A major expansion in the school nursing workforce is needed in England in order to address a steep decline in workforce numbers, a report from nurse leaders has warned.
It made a raft of recommendations around increasing the size and influence of the school nursing workforce, better commissioning of posts and spotlighting the specialty to national policymakers.
“Re-emergence of Dickensian diseases such as rickets, scurvy and malnutrition, hospital admissions for teeth extractions, rises in vaping, in sexually transmitted diseases”
Sharon White
The report – titled School Nurse For Every School – was compiled by the Queen’s Nursing Institute (QNI), the School and Public Health Nursing Association (SAPHNA) and the College of Medicine.
It was based on a roundtable discussion organised by the QNI, SAPHNA and the College of Medicine, which featured clinicians and local authority figures from across England.
The report, published on Wednesday, set out the case for more school nurses to be commissioned, with at least one per school, and for an end to the erosion of the role’s clinical duties.
School nurses, the three organisations warned, have fallen in number by roughly 33% across England between 2009 and 2022.
This was driven, they said, by an alleged de-prioritisation of child health in national policy, changes to local commissioning and a lack of data demonstrating the value of school nursing.
The report stated: “With a reduced focus on funding services for children and young people, school nursing has become depleted, resulting in school nurses feeling overwhelmed and unable to deliver all elements of their role. This then leads to a cycle of recruitment and retention challenges.”
In some local authority areas, the local commissioning of school nurses had ended entirely, according to the report, the publication of which was funded by Sanofi.
This trend, it said, had led to “increasing” numbers of schools hiring their own healthcare staff, who were not necessarily qualified school nurses.
However, where school nurses were still being actively commissioned, the roundtable attendees highlighted that a degradation of the role was taking place, noted the report.
“While the Healthy Child Programme 5-19 offers a plan for good child health, local authorities, which have commissioned school nursing since 2012, do not have the resources to deliver on the plan,” it said.
“School nurses are unable to work as true public health professionals, [and are] instead being limited to predominantly concentrate all nursing work on safeguarding for the most vulnerable,” said the report.
SAPHNA chief executive Sharon White said a bolstering of the school workforce was necessary to tackle the current key challenges for child health.
“The downward trajectory of our children’s health is nothing less than horrifying,” she said.
Ms White cited the “re-emergence of Dickensian diseases”, such as rickets, scurvy and malnutrition, along with hospital admissions for teeth extractions, rises in vaping, in sexually transmitted diseases.
“All of this and more can be positively impacted by urgently resourcing the school nursing workforce,” she said.
School nurses were “trusted and respected” by parents, children and schools and, for a relatively low investment, could “change this picture and restore hope and respect for our children’s futures”, she said.
In particular, the roundtable report made a series of recommendations targeted at national and local policymakers.
It called on national leaders to shadow school nurses in England in order to see their impact and “build understanding” of how children and young people’s health was currently being “neglected”.
For comparison, they should also shadow school nurses in countries where health outcomes for young people were better, the report suggested.
In addition, politicians were urged in the report to continue legislating “around” smoking, alcohol and obesity and to make more elements of the Healthy Child Programme mandatory.
The report asked leaders of integrated care boards (ICBs) and local authorities to “prioritise” school nursing, when building local strategies for the health of children and young people, and improve school nurse commissioning to be “braver”.
It also suggested that “greater connections” should be built between ICBs, schools and health services to help decide how best to change and improve services.
Dr Crystal Oldman, QNI chief executive, said there was an “urgent” need to invest in school nursing services.
“It is remarkable that we are talking about building political will to improve the health of children in this country,” she said.
“School nursing services have been allowed to atrophy since they were transferred to cash-starved local authorities,” she added.