Hospital and Outreach Teaching Service (HOTS)

Claire Gilfillan, Web Content Editor, recently met Juliet McCann, Principal Teacher for Children with Medical Conditions within the Hospital and Outreach Teaching Service, to discuss the barriers to learning children face when learning in a hospital environment.

Claire Gilfillan, Web Content Editor, GTC Scotland

I recently met Juliet McCann, Principal Teacher for Children with Medical Conditions, within the Hospital and Outreach Teaching Service (HOTS). Juliet works in the Royal Hospital for Sick Children in Edinburgh teaching children who are too ill to attend school.

The Hospital and Outreach Teaching Service (HOTS) provides educational support to meet the needs of vulnerable children and young people experiencing interrupted education. The Service is referral-based and works with children, young people, schools, parents, partnership services and agencies to facilitate continuity and progression in the pupils’ learning. The child’s school retains overall responsibility for the provision of appropriate resources and information while the service provides support for children in the following areas:

  • The education of pregnant school girls and young mums
  • The education of children and young people with medical conditions
  • The education children and young people with mental health needs
  • The education of children and young people who are excluded or on the verge of exclusion from school
  • The education of looked after and accommodated children and young people
  • The education of Gypsy Travellers, Occupational Travellers and Roma

Barriers to learning

Learning in a hospital environment can impact a child greatly. Often a child will feel anxious and ill due to treatment that they are receiving in the hospital. They may also feel worried if they are newly diagnosed and they are dealing with a particularly serious illness. Children often lose a lot of their confidence as they are separated from immediate family members and their friends from school. The HOTS team deliver a personalised teaching experience with each child to ensure that they meet the specific needs of each individual child. A child being treated for cancer will have different needs to a child being treated for a brain injury for example. It’s important that the HOTS team is extremely flexible with its lesson planning as the needs of the child can change from day to day and in some cases from hour to hour.

Juliet said:

"There are a number of reasons why children are in hospital and each and every illness offers its own barriers to learning.

“For example a child with a brain injury may experience visual impairment and/or hearing impairment. They may also be cognitively impaired, so that means that they are not functioning at their chronological age so their processing may be affected, their concentration, they may also be fatigued, and all of these things will challenge their ability to access the curriculum.”

The HOTS team works closely with the base school of the child providing continuity and relieving anxiety the child may be feeling about missing school and falling behind with work. The team will help to reassure the child that they are doing the same work as their peers and are progressing along with their ability group. This also helps with re-integration back into school when the time comes. The Primary education team within the Royal Hospital for Sick Children try to cover as many subjects as they possibly can, however literacy, numeracy, health and wellbeing and ICT are the main focus.

What do teachers need to be aware of?

More often than not a child or young person who has spent some time in hospital can go back to school a changed person; their appearance may have changed, they may have a physical disability or they may have behavioural or cognitive problems. It’s important that the class teacher and pupils within the class are made aware of this so the situation can be treated sensitively. In many cases the HOTS team can arrange for someone to go in and speak to the teacher and the class if this is something that the child’s family would like.

The HOTS team also advise that children who have spent time in hospital are always re-integrated back into the same school year and the same ability groups. This has proven to be very beneficial to the child in helping them to settle back into school life and making them feel like being ill hasn’t hindered their education.

Juliet said:

“We always suggest quite strongly that a pupil should always be re-integrated back into the same class and the same ability group that they were in prior to their diagnosis, otherwise they are doubly punished if firstly they are sick and then they are moved ability group on their return to school.

“Now I know that this may cause problems for the school and that the child will likely require some extra support when they go back to school but I think for their confidence, it’s really worthwhile making the effort to do this.”

Partnership working

The Hospital and Outreach Teaching Service works closely with a range of people including, the hospital specialist staff and the base school staff. The HOTS team attends weekly meetings with the hospital specialist staff to discuss the medical, physical and social issues of each child and to work on shared goals. They may have to deal with the fact that a child is being given a particular drug that is going to make them particularly ill/distressed/sore, and they will have to tailor their lesson plans to adapt to this. There may be some family issues that the child has to deal with so the HOTS teacher will have to be mindful of this when talking to the child so as not to further distress the child. Due to the complex needs of ill children these meetings are vitally important for the well being of each child.

Receiving lessons in hospital is not an ideal scenario as so many factors can affect the child’s ability to learn. However it is important that children have access to education when faced with a prolonged stay in hospital to give them a bit of normality in what can often be a very difficult and distressing time for the child and their family.

Further information

If you would like to find out more about the work of the Hospital and Outreach Teaching service you can visit their website at

Listen to a podcast on the Hospital and Outreach Teaching Service about the work they do with children who are too ill to attend school.