching assistants and pastoral staff. UNISON is submitting a thorough response to this call for evidence via the Special Education Consortium. However, we are also submitting this separate response to provide detail on the importance of considering how the health needs of pupils are met as part of this review, and to share a UNISON survey of our members who work with children with SEND.

 

1)     Supporting children with health needs

Our evidence here is most relevant to these specific questions:

 

The definition of inclusivity in mainstream schools and early years settings should encompass the need for the health requirements of pupils to be appropriately met, regardless of the school setting they are in. Under the NHS constitution, every individual is entitled to receive care and treatment that is appropriate to their needs and NHS services should work across organisational boundaries when necessary. But at the moment, school support staff are increasingly being used as substitutes for clinical professionals in both mainstream and special schools, which we believe is a result of funding pressures on the NHS since 2010. 

 

This practice jeopardises the safety of both staff and children and is also incompatible with current legal, governance and regulatory frameworks which, in our view, do not allow for the delegation of clinical nursing tasks into the education sector. A compliant solution must be found, which puts the right people in the right place to provide care. This should include an NHS-commissioned, needs-led clinical school nursing service for all schools, alongside the LA-commissioned public health nursing service. Ensuring safe care for pupils with medical needs must be a top priority.

 

For children who require health provision whilst at school, system-level change is needed. The DfE statutory guidance on supporting children with medical conditions does not place a clear limit on the health care that schools can directly provide and fails to recognise the concept of delegation of NHS care at an individual or organisation level. There appear to be no general legal provisions in place at an organisational level which permits NHS Act 2006 healthcare services to be delegated from the NHS to schools. Without an organisational level framework, governance structures are not in place, hence it is hard to see how delegation at an individual level from a registered professional to an unregulated member of staff is possible.

 

By contrast, a general framework IS in place, allowing NHS Act 2006 healthcare services to be delegated to the adult social care sector. This is set out in section 22 of the Care Act 2014 which explains the specific circumstances in which health activity can be delegated from the NHS. DHSC national guidance provides examples of healthcare activities that may be considered suitable for delegation in health and social care settings. Examples include supporting diabetes management e.g. monitoring blood glucose levels and administering insulin and also catheter care. The DHSC guidance sets out the principles for the health and social care sectors in the context of individual and organisation-level delegation. Further, CQC regulation and governance cover both sectors, providing a cohesive system with the appropriate safeguards in place.

 

This comparator makes clear the lack of statutory, regulatory and governance schemes linking the health and education sectors.

 

We do acknowledge that there is, in limited circumstances, a legal basis for delegation of NHS Act 2006 healthcare activity in the school setting i.e. for children with Education, Health and Care (EHC) plans where the healthcare activity has been ‘deemed’ special educational provision. However, as noted, this would be limited (4.8% of pupils in England have an EHC plan), and the important proviso is that the health care provision must function to ‘educate or train’. This legal provision was included to reflect case law around therapy interventions. Assuming a compliant decision-making process, in our opinion, the very nature of nursing care would typically exclude nursing interventions from meeting the ‘educate or train’ function criteria.

 

The medical care which some teaching assistants are being asked to deliver (such as intermittent catheterisation, enteral feeding and tracheostomy care) with minimal or no NHS-commissioned clinical support, goes far beyond the health support a school can reasonably be expected to provide under their statutory duties such as:

 

 

The Children and Families Act 2014 Section 100 duty on schools is for them to ‘make arrangements’ to support pupils with medical conditions; however the accepted narrative has become that ‘schools must provide what is needed’. This narrative sidesteps the legal obligations of the NHS and positions schools as a substitute NHS service. This is causing acute local issues between schools, NHS practitioners/commissioners and local authorities and exposes everyone involved to unacceptable risks. A further workforce issue is that the majority of support staff are not paid any extra to take on these extra responsibilities  and the additional stress and worry about things going wrong is impacting on staff retention (see our survey on these issues for more information).

 

We note that a 2022 House of Lords report providing post-legislative scrutiny on the Children and Families Act 2014 says the following:

“….in relation to section 100—the duty on schools to make arrangements for supporting pupils with medical conditions—the Government’s one sentence assessment was: “The department does not monitor compliance with the duty and has not carried out any research on the impact of this duty.”

 

It is vital that compliance with the duty is urgently reviewed by the Government and systems put in place to enable children with medical conditions to receive the NHS care they are entitled to under the NHS Constitution.

 

For more information on these issues please see Supporting-pupils-with-medical-conditions-1.pdf

 

 

2)     UNISON survey of members who work with children with SEND

In October 2023 we surveyed our members who work with children with SEND across England. Of the respondents, over half provided in-class support in mainstream settings, with over a quarter performing a similar role in special schools. We received a smaller number of responses from members who worked in non-classroom based roles in special schools and alternative provision settings.

 

Members who worked in specialist settings providing in-class support were asked if they felt that the children were best served by this setting. Over half agreed that they were, 32% felt they were not whilst 12% were unsure. Amongst the comments, many respondents felt that the problem for these learners was the lack of staff, funding and adequate resources to be able to support them properly.

