Can any teachers or workers in the insurance industry help?

[Rjae]

Not really sure where to ask this but I need to know what the insurance issues are with schools when it comes to feeding a child in a different way. What are their risk assessment policies? What their insurance covers? How it is interpreted?

I know any answers will only be generalised but any light that can be shed and any direction would be brilliant.

The problem briefly is DD is severely disabled and fed through a tube into her stomach. She is to attend a MS school soon. Normally children with gastrostomies are fed a type of 'complete' formula milk but many including DD vomit, reflux and are not thriving on this milk. We have now changed to feeding whole, natural, normal food, blended and fed through the tube and DDs health and wellbeing has improved beyond recognition. However her proposed school insists on formula feeds and the dietician says the schools insurer will not contemplate this feeding.

We need to know why the schools insurance is interpreting this like this. We have done a dieticians risk assessment and will sign a disclaimer but still they refuse. Any ideas how we can appeal and to whom?

[schoolnurse]

Does your DD have a medical "passport"/care plan stating that she should have "whole natural normal" blended food not the usual complete formula milks? If yes then the school has to do what is says. Also as I'm sure know these whole complete milks are only available on prescription and are usually ordered and delivered in bulk to your home organised by community paediatric nurses/dieticians/GP they cannot be simply purchased over the counter if you the medical advise is blended whole food where do the school think you're going to get the complete milks from?
Are you expecting the school to blend up their food themselves? Is this what's worrying them? You must have at the very least a community paediatric nurse and your school must should have a named school nurse what do they say? Who is administering the feed; your DD? On AN Other? School staff in the beginning are often very reluctant to take this sort of thing on, even if it's overseeing it because they worry they're going to get it wrong or it will go wrong, and they won't know how to deal with it let's face it from their point of view it's easier to oversee a pre prepared formula milk.

[PandaMummyofOne]

We cannot refuse any medical request such as this without a 'safeguarding' (I know it's not an actual safeguarding issue, but there's nothing that actually covers it IYSWIM) meeting between us as the course providers, the insurers and obviously the parents and learner.

It still may not come out the way you want it but it may be worth asking for that. IMO it the very least they can do.

[Rjae]

We will be sending in 60 ml syringes ready drawn up with the blended food so no kitchen involvement. The gastroenterologist ,supports us (given us a letter) but it cuts no ice with the british dietetic association or the school apparently. He after all only sees a child thriving instead of vomiting and starving (sorry bit bitter sounding!).

We will be expected to start receiving the formula at home again and send it in to school. Her statement on,y states she is gastrostomy fed medically prescribed formula. It's not been amended to reflect what she has at home, but it's actually a very good point and one I will look at changing as the dietician is supposed to support our choice if she feels the child is better on blended food.

The gastro nurse supporting us and the dietician will demonstrate to the TAs how to give the formula and the only thing that needs to happen then is we demonstrate how we substitute it with our blend. So no major change in administration.

I can totally understand from the laypersons point of view. I am a nurse so there is no mystery for me. Is the statement the same as a medical passport? DD doesn't actually have any medical issues as such apart from the gastrostomy. I'll need to read up on the new statements and equal opportunities for disability from the government site.

Have received super advice from mumsnet!

[schoolnurse]

You need to get your statement amended the school will not and in fact cannot give her blended food if your statement says "medically prescribed formula" it's quite simple. Get your GP, (if they're any good)/dietician/gastroenterologists/paediatrician/community paediatric nurse to help you with this it's completely irrelevant what the British Dietetic Association say it's all about what is written on the statement. Contact your schools named school nurse as well.
A medical passport is hopefully up to date medical/nursing/family/likes dislikes etc information that children with complex needs have to ensure continuity of care.

[Rjae]

That's a brilliant suggestion. Just didn't think about the statement!

If the dietician accepts it and the BDA risk assessment is fulfilled it should be less of a problem. I will look into the medical passport as I've never hear of them before.

Thanks

[schoolnurse]

If your gastroenterologist/dietician support blended whole food then I personality don't see it as any higher risk than complete formula milk, assuming you're pushing it in via a large syringe rather than using a pump, it's less complicated in fact. Many lay people don't like gastrrostomies for a reason Im not sure why they are basically fool proof unlike an NG and they don't require the same hygiene levels of an NJ.
Good luck.

[Rjae]

Thank you. It's great to talk to someone who is not terrified of a g tube or the fact that real live food goes down it! Very refreshing.

[schoolnurse]

Do get a passport, kept up to date, they are invaluable it does mean any medical staff coming into contact with your DD (very important if your not there) will know what the diagnosis is, any medication she's on, what care she needs, contact details including your but also the medical team normally looking after her etc etc.Teachers frequently don't know all the minor details and it's very frustrating and worrying for medical staff when they're presented with a child they know nothing about who has a variety of long term medical problems and they're desperately trying to work out what to do and what is normal for the individual child.

