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?

From an insurance perspective I often find we get blamed (along with H&S) for a reason why something can't be done!

I work in insurance particularly in the education sector.

We get the 'child with particular medical/diet' requirements query every so often and there's no one size fits all approach but our basic position is:

an insurance policy will respond to the school's legal liabilities

school's don't generally have any element of med mal cover in their policies so in situations like this our preference is that any procedure is carried out by 1) medical professional 2) parents 3) the child themselves.

If that isn't feasible then willing teachers given full training and guidance by medical professionals and in keeping with the health care plan.

As the plan isn't saying what you want it to OP this is where the sticking point is (as pp have said).

new name?

I've tried to explain the schools statutory duty and the statutory paperwork used by schools which will contain all essential information regarding a child's medical needs. Schools don't use medical passports and from what I understand they aren't universally used even in the NHS ...or am I being misinformed?
Schools can't just comply with parental wishes and must take legal and medical advise if a parent expresses a desire to change the way the child's medical needs are met within school. From what the OP has said even medical professionals disagree with what she does and while that is her choice within the home the school cannot comply ...so repeating that the school can't refuse is far from helpful. They can and they have otherwise they could face legal action.
hopefully the OP can get the changes she wants written into her daughter's statement (EHCP) but if there is medical opposition this might be difficult.

good luck OP please don't blame the school for following the rules.

I've never heard of a medical passport either to be fair.

Health care plans and statements are what we follow. Agree with mrz that this is what needs to be sorted out and agreed first (as the OP is doing I think). Until then the school will refuse - if they didn't and followed mums new way of working they would be wide open to claims of negligence if anything went awry.

The medical professionals do not disagree with how we feed. The dietician is in agreement, but the school are saying no, citing insurance reasons. The BDA states it should support parental choice on this matter of food. They would clearly rather stick to the conventional methods but with the risk assessment it's supportative (although grudgingly). We need to get them together to change the ehcp. The gastro surgeon has given us full support too. We have a big school meeting in a few weeks time, which is why I am asking for help.

I'll look into 'team around the child' as I've not heard of this.

apocalypse. Does a disclaimer (witnessed) from us help the position? Other schools have accepted them. It obviously does not absolve the school of its responsibilities, but it does wrt the supply and safety of the food.

The BDAs stance is very odd. Considered a retrograde step but we must support following a risk assessment! No wonder I am confused! Brilliant advice all round

So the dietician isn't saying there are conflicting medical opinions about using blended feed? And the BDA?

Sorry for question but I'm confused

Rjae I'm afraid disclaimers are pretty useless - they give no protection from claims. You can't contract out of legal liability in effect so they're not worth the paper they're written on. Sorry.

I hope your meeting goes well. If you can get an agreement with all involved for a new plan I would very much think the insurers would go along with it. (I would anyway!)

The dietician is supportative insofar as she has gone through the risk assessment with us and is happy DD is thriving on the real food diet. She says there is conflicting evidence as the practice is not researched. She says the BDA don't like the practice for various reasons but will support parent choice. I would say she is lukewarm rather than enthusiastic. She would rather we towed the official line is my feeling, but she can't argue with the improvement in DD. I'm honestly not sure what her real feelings are but she is in theory supporting us.

The only conflict wrt the medical side is the lack of research. But of course there is no willingness or money to fund research which will deprive the companies from important revenue. There does look to be some research in the offing but research is evidence. There is no negative evidence and some incidental research supporting food blending.

I think the disclaimer is a recognition on the part of the parent and the school that the parent has taken responsibility for providing safe food. It certainly wouldn't absolve the school of negligence or the parent for that matter. The ehcp is definitely the way to go.

It certainly is a minefield!

BDAs official line.

www.bda.uk.com/improvinghealth/healthprofessionals/policystatement_liquidisedfood

Reading the BDA recommendations I can see why the school is reluctant to go ahead and why the insurance company are taking the stance they are.

Ok, I see. If that query landed on my desk I'm afraid I would not be happy for the school to be involved.

I feel for you OP because you say your DD is thriving and obviously that is the most important thing. But from a purely business/insurance perspective in no way would we 'green light' something that the BDA does not support.

Please read the document again. It says it does not recommend because it cannot promote this. Not recommend does not mean prohibit. Their stance is undoubtedly negative but even they admit the growing groundswell of opinion and anecdotal evidence needs to be listened to. Our Facebook page has 800 people, most of whom use this method.

But if you read on it says (will need to go onto other messages as copy and paste on iPad will probably wipe this post!)

I'm sorry but the fact that it's not recommended /promoted is enough to alarm most schools and insurers

The Dietitian must:
? Work in partnership with their patient and carers to ensure that they receive the
individualised information they need to enable them to make an informed choice about using liquidised food.
2
? Perform a risk assessment to identify the potential for tube blockage, microbial contamination and compromising of nutritional stability
? Ensure that they protect themselves as an individual practitioner by following their Employers clinical governance, risk management frameworks and guidance.
The term liquidised food has been used throughout this document; alternative descriptions that are used include blenderised feeds, blenderized food, liquidised diet, blended diet and pureed table food.

