Increase the school nurse workforce to boost health outcomes for children, says Unite’s Rosalind Godson
School nurses are delighted that the Department of Health has produced a strategy for the future of their role, and commend the modern approach to the public health of school-aged children. In particular, they agree that all children – not just those in school – should benefit from the service.
The strategy clearly sets out what children and young people should expect from their school nurses, and seems to deliver what school nurses crave: a definitive service level agreement across the country, so that a qualified school nurse in Truro does the same job as one in Leeds.
The vision states that they will offer a universal and targeted service to improve health outcomes for all. They will also help build community capacity for the prevention of poor health in schools and neighbourhoods and ensure that the health needs of children with disabilities or long-term conditions or mental health problems are understood.
“It is evident that, even with the best will in the world, school nursing is set up to fail unless the numbers are increased”
However, the devil is in the detail and, having read the document, it is clear to most school nurses that this optimum service cannot be attained with the current paucity of staff. There are 8.2 million pupils in England and only 1,165 whole-time equivalent qualified school nurses to lead on delivering the Healthy Child Programme. In most areas, school nurses are supported by school staff nurses, and sometimes community nursery nurses and healthcare assistants, but the entire workforce is less than 5,000, many of whom work on a part-time basis.
The number of schools is daunting; there are 16,884 primaries, 3,268 secondaries, more than 1,000 special schools and 403 pupil referral units. As a pupil referral unit or a secondary school on its own can be a full-time job, it is evident that, even with the best will in the world, school nursing is set up to fail unless the numbers are increased.
However, although the strategy follows the equivalent health visitor implementation plan closely, there is no equal commitment to funding or increasing numbers. Indeed, some areas have decided not to commission school nursing training places so they can fulfil their requirement for health visitor numbers. The result may well be that all the good work done on improving health outcomes of under-fives fades at school entry.
Children, young people and parents have been active participants in the development of the vision and model for school nursing and have recommended a more accessible and visible workforce. However, many school nurses cover two or three secondary schools and several primary schools, and are completely overwhelmed with work. They do daily, unpaid overtime, which is not recorded, and meal breaks are a forlorn hope.
This gap between rhetoric and reality is explained by school nurses themselves. Where there is understaffing, they are sure that their managers do not have a full understanding of the depth and breadth of the role. It is a common experience for students on placement to express their amazement at what the job entails and, where health visitors have worked alongside school nurses, they are similarly surprised at the scope of the job.
The government has made it clear that local not national commissioning will define the future of public health for children.
School nurses themselves must ensure that their work is reflected in the joint strategic needs assessment (JSNA)and that the new health and wellbeing boards have a thorough knowledge of the vision.
Good commissioning will ensure that school nurses can at last do the job they have trained for, and deliver the improvements in obesity, mental health, smoking and so on that society needs. Poor commissioning will result in stressed staff unable to deliver any of these.
Rosalind Godson is professional officer, health sector, at Unite the Union