Education: Ill at ease in the Royal Free: Martin Hennessy reports on a highly regarded hospital school in London that is now under threat

AMANDA MARDELL could barely believe her luck when she turned over her GCSE biology paper last summer and found it was all about the kidney.

Eight years ago, Amanda, now 17, was diagnosed as suffering from the incurable condition of focal segmental glomerulosclerosis. Since then, she has spent three years in hospital, two of them on dialysis. She has undergone two kidney transplants, and has inadvertently become something of a biology buff.

But Amanda, who plans to use her three GCSEs to take a dispenser's qualification with a chemist, is a lucky one among the thousands of children who are confined to hospital for long stretches of time during their school years.

Unlike many patients in children's wards, Amanda has enjoyed constant attention from good teachers, and constant access to good national curriculum materials. Her schooling has only been slightly disrupted by the periods of absence that she has been forced by her condition to spend away from the classroom.

As a result, when she has been able to attend her local school - Francis Bacon, in St Albans, Hertfordshire - Amanda has returned on an equal footing with her classmates. The Royal Free Hospital, in Hampstead, north London, where Amanda has spent much her time over the past eight years, benefits from having its own school. Its main purpose is to enable children to slip back into mainstream schooling when they have recovered, or do not need to be in hospital.

'Hospital can be a terrifying place for children who come here for the first time. Not only do they have to cope with the trauma of a long-term and serious illness like leukaemia or renal failure; they are in a completely strange environment,' said Barbara Andrews, the hospital school's deputy headteacher. 'Classes can be the children's way of socialising with one another, as well as giving them a view beyond the hospital walls, towards their eventual

discharge.'

The Royal Free school has between 60 and 70 primary and secondary pupils in its care. While many may be suffering from acute illnesses such as appendicitis, for which they will only need to remain briefly in hospital, others, such as Amanda, suffer from chronic, long-term conditions: they need to undertake a large part of their schooling in hospital.

The school also runs a group for out-patient 'schoolphobic' children, who are unable to cope with ordinary schools without the support of the hospital's psychiatric and special needs experts.

Under the Government's recent White Paper Choice and Diversity, local authorities such as Camden, which funds and runs the Royal Free school, will be required to provide hospital education. Until then, however, the Royal Free school is under threat. This week, staff morale plummeted following Camden's announcement that heavy pressure on its education budget could mean shedding two of the hospital school's teaching staff.

Andre Polya, chairman of the school's board of governors, is furious. 'I could understand the decision to cut staff if we were not doing well. But we have won government praise, and commendations from school inspectors.

'It's crazy. If these cuts go through, some hospitalised children are inevitably going to go without education.'

However, Mr Polya may be fighting a losing battle. Camden must cut pounds 200,000 from its special needs bill, and the authority has already shed four posts - including a nursery nurse in July this year - from the Royal Free school.

Brent Taylor, Hampstead's principal school medical officer and a professor of community child health at the Royal Free, is alarmed. 'I have worked in child health and hospitals for 25 years. The Royal Free is the best I have come across, both in terms of its original approach to teaching, and its commitment to quality.

'School in hospital is fundamental to a child's recovery. It's part of growing up, as well as an essential part of their future. But unless children have access to high-quality education during their period of illness, that future may be clouded.'

Amanda Mardell agrees: 'It would be dreadful to lose any more staff here. I have been to many hospital schools, and this is definitely the best. In some ways I like it more than my own school - you never get detention here.'