Sharon White and Sallyann Sutton, from the School and Public Health Nurses Association, on how school nursing has become more nimble in local government and why supporting the mental health of young people has to be a priority from now on.
I remember being employed by a council at the beginning of my career. I was co-located with school staff and other education teams, such as psychologists and welfare officers. Working alongside them was of real benefit.
Between them, Sharon White and Sallyann Sutton have more than 70 years’ experience working with children and young people. They have seen first-hand how school nursing has had to change and adapt as the decades have passed. The move into local government has had, they both agree, a significant impact – both good and not so good.
Sharon White is Chief Executive Officer at the School and Public Health Nurses Association (SAPHNA). She said: “The rationale was laudable and I bought into it. I remember being employed by a council at the beginning of my career. I was co-located with school staff and other education teams, such as psychologists and welfare officers. Working alongside them was of real benefit.
“So I was quite excited to reclaim what we had lost, while keeping some of the good bits about being in the NHS – the professional development and working alongside other nurses.”
Being nimble and innovative
SAPHNA Professional Lead Sallyann Sutton agrees – and believes many of those benefits have been realised.
“The move has allowed us to better engage with partner agencies and develop relationships across other areas such as housing. We have had also had the ear of councillors and they have been very good at promoting our role and challenging schools to engage and use school nursing.
“We’ve have also seen a greater array of providers develop. Before, services were mainly in NHS trusts – community and acute trusts. In acute trusts we could sometimes be marginalised – they did not always understand the differences and complexities of working in the community and understandably the focus was always on the acute hospital services.
“The move into local government and tendering processes saw social enterprises, charities and the private sector establish themselves as providers. Some have been smaller organisations, which have been more nimble to respond to change and that has been good for innovation.
We have seen services innovate with new ways of working, for example, expanding skill mix, such as employing other public health staff to work on healthy lifestyle initiatives, and there has also been innovative use of digital technologies, such as the ChatHealth messaging service and video consultations.
Coping with cuts
Ms White said that innovation has been needed to allow school nursing to cope with the cuts that have been seen. Latest figures show the number of school nurses has dropped by around a third in the past 10 years.
“The cuts have been difficult. The impact of reducing numbers of qualified school nurses has resulted in some services making decisions to dilute their skill mix, some taking on non-nurses (unqualified), into the school nurse role or stretching schools’ nurses across too many schools.
“It means vulnerable children miss out – the work on prevention suffers as school nurses must focus on the acute end of child protection to the detriment of what they’re trained and skilled to do: promotion, prevention and early intervention. Many services have also lost those regular and invaluable drop-in clinics.
“But it is important to remember none of this is purely a consequence of moving into local government – rather it was a consequence of the government cutting funding.”
The impact of the cost of living and COVID-19
Looking ahead, both agree there are huge opportunities to be had through the introduction of integrated care systems.
“In many ways it is a natural evolution of the joint working that has happened since public health moved across to local government. It is about providers working together strategically to meet local needs and reduce inequalities,” said Ms Sutton.
“And that is going to be needed given the challenges we face post COVID-19. Mental health in children and young people is perhaps the biggest problem. COVID-19 and the response to it has exacerbated existing mental health problems and seen children and young people who’ve not previously experienced difficulties now starting to struggle. And then off the back of that we have had cost of living crisis. One has blended into another – it is actually hard to distinguish what is causing what.
We are seeing more abuse and neglect. We are also seeing very young children – those who were under five during the pandemic – with delayed social, emotional and academic development who are now entering full-time schooling with developmental and behavioural difficulties which were not picked up in a timely way and intervention delayed. Non-attendance at school has also worsened.
Ms White is particularly worried about the rise in eating disorders. “It is huge and is having a devastating impact on young people and their families."
To help, SAPHNA has developed an eating disorders toolkit to train school nurses and out of this one has also been developed for the wider school workforce.
One area that school nurses are finding difficult to offer support for young people is gender dysphoria, she said. “It is a huge challenge not just for school nurses, but society as a whole. It is an area many school nurses do struggle with to be honest. We need greater clarity and training. SAPHNA is currently developing a further toolkit to support the workforce.
“What’s frustrating though is that government responds to workforce issues by developing new roles and ways of working. We have mental health teams in schools for example, but why didn’t we just invest in what was already there - in CAMHS and school nursing teams and build on that?"
There are also changes to the way the system was set up that may be needed. Ms White gives the example of childhood immunisation rates, which have fallen since the start of the pandemic. “This is a perfect example of how fragmented the system is in places. The NHS is responsible for the uptake of childhood vaccinations, however, public health, including school nursing, is expected to support this uptake. In reality, because this comes without funding, very little activity is undertaken.
“This would be simplified if, as before when our uptake was seen as ‘world beating’, school nursing and immunisation services were commissioned together. Perhaps we need to re-think that – there are always things that can be improved.”