Negotiating Access to Health and Wellbeing Support in Schools for Young People with Chronic Health Conditions in English Secondary Schools: A Qualitative Multi-Informant Study.

Background: Schools have a statutory duty to support pupils with medical conditions in England, but limited evidence exists on how support is managed in practice. This study explores young people's, caregivers', and school staff's experiences of access to health and wellbeing support in state secondary schools for pupils with chronic health conditions. Method: We used an online qualitative survey design: one for young people or caregivers, and one for staff. Data was analysed using framework analysis, applying candidacy theory. Results: Twelve young people, 33 caregivers, and 18 secondary school staff responded to the survey. Participants described highly varied offers of health and wellbeing support, with caregivers and young people often unaware of what support schools could feasibly provide. Participants highlighted communication gaps and a lack of collaborative work between primary or secondary healthcare and schools. Many caregivers and young people reported that staff had insufficient understanding of their condition(s), had not trusted or believed them when they had explained their health needs, or had left them out of conversations about support. School staff also noted communication difficulties with caregivers. Many caregivers and staff described aspects of the secondary school setting that prohibited inclusivity including insufficient staff time, high pupil numbers, a focus on national attainment measures, and attendance targets. Conclusion: The support options that young people with chronic conditions can feasibly be offered should be clarified in government guidance. Further research is needed on the prevalence/utility of individual healthcare plans and on procedures to ensure that pupils with medical conditions are justly supported.