 

Concerns

 

The main concern highlighted was the behaviour of learners, followed by concerns that job descriptions did not reflect the day-to-day realities of their roles and then, a lack of facilities/resources:

 

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Behaviour concerns

 

Of those who reported concerns with behaviour, over 9 in 10 respondents felt that the behaviour of learners made learning difficult/impossible for others in the class, with over half reporting that they personally do not always feel safe, particularly those in special schools (67%). Nearly 3 in 10 felt that the school’s behaviour policy was not effective. Many staff reported being the targets of violent behaviour. Hundreds of harrowing stories were revealed:

“I get hit on a daily basis”

“I have been pinched, kicked, hit in the face…”

“I have new bruises every week on my arms and legs”

 

Parental concerns

 

Of those respondents who reported concerns with parents, 4 in 5 felt that parents did not work in partnership with the school, just under ½ felt that parents were too demanding and a 1/3 did not like the way they were treated by some parents. Many of the comments reflected that some parents were abusive to staff, many do not understand the pressures of having to cope with the needs of every child not just their own and some expected staff to deal with issues that should be dealt with at home.

 

Healthcare needs (see first section on page 1 ‘Supporting pupils with health needs’ for the legal, regulatory and governance issues around this)

 

Of the respondents who indicated that they deal with the healthcare needs of pupils, over 4 in 5 do not feel that their pay reflects these specialist skills (88% in special schools) and 70% are worrying about the consequences if something went wrong (rising to 75% of staff in mainstream). Nearly 1/3 were not made aware that they would need to carry out these procedures when they were offered the job and nearly 2/3 feel that they shouldn’t be treated as a healthcare assistant when they are an education worker. Many reported that many hours are taken up with non-education needs with one reporting that she feels lucky if she spends 25 minutes of a lesson actually supporting learning, due to the lack of school nurses. Many respondents pointed out that learners are presenting with ever-more complex needs and the lack of specialist provision is compounding the issue.

 

Intimate care needs

 

Of the respondents who deal with intimate care needs, over half were asked to undertake these tasks unchaperoned, which they feared could leave them at risk of an unfair allegation. Over 43% were not made aware that they would need to carry out these tasks when they were offered the job and ¼ are not given the correct equipment. Worrying, ¼ have raised their concerns with their employer, but these have not been dealt with.

 

Job descriptions

 

Of the respondents who indicated concerns with their job description, a huge 86% state that their role has changed but it is not reflected in their JD, or importantly, pay. Over ½ often feel they are expected to do a teacher’s job and 1/3 are often asked to do jobs that other members of support staff should be doing. Staff told us that they are expected to take on break/lunch-time duties, many told us that they spend a lot of time dealing with behavioural issues – many of the problems are caused by staffing and funding shortages.

 

Management

 

Of the respondents who identified management as a top concern, over 4 in 5 stated that they did not feel personally supported by management, rising to 90% in AP settings. This was not reflected in overall management, since just over ½ stated that the school is not well managed in general. Most of the comments suggested that management simply do not have enough understanding of SEND leaving support staff feeling unheard, over-worked and disrespected.

 

Resources

 

Respondents were asked for comments regarding lack of resources/facilities in the school. Issues were pointed out including lack of space/additional rooms, lack of equipment, lack of intervention resources and lack of staff.

 

Only ½ of the members we questioned felt they had enough relevant training to feel competent in performing their job role.

 

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43% of staff had felt pressured to undertake tasks that they did not feel confident doing. Of these, only 5% received extra training to give them the confidence to do their job, 10% refused to do the task and the remainder did it anyway, despite feeling uncomfortable. The comments showed that this resulted in children sometimes being put in danger (to their health), staff being put in potentially violent situations and children’s learning being detrimentally affected.

 

Safeguarding

 

Nearly 1 in 5 respondents felt that safeguarding issues were apparent in their workplace, often due to children’s behaviour and not enough staff to deal with violent episodes.

43% of respondents had felt the need to make a safeguarding concern to their employer, but only 70% felt that the concern reported was responded to adequately by their employer.

 

Most staff reported having been assaulted in their job, with 2/3 reporting physical assaults.

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42% of staff who had reported assaults did not feel that they had been dealt with adequately. Many staff commented that no action was taken at all, with others reporting that that the situation was trivialised and staff were not offered any support.

 

A particular problem was noted in respondents whose job role was to provide in-class support to learners with social/communication needs or social/emotional/behavioural difficulties, across all settings.

 

Here 87% of members reported having been assaulted physically by children, with over 1/3 feeling that reported assaults were not dealt with adequately.

 

We asked members if their school had a policy for preventing and dealing with violence towards staff in schools, but only just over 1/2 of respondents were aware of a policy and had read it.

 

Conclusions

 

This report highlights several issues amongst support staff working in SEND in England’s schools.

Schools are under-resourced and the consequences of this are being felt keenly amongst the lowest paid members of staff. Most significantly, this situation has not improved, and in many cases is worse than when we previously surveyed staff who work with learners with SEND in 2021. There was a particular increase in members who reported behaviour as a main concern, from just over half of respondents in 2021 to approximately 2/3 in 2023. There was a significant increase in respondents who said that some children’s behaviour made it difficult to learn. Staff providing in-class support in special schools in particular feel neither safe at work, nor paid adequately.

 

Staff do not feel supported, either by their managers or by parents. There was a significant increase in the numbers who said that they do not feel parents work in partnership with staff at the school. Many staff, even if they think their school is generally well-managed, do not feel personally supported by management.

 

February 2025