From September 2014, Governing Bodies of Schools must ensure that arrangements are in place to support pupils in school with medical conditions under statutory guidance “Supporting pupils at school with medical conditions”, updated December 2015. Whenever a school is notified that a pupil has a medical condition that will require support at school, an individual healthcare plan should be agreed to help ensure effective support for a pupil with a medical condition.

However, for those pupils who are too unwell to attend school, the key to successfully maintaining continuity of education is for the local authority and schools to have clear strategies and timely support available.

It is recognised nationally in statutory guidance that pupils who continue in education during their illness and recuperation are likely to recover more quickly with the minimum possible adverse effect on their educational and life outcomes.

Overview: The Disability Discrimination Act and Health/Medical Needs.

Pupils with certain health needs may be considered disabled in terms of the Disability Discrimination Act (examples of this might include those with epilepsy, diabetes, brain injury, or degenerative neuro muscular conditions).

The school therefore must have regard to the duty outlined by the Act to make reasonable adjustments for the inclusion of such pupils and anticipatory planning must be part of the school’s Disability Equality Scheme.

Only after such consideration and reasonable adjustments have been made, should the school consider referral to STARS for provision of continuity of education as follows:

  • Pupils whose mental health needs are at Tier 3 or 4. (CAMHS relates to tier 3 and Acute Psychiatric Support Service relates to tier 4.)
  • Pupils whose physical health is evidenced by a hospital (paediatrician, consultant or registrar) to be too unwell to attend school. This applies to pupils whose cases are managed by hospitals within Sutton as well as in more specialist hospitals in London and across the country.

Admission of Pupils with Medical Needs

As a duty of the Local Authority, the London Borough of Sutton provides access to education for pupils, children of compulsory school age, who are absent from school on medical grounds through Sutton Tuition and Reintegration Service (STARS) which is designated as a medical pupil referral unit (PRU). This will cover a wide range of need including children who are terminally ill and young people who are recovering from accidents. It will also include children and young people with mental health problems. Whatever the circumstances leading to a young person being admitted to Alternative Provision for medical reasons, there will, almost always, be a continuing role for the school. Schools have a vital role to play in ensuring that pupils who are absent from school on medical grounds have the educational support they need and as far as possible the child/young person should be able to access the curriculum and materials that he or she would have used in school.

(a)   The school can only remove a pupil from their roll who is unable to attend school because of additional health needs where: the pupil has been certified by the school medical officer as unlikely to be in a fit state of health to attend school, before ceasing to be of compulsory school age, and;

(b)   Neither the pupil nor their parent has indicated to the school the intention to continue to attend the school, after ceasing to be of compulsory school age. (see appendix 2)

The Statutory guidance is: “Ensuring a good education for children who cannot attend school because of health needs”, Jan 2013.

Pupils that present serious mental health conditions confirmed by a Psychiatrist from CAMHS:

This referral route is only appropriate where a pupil’s psychological/medical condition prevents them from being able to access school. The vast majority of pupils with medical conditions have their needs met effectively in schools, often with detailed arrangements for support identified in an individual healthcare plan.

It should be noted that this referral route is not usually appropriate where pupils have an Education, Health and Care Plan (EHCP), as STARS is not a specialist provision.

Schools should fully complete the Information in the referral form and are responsible for ensuring the correct completion of the medical section of the referral with a Consultant psychiatrist supporting the referral. There is an expectation that schools will have evidence of support and preventative measures together with the individual healthcare plan used prior to requesting the medical PRU placement. Pupils must have ongoing treatment from CAMHS.

Pathway to Support for pupils with short term medical needs

When a school becomes aware that a pupil is medically unwell and their attendance has ceased or will cease, for instance due to, or following surgery, they have a duty to provide work to the pupil at home in instances where it is likely that the pupil will return to school within 15 days. However, as soon it is clear that a pupil will be away from school for 15 days or more, whether consecutive or cumulative, then the medical professionals should be liaised with and a referral made to STARS without delay. During that time, if the illness is going to last longer, the school can apply to STARS for an appropriately agreed package of support which might include the following types of support:

  • Home or Hospital Tuition.
  • Attendance at a base or satellite.
  • Individual tuition in school.
  • A combination/bespoke package.

All of the support programmes will include how the home school will maintain links with the pupil and their family and will require the provision of the school work for the pupil to facilitate a successful reintegration.


All schools and agencies making referrals to STARS should adhere to the following principles:

  • It is the intention that all pupils will return to mainstream education.
  • The pupil must remain dual registered with their home school.
  • Prior to admission all the information necessary to ensure continuing education for the pupil should be submitted as requested on the Pupil Data Form, together with the pupil’s SIMS attendance record, individual healthcare plan and most recent school report.
  • On acceptance, in principle, pupils will become dual registered once the home visit has been completed and a programme of support agreed.
  • There will be regular liaison with staff at STARS and the pupil, together with provision of school work, until there is satisfactory reintegration back into mainstream or into post-16 provision.

In unusual cases where a pupil in Y11 has made progress and their health needs no longer meet the threshold for support at STARS, STARS will liaise with the parents, pupil and their referring school with regard to reintegration. In taking into account the views of all concerned, if the pupil has engaged well with support at STARS and it is agreed that reintegration to their mainstream school could jeopardise their outcomes, STARS will continue to offer a package.

Admissions Criteria

STARS accepts pupils who have a diagnosed medical condition that temporarily prevents attendance at mainstream school.

For a pupil to be considered for a placement at the time of the referral:

  • The pupil must live in the London Borough of Sutton
  • Parental or carer permission must be agreed with signature
  • Current medical evidence and medical treatment plan must be provided
  • The current Individual Health Care Plan must be provided (except in acute conditions)  
  • The pupil must be of compulsory school age, between the ages of 5 (Year 1) and 16 (Year 11).

There needs to be clear evidence that appropriate support and intervention has been provided at their mainstream school which shows clearly identified approaches, targets and strategies along with their outcomes and the response of the pupil to this support.

Pupils with an Education Health and Care Plan (EHCP)

Where a pupil with an EHCP develops additional health needs, following referral the school will need to invite the Deputy/Assistant Headteacher of STARS and a representative from the Borough SEN team to an interim review meeting to agree the referral and identify if/how the pupil’s wider needs can be temporarily met.

Pupils who are home educated

Where pupils who are home educated develop additional health needs, STARS will liaise with the Borough team.

Inpatient provision

Pupils (aged 4-18) who are inpatients at Royal Marsden Hospital are automatically entitled to education which is provided in the schoolroom, the Hub or at the bedside. Pupils at Queen Mary’s Hospital for Children receive education after an illness/diagnosis which indicates a hospitalisation or recuperation period (absent from school) of more than 15 working days. If a pupil is returning from Tier 4 (hospital provision in or out of Borough) and remains too unwell to return to school, the home school needs to complete the referral form to STARS. If possible this is submitted before the pupil leaves hospital so that liaison can be initiated. STARS will support the pupil and home school as required.


STARS will offer advice and appropriate support to schools in carrying out their duties under the statutory guidance: ‘Supporting pupils at school with medical conditions’, where pupils do not meet the criteria for a referral to STARS.

To discuss this further contact the Deputy headteacher or Assistant headteacher on: 0208 404 3124