“They’re taking the classroom.”

James Gibson, executive headteacher at Becton School - a hospital school based within Sheffield Children’s Hospital and part of Nexus Multi-Academy Trust - is preparing to lose yet more teaching space.

Last year he lost the school gym in Becton’s child and adolescent mental health services (Camhs) unit setting - it’s now a family room. Now he’s losing a classroom on an oncology ward.

He’s not alone. Hospital schools across the country are being forced into more bedside teaching rather than classroom teaching as space is increasingly being repurposed.

There are benefits to bedside teaching, but the loss of classrooms as an option is causing significant concern for the learning and long-term engagement with education of those pupils affected.

As such, it should be of concern to all in education. Hospital schools are on the frontline for many of the most vulnerable pupils in the system.

Gibson says he finds it “hard to argue” with the decision: “It’d be churlish of me to say ‘no’ to spaces I’m struggling to use.”

But, he adds, “It’s unlikely that the space you give up you ever get back”.

Hospital schools: a bespoke service

Hospital education is a small part of the overall schools sector.

According to government data, on census day in January 2024 there were just 652 pupils in hospital schools in England - although Cath Kitchen, chair of the National Association for Hospital Education, says this is likely an undercount due to inaccuracies in recording.

But for those children whose lives it touches, hospital education is significant.

“It’s the one constant thing in their life, the one bit of normality they’ve got in their day,” says Lucy Stocker, principal of Community and Hospital Education Service (CHES) Academy in Cornwall.

The reasons why a child might receive hospital education are numerous - perhaps they are in hospital for cancer treatment, have suffered a brain injury or have mental health problems so severe they cannot attend mainstream school.

Whatever the cause, their legal right to education is the same under Section 19 of the Education Act, which says local authorities must arrange suitable teaching for children who are unable to attend school due to illness.

The hospital school will try to get information from the pupil’s usual school on what work they should be completing.

But, in reality, those working in the hospital schools sector say delays in getting that information and communication issues mean staff often have to work out the best approach without that steer.

Missing classroom space

Hospital schools are usually run by external providers that rent space from an NHS trust. As such, they don’t own their buildings, and so when, as happened with Gibson, a classroom is repurposed, the school has little power to say “no”.

Since the Covid pandemic this has been happening more and more. Firstly, it’s because of stricter infection control protocols, meaning that some children aren’t allowed to leave their wards, so classrooms go unused.

It’s also because “the nature of care has changed”, Gibson says. Developments in chemotherapy, for example, mean that lots of child cancer patients now receive treatment at home, so hospital schools have fewer long-term pupils.

At Manchester Hospital School, headteacher Joanna Beswick describes how, before the pandemic, her pupils would have had lessons in small groups in one of two classrooms, as well as one-to-one at their bedside.

But when Covid hit “everybody had to stay within their ward”, she says. Bedside teaching became the norm. And since then Beswick has gradually had the classroom space taken away from her.

There were previously two wards with classrooms, but two years ago those wards were swapped around, “and when the changes were made, we lost one classroom”.

A “classroom” sign still hangs outside the room, which is now a ward manager’s office.

There is one remaining classroom. But Beswick says that “we’ve just been told we’re losing that one as well”.

Teaching in hospitals

Stocker is also losing education space. She first joined CHES 17 years ago when the Royal Cornwall Hospital School in Treliske had two classrooms.

One classroom was lost when long-term cancer care was moved to Bristol and the other classroom was moved down some stairs, which meant access became difficult for children with mobility issues. That space has since been halved.

At Newcastle Bridges School in the Great North Children’s Hospital, hospitals lead Rebecca Neillis hasn’t lost teaching space - most teaching is done at the bedside anyway - but staff are now sharing their office with a host of other agencies and organisations.

“I’ve been in the role here for seven years,” Neillis says, “and initially it was just a space for the school.”

But since then she says other external hospital providers - including staff from the Durham Cricket Foundation, the Newcastle United Foundation and arts and music therapists - have also started using the room.

“It means all these extra bodies and all their equipment are here, too. We haven’t lost space, but...there’s a lot more squeezing, and it’s much more difficult to organise,” Neillis adds.

“It’s the one constant thing in the child’s life, the one bit of normality they’ve got in their day”

What all this has led to is more one-to-one teaching at the bedside. As part of an overall educational approach, most who work in hospital schools are not against teaching on the wards rather than in classrooms - in fact, they can see benefits.

One is that, logistically, it’s easier than organising classes with multiple pupils. Children stay in hospital for different lengths of time and are of different ages and abilities. Even if there are pupils from the same school year, the nature of hospital treatment means schedules change at the last minute. A surgery might overrun or a new medication might unexpectedly make a child too tired to learn.

