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Right on, sisters

As schools prepare for an ambitious new approach to health education, many are unwisely ignoring the one qualified health professional in their midst, argues Diane DeBell

MANY A headteacher in this country has been known to give a hungry child breakfast or leave another little one to sleep in a corner of the office.

Indeed, teachers have always played an important, albeit informal, role in children's health and in their health education. Inevitably, however, questions or problems arise they cannot deal with. When this happens it is rarely a doctor that schools need but a health adviser who knows how to work with young people.

That role has traditionally been played by the school nurse. She is the one who knows how to circumnavigate the complexities of the National Health Service, deal with the council, and tap into voluntary-sector support.

She (and it invariably is a "she") is also the one professional who has practical answers to health questions. Young people feel they can talk to her about their bodies.

But does your school have a nurse any longer? Even if it does, do you know what she does or what her job is? Schools have tended to take it for granted that they will be provided with a nurse free of charge by the NHS. But in some parts of the country this has proved a naive expectation. The service has been cut back in recent years and there is no statutory requirement on the NHS to provide it.

The new Personal, Social and Health Education (PSHE) curriculum has alarmed some teachers. This is because, for the first time, it demands that they provide comprehensive health education. PSE, the forerunner of PSHE, was always a minority subject choice for teachers. That curriculum is now expanded. And the new health dimension is likely to be particularly challenging for hard-pressed staff.

On top of this, there are new requirements for sex education in schools. Guidance for primary and secondary schools will be produced by the Department for Education and Employment shortly. And from the autumn of this year all Office for Standards in Education inspections will cover sex and relationships education.

What is alarming, however, is the way that few schools have noticed the potential of the school nurse to help respond to these new demands.

As part of the broader school health service, nurses have historically played a key role in preventative care for children. They have a fundamental public health role coupled with experience of working in schools. Most of all, they are health professionals.

Yet the nursing service any school receives is largely a matter of chance, geography and the views of the headteacher. There are wide variations across the country and much depends on the initiative of individual nurses.

In many schools, the nurse comes in rarely and then only for mass immunisations or when children are periodically screened for height, weight, vision or heaing tests. At the same time, other schools see a nurse quite regularly, either because these nurses help children who have chronic or complex health needs, or because the school nurse offers an informal "drop-in"service. Her presence is an enormous support for children who have questions about health, diet, relationships, friendships, or who simply want a confidential adviser who is not also a teacher.

Schools today will have to take children's health ever more seriously. To do this, they will need to work in partnership with the health service, social services, and the voluntary sector.

Ideally, that means recognising that health is about more than just medicine. It is as much about housing, income and family structure as it is about transport, playgrounds and nutrition. Healthy children learn better- and their health in turn depends upon the social and economic environment outside the school gates.

The Mental Health Foundation estimates that about 20 per cent of schoolchildren have mental health problems. Most of these emerge as behavioural problems at school. Moreover, the drive for social inclusion has put more children with disabilities or chronic health needs in mainstream schooling. This has radically changed the nature of teaching and learning - and for the better. But teachers cannot and should not be expected to manage these more demanding learning environments without the support of professionals.

Schools are approaching the new PSHE curriculum, sex education, the healthy schools initiatives (now at pilot stage), and the emerging parenting skills programmes in secondaries as if they were problems to conquer on their own. But recent research (see the Nursing Times Research Journal, SeptemberOctober 1999) shows that children and young people actually prefer to have a health professional at school, particularly when it comes to sensitive issues such as sex education.

Nurses are the only professionals in the NHS trained to understand the cultures of both education and health. Now they need teachers to act as their advocates, and pressure policy-makers to integrate them fully into the health and education agendas.

A proposed national framework for school nursing practice is out soon for public consultation. Given the speed at which change is happening in schools, the future of the service may depend on the vocal support of teachers.

Clearly school nurses are vulnerable: the new health Act, which became law in June, did not provide for a dedicated nursing service.

Teachers must ask themselves if they are fully exploiting the potential of school nurses and whether, in the future, these experienced professionals could play a vital role in safeguarding the health of our children.

Dr Diane DeBell is Reader in Health and Social Policy at the Graduate School, Anglia Polytechnic University, and author of "In a Class Apart: a study of school nursing" (1997)

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