Rosalind Godson on why we need more school nurses
All children have a right to attend school, and many parents of children with healthcare needs choose to send their children to mainstream schools. Other children with complex healthcare needs may go to a special school.
There is no legal duty requiring staff to administer medicines or supervise a child taking medication, but anyone caring for children has a common law duty of care to act like any reasonably prudent parent. In exceptional circumstances this could include administering medicine or taking action in an emergency.
The Healthy Lives, Brighter Futures guidance proposes that each child with a complex condition should have a care plan. In schools, this should be the responsibility of the school nurse, who would then be able to make sure that those looking after the child have a full understanding of the health issues and are trained to deal with them.
Unfortunately, many teaching assistants and support staff are expected to deal with significant medical procedures, while looking after these children, but lack the training and ongoing support to do so.
Teachers’ conditions of employment do not include giving or supervising a pupil taking medicines. There are, however, over 300,000 support staff with various contracts working in schools in England, and significant numbers in Scotland, Wales and Northern Ireland. Some may have specific duties to provide medical assistance as part of their contract.
As well as normal procedures such as giving asthma inhalers or antibiotic medicine, these duties may include procedures such as administering nasogastric feeds, suctioning of tracheostomy tubes, supporting oxygen administration, stoma care, inserting rectal medication and giving injections with a pre-loaded syringe.
‘We owe it to these very vulnerable children to offer a “world-class service” for 21st century schools and not rely on ad hoc arrangements by overstretched staff’
It is the responsibility of the employer to ensure that all such staff are trained to have sufficient understanding, confidence and expertise and that they are regularly updated. Furthermore, arrangements must be in place to cover for staff absence and unavailability. This means that at times, midday supervisors or other part-time staff may be involved with the child’s care.
Training in the administration of medicines must be given by a qualified health professional. Usually this is the school nurse or the community paediatric nurse, but it may be from a specialist clinical nurse. The training should be specific to the child or the condition, and should cover all the relevant policies. These need to be robust and cover: care plans; permission, consent and self-administration; safe storage of medicines, including transportation when off site; record keeping; confidentiality and information sharing; child protection and safeguarding; and training.
If staff follow documented procedures, they should be fully covered by their employer’s public liability insurance if a parent makes a complaint. The healthcare professional should provide written confirmation of proficiency in any medical procedure, including a recommendation for regular updating.
School nurses, although very willing and able to do this work, are often stretched by having to deal with up to 20 schools. Unite has been campaigning against this serious lack of school nurses for at least five years.
Ideally each secondary school and its feeder primaries should have a specialist community public health nurse (school nurse) who can facilitate all the health care of the school. They should be responsible for: the health component of the Every Child Matters outcomes, the childhood obesity target; individual children’s health needs (including children not attending school because of underlying health issues); school health ‘drop-ins’ for children and young people to self-refer, on-site sexual health services where required; liaising with GPs and hospital doctors; public health issues such as pandemic flu or other infectious diseases; transition of children with health needs to new schools; and immunisation programmes.
The nurse would work with the Healthy Schools coordinators and help the school with its health policies. The school nurse would be part of the induction process for all new temporary and permanent staff, so that untoward incidents would be caused by lack of knowledge or procedures.
Teaching and support assistants would be able to see or phone the nurse at any time for advice, or to feed back health information to the specialist concerned.
Unite estimates that, based on the NHS’ latest workforce figures, one specialist school nurse in England is looking after 6,900 children - hence our call for the immediate employment of 2,000 more qualified school nurses. Each PCT and trust should train 10 school nurses from September 2009.
We owe it to these very vulnerable children to offer a ‘world-class service’ for 21st century schools and not rely on ad hoc arrangements by well-meaning but over-stretched staff, whether they are school nurses or teaching assistants.
PCTs in England and health boards or trusts in Scotland and Northern Ireland should follow the good example set by the Welsh Assembly Government, and deliver the promised one full-time specialist school nurse per secondary school.
Rosalind Godson, is professional officer, health sector, Unite the union