Lancashire Operational Guidance Section 19 Medical

Arranging education for children who cannot attend school because of health needs

September 2025

This guidance is for Lancashire schools when dealing with cases of pupil absence due to health needs. It draws on the following document and linked documents from the DfE:

Department for Education (2023) Arranging education for children who cannot attend school because of health needs

This guidance also relates to the Local Authority’s duty under Section 19 of the Education Act and refers to Lancashire Local Authority’s policy under that duty.

The application of this guidance will be rare and due to exceptional circumstances. It does not cover situations in which children are able to attend school but not attending. Such situations are often characterised by a disagreement between schools and parents or pupils, often to do with perceived bullying or school procedures. In these situations, schools and parents are expected to work together to find a solution to the absence.

The children covered by this guidance will have needs which require support additionally to what can reasonably be provided by school. They will not have an EHCP (as a change in circumstances would trigger a review of the plan, which is a different route). Their parents will be worried enough to be seeking medical advice, and the child may well already have been referred to various support services relating to medical needs. Parents will be concerned about their child’s education and will want to engage with school for support. School is able to meet the needs of the child but require further support to progress attendance and engagement with suitable education.

If schools are in any doubt about whether this guidance applies to an absence, they should contact their School Attendance Support Worker directly or via the mailbox schoolattendance@lancashire.gov.uk for further queries.

School Responsibilities

Schools must be aware of their responsibilities when health issues are impacting on a child's attendance. Schools are responsible for safeguarding any pupil on their roll.

Shorter term illnesses or chronic conditions are best met by school support and resources. Such conditions that might meet these definitions include short term post-operative support and periods of reduced immunity. Where possible, schools should continue to provide education to children with health needs who cannot attend school.

Under the equalities legislation, schools must consider whether they need to make reasonable adjustments to provide suitable access for a child whose condition amounts to a disability.

Schools should use the graduated response to assess, meet and review the needs of their pupils. When the pupils medical condition becomes too complex, or the risks are too great to manage, the school should make a referral to relevant agencies for additional support.

School should provide support for their pupils with medical needs under their statutory duties set out in 'Supporting pupils with medical conditions at school' (DfE, 2014) and 'Arranging education for children who cannot attend school because of health needs' (DfE, 2023). Further LCC guidance documents have been created to support schools.

Local Authority Responsibilities

Lancashire County Council has a responsibility for promoting and protecting public physical and mental health and safeguarding children and young people.

Lancashire County Council can advise on and arrange a continuum of provision for children with health and medical needs. This includes outreach support to schools, education provision and provision at Hospital schools.

Lancashire County Council will work with schools to set up an individually tailored reintegration plan for each child.

The local authority does not need to become involved in such arrangements (from a Section 19 perspective) unless there is reason to believe the education being provided by school is unsuitable.

Lancashire County Council will, in line with Section 19 of the Education Act 1996, arrange suitable full-time education (or as much as the child's health condition allows) for children of compulsory school age who, because of illness, would otherwise not receive suitable education.

Many children experience anxiety about school. In the vast majority of cases this should not prevent attendance and can be managed by having strong communication and pastoral systems.

In addition, schools should have personal development programmes that teach children how to cope emotionally and socially, manage relationships and social media, be able to speak about their feelings and ask for help.

On rare occasions, however, a child’s health needs may make them unable to attend school. Parents have a legal responsibility to ensure that their children attend school, so they should immediately inform the school about the absence. As described in the documents in the appendices, parents and schools should work together to understand the barriers to attendance. Once these are understood, the school and parents should draw up a plan with the aim of a full time return to school for the child. Such a plan should include any reasonable adjustments that can be made by the school. It should also include what parents, and the child can do to support a successful return. In some circumstances, this may involve a remote education offer and a partial timetable. In Lancashire, there are a range of services who can support school to implement reasonable adjustments and ensure a clear plan:

• EBSA strategy and toolkit: Emotionally based school avoidance (EBSA) guidance and training

• Request Specialist Teacher Support or access the online resources: SEND Specialist Teaching Service

Where pupils have significant health needs which impact them accessing their mainstream educational offer and demonstrate the following with evidence: 

• What significant health needs a young person has

• Why those health needs prevent access to their mainstream school or Short Stay School

• Evidence of what school have put in place to support the young person

• The anticipated length of time the young person may need Home Teaching

• Confirmation of active on-going work with specialist/Tier 3 ELCAS/CAMHS health professionals including treatments/therapies being undertaken

Then a direct referral to the Lancashire Hospital Education Service should be requested directly and the e-form for local authority support not completed. Information on the service can be accessed here: Hospital or home teaching if your child is ill and on the Schools Portal. In exceptional circumstances, it may become apparent that a mental health related absence is likely to last a significant period. In these cases, a re-integration plan should include a remote learning offer. This will minimise the risk of the pupil falling behind and additional anxiety. Guidance about remote learning and reintegration plans are outlined in the remote learning and reintegration support document. In these circumstances, a partial timetable is likely to be considered as a means of gradually increasing attendance. Absence due to a mental health illness in these circumstances should be marked as authorised absence (most likely the C code or C2 if the pupil is on a part-time timetable and is not expected to be in school during those sessions.

If an absence due to mental health is likely to last more than fifteen school days, either consecutively or in any single school year, schools should ensure they are following the LCC medical guidance document: ‘Managing Pupil Absence due to Illness’, the LCC Reintegration support document and considering a graduated approach to meeting the pupil’s needs. If school feel they require further support under Section 19 of the Education Act 1996, they should complete the form to request support.

