Lack of investment in health visiting and school nursing services risks harming children’s health warns the Royal College of Nursing, which has again called for urgent action to address an ongoing decline in these specialist early intervention roles.
A new analysis published by the RCN shows health visitor and school nurse numbers have continued to drop and reveals those working in the field are under increasing strain, working extra hours and unable to take breaks.
“Children and young people are still not getting the care they urgently need”
The Best Start: The Future of Children’s Health – One Year On update also raises serious questions about training with a drop in the provision and take up of specialist community and public health nursing courses.
It follows a previous report published by RCN this time last year, which made a series of recommendations to the government, local councils and Health Education England. However, this latest analysis, which focuses on England, found progress had been “minimal”.
“A year since we lifted the lid on the decline in these services, children and young people are still not getting the care they urgently need. It has been a year of drift,” said RCN chief executive and general secretary Janet Davies.
“Children’s health services are the frontline defence against childhood obesity and poor child mental health, but nurses report they are understaffed, unable to take breaks and feel the care they give is compromised,” she said.
“This downward trend cannot continue,” she said. “The government risks turning back the clock on children’s health if it does not invest in the school nursing and health visitor workforce.”
Nurses will use a debate at RCN congress today to call on ministers to reverse cuts to public health budgets and ensure more health visitors and schools nurses will be trained to halt the steep decline in numbers.
The report flags up NHS workforce statistics that show health visiting numbers fell from 10,039 in October 2015 to 8,275 by January 2018.
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Meanwhile, the number of school nurses employed full-time by the NHS fell by 23% – or 680 jobs – between March 2010 and January 2018. From January 2017 to January 2018 alone, 221 posts were lost.
Rising pupil numbers mean there is now about one nurse for every 3,700 pupils in England, said the report.
“The value of health visitors and school nurses should be clearly understood”
A survey undertaken by the RCN in 2017 to gain a snapshot picture of the last shift nurses’ worked found health visitor were the group most likely to have experienced understaffing.
Nearly three quarters – 73% – of health visitors said they were a least one registered nurse down on the last shift they worked compared with the overall survey average of 55%.
In all, 85% of health visitors and 64% of school nurses reported not being able to take breaks compared, with 59% for the survey overall.
The majority – 81% of health visitors and 70% of school nurses – said they had worked extra time during their last shift, compared with the survey average of 65%.
Many teams have reported a drop in nurse numbers as a result of the re-commissioning of 0-19 public health contracts by cash-strapped local authorities, who are keen to reduce spending.
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“The RCN’s regional offices have reported numerous examples where local authorities, as part of managing pressures on their budgets, have sought reductions in the cost of contracts to deliver these services, which usually means fewer nurse and other staff being employed,” said the report.
However, the overall picture is somewhat murky because of wide variation in contracting arrangements and the way staff numbers are counted, which is why the RCN is calling for more robust data and monitoring to give a much clearer idea of what is going on.
“Children’s health services are the frontline defence against childhood obesity and poor child mental health”
There are fears that funding cuts could get even worse in the light of changes to the way councils are funded, noted the college. Local authorities currently access funding for public health service through a Public Health England grant.
But from 2020 funding will be obtained by councils from business rates charged to local companies, which could mean a drop in spending in poorer areas, where children are most likely to need extra support.
The report stressed that intervening early was key to improving both physical and mental health outcomes for children and preventative work by health visitors and school nurses – often the first point of contact for families experiencing problems – was, therefore, key.
“In a context where the government and NHS are increasingly focused on reducing pressures on acute health care services by improving public health and seeking to deliver more services in the community, the value of health visitors and school nurses should be clearly understood and their service properly resources,” stated the report.
“The drop in the provision and uptake of public health nursing training is storing up significant problems for the future”
It also raised concerns about the supply of specialist public health nurses and access to training. Funding for Specialist and Community Public Health Nursing education programmes has been made available by Health Education England for 2018-19, the report highlighted.
“However, this does not include backfill salary to enable providers to release staff to undertake the programme,” it added.
This coupled with uncertainty about the availability of jobs was reducing take-up of training places, despite work to review and update standards.
“The drop in the provision and uptake of specialist community and public health nursing training reported over the past 12 months, coupled with an ageing school nursing and health visiting workforce, is storing up significant problems for the future,” warned the report.