Scores of school nurses in Birmingham could be facing redundancy amid plans to cut funding by virtually half and scrap the school nursing service.
The decision to decommission the service comes after the city council agreed to slash funding by £2m – almost half the current £4.2m budget for the School Health Advisory Service.
“Removing the School Health Advisory Service leaves our young people even more vulnerable”
One school nurse told Nursing Times that she feared for the safety of vulnerable youngsters if the service, currently provided by Birmingham Community Healthcare NHS Foundation Trust, was cut.
“Schools themselves are under great pressure and currently rely on school nurses to bridge the gap between health and education,” she warned.
“School nurses also support schools with safeguarding cases and support pupils with emotional health needs, both of which are areas of increasing concern for children in this city,” she said.
“Birmingham has the highest proportion of 0-to-25-year-olds in Europe, which means that removing the School Health Advisory Service leaves our young people even more vulnerable with the creation of this additional gap in vital support services,” she noted.
The nurse – who asked to remain anonymous – maintained that her own job and up to 100 others were under threat from the plans.
She added that the proposals currently on the table did not “include any mention of qualified public health nurses”.
The decision to decommission the school nursing service as it stands comes after the council agreed to move from a universal to a “targeted” service, in light of substantial cuts to its overall funding allocation for public health.
As previously reported in Nursing Times, this would mean services “will be focused on communities of greatest need”. However, it is not yet clear how this model might work in future and whether or not qualified nurses will be involved.
Nursing Times understands options being considered include schools receiving a “health premium” to pay for their own health support services or the establishment of local “child health groups”.
Another option could mean school nursing services becoming an extension of health visiting and nursing services for younger children.
The move has already been described as “futile” by the School and Public Health Nurses Association, which said a targeted approach would mean most children missing out on key public health messages and that opportunities to identify issues early would be missed.
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“Moving to a targeted approach makes no economic, let alone ethical and moral, sense to improving the significant needs of the population of Birmingham’s children and young people,” said chief executive Sharon White, when the budget plans were first unveiled.
The current state of affairs is a far cry from when the contract for the School Health Advisory Service was awarded to the trust in 2016.
Managers and commissioners pledged school nurses would continue to be “highly visible and accessible” to the city’s children and young people, with a nurse visiting each secondary school at least once a week and each primary school at least once a fortnight.
The service also included targeted community clinics and home visits for vulnerable families and featured a year-round text service covered by a rota of school nurses five days a week.
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Nurses were told it was “an exciting time to be a school nurse in Birmingham” and that they provided an “invaluable service”.
Yet a confidential letter from Birmingham Healthcare seen by Nursing Times confirms the service in its current form will cease in July this year.
The letter dated March 2018, which acknowledges this is an “unsettling time” for staff, promises the trust will bid to run a revised service should the opportunity arise.
“If a new model is proposed, BCHC [Birmingham Community Healthcare] offers full assurance to our affected colleagues that we will seek to bid for any opportunities which emerge, in line with our strategy to retain our core services in Birmingham wherever possible,” said the letter.
It also reveals that the trust has raised concerns with the council about the potential impact of decommissioning the service, including on the most vulnerable children.
“BCHC has communicated out concerns directly to BCC [Birmingham City Council] and, through the Birmingham Safeguarding Children Board, highlighted that there are areas that require more thinking about the quality and equality impacts and risks of the service being decommissioned,” said the letter.
However, it makes it clear that a formal decommissioning process is under way and goes on warn that redundancies or a transfer of staff may take place.
“It is possible that either a redundancy situation or a Transfer of Undertaking with Protected Employment (TUPE) situation may arise,” stated the letter.
A spokesman for Birmingham City Council said he could not provide any further details of plans for the service at this stage but said this would become clearer during the tender process.
“We don’t employ school nurses so I am unable to say how many are at risk,” he said. The tender process was expected to start soon, he added.
A Birmingham Community Healthcare NHS Foundation Trust spokesman said: “We currently work closely with the service commissioners, Birmingham City Council, and are keen to continue to provide this vital service.
”As part of this, we are keen to develop a deeper understanding of the specification and to formulate a response in line with our aim to deliver improved outcomes for children and families,” he said.
“Our children deserve their school nurses and their specialist skills and experience”
Unite, which includes the Community Practitioners’ and Health Visitors’ Association, called for the proposed £2m worth of cuts to the service by the city council for the financial year, starting July 2018, to be halted.
Unite regional officer Su Lowe said: “School nursing, once again, faces the biggest hit to our community health services and Unite is concerned for the future of this very British institution that has served vulnerable school-aged children for many decades.
“School nursing services are, sometimes, the only access many children and young people have to health services and it is feared the most vulnerable will slip through the net as a result of these significant cuts.”
Unite said the situation was made worse because of the uncertainty hanging over the school health advisory service’s future in Birmingham. The contract ends in July and no decision, as yet, has been forthcoming regarding future commissioning, said the union.
Ms Lowe added: “Our children deserve their school nurses and their specialist skills and experience. Our members are devastated by the threat to the services and their jobs - these cuts should be reversed; and there needs to be clarity and transparency on future commissioning.”