5.26 Joint Protocol between Health Services & Schools in respect of the management of pupil absence from school when medical reasons are cited

1. Context & Aims

1.1. The aim of this Protocol is to provide advice in respect of the management of pupil absence from school. The Protocol aims to clarify information sharing arrangements between health professionals and schools in Norfolk to promote the health and well-being of school children in relation to the management of sickness absence and to reduce unnecessary attendances at GP surgeries and inappropriate requests for medical information.

1.2. This protocol has been devised in response to the findings of Norfolk Safeguarding Children Partnership Serious Case Review: Case P (2016). A recommendation from the Review was for NSCP to commission the development of a protocol and associated guidance for best practice in managing absences from school reported by parents to be for health-related reasons. Case P is a complex case, but the existence of medical evidence appears to have been a key driver influencing the decision not to proceed with more formal legal action to address the child’s chronic poor school attendance. The Review identified that a considered discussion about the parentally-asserted versus professionally-provided medical evidence to support school absence would have clarified that there was a need to better understand the way in which the child’s family operated and the needs of the child.

1.3. The protocol has been updated following consultation with representatives from the Local Medical Committee (LMC), Named GPs for Safeguarding Children, 5-19 Healthy Child Programme (formerly known as the School Nursing Service), Norfolk Practices Data Protection Officer and Norfolk County Council Medical Needs Service and Attendance Service.

2. Background:

2.1. Nationally, illness is the most common reason provided for pupil absence. In the academic year 2020-21, illness accounted for 44.4% of all pupil absence and 20.5% absence of all possible sessions (the equivalent to a day per week across the country for all pupils). There is much research that shows a strong correlation between high attendance and high attainment for all children. Department for Education research indicates that even missing a short amount of time from school can reduce every pupil’s chance of securing the grades they are capable of achieving.

3. Consent & Information Sharing

3.1. Timely and appropriate sharing of information between education and health services is important in meeting the needs of the child when reported illness is impacting on school attendance. This may be more pertinent if the child is in receipt of Free School Meals [FSM], and/or has a special educational need. Pupils eligible for and claiming FSM and/or who have a special educational need, are at greater risk of non-attendance, The absence rate for pupils with an EHC plan was 13.1% over 2020/21. This rate was 9.4% in Autumn 2020, 21.1% in Spring 2021 and 10.0% in Summer term 2021. This reflects the fact that during the national lockdown vulnerable pupils were prioritised to continue attending school but, where a parent wanted their child to be absent, schools were advised to grant a leave of absence.

For those with SEN support, the overall rate for 2020/21 was 6.5% (6.6% in Autumn 2020, 4.8% in Spring 2021 and 7.9% in Summer 2021). This compares to 3.9% over the full year for pupils with no SEN (4.1% in Autumn, 2.3% in Spring and 5.3% in Summer).

The overall absence rate for pupils eligible for FSM was 7.8% across the full year, more than double the rate for pupils who were not eligible for FSM at 3.7%. This can be broken down as 7.8% in Autumn term, 6.4% in Spring term and 9.2% in Summer term. The persistent absence rate for FSM eligible pupils across the whole year was 24.4% compared to 8.3% for pupils who were not eligible for FSM.

3.2. Confidential information can only be shared with the consent of a person with parental responsibility for that child, and the young person themselves if deemed to be ‘Gillick competent’. In England, Wales and Northern Ireland, children aged 12 or over are generally expected to have the competence to give or withhold their consent to the release of information. The only exception to this would be where there are Child Protection/safeguarding concerns.

Information sharing between health professionals and referring schools will be proportionate and in negotiation with the parent/carer and child. It must be noted that the purpose of the protocol is not to provide education professionals with unnecessary personal health information, it is to ascertain the impact of a medical condition on the child’s ability to attend school.

4. Managing Pupil Absences for Medical Reasons

4.1. At all stages, schools should consider the impact on the child, wider context and case history and follow early help and safeguarding processes as applicable. If school attendance improves, monitoring and appropriate support should continue. All school staff have a key role in early identification, intervention, and support for children. Where there are concerns regarding a pupil’s unsatisfactory attendance, interventions should be implemented by the school at the earliest opportunity to try to improve the situation and to support the child appropriately.

4.2. Working together to improve school attendance (publishing.service.gov.uk) states that, Schools should advise parents to notify them on the first day the child is unable to attend due to illness. Schools must record absences as authorised where pupils cannot attend due to illness (both physical and mental health related). In the majority of cases a parent’s notification that their child is ill can be accepted without question or concern. Schools should not routinely request that parents provide medical evidence to support illness. Schools are advised not to request medical evidence unnecessarily as it places additional pressure on health professionals, their staff and their appointments system particularly if the illness is one that does not require treatment by a health professional. Only where the school has a genuine and reasonable doubt about the authenticity of the illness should medical evidence be requested to support the absence.

