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Medical advances in paediatric care have resulted in an increase in the number of children needing long term medical and nursing care. These children are dependent on complex technological devices such as mechanical ventilation, tracheostomies, and artificial feeding. Most technologically dependent children live at home with parents as the main carers. The complexity of caring for these children in the community demands that statutory and voluntary agencies work together effectively to provide coordinated services.
Background
HEALTH
In 1995 the Department of Health issued guidelines to all health authorities clarifying NHS responsibility for meeting continuing care needs.1 The guidance confirmed the NHS responsibility to meet the continuing care health needs of individuals and set out a process for health authorities to agree local criteria for access to this care in collaboration with health providers and local authorities.
The documents were detailed about the process to be followed but left establishing criteria to local discretion. The structure and framework advised in the guidelines related primarily to the needs of the elderly population. The needs of children were acknowledged but detailed guidance was not given.
EDUCATION
The 1993 Education Act required the Secretary of State to issue a Code of Practice giving practical guidance to local education authorities regarding their responsibilities towards children with special educational needs.2 Section 3:89 considered children with medical conditions and mentioned “consultation and open discussion” between education and health agencies. The …