Greater role and recognition
The Scottish Executive has specified that implementation of the framework will be tied to the national roll-out of New Community Schools and will be completed by 2007. There are now pilot community schools in each authority and school nurses in many of these are already involved in all aspects of health. In some they are the "key driver for health issues within the schools".
In East Lothian, Monica Hoenigmann is integration manager for three clusters of schools, including Preston Lodge High and its feeder primaries.
"Our job is to work with the services, the schools and the children's families, to pull it all together and make it happen. All New Community Schools have integration managers.
"Anything connected with health we co-ordinate with the school nurses, and that's very new. Previously they worked very much in isolation, with targets that were all about eye examinations, weight and height, giving injections, advice on head lice and quite a lot of tick-box stuff that just wasted their skills.
"New Community Schools have been influential in getting other professionals to work with school nurses and recognise their wider abilities, while the nurses themselves have been very willing to engage with us and other professionals in broadening their remit," says Ms Hoenigmann.
"The nurse at Preston Lodge High, Rose Brown, currently runs an evening support group for parents of hyperactive children. In the past that sort of thing has been down to the nurses' goodwill, rather than being recognised as an important part of their work. Now, because community schools are supporting them to do these things, people are seeing the benefits, so they're saying that school nurses everywhere should be more involved with guidance teachers, working with the curriculum, working with staff from a variety of agencies and supporting parents in a wider way within the community.
"But the nurses can't do everything they have traditionally done and take on this new role as well. Recognition of the value of their work should mean it becomes properly resourced, instead of relying on goodwill.
"At the moment our cluster has one nurse dedicated to it but she is not full-time. School nurses are a crucial component of New Community Schools, but there are not enough of them."
Ironically, when the framework document was launched at Prestonpans Primary, one of the Preston Lodge cluster schools, the one person missing was Ms Brown. She was giving BCG injections to a long line of schoolchildren.
While there is growing recognition of how much school nurses can contribute to children's health, the necessity for some of the routine work they have always done has not diminished. So there is continuing tension.
One of the big advantages of working in community schools, say the nurses, is that it allows them to become more familiar with the children in their care. This is essential in ensuring their physical and mental health needs are met and they are able to gain full benefit from their education.
"There has been a lot of talk about dropping the name 'nurse', but youngsters see nurses as people they can talk to in confidence about things they maybe wouldn't tell a teacher," says school nurse Janice MacLeod, who co-ordinates the team for East Lothian.
"Take the virtual babies programme set up to tackle teenage pregnancy. What that showed was that the young people who self-refer are the ones you want to be in contact with. So, that one parenting programme let us build up really good relationships with them and when the programme ends the support can continue."
Other initiatives which Ms MacLeod and Ms Brown have recently been involved in include breakfast clubs, to make sure children get a decent meal at the start of the day, making water more widely available in schools, which is linked to children's attainment, increasing physical activity, by training senior primary pupils to organise playground games for younger ones, peer education on the dangers of alcohol, workshops on how to stop smoking, sex education within the health centre, which makes it easier for young people to access services, and mental health workshops to help children cope with the stress of exams.
"In most of these initiatives we are collaborating with other agencies," says Ms MacLeod. "If someone comes to us with a problem, we ask who we can work with, then we all sit around a table and decide how to make progress.
"One of the joys of working in a New Community School is that you really get to know the kids, particularly the vulnerable ones, and you are able to help them through their school careers."