Schools should not routinely be asking parents/carers to obtain appointment cards for the sole purpose of providing medical evidence for absence. An appointment card does not confirm that a child attended the appointment. When considering medical evidence provided in the form of appointment cards and prescriptions, schools should review the evidence available to consider whether the evidence specifically confirms or makes comment upon a diagnosed condition that would explain the level of absence. Schools should also consider whether pupil absence is indicative of wider concerns and the implications for the child’s health, development, and well-being, thinking beyond the medical issues presented by parents/carers.

4.3. Authorised absence means that the school has either given approval in advance for a pupil of compulsory school age to be away or has accepted an explanation offered afterwards as justification for absence. If schools are unsure how to code absence due to health needs, colleagues can contact the LA attendance service on csattendance@norfolk.gov.uk or by telephone at 01603 223681.

In law, the decision whether to authorise absence rests with the Headteacher of a school or a person designated with this responsibility by the Headteacher. In cases where attendance does not improve and no clear medical evidence is available to support a child’s absences from school and parents fail to engage with a school-led Attendance Support Panel and/or fail to give consent for a referral to the 5-19 Healthy Child Programme (formerly School Nursing Service), schools are advised to carefully consider whether to authorise further absences and to instigate the ‘fast-track’ process (Education Fast-track to attendance process).

4.4. Most minor illnesses are self-limiting and do not require contact with a General Practitioner or a medical certificate. Medical certification for short term illness is not appropriate and should not be requested as standard school policy.

4.5. Where a child has an emerging a pattern of non-attendance, and parents/carers are stating that this is due to ill health, schools should discuss the reasons for absence with the child’s parent/carer. If up to date medical evidence (e.g. post-surgery or via a specialist service) is available, then the school does not need to use the Joint Protocol. Where the reasons for such absence are unclear however, and no other health care professionals are involved it is appropriate to seek consent from parents and make a referral to the 5-19 Healthy Child Programme team. This must be done by calling the Just One Number on 0300 300 0123. Referrals can only be made by telephone.

While statutory guidance states that ‘LAs should […] arrange provision as soon as it is clear that an absence will last more than 15 days’, early intervention is preferable and can prevent further disruption to a child’s education. It is recommended therefore, that schools contact the Just One Number (with consent) in the early stages of an attendance issue where health reasons are cited, (and no other health services are involved).

The HCP 5-19 team can help the family access appropriate support and share relevant information with the referrer as required.

For young people (11-19) there is also a confidential text messaging service: Chat Health 07480 635060.

More information is available via the Just One Norfolk website: 5-19 Healthy Child Programme.

School-led Attendance Support Panels are also recommended as an appropriate early intervention strategy.

4.6. Where a pupil has a verified and chronic health condition, the school should provide appropriate support in line with Supporting pupils with medical conditions at school and Norfolk County Council policies via the Medical Needs Service. The school should consider whether an Individual Healthcare Plan is appropriate.

4.7. The guidance and flow chart provided at Appendix 1 are intended to support schools to manage medical reasons for absence effectively.

4.8. NHS colleagues who have concerns around the education of their young patient can use the flowchart in Appendix 2 to make contact with either Norfolk County Council or the school (as appropriate). This may be, for example, if a young person is under the care of a specialist team (e.g., ADHD, epilepsy, diabetes) and their diagnosis impacts on the young person’s ability to attend full-time or requires reasonable adjustments to their education offer. A trial of this process in 2021 resulted in improved outcomes for a young person with ADHD, whose specialist nurse was subsequently able to attend EHCP reviews, for example.

4.9. Whether it is the school, or the NHS colleague seeking to make contact, parent/carer consent must be obtained. This form can be found at Appendix 3 and is downloadable below. For schools, this request may be made either before or as part of a fast-track attendance process. A call to the Just One Number 0300 123 0300 (see above) should have been made or offered before this action is taken.

When a formal request is made, health professionals and schools can provide factual information to each other, with the parents’/carers’ informed consent. Forms for making these requests have been designed to standardise the medical information requested. They should help the school determine whether non-attendance cases have valid medical reasons to explain persistent absence and/or to support the NHS colleague in providing guidance to the school. Schools should complete the form provided in Appendix 4; health professionals complete the form in Appendix 5.

5. Funding

General Practices may claim following the completion of reports through the collaborative arrangements. This is done via the CCG in the same way as claims for similar work such as medicals for potential foster carers and is monitored by the CCG.

6. Conclusion

6.1. It is important for schools and health professionals to have a clear and consistent approach in managing genuine medical absences and making and responding to requests for medical information. This document provides a model for schools to manage sickness absence and promote good school attendance.

Training is available on the background and use of this protocol; please contact medicalneeds@norfolk.gov.uk for further information.

7. Supporting Guidance:


This Joint Protocol was updated September 2022.
Review date: July 2023