On the 4th of November, the School and Public Health Nurses Association (SAPHNA) in collaboration with the Institute of Health Visiting (iHV) and the Association of Directors of Public Health (ADPH) published the long-awaited policy position on the safeguarding role of public health nurses (iHV et al, 2024). This is a call for action to ensure the public health function of 0–19 services is not lost.
The policy position was written in response to school nurses who raised concern about their public health roles being eroded, diminishing their ability to effectively work to improve the health and wellbeing of school-aged children and young people and contribute to reducing inequalities. In response to SAPHNA's (2024a) inaugural survey of school nursing, school nurses told us that they have seen a rise in the number of children who are being supported on child in need and child protection plans. The impact is that they are spending more and more time working ‘downstream’. Thirty-seven percent of respondents who work in school nursing services in England told SAPHNA that they spend 75% or more of their time attending child protection and child in need meetings. They felt that they are ‘at the table’ as the ‘health representative’, however, that they are not always best placed to be supporting the child. School nurses told SAPHNA that they are struggling with the challenges of balancing the expectations of supporting school-aged children and young people on plans while effectively delivering their wider specialist public health role.
During roundtable events lead by SAPHNA, The College of Medicine and The Queen's Nursing Institute (QNI) we heard how the school nurse workforce is facing a crisis, that the number of school nurses has fallen by over a third since 2009, at the same time the public health grant has been cut by £1 Billion in real terms (SAPHNA, 2024b). In addition, SAPHNA's survey found that a significant number of qualified school nurses are 51 years of age and older and planning to retire in the next 3 years. This represents a further loss of experience and expertise. There is an urgent need to focus their specialist skills and knowledge to maximum effect, working ‘upstream’ with school-aged children, young people, and their families to promote, prevent, identify, and intervene early with problems before they reach crisis point in the next 3 years.
‘…the school nurse workforce is facing a crisis … the number of school nurses has fallen by over a third since 2009, at the same time the public health grant has been cut by £1 Billion in real terms. In addition, a significant number of qualified school nurses are 51 years of age and older and planning to retire in the next 3 years.’
Let us be clear from the start, safeguarding is a crucial part of the role of the school nurse which runs as a thread throughout the Healthy Child Programme 5–19. We need to be clear about what safeguarding is and how school nurses effectively contribute to this work. The NSPCC (2024) defines safeguarding as ‘the action you take to promote the welfare of children and protect them from harm. Child protection is part of the safeguarding process.’ The NSPCC goes on to list actions that achieve this goal. Safeguarding means:
Public Health England (2021) clearly describes the role of school nurses, articulated in the delivery model which includes focusing on the use of their specialist skills and knowledge to respond to significant public health priorities identified in the 6 high impact areas. The model describes how school nurses and their skill-mixed team's role provide ‘a crucial interface between schoolaged children, young people, families, communities, and schools. They are part of the wider ‘early help’ system, bringing health expertise, providing a service which is universal in reach, personalised in response. They have a skill set which can support holistic assessment of the health and wellbeing needs of children and young people, provide health promotion, prevention and early intervention approaches to support individual, community and population health needs.’ School nurses do this through a range of provision including:
At the ‘acute’ end of safeguarding, school nurses have a role in participating in the multi-agency response required to support and protect children and young people when they are the most appropriate professional to do so. Working Together 2023 (Department for Education, 2024) sets out principles for multi-agency working including a range of professionals working with the same child and family share information and collaborate to support and keep a child safe. It is essential that the most appropriate health professional is identified to be part of child protection and child in need processes, those who know the child and family and have the right skills and knowledge. School nurses must not be used as the default health representation. SAPHNA alongside the ADPH and iHV call for alternative options to be explored to provide health input into the safeguarding system where children do not have an identified health need, but health representation is required in safeguarding processes, such as additional health capacity in multi-agency safeguarding hubs.
‘Let us be clear from the start, safeguarding is a crucial part of the role of the school nurse which runs as a thread throughout the Healthy Child Programme 5–19. We need to be clear about what safeguarding is and how school nurses effectively contribute to this work.’