The role of school nurses in understanding and boosting school attendance

As councillors and as Chief Executive of the School and Public Health Nurses Association, we are deeply concerned about the rising levels of school absence, meaning that thousands of children are missing out on their right to education.

The latest statistics from the Department for Education, show that 20.2 per cent of children were persistently absent (pupils who missed 10 per cet or more of their possible sessions) from September 2023 to up to 22 March 2024.

We are concerned that children in need of additional support continue to have higher rates of school absences. The statistics highlight that children who are eligible for free school meals and those with identified special educational needs (SEN) have much higher rates of persistent absence, relative to their peers.

Why is school attendance so important?

Being around teachers and friends in a school or college environment is an important way for pupils to learn and reach their potential. Time in school also keeps children safe and provides access to extra-curricular opportunities and pastoral care.

Research shows that maintaining regular school attendance throughout the formative years has a profound impact on a child's health, education, and future life prospects. It's not just about showing up; it's about thriving.

Good health and emotional wellbeing are closely linked to improved attendance and academic achievement, creating a positive cycle that extends into adulthood and enhances employment opportunities.

Children who thrive at school are well-placed to act on information about good health. Poor health in adolescence can last into adulthood. However, early preventative measures, including through school nursing interventions, can make a huge difference.

The vital role of the school nurse

School nurses are specialist community public health nurses (SCPHN) who work with school-aged children and young people and their families to improve health and wellbeing outcomes and reduce inequalities and vulnerabilities.

They provide a vital and unique link between school, home and the community. They are there from the start of primary school all the way through to secondary school and on to young adulthood. Throughout these years they guide and support children and help promote good physical and mental health. School nurses also play a key role in understanding and improving school attendance.

They lead the evidence-based delivery of the 5-19 element of the Healthy Child Programme. This comprehensive programme focuses on interventions, developmental reviews, and providing information and guidance to support and improve the health and wellbeing of children aged 5-19 years old, and up to the age of 25 for young people with special educational needs and disabilities (SEND).

Among the programme’s high-impact areas, number four stands out: "Reducing vulnerabilities and improving life chances," highlighting the crucial connection between regular school attendance, overall health, attainment levels and socioeconomic outcomes in later life.

School nurses play a key role in in supporting children and young people to attend school. Beyond that, they advocate for alternative arrangements when a child is too unwell to attend, recognising the importance of balancing health with educational needs. The Department for Education's 2015 statutory guidance "Supporting pupils at school with medical conditions" serves as a guiding framework, emphasising the collaborative efforts required to safeguard the health and education of all students.

Beyond the school gates: support for pupils educated at home 

The role of the school nurse extends beyond supporting pupils within schools and instead encompasses all school-aged children. They are the only health professional that provides universal health services to school aged children and young people and have a pivotal link between home, school and other health provision.

Data on the number of publics who are EHE is now collected by the Department for Education (DfE). At the last census date in autumn 2023, an estimated 92,000 children in England were in elective home education (EHE). This includes adjustments made for non-response and is based on a figure of 87,700 reported by 95 per cent of councils. This is an increase from an estimated 80,900 in the previous autumn term of 2022.

Home education however can mean pupils miss out on the opportunity of regular contact with school nursing services. School nurses have also reported challenges in being able to identify and provide support to children and young people who are educated at home.

The majority of children who are EHE are under the care of parents or guardians who have made an informed choice to be the best option for their child, and they typically fulfil this responsibility well. However, there are cases where children are electively home educated due to difficulties for the child or young person in attending a traditional school setting.

Some local areas are developing services specifically to address this. For example, Northamptonshire’s countywide school nursing service has set up a dedicated pathway to ensure home educated children do not fall through the gaps. All electively home educated pupils are contacted by the service – with those identified as most in needed offered appointments.

Identifying vulnerabilities

Through health needs assessments and holistic evaluations of individual children, school nurses collaborate with partners in health, education, and social care to identify vulnerable students at risk of health inequalities.

These may include children in care, young carers, asylum seekers, travellers, those in temporary accommodation, groups that are often less visible. Through actively seeking out and addressing the unique challenges faced by these pupils, school nurses contribute to breaking down barriers to attending education by providing effective support.

School nurses play a key role in prevention, early identification and intervention, via Early Help. However, as the workforce is estimated to have reduced by almost 40 per cent since 2015, school nurses are often spending more of time at the acute end of safeguarding (child protection), with less time to focus on Early Help – arguably the area they can make the greatest difference.

Warwickshire deliver individual health needs assessments at key transition points using an online questionnaire. Universal reviews use the school nurses’ specialist public health skills and clinical judgement to work with the child or young person to identify issues early and provide an opportunity for ‘personalised in response’ support.

Supporting pupils with medical needs

Children and young people with medicals need to be appropriately supported so that they feel safe in school and their parents and carers are assured that they are well looked after.

School nurses play a crucial role in providing training to school staff about medical needs. In Northumbria, the school nursing service responded to the risk increasing prevalence of severe allergy which can result in anaphylaxis by providing schools with training sessions to help them recognise and manage anaphylactic reactions in pupils with known severe allergies.

Funding challenges 

Schools are facing a range of pressures which can impact their ability to identify and support children with these needs. School leaders and local authority officers report that financial pressures compound challenges around maintaining a broad-based curriculum and additional options for more vulnerable, disengaged or at-risk pupils.

Schools have also been forced to make savings by reducing non-teaching staff capacity, such as pastoral support, which can impact the support available to keep vulnerable children in formal, full-time education. Councils want to work with schools to develop a preventative approach to ensure that these children can remain in the mainstream school system, but they need to be adequately resourced by the Department for Education for this to happen.

Between July 2015 and 2024, the Public Health Grant received by councils has been reduced in real terms by £858 million (in 2022/23 prices). This has resulted in reduction in councils' ability to spend on public health commissioned services, including public health nursing.

As a result, the school nursing workforce is estimated to have reduced by around 40 per cent Contributing factors include cuts to the public health grant, reduced numbers of training places, retirement and staff moving to other roles.

What is the role of councils?

Councils have a statutory duty, working with schools, communities and families, to ensure that all children of compulsory school age receive a suitable, full-time education. They are committed to supporting children who are missing out on school, tackling the disadvantage gap in educational attainment, and ensuring every child has the support they need to achieve their potential.

The LGA supports the introduction of a register of children who are out of school (EHE) to improve data and visibility of these children, combined with powers for councils to meet face-to-face with children. This measure is vital to allow councils to verify that children are receiving a suitable education in a safe environment. However, concerns remain over whether councils can verify if a child is receiving a suitable education.

The LGA has long raised with Government that there are significant omissions in the current powers local authorities have to exercise their statutory duties, which means that it is possible for children who are missing school to slip through the net.

Where next?

There is an urgent need for a cross-government, child centred-strategy to tackle rising disadvantage and the wider factors that are contributing toward causing persistent absence and for children to miss out on school.

This must include reforming the SEND system; expanding access to mental health support and youth services; investing in school nursing by increasing funding to the public health grant; and ensuring schools are resourced, supported and incentivised.