“You didn’t always know who you were going to get,” Beswick says. “Planning for sessions to ensure pupils were receiving a high-quality education became impossible.”

By comparison, one-to-one lessons - while still reliant on children being well enough to learn - allow teachers to be more agile with their planning, and mean pupils receive more personalised work.

Benefits of socialisation

However, some in the hospital schools sector caution against relying on bedside teaching completely.

For example, it is very difficult to give every child the full time for education they are due because of staff capacity issues.

“We see fewer people in a day. Essentially, there’s less teaching time,” says Stocker.

This makes it “really difficult” for staff to continue their job of helping pupils to maintain “some connection with the outside world”, she adds.

Bedside teaching is also resource-intensive, and staff need physical space to plan, to deliver remote learning and to work. That space is often not available.

“We did ask the hospital if there was any more space for us, but there wasn’t. So we had to stay within the rooms we had,” Beswick says, showing me around an office that holds teachers’ desks, piled high with books and other resources, which teachers wheel to bedsides on trolleys.

“You can see the difficulty we have around space,” she adds.

More on special education:

• Robots to help hospitalised pupils return to school
• SEND and special school provision: the capacity crisis
• Revealed: the scale of the SEND crisis in numbers

Teaching on wards is not exactly easy. On a walk around Manchester Children’s Hospital with the school team, it’s evident that there can be distractions when delivering a lesson on a ward, with machines bleeping and clinical staff hurrying in and out.

“It can get very noisy,” Beswick confirms.

Meanwhile, Janine Zablocki, centre leader at James Brindley Academy, which has a site in Birmingham Children’s Hospital, says the longer a child stays in hospital, “the more beneficial it becomes for them to come down to the hospital school, away from the ward, from a mental health perspective”.

Neillis in Newcastle agrees, adding that classroom teaching offers a “change of scene” for pupils and an opportunity for socialisation during an experience that can otherwise be isolating.

Gibson says the socialisation provided by classroom teaching is even more important in Sheffield, where new wards have single bedrooms, meaning that some patients “don’t see another child for the entirety of their stay”.

“If you speak to children in hospital, the thing they say they miss most is their friends, and that’s the thing I think is worst about not having that space where they can socialise,” he says.

Reintegration into schools

All of these factors could have a long-term impact on a pupil’s perception of education and their ability to reintegrate into school life on leaving hospital. They will also likely impact the level of learning that takes place during hospital stays.

This is an issue that the whole sector should pay attention to.

Margaret Mulholland, special educational needs and disabilities and inclusion specialist at the Association of School and College Leaders, agrees that the reduction in hospital education space is worrying because it essentially shows that children’s needs are becoming the last priority.

“There is a place for bedside teaching and other forms of flexible learning, but this should be driven by the needs of the cohort rather than being dictated by the amount of space or level of funding available,” she says.

A personalised approach

In London there are signs that this issue is being recognised. I recently visited the brand-new Pears Maudsley Centre for Children and Young People, which sits just down the road from the current Maudsley Hospital in South London.

While elsewhere school space is being squeezed, in this new building the Maudsley and Bethlem Hospital School has a dedicated floor.

Headteacher Maarten Crommelin explains that when the building opens later this year, the school will be able to teach across two classrooms as well as art and science rooms, the latter of which includes a specially designed glass booth for a teacher to demonstrate chemistry experiments in a way that passes the psychiatric hospital’s strict risk assessment.

“We are very blessed to have such fantastic teaching spaces and have worked closely with the hospital trust for this design,” Crommelin says.

He acknowledges that, because it is for psychiatric rather than paediatric patients, the school benefits from not needing to be concerned about infection control, and therefore has more flexibility in how it uses its space.

Nevertheless, the school’s multi-purpose rooms are a model for hospital teaching because they allow flexibility of use.

“So much of hospital education is, by its very nature, going to be personalised, individualised, fitting around the needs of the child,” Crommelin says, sitting atop the building’s impressive roof terrace, which houses outdoor space that the school will share with the clinical teams.

“That’s the way it has to be when you’re working with such a varied cohort of young people.”

The hope is that flexibility and space will be afforded to all children and young people in hospital.

And Stocker recalls an example that shows just how vital space for learning is, concerning the school’s dedicated music room at a Camhs facility called Sowenna, in Bodmin.

“We had a 16-year-old student with psychosis who would not come to education. We said: ‘Just come, we’ve got a guitar and a keyboard.’ He would come for 10 minutes at first. Last week he spent a whole afternoon. If we didn’t have the music room, I don’t think we’d ever see him.”

Tes contacted the Department for Education for comment but did not hear back in time for publication.

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