Health needs

An increasing number of children and young people with disabilities and medical conditions are being included in mainstream settings.

A significant number of these pupils require adult assistance for their personal and intimate care needs.

To meet their responsibilities under Disability Discrimination legislation, schools must make 'reasonable adjustments' to avoid disabled pupils being put at a substantial disadvantage to their non-disabled peers. These adjustments may include the provision of personal and intimate care.

Headteachers and managers should refer to this guidance to ensure that intimate care needs are managed appropriately and sensitively.

The following files can be downloaded and completed as needed

• School Intimate Care Model Policy (Word doc) [30KB]
• Intimate care checklist (Word doc) [29KB]
• Intimate care: discussion with parents (Word doc) [28KB]
• Intimate care permission form (Word doc) [28KB]
• Intimate care: record of other agencies (Word doc) [27KB]
• Intimate care record sheet (Word doc) [31KB]

More guidance on intimate care

What is intimate care?

Intimate care is defined as any care which involves washing, touching or carrying out an invasive procedure that most children and young people carry out for themselves, but which some are unable to do.

Examples include support with dressing and undressing (underwear), changing incontinence pads and nappies, helping someone use the toilet or washing intimate parts of the body.

Is it okay to leave children until parents arrive to change them?

Ask yourself if you would leave an injured child until the parents arrived. Leaving a child in a soiled nappy or wet or soiled clothing for any length of time is a form of abuse.

Asking the parents of a disabled child to attend school to change them is likely to be in breach of the Equality Act 2010.

Who provides nappies for children who require intimate care?

Parents are responsible for the provision of nappies. Families will usually receive nappies from the Continence Service.

The service may ask the school how many nappies they require in order to calculate how many to supply to parents.

What if we have no facilities to change children? 

If your school has no accessible toilet with a changing bed then it may be necessary to change the child in an alternative private and hygienic area.

This should be a temporary arrangement (reasonable adjustment) and you should contact Children's Services Estates Infrastructure team to discuss provision of suitable facilities.

There may be financial support towards building works for disabled pupils but schools should be aware that they have to make a contribution from devolved formula capital.

All schools should be planning to improve access for disabled pupils in their access plan as required by the Special Educational Needs and Disability Act 2001.

Is it okay that an adult will have to leave the classroom to change a child?

Yes, but changing a child is unlikely to take more than ten minutes or so. This is not dissimilar to the amount of time that might be allocated to work with a child on an individual learning target. The time spent changing the child can be a positive and learning time.

If a child needs changing on a regular basis, then preparing a care plan will clarify whether additional adult support, above that usually provided in the classroom, will be necessary to meet an individual pupil's needs.

Can male staff be involved in intimate care procedures? 

Yes. There is a positive value in both male and female staff being involved in intimate care tasks.

All designated staff, of whatever gender, are DBS checked and given training in good practice. Male staff will not usually be involved in the intimate care of girls.

Where cultural or family reasons make a carer of the opposite sex unacceptable this must be respected.

What happens if a staff member refuses to change a child who requires initmate care?

The Equality Act 2010 is clear that children should be protected from discrimination. Therefore a child who has soiled should be changed and enabled to return to the classroom as soon as possible to resume learning.

The issue should not arise if designated support staff have been advised on appointment and induction and existing support staff trained in relation to the school's duties under the Equality Act 2010.

Why might a child continue to soil themselves?

Medication to resolve constipation difficulties will often result in leakage. The medication can take some time to resolve problems and the child may need more frequent care during this time.

Health professionals involved with the child's treatment will be able to advise.

What should I do if a child seems anxious or upset about their personal care?

If it's new or changed behaviour then it's important to ask the family whether anything has happened that may have led to the change.

If you remain concerned you should follow normal child protection procedures.

What steps should be taken to ensure the child who receives intimate care isn't teased?

The Disability Equality Duty means that schools have a duty to eliminate the harassment of disabled people.

Changing a child promptly and discreetly will minimise the attention drawn to them. Reasonable adjustments might include allowing privacy when changing for PE, appropriate clothing to avoid drawing attention to a nappy and systems for leaving class without fuss.

The school should consider whether:

• Its anti-bullying policy addresses bullying of disabled pupils

• The curriculum celebrates difference and promotes positive attitudes towards disabled people

How should the school dispose of nappies?

Nappies can be disposed of with normal waste unless there are very large quantities involved.

Wet nappies should be single bagged and soiled nappies double bagged.