Breaking news at the 2023 Chief Nursing Officer's summit was that school nursing, alongside other public health nurses will come under the professional leadership of the Chief Nursing Officer (CNO). This is exciting and very welcome news after the gap in leadership that was left following the retirement of the chief public health nurse in 2022. This announcement came along with a high-level overview of the CNO Vision which will focus on supporting and protecting the health of our nation. One of the five priorities is prevention, protection, promotion and reducing health inequalities. Ruth May (CNO) stated that it is clear that all nurses, midwives and nursing associates have a critical public health role and importantly that work is required to ensure that we have the right capacity in our specialist public health workforce which includes school nursing. She commented on the commitment in the NHS workforce plan to increase training places and stated she had ‘fire in me to do more’. It was humbling that improving access to school nurses was among the priorities that young people shared in their presentation to the summit.
This renewed focus on school nursing and the commitment of the CNO to do more to rebuild the profession after years of disinvestment is fantastic. SAPHNA was privileged to have worked with the CNO team to shape the vision and ensure that the critical role of school nurses is recognised within it. It feels like the tide is about to turn for school nursing after years of cuts to the public health budget has seen a decline in the numbers of qualified school nurses in post, with some areas no longer commissioning school nursing provision.
Of course, things will not change overnight. It will take time to regrow the workforce. However, it is timely to really think about what our role is. How do we use our specialist public health knowledge and skills to the best effect and have the greatest impact on the health and wellbeing of children and young people. We have our evidence base set out in the school nursing service delivery model (Public Health England, 2021). As part of continuous improvement, we need to review what we deliver and the outcomes that are being achieved and where the gaps in delivery are.
One theme that SAPHNA hears school nurses consistently raising as a concern is that there is little time left for our wider public health work because of the time spent on ‘safeguarding’. The challenge we give is ‘what do you mean by safeguarding?’ After all, safeguarding is embedded through the delivery model and school nurses have a vital role to play in keeping children safe, supporting them to be as healthy as they can so that they achieve their potential and thrive. Our safeguarding responsibilities run through all elements of the Healthy Child programme, from identification of risk and need, to early help and targeted work, and formal child protection. So, what school nurses mean by ‘safeguarding’ takes up so much of our time is actually the time spent supporting children on child protection and child in need plans is disproportional to the time spent on their wider safeguarding role.
Let's be clear. Supporting children on plans is important and a school nurse has a critical role to play, working in partnership with other professionals to carry out their duties in statutory guidance (Department for Education, 2022). However, this needs to be appropriate and proportionate. When a school nurse knows the child, has been supporting the child and/or is the health professional with the right skills and knowledge to provide intervention, then they should be part of the protection or ‘child in need’ plan.
‘School nurse leadership needs to be bold, constructively challenge and use evidence to support changes in practice.’
‘Let's be clear. Supporting children on plans is important and a school nurse has a critical role to play, working in partnership with other professionals to carry out their duties in statutory guidance. However, this needs to be appropriate and proportionate.’
There are school nursing services that have moved to a model of working whereby the school nurse actively supports a child on a plan when there are health needs which can be met by the service. However, there are school nursing services who continue to be the ‘health’ representative when children are on plans. There needs to be consistency across school nursing, ensuring that our specialist public health nursing skills and knowledge are used effectively so that we are able to fully discharge our responsibilities for safeguarding across all the elements of the HCP and fulfil our public health role.
To change practice we need to articulate our role clearly to others. We need to tell others what school nurses can do, how we do it, where our time is best spent and evidence the outcomes that we achieve. One of the challenges we face to change the demand for school nursing at the acute end of safeguarding, is that the systems we work in see ‘health’ representation in child protection for school-aged children as the school nurse's responsibility. Issues such a quoracy in meetings and concern about who will represent ‘health’ are cited as reasons for resistance to allowing change. Poor understanding of the role of the school nurse, and lack of recognition of the role that school nurses have in safeguarding at a promotion, prevention and early intervention stage, and the importance of this part of the role, are likely to be among the barriers to making change.
Rachel Livsey (2023), a school nurse working for CLCH explored the school nurse's role in supporting children in need of protection, presenting an approach to assessment of need which supports decision-making about whom the best health professional is to be part of a child's protection plan. (Her work has been published in the October/November issue of CHHE, see Livsey [2023]). A holistic health assessment, which has the voice of the child running throughout, was developed and supported searching for and identifying health needs, and sharing findings, helping to identify when the school nurse is the most appropriate health professional to be part of the child's plan or whether another health professional is better placed. This approach has now been implemented in practice and will be evaluated. I am sure that the evaluation will include how much time has been released, and redirected to deliver on wider public health priorities and how this has benefited children and young people.
The role of the school nurse in safeguarding will continue to be a hot topic. SAPHNA is working collaboratively to further this discussion and aims to produce a position statement early next year. Watch this space!
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