1. When an individual, or their carer, is considering the use of liquidised food the Dietitian:

? Has a duty of care to ensure the patient/carer has had all the individualised information they need to enable them to make a fully informed choice ? The information must include making the patient/carer aware of the potential risks to health and the viability of their feeding tube 4

1. The Dietitian must ensure that the clinical team caring for the patient

? Considers all alternative feeds and feeding strategies ? Discusses, and fully documents, the reasons for the patient/ parent/ carer decision ? Have endorsed the practice.

1. The BDA recognizes that some patients /carers may choose to use liquidised food having considered the information and advice given by the Dietitian. The expectation of the Dietitian is that they will continue to fulfil their duty of care towards the patient and will support the patient and carer in the decision they have made.
2. Under these circumstances the Dietitian must protect themselves as an individual practitioner by ensuring that they:

? Work within their employers’ clinical governance guidance ? Work within their employers’ risk management frameworks

1. The Dietitian responsible for devising the feeding regime must:

? Carry out a full risk assessment to highlight and ameliorate the potential health risks that are specific to the individual patient. Consideration must be given both to the environment in which the liquidized food will be prepared and to the mode of delivery ? Follow BDA recommendation to use a device that:

1. Meets the Medicines and Healthcare Products Regulations (MHRH) recommended standard for use information (IFU) 6.
2. Is endorsed for the administration of liquidized food by the Manufacturer7.

? Use a validated risk assessment tool that is either specific for enteral feeding purposes or one that is endorsed by their employer. ? Document the reasons for the patient/carer wishing to use liquidised food in the patient’s medical, dietetic and any joint case notes, together with the outcome of any Multi Disciplinary Team (MDT) or Best Interests Meeting.

As you can see. despite the negativity of the governing body they have been forced legally to support the patients informed choice. "No decision about me, without me".

We have fulfilled all the criteria listed above and are therefore supported by the dietician and the hospital's governance.

Precedents have been set in other ms schools.

Written into the statement/EHCP we should have a much more persuasive case.

I am sure in the future when this form of feeding is more accepted and supported by the forthcoming research other parents will have an easier ride.

Eventually someone will take a legal route under disability discrimination legislation. The legal DoE guidance for 'supporting pupils at school with medical conditions' also looks very useful. Fortunately we have a few lawyers among our parents along with media personnel so eventually it will be accepted and implemented.

I think you must appreciate that schools and insurers are sympathetic to parent's wishes but they must also weigh up the consequences if something goes wrong and they haven't taken account of expert advice.
Staff could face prosecution, even prison if something went wrong - blockage or infection due to using a non recommended feed a school isn't going to put staff at risk.

If the expert advice (support from the dietician) is that a risk assessment has been carried out and they and the hospital are supporting the parental choice, the child's hospital consultant is supporting the parental choice and responsibility lies with the dietician and the parent to ensure safety, where precisely would any risk of prosecution come from? I'm mean please give me an example of where a staff member would be taking a 'risk'?

As you accept, there is no 'risk' that has not been ameliorated by the dietician rigorous risk assessment. This is what we hope to put across to the meeting, along with the BDA statement which says it does not recommend but it does (more importantly) support.

The risk is that the BDA is clearly stating that it isn't recommended. Im not saying you won't win but I don't think it will be easy convincing the LEA to change the statement. Good Luck

The school staff are taking a risk by being the ones who physically carry out the task. They have to follow what is written in the paperwork otherwise they leave themselves open to prosecution. It doesn't matter what who thinks what if it isn't written down and formalised they won't have a leg to stand on if something goes wrong.

As an example, most schools won't give medication unless prescribed. Let's say little Tony is prescribed an over the counter medication, it goes into school and the school give the required doses. Then it runs out and mum gets the same medication but just over the counter rather than prescribed again by the gp. The school give the same dose but for some reason little Tony has a reaction this time and ends up in hospital. Legally the school don't have a leg to stand on. Even though the mum gave the medicine and the gp originally prescribed the same thing. The school are in trouble because they physically gave the medicine, irrespective of parental consent, that caused harm. Now a situation like that may come to nothing but anyone in connection with the child could make a complaint, such as the gp or other parent, as the school were not in a position to make a medical assessment of need.

I suspect once you get the paperwork changed with the backing of your consultant, you won't have any problems.

Thank you soapbox. Yes we will work with the dietician to amend the statement. As you say, once it is formalised there shouldn't be a problem. I've had a lot of good advice from my posts so I need now to get everything together for the meeting and take it from there

??

From Apocolypse:

"We get the 'child with particular medical/diet' requirements query every so often and there's no one size fits all approach but our basic position is:

an insurance policy will respond to the school's legal liabilities

school's don't generally have any element of med mal cover in their policies so in situations like this our preference is that any procedure is carried out by 1) medical professional 2) parents 3) the child themselves.

If that isn't feasible then willing teachers given full training and guidance by medical professionals and in keeping with the health care plan."

I'm interested in the words "willing teachers" as it is my understanding that no-one on a school staff can be required to give medication or treatment, they have to be willing and happy to do it. Therefore, even if you get the agreement of the LA, if there is no-one on staff willing to give your dd the blended food, then you are still back at square one.

Apocalypse