Overstretched school nurses in Rotherham are struggling to help protect vulnerable children, a critical report by the Care Quality Commission has concluded.
The regulator found progress was disappointingly slow in the way the city’s health services were working to safeguard children, despite the huge amount of scrutiny resulting from the major child protection failures there.
“While progress has been made, it is too slow and more is required. This is unacceptable”
The CQC found health services were still unclear about their roles and responsibilities and not working together. Meanwhile, limited capacity in school nursing teams meant they could not fulfil their vital role.
“We’re disappointed that despite intense scrutiny on child protection in Rotherham and the help packages that have been made available, services with a key role in safeguarding are unclear about their responsibilities,” said the CQC’s deputy chief inspector Sue McMillan.
“While progress has been made, it is too slow and more is required,” she said. “This is unacceptable.”
The CQC identified joint working between midwives, health visitors and school nursing teams as a particular area ripe for improvement.
“Arrangements to transfer children from the health visiting service to the school nursing service are well established,” stated the regulator’s report.
“However, the capacity within the school nursing service means that the availability of support from school nurses is restricted,” it said. “This has a significant impact as children get older.”
“There is no shared vision across Rotherham about the role of the school nurse”
The school nursing service is commissioned by the public health department at Rotherham Council and provided by Rotherham NHS Foundation Trust.
The CQC report found school nurses were predominantly working with children and young people officially recognised as at risk of abuse and neglect – but this meant the needs of others were not being identified or support provided.
“There is no shared vision across Rotherham about the role of the school nurse,” said the report. “The ability of the school nursing service to provide the commissioned service is compromised by high levels of activity in supporting children and young people who have child protection or child in need plans.”
The CQC’s review of safeguarding procedures comes a year after a major report concluded that NHS failures contributed to the widespread sexual exploitation of 1,400 children over a 16-year period.
Professor Alexis Jay’s report, published last August, said that from 1997 to 2013 vulnerable girls were raped, abducted, beaten and intimidated and trafficked around the north of England. It was sparked by the conviction of five men of Pakistani heritage for grooming teenage girls for sex.
The CQC’s review was published at the same time as a separate inspection report on Rotherham NHS Foundation Trust, which rated services for children and young people as “inadequate”. Overall the trust was rated as “requires improvement”.
“The trust was making progress towards increasing the numbers of health visitors and school nurses but staff felt their caseloads were unmanageable,” said chief inspector of hospitals Professor Sir Mike Richards.
“Inspectors raised concerns that information was not always effectively shared between teams regarding children who may be at risk,” he said.
However, Rotherham’s Family Nurse Partnership – delivered by the trust – was cited as an example of good practice in the over-arching review.
As well as looking at community healthcare services, inspectors visited Rotherham Hospital, where they identified nurse staffing shortages in several areas.
“Planned staffing levels were not being achieved on a number of wards, particularly those in the medical care services,” said the inspection report. “This was impacting heavily on staff morale, sickness and retention.”
It found the trust was reliant on agency nurses, but did try to use the same agency staff where possible.
However, inspectors also flagged up some outstanding practice including the “exemplary care” provided by the trust’s nurse-led BreathingSpace service for people with chronic obstructive pulmonary disease and other respiratory conditions.
The community service is part of the trust’s medical division and inspectors praised the “highly skilled and knowledgeable staff”.
“Staff were caring and compassionate and continued their caring role by supporting families after the loss of a loved one,” said the report. “It was an example of an innovative community service that met the needs of the population very well.”
“We are recruiting more school nurses in addition to those we recruited earlier this year”
The CQC rated all services provided by the trust as “good” for caring.
The trust is drawing up an improvement action plan to address concerns raised by the CCQ, but chief executive Louise Barnett said work was already under way to tackle the most pressing issues, including in children’s services.
“We are recruiting more school nurses in addition to those we recruited earlier this year, improving the way information is shared between teams and offering extra safeguarding training to help colleagues identify vulnerable patients who may be at risk of abuse and to raise concerns in the proper way,” she said.
“We have focused in particular on additional training for colleagues delivering care to children in hospital and in the community,” she said.
Ms Barnett said recruiting enough nurses continued to be one of the trust’s “biggest challenges”.
A series of overseas recruitment drives were under way at the time of the inspection, leading to the trust employing nurses from Italy, Spain and Romania.
New nurses are also due to arrive from Croatia, bringing the total number of nurses recruited internationally this year to 70.
“We are also working in partnership with our local university to encourage newly-qualified nurses to choose use when looking for their first job,” said Ms Barnett.