The figures are stark – the number of qualified school nurses has fallen by 33% in the last 13 years from 1,135 to 852 – many of whom it is feared will no longer be practising in schools.
Likewise, the number of NHS professionals working in school nursing (including qualified school nurses) has fallen from 2,915 to 1,945.
A report has laid bare the impact of this “significant loss of expertise, knowledge and skill” seen between September 2009 and December 2022.
The figures (NHS, 2023) show that the number of qualified school nurses first fell below 1,000 in 2019 and has been in decline ever since.
And the figures also hide “great variation” across England with children and young people facing a postcode lottery of provision “with very serious consequences for families and for child health”. The report warns that in some local authority areas, school nursing is no longer commissioned at all.
The report is based on a roundtable discussion held in December between nursing leaders, charities and government representatives and hosted by the Queen’s Nursing Institute (QNI), the College of Medicine, and the School and Public Health Nurses Association (SAPHNA).
The report warns: “Current services are insufficient to meet need. 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.”
Identifying the problems
The report says that “a reduced focus” on funding for services for children and young people means that “school nursing has become depleted resulting in school nurses feeling overwhelmed and unable to deliver all elements of their role.”
It adds: “This then leads to a cycle of recruitment and retention challenges.”
The report explains: “School nurses are skilled and qualified professionals, educated to post-graduate level, whose practice is informed by a biopsychosocial perspective and grounded in prevention. The roundtable heard it was a role which traditionally involved considering the broad range of biological, psychological and social factors, and intervening appropriately to support not only children and young people but their wider families. Increasingly, however, roles do not offer opportunities to use these skills.”
One participant described the job now as “firefighting and plugging gaps”. Another spoke of school nurses often working “solely as safeguarding nurses – not public health professionals”.
While acknowledging the “crucial” role school nurses play in safeguarding, the report warns that a “disproportionate amount of school nurse time is often focused on the child protection and child in need end of the continuum”.
It continues: “The change in the focus of the role means that it is difficult to retain experienced staff, who may be disillusioned by an inability to use the full range of their skills. It also makes the role less attractive to prospective nurses.”
Another consequence of the lack of school nurses is that “an increasing number” of schools are now employing their own nurse. The report warns: “This is usually in response to the reduced visibility of school nurses from the local authority. However, these school-employed nurses tend not to be qualified school nurses and are often professionally isolated, which can be problematic.”
In particular, the report pinpoints the Health and Social Care Act 2012, which transferred responsibility for many public health services, including school nursing, from the NHS to local government at a time when funding for local authorities was being cut back severely due to austerity.
A lack of national oversight is also a problem, participants at the roundtable heard: “There is no central government oversight, so it is not possible to state with certainty how many school nurses are in place and in which areas, or to comprehensively know where services have been increased or decreased,” the report adds.
Identifying the solutions
The roundtable recognised the importance of building political will, clarifying the role and responsibilities of school nurses, and improving school nurse workforce data to better understand how their work has an impact on outcome measures.
Ultimately, the roundtable said that a “coalition of support for school nursing” had to be built – not least encouraging Integrated Care Boards to prioritise school nursing in their areas.
There is hope because, as was reported at the roundtable, from November 2023 the chief nursing office has taken over professional leadership of public health nursing meaning that school nursing will be part of their forthcoming strategy. Furthermore, the NHS long-term workforce plan has set out an ambition to increase school nurses by 48% – although as the participants noted this relates to training places, not funded roles.
Participants also want to see more elements of the government’s flagship 5 to 19 Healthy Child Programme mandated for delivery by school nurses.
A School Nurse in Every School
SAPHNA, the QNI and the College of Medicine have now pledged to work together to begin a campaign entitled A School Nurse in Every School.
In 2021, the College of Medicine included this goal in its Hope for the Future manifesto and Dr Michael Dixon – who chaired the roundtable – said the discussion and report were “an important step” in achieving this.
He added: “Participants pledged to move into action to help ensure school nursing is prioritised with investment in this highly skilled workforce.”
Sharon White, CEO of SAPHNA, pointed to a “horrifying downward trajectory” in children’s health, including the re-emergence of diseases such as rickets, scurvy and malnutrition, rises in vaping and sexually transmitted diseases among others.
She added: “We know that this workforce is a crucial part of the solution, and it is no coincidence that after over a decade of disinvestment aligned to the Treasury’s Public Health Grant cuts, and an around 35% loss in staffing, that we find ourselves in this dire situation.
“As leaders of the Healthy Child Programme who are public health nurse specialists, expert at promotion, prevention and protection, there is no one better placed to help our children and young people repair, recover and restore.”
Sallyann Sutton, SAPHNA’s interim professional officer added: “The Healthy Child Programme is an evidenced-informed programme to improve health outcomes and reduce inequalities through a public health approach. Yet, the programme cannot effectively be delivered because school nurses, leaders of the programme, have declined significantly over the past decade. The result is sketchy delivery, a postcode lottery and an exhausted workforce.
“Our children and young people deserve better. They must have access to this universal reach – personalised in response, promotion, prevention and early intervention programme.”
- NHS: Workforce Statistics December 2022, April 2023: https://tinyurl.com/2p9x8hdv