One in four school pupils in England lives with a long-term medical condition. These children have the right to fully participate in school life and to receive quality NHS healthcare.
However, cuts to clinical services have increasingly shifted responsibility for healthcare to schools. As a result, non-clinical school staff – including teaching assistants and office staff – are performing complex medical procedures such as intermittent catheterisation, tracheostomy care and enteral feeding, often with little or no NHS support.
UNISON’s survey of 4000 members in June 2025 revealed the extent to which school support staff are expected to carry out medical procedures.
UNISON’s campaign
UNISON argues that this situation exposes staff and pupils to unacceptable risk and is inconsistent with legal, regulatory and governance frameworks, which establish the delivery of:
- Clinical services via the NHS
- Public health services via local authorities
- Welfare and health support via schools
Despite this framework, there is widespread confusion in practice. While schools are required by law to ‘make arrangements’ to support pupils with medical conditions, this has been misinterpreted as meaning that schools themselves must deliver healthcare. In fact, it is our understanding that schools are not authorised to provide NHS healthcare services, except in limited cases where healthcare is deemed special educational provision. This would only apply to pupils with an Education, Health and Care Plan (EHCP) where specific criteria has been met.
UNISON is calling for a needs-led, NHS-commissioned clinical school nursing service embedded in all state-funded education settings with any delegated clinical tasks undertaken by NHS-employed staff e.g. healthcare assistants. This would operate alongside the local authority-commissioned public health nursing service.
With the forthcoming refresh of the 2023 NHS Long-Term Workforce Plan and anticipated reforms to the SEND system, now is the time to fix these problems.
Joint position statement
UNISON has agreed a joint position statement on these issues with the Association of School and College Leaders (ASCL), GMB, the National Association of Head Teachers (NAHT) and Unite.
Joint MP briefing
UNISON has developed a briefing for MPs (England) along with GMB and Unite which members can send to their MP.
Advice for union members
UNISON’s branch guidance on supporting pupils at school with medical conditions provides a commentary on the Department for Education’s statutory guidance, ‘Supporting pupils at school with medical conditions’.
Members who are concerned about being pressured to carry out clinical tasks should also contact their branch for advice and support.