Effective partnerships with hospital provision


Over the past year we’ve become accustomed to educating at home – but what about when your student is in hospital or is not well enough to attend mainstream school? Victoria Franklin interviewed staff in the Bristol Hospital Education Service to discover how mainstream schools can best work with them.


  • Hospital education provision takes a variety of different forms, including at the bedside, at base or in the child’s home.
  • There can be tensions in terms of whether to follow a national curriculum or the hospital curriculum.
  • The Service Level Agreement enables school and hospital teams to work together and understand areas of accountability.

As I write this article, we are exactly one year on from the time schools were closed to all but vulnerable and key worker children. The world was rocked by a pandemic with far-reaching and, as yet, many unknown long-term consequences for education.

Some of the most vulnerable children already had experience of being unable to attend a mainstream school due to health reasons, often experiencing long periods where education was not accessible. Their parents had also had to adapt to their children being at home. With Covid-19 demands as an additional factor, managing the education provision for these children became more complex.

What is hospital education?

Hospital education provision is diverse and wide-ranging, delivered through a variety of mediums and geographical difference is apparent. Funding, structure and local commissioning make uniformity of the ‘offer’ to children extremely difficult to standardise.

As government guidance was issued throughout to support the continuation of education provision, it became apparent that this had to be interpreted and applied in a bespoke way for each hospital education setting. The role of governance in this scenario was paramount to ensuring compliance, safety of all stakeholders and enabling staff to continue to provide education. 

The Chair of the Bristol Hospital Education Service management committee, and the headteacher, have responsibility for four distinct provisions in the city. Two are NHS in-patient settings where teaching takes place either at the bedside or in adapted classrooms. Much of the direct teaching was halted during the pandemic but children were already used to using remote learning devices and this was increased.

The other two provisions are one-to-one tutoring at a child’s home and small group teaching at a dedicated school base. The Bristol Hospital Education Service (BHES) small teaching base is its own standalone provision, housed in a recently refurbished Victorian grammar school building near the centre.

Its appearance is that of a small school with a reception area, meeting rooms, classrooms, science labs, kitchen and outdoor area. There are also a number of adjacent small buildings where children moving from one-to-one tutoring at home to the base can transition halfway and are taught one-to-one on the site. The children have individual timetables related to their health needs and the base has approximately 78 attendees.

The referral route is via a health professional where a child has been absent for 15 days or more and their health determines that they cannot access mainstream provision. Local authorities have a duty in law to provide a suitable education in these circumstances (see the DfE link to statutory guidance at the end of this article).

The BHES is a local authority-maintained provision and continues to link closely with health professionals and other education professionals, including the child’s mainstream school. Most of the children attending the base and receiving one-to-one tuition at home experience high levels of anxiety and poor emotional health.

The curriculum

One-to-one tutoring in the child’s home was no longer viable with lockdown and social distancing measures in place. Attendance at the base became very fractured due to the nature of the children’s emotional health, although it did remain open for those who felt able to attend.

The impact of staffing the base and providing remote learning was considered carefully and a decision was made to provide online learning/live lessons for all at an early stage. This was already a strategy employed for some students and the service was ahead in this respect for curriculum delivery.

The Oak National Academy provision coming online during the first lockdown highlighted issues around continuity of the curriculum for children receiving education through the hospital education service and the benefits that such a national strategy could bring.

When a child starts to receive support from hospital education, decisions must be made about whether to follow their mainstream school curriculum or the one on offer at the service. This is particularly acute in Years 10 and 11 when the aim is to support the child to achieve GCSEs to enable them to engage in further education.

Links with their school curriculum are pursued but this is not always practical. Choosing the hospital education curriculum makes a return to mainstream school extremely difficult and it is often not possible, even if they wish to follow this route and are deemed well enough to return. Having a national curriculum would enable continuity between school-hospital education and facilitate a more successful chance of school return.

Remote learning

Remote learning engagement was well supported and increased accessibility to education for many highly anxious students. The hospital education service did not receive any direct funding for additional provision of devices but links with the children’s mainstream schools enabled this to be rolled out.

An observation from Jim Bowyer, the headteacher, is that, going forward, a discussion around whether mainstream schools could consider providing remote learning in the future (where appropriate) for those children not able to attend school for health reasons and lessen the numbers of referrals to hospital education services, is an idea worth exploring. This would not work for all children as the mainstream school connection is often where their anxieties are rooted.

This would require challenging the status quo and taking a leap of faith as schools are reluctant to provide education for children not at school in case they are seen to be condoning absence. This has wider implications related to the recording of types of absence and the law.

Delivering remote learning provided many challenges for staff and the opportunity was used to upskill and develop the staff group in key technology skills. In addition, investment in equipment to meet this need was endorsed by the management committee for the future. Staff reported that this style of delivery was more flexible and enabled them to meet children’s different needs.

Case management

Children at the Bristol Hospital Education Service are dual registered and remain on roll at their mainstream school. Over time, the headteacher and staff at the hospital education facility have worked hard to develop good working relationships with mainstream headteachers and key staff and have a clear Service Level Agreement in place. This enables joint responsibility and accountability for the children’s safeguarding and outcomes.

When local schools are inspected, Ofsted will contact the provision to discuss how both settings work together. These relationships were key during the lockdown phase of the pandemic, with devices and the provision of free school meal vouchers being provided when required.

There is a requirement that schools and other professionals supporting the child attend review meetings once a term. These were either held at the school or at the hospital education base, but often not all parties could attend. The use of online communication via Teams/Zoom meetings has proved to be highly successful and saves travel time as well as time away from colleagues’ main places of work. Staff report better input at these meetings, and this will be adopted for future practice.

As we begin to consider the start of a new academic year, much of the adaptability that has become essential over the last 18 months will be embedded into practice, not only by teaching staff but by governors too; it demonstrates how we still have capacity to change and develop as situations arise. Some of the changes could benefit our most vulnerable children and we should embrace that.

Further information


Use the following item in the Toolkit to put the ideas in the article into practice:

This article is only available to Premium Plus subscribers
Please login or subscribe to read the whole article.
Share this post:

About Author

Victoria Franklin

Victoria Franklin is a qualified social worker with more than 25 years’ experience working in education settings. She is currently a senior education welfare consultant working across all phases of education. Victoria is the President of the National Association of Support Workers in Education (NASWE) and delivers national training on a wide range of attendance matters. Victoriafranklin4@virginmedia.com

Comments are closed.