School nursing services across the country face major upheaval, with councils preparing to integrate services following the full transfer of public health commissioning this autumn, an investigation by Nursing Times has found.
Some of the contractual changes are resulting in “brutal” cuts and potential job losses for school nurses and other public health nursing staff, as new service specifications are drawn up by councils, it has been warned.
Local authorities gained control over budgets for public health services, including school nursing for five to 19 year olds, in April 2013.
“This is very worrying given the robust evidence regarding the increasing emotional health and wellbeing needs of children and young people”
They will also become responsible for funding health visiting services for 0 to 5 year olds from October, when commissioning responsibility transfers from NHS England.
Ahead of this transition, many councils have reviewed their arrangements for school nursing alongside making plans to introduce a single service that spans all ages up to 19 year olds.
Derbyshire County Council has proposed to cut its school nurse funding by £500,000 – from £3.6m in 2014-15 to £3.1m in 2015-16.
The re-procurement of services from this October is part of plans to create a new public health nursing and prevention service for those aged up to 19, which would integrate health visiting and school nursing.
Durham County Council is also making plans to put its school nursing service out to tender, as part of a proposed revised service to be introduced from April 2016.
A spokeswoman for the council said no school nurse redundancies were anticipated at this stage.
As previously reported by Nursing Times, school nurses who work for Staffordshire and Stoke-on-Trent Partnership Trust could face redundancy because of changes to services in the region.
In June, Ealing Council in west London approved a 50% cut to school nursing services over the next three years, as part of plans to re-allocate funds within the public health budget.
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Meanwhile, South Tees, Redcar and Cleveland Borough Council has decided to run the school nurse service “in house” from September, after no organisation bid to run the service under new arrangements.
A joint tender for the service was put out by Redcar and Cleveland Borough Council and Middlesbrough Council earlier this year, but no bids were submitted – including from the current provider, South Tees Hospitals Foundation Trust.
South Tees told Nursing Times it “could not provide a quality service within the framework of the tender”.
Since then, the councils have decided to commission the services for their local populations separately.
This has resulted in almost 20 school nurses transferring from South Tees Hospitals to work for Redcar and Cleveland Borough Council, which said the “in house” option provided “the best opportunity” for integration with its broader services for children and families.
The local authority said no redundancies were expected, but it planned to re-model the service once staff have moved over.
South Tees Hospitals will continue to provide school nursing for Middlesbrough Council until the end of March, with a 10% increased budget.
The contract will be put out to re-tender to provide an integrated service for those aged up to 19 beyond this point, said the local authority.
Sharon White, professional officer at the School and Public Health Nurses Association, said it was concerning to see significant cuts being proposed for services in a number of areas.
“This is very worrying given the robust evidence regarding the increasing emotional health and wellbeing needs of children and young people, in which school nurses play a critical role in identifying, supporting and referring them to other services,” she said.
“To maintain the confidence of the workforce the commissioner has to be absolutely clear how the changes will maintain and improve the workforce”
Ms White claimed some local authorities were using external auditors who did not fully take into account qualitative information – including the views of children, young people and families – when advising on the redesign of services.
However, she noted that some councils were using new approaches, such as using mobile devices and a focus on prevention for safeguarding work, to improve services, and called on others to follow suit.
“Commissioners and providers a like need to explore and implement these strategies, rather than brutal cuts to public health services and loss of a highly skilled school nurse workforce,” she said.
The Royal College of Nursing’s head of policy Howard Catton noted many nurses would be concerned that contract changes were being made to cut costs and for other contractual reasons.
Although he acknowledged that some councils could be integrating health visiting and school nursing in order to try and provide “more seamless and coordinated services”.
“[But] to maintain the confidence of the workforce the commissioner has to be absolutely clear how the changes will maintain and improve the workforce,” he said.