In the last issue, I talked about SAPHNA's collaboration with The QNI and College of Medicine which led to a roundtable event which took place in December. This launched the campaign for ‘a school nurse in every school.’ The response was humbling. It brought together over 30 strategic partners, drawn from across the health and care systems. All made pledges about how they will contribute to the campaign. The full report will be available via the SAPHNA website by the time you are reading this article.
All agreed that there is a clear and worsening crisis in the physical, emotional, and mental health of England's children and young people. School nursing roles and services have been eroded in recent years and in many instances, resources are now insufficient to deliver the Government's National Healthy Child Programme. Children and young people's health must be made a societal priority if our nation is to flourish. And the specific contribution of school nurses to the nation's health must also be amplified, both within local communities and at a national level.
There was concern that the changes to commissioning and a lack of data have contributed to this problem. More robust data is urgently needed on how the availability of school nurses varies across the country. It is also critical to build an understanding of how these varied services affect outcomes. SAPHNA's inaugural survey ‘School Nursing: Where are we now?’ closed at the beginning of March and we want to thank all those school nurses and members of their skilled mixed teams who took part. The response rate was fantastic. We are now crunching the data and there is a lot of it! We will produce a report, based on making practitioner intelligence that paints a picture of school nursing in the UK. Emerging from the data are some worrying results.
The Royal College of Paediatrics and Child Health (RCPCH, 2020) State of child health in the UK report shows a deteriorating picture of children's health and wellbeing with increases in the prevalence of mental illness; child poverty; poor oral health; use of cannabis; rates of suicide; and rates of children on a child in need plan or having a child protection plan. In our survey, school nurses told us they were seeing this deterioration and increasingly seeing children and young people who needed support with mental wellbeing, healthy weight, worries about gender and sexuality (see the graph below showing emerging results).
During the roundtable we heard evidence that the child health workforce was insufficient to meet demand. Where nursing increases had happened, these had ‘primarily come in the hospital sector, at the expense of all services in the community such as the school nursing service.’ These have been eroded by around 35% since 2009. This is something that SAPHNA hears from practitioners on a weekly basis. Our survey asked questions about the workforce. We want to understand what the age profile looks like. Of the qualified school nurses who responded, 46% were aged 51 years and older, this rose to 81% indicating that they were 40 years and older. The number of those age 51 years and older who plan to retire within the next 3 years is a concern. The workforce will lose a wealth of experience that cannot be replaced at the rate at which they will be lost. The NHS Workforce plan which includes increasing the number of school nurses trained, however, this extends over 6 years.
At the roundtable, concern was also raised about the reach of the Healthy Child Programme 5–19 (25 years for those young people with additional needs). The evidence-informed blueprint for services and interventions that are required to support the health and wellbeing of young people in England, led by school nurses, is designed to support universal and uniform coverage for children and young people. With the depleted number of school nurses, with some areas having no commissioned service, falls well short of its aspiration. Our survey will reveal what coverage looks like, what is been delivered, where the gaps are and how school nursing time is spent. During the roundtable, one participant described the job now as firefighting and plugging gaps. Another spoke of school nurses often working now solely as safeguarding nurses – not public health professionals. The results of our survey support these comments, with significant amounts of time being spent attending child protection and child in need meetings, at the expense of fulfilling the wider public health role, promoting wellbeing, preventing ill health, and intervening early to prevent escalation of problems.
The aim of the roundtable was to explore solutions and to develop an action plan. Participants made pledges towards these actions and progress is already being made such as our recent, presentation to the ICB Executive lead nurses for children and young people; with some very positive discussions happening as a result.
Our school nursing survey is not all doom and gloom, we asked about examples of good practice and the data does show the immense amount of work that school nurses and their teams are going to improve outcomes for children and young people. So, I have started to tease you with some snippets of the data. We will invite you to an event to launch the findings of the survey.
Until then, how can you help to amplify the voice of school nursing? SAPHNA takes every opportunity to advocate for children and young people and to amplify the role that school nursing play in improving health outcomes and reducing inequalities. We are frequently approached for comment by the press and media to give comments. When we do this, we share articles via our website, social media and shout out. The press and media are always keen to hear about stories from the frontline, what are school nurses seeing in practice and what are school nurses doing to respond to the issues. SAPHNA collates case studies that help us to bring school nursing to life. So, please share the excellent work that you are doing (https://saphna.co/get-involved/case-studies/).