[mrz]

As a SENCO I've never heard of a passport being used in schools ... We use Health care plans as per government guidance.
You do need to ensure your child's Education Health Care Plan (replaced statements in the new code if practice) reflects the changes you want to make. The school is in a difficult position as they cannot comply with parental wishes without risking prosecution should anything go wrong.

[schoolnurse]

A medical passport is carried by children with complex medical needs to ensure continuity of care it's particularly useful in the event of an unplanned admission into hospital.
If a chld has a gastrostony there is obviously a significant medical issue, so if for example she attended an A and E dept with a member of school staff (who IME often no little about the child) medical staff will need to know what the diagnosis is, what medication she takes, is she nil by mouth, etc medical passports should provide this information. They are widely used.

[mrz]

I know what a medical passport is but I've never known them to be used by schools who have to follow guidance laid down by the DfE.

[schoolnurse]

I think we're getting our wires muddled up here Im aware schools follow care plans I was interested to know what her passport stated, the OP then asked what one was.

[mrz]

What I'm saying is that the school wouldn't use a medical passport so having or not having one wouldn't change anything.

[mrz]

OP the gastro nurse would normally work with you and the school to draw up a care plan but be aware the school can only follow official guidance.

[Rjae]

It seems very sensible to have a medical passport. Cerebra do a child information thing which may cover that, but there seem to be a few templates out there. It's on the list!

It would be worth having a copy of DDs medical history to accompany her if she ever needs to go to hospital with the school. She has 3 TAs who share her care through the day so they know her pretty well. It does sound common sense. I'll look more at the ehcp as I'm not sure when the review is.

mrsz the gastro nurse says she would feed her child the same way but it's getting so complicated finding out where the log jam is! but I've had some great ideas here. The first thing is the amended statement. There is no official guidance set in stone, it's very much how LAs are interpreting it. The dietician says there are very conflicting views. It's like a power struggle at the moment! But if the statement/ehcp contains blended food with the blessing of the diatetic department, then that has to be the official line. ..I hope! It's certainly a start.

[mrz]

It isn't about how the gastro nurse would feed your child it's about involving medical professionals in producing a care plan for your child in school (usually impossible to get doctors and paediatricians to sit down with school staff so most hospitals send nurses who are closely involved in the child's care)

It's common practice

[schoolnurse]

OP do you have a community paediatric nurse? What does she say about the feeds? The school are not there to question why a particular feed is being used this is not their role they are there to implement the recommendations and/or ensure your TA's/carers can can deliver the care she needs. I suspect quite a few experts are involved in your DD's care gastroenterologists dieticians gastrostony nurses etc certainly in my experience community paediatric nurses can be good at bringing all this advise under one umbrella.

[mrz]

I'm afraid that the school would be in breach of their duty if care if they didn't question instructions that differ from those on the statement

[schoolnurse]

mrz as I stated up thread "the school will not and in fact cannot give her blended food if her statement day "medically prescribed formula" it's quite simple".
But it is not also not their role to question why the statement says blended food instead of medically prescribed formula even if this is more inconvenient for them or something they're not used to.

[mrz]

Unfortunately the statement doesn't say blended food ...

[Rjae]

I will get our copy of the statement out to see exactly what it says as I'm not exactly sure. My first aim is to get this blended food written into the statement though either way.

No community paed as DD doesn't have anything other than her CP and the gtube. Community gastro nurse is on board but has to go along with the dietician. At home we do BD and she asks us how we do it and thinks it's brilliant. I've even spoken to the lead nurse at the hospital who did the surgery and she is very pro blended food! DD has physios, OT, SLT and probably several other professions but no paed nurse! We rarely see the gastro nurse as we have no problem feeding at home, no gastro meds needed, no constipation meds either. I will speak to her though about the current situation to see if she can offer some insight into how the system works and to get what we want into the ehcp for September.

[mrz]

I would ask the school to call a Team Around the Child/Family meeting to put together a plan for your daughter's needs with all professionals involved.

[schoolnurse]

mrz am I just misinterpreting you comments or are you being slightly aggressive here? The OP asked for advise which I happily gave she seems very grateful I clearly stated at the beginning that the school would only implement what her statement said and she would need to get it changed if she want her DD to have whole food. I mentioned a medical passport because I was interested to know what that said, was the OP completely at odds with the medical advise she'd been given (not uncommon) but it appears she's not. The OP didn't know what one of those was so I explained and their essential use if her DD was taken to hospital in particular A and E by school staff who in my now very extensive experience often don't know all the essential micro details about a child's condition and thus this causes significant concern to medical staff trying to treat a child whose often very sick with a very complex medical history who they know little about. I'm not quite sure why your constantly coming back at what I'm saying when we are largely in agreement?

[mrz]

And I'm trying to explain the position from a school perspective which you seem to disregard