Diabetes UK position statement on caring for children with type 1 diabetes in nurseries

Diabetes UK launched its first position statement on caring for children with type 1 diabetes in nurseries in April 2016. It is of great importance to the parents of the approximately 1800 children under the age of 5 years who are living with type 1 diabetes in Scotland, Wales and England – a figure which is set to rise. The statement sets out the Diabetes UK position on what parents of children with type 1 diabetes should expect from nurseries, as well as outlining the role of parents.

Our basic position is that all children with type 1 diabetes should be able to attend a nursery of their parents’ choice and that nurseries should make all reasonable arrangements to help their staff to care for the child.

Although this has been happening successfully in many cases, we had been made aware that some nurseries needed to improve their practice, as a number of parents were having difficulty accessing nursery places for their children or were concerned about the quality of care once their child was there. Some parents, for example, felt that staff were frightened of their child’s condition or were reluctant to be retrained to be able to assist children with the condition.

There are already many pieces of legislation which require the nursery to look after children with type 1 diabetes. The Equality Act 2010 in Scotland, England and Wales and the Disability Discrimination Act 1995 in Northern Ireland both state that nurseries have a duty to make reasonable adjustments for children with type 1 diabetes (as disabled persons). The Early Years Foundation Stage Statutory Framework states that nurseries must meet certain requirements in relation to health and medicines, and the Special Educational Needs and Disability Code of Practice: 0 to 25 Years provides a statutory framework for organisations that work with and support children and young people who have special educational needs or disabilities.

If parents feel that the care their child’s nursery provides is failing to meet such legal duties, they should raise this view with the nursery staff and discuss opportunities for improving the care in order to meet these duties. If nursery staff refuse to engage in such discussions, parents could then consider a legal solution as a last resort.

The role of the nursery and nursery staff
The position statement contains five key recommendations, as summarised below:

1. Medical conditions policies
The nursery should have a medical conditions policy, which recognises that every child with a medical condition is different and must be treated as an individual.

This policy must acknowledge that medical conditions can be life-threatening and it must clearly identify the roles and responsibilities of those involved in supporting the child whilst at nursery.

2. Individual healthcare plans
The nursery should have in place an individual healthcare plan for every child with type 1 diabetes.

The nursery needs to coordinate a meeting between the child’s parents and the paediatric diabetes specialist nurse (PDSN) to discuss the child’s needs and to draw up an individual healthcare plan together, to determine how the child’s care needs will be met.

3. Emergency situations
The nursery should ensure that all staff are aware of a child’s type 1 diabetes and that all staff know what to do in an emergency.

4. Nursery staff training
The nursery should ensure that sufficient staff receive adequate training from a PDSN to enable them to look after children with type 1 diabetes.

Such staff should have the right skills and knowledge to provide an adequate level of care for all children with type 1 diabetes. The number of staff required will vary between nurseries, but there should be at least two staff members at each nursery who are trained to administer insulin and to check blood glucose levels.

5. Nursery staff availability
The nursery should ensure that sufficient staff are available at all times to care for the child with type 1 diabetes.

There should be one-to-one support, in the sense that there should always be a trained member of staff available to support the child, but the nature of that support may vary depending on the child’s needs. The support required should be agreed between the parents, the PDSN and the nursery.

The role of the parents
The position statement also clarifies the role of parents of children with type 1 diabetes. Parents should not be required to go into nursery to meet their child’s medical needs, such as regularly administering insulin, but it is reasonable for nurseries to expect parents to provide them with their contact details in case of emergency, in addition to any other information necessary for staff to provide them with adequate care.

EHC plans
Finally, the statement has a section on Education, Health and Care (EHC) plans, which parents can apply for if they feel that arrangements made by the nursery are insufficient. Parents can ask for an EHC needs assessment only if their child has special educational needs, not just health or care needs, regardless of how severe those needs are. However, if the child’s type 1 diabetes is difficult to manage to the extent that it impacts their ability to learn, this could be defined as having special educational needs. The application for a needs assessment is made to the Local Authority where the nursery is based, and the Local Authority then decides whether to issue an EHC plan for the child.

Further information
The position statement can be found on the Diabetes UK website: www.diabetes.org.uk/Documents/Position%20statements/caring-children-type-1-diabetes-nursery-0316.pdf