Section 19 Request Form and Guidance

Please note: The Section 19 Request Support Guidance document outlines what information is required throughout the e-form to ensure most detailed information is provided to panel. This also includes what to save documents submitted as supporting information as so panel can consider the information carefully.

This document outlines best practice and evidence required to collate through supporting the child to attend school.

• Evidence of medical needs / referrals for support made.

• Evidence of pastoral and academic actions undertaken by school.

• Evidence of assessment of needs.

For Section 19 panel to assess the suitability of education available to a pupil, evidence of actions undertaken and support accessed is required. This may include but isn’t limited to:

• Pupil passport detailing reasonable adjustments and pupil voice.

• Risk assessment

• Evidence of their cognitive function / assessment of cognition and learning

• Suspension details

• Reintegration plans

• Pastoral support / relational approaches used

• Sensory support

• Information on parent / school relationship

• Early Help support / CFW involvement

In many cases, the pupil voice is vital to ensuring Section 19 support is targeted and impactful. Occasionally, in the absence of an EHCP, an in-year admission may be most appropriate and Section 19 support offered to ensure reintegration and re engagement is successful and suitable education is accessed.

An appropriate education offer in these circumstances is likely to include virtual or in person tutoring, as face to face learning is expected to make up the majority of an education offer. This obviously comes at a cost. The bulk of the funding for such an offer comes from the Local Authority’s high needs block, but DfE guidance states:

‘Where a child remains on the roll of their home school but requires a period of time in alternative provision due to their health needs, the local authority and home school may wish to consider the transfer of a portion of the school’s funding associated with that child to the alternative provision.’ (DfE 2023 ‘Arranging education for children who cannot attend school because of health needs’)

The cost of a plan should be based on weekly hours of face-to-face provision, with each hour of provision given the value of £45. This is the average cost of a tutoring offer. Plans will be individualised to the needs of each pupil, but in most cases a full time offer is unlikely to exceed the equivalent of fifteen hours of tutoring time per week. Where other provision is in place, there may be less tutoring time required as outlined in a reintegration timetable to support the pupil.

On the basis of £45 per hour, schools will be expected to fund the weekly cost of a plan up to the equivalent of the pupil’s AWPU plus the notional SEND budget, divided by 39 school weeks. This is £251 for Primary and £298 for secondary. External costs beyond that amount will be covered by the local authority and agreements will be outlined in the SLA documentation between agreed parties.

Provision will be defined as face-to-face education (including remote face-to-face education if appropriate) and meaningful in person contact that supports re integration into school as part of a plan. For instance, a ‘live’ lesson online would count as provision. As would an in person meeting in school, an individual school lesson or any part of a part time timetable. However, a telephone call safe and well check or review meeting with parents would not count as educational provision.

The school, with support from the LA attendance team, the LA alternative provision team and other SEN support services, will develop and manage the plan, and invoice the council for costs over and above their contribution.

Upon panel decision being communicated and Section 19 support being offered, school should arrange the provision as soon as possible. This timescale should not span more than two weeks following panel decision being communicated. The SLA document (see appendix) returned to the Section 19 mailbox (section19support@lancashire.gov.uk) should detail provision commissioned by school.

A re-integration plan should include regular contact between school and parents. This does not need to be a formal meeting but should be at least weekly and this can take the format of a call, video call or a meeting. A more formal review, involving parents and the School Attendance Support Worker, should take place every three weeks. If the plan needs an urgent review, is not working or is not being adhered to, schools should contact the Alternative Provision Team via the mailbox section19support@lancashire.gov.uk to ensure re-consideration at panel for amendments to provision.

There is no legal definition of a full-time offer. In the context of this guidance and Lancashire, up to fifteen hours per week of one to one or small group tutoring would be a reasonable offer, but this should be agreed as part of a plan. The purpose of the offer is to prevent more anxiety caused by fear of falling behind academically. Where children require a tailored approach to address barriers to accessing and engaging with suitable education, Lancashire may agree targeted provision is required but this would be agreed within the plan constructed in partnership with school.

Similarly, there is no legal definition of reasonable adjustments. However, the guidance is clear that a plan for children in these circumstances should be individualised to need as much as possible and include an assessment of SEND needs which may be unidentified.

This may include but isn’t limited to:

• Reading age data

• Evidence of cognition and learning needs using a standardised assessment

• Specialist reports which outline additional educational needs

• Inclusion hub support for primary applications or individual plans outlining support accessing the curriculum offered

Rigid expectations and systems that offer limited flexibility will not be appropriate for pupils who are ill.

Currently, there is no legal definition outlining the frequence of welfare checks. If the pupil is accessing provision off-site for most of their education, it is best practice to physically see the pupil at least weekly. Where a more relational approach is required to support the pupil to reintegrate, more frequent physical contact should be planned.

When a young person is accessing AP the school has commissioned, it is your responsibility to ensure the quality assurance of the AP agreed. Additionally, it is your responsibility to agree lines of communication between the AP provider / site and school when non-attendance, no-contact or safeguarding incidents occur. The school would follow their safeguarding procedures and where appropriate communicate safeguarding practice concerns about AP provision to the LCC Safeguarding Team and Alternative Provision Teams so action can be taken.

For young people accessing a PRU medical placement for a short intervention, it would be best practice for the on-roll school to plan to have virtual or physical contact weekly. Not exceeding two weeks without physical contact. Where physical contact is triggering, the PRU and on-roll school pastoral support teams must liaise to create a bespoke contact plan to support