School nurses are ideally placed to offer advice, support, care and expertise to enable young people to make healthy choices. The Government pledged in 2004 to resource a full-time, qualified school nurse for every secondary school and its cluster of primaries by 2010. It sent Looking for a School Nurse to all schools to detail the scope of their work and reiterated many of these functions in the Children's Plan.
Unfortunately, this commitment was not acted upon and money to train nurses for the specialist postgraduate qualification has not been ring-fenced. Consequently there are just too few of them to deliver the effective interventions required to have an impact on public health targets. Official figures show that in February 2006 there were only 856 specialist community public health practitioners (school nurses) out of a workforce of 2,500 general nurses working in schools, most of whom are part-time.
Last year only 156 postgraduates were trained, so at this rate it will be 2023 before the target is reached to cover all 3,367 secondaries. This despite the Children's Plan stating that the single most important factor in delivering the aspirations for children is a world-class workforce.
Where school nurses are properly employed, they are integral to pupils' welfare. The Children's Plan proposes extending individual health records (the red book) until the child is 11. Reviewing each child's health status regularly through primary school allows for early detection of such problems as obesity. Regular liaison with teachers also means unnecessary absence attributed to sickness can be acted upon before it becomes habitual.
Young carers can be more easily identified and the common assessment framework used to set up appropriate services. School nurses with the extra training are able to offer emotional support to youngsters, allowing the children and adolescent mental health services to deal with more difficult cases. They are trusted by young people because they have to work in confidence to maintain their registration.
School nurses are heavily involved with the healthy schools programme and work with teachers to amplify the science and PHSE curriculum, promoting healthy eating, influencing packed lunches and helping with food policies. They can offer valuable information about the effects of alcohol, poor diet and smoking.
Where health is part of the extended school plan, school nurses can offer work for young people and parents, including fathers, in accident prevention, healthy lifestyles and negotiating access to health services, particularly for disabled and vulnerable children. School nurses nowadays often undertake the annual health assessment for looked-after children, which influences individual health care plans.
Teachers frequently call on their school nurse for help in delivering puberty lessons, so that these can be offered in smaller, more intimate groups and children can ask the questions they need. Many school nurses have received extra training in delivering effective sex and relationship education. This is valuable where teachers don't wish to become experts. Some school nurses are additionally trained in family planning and can provide advice and contraception. They work in partnership with the teenage pregnancy co-ordinator to bring down the under-18 conception rate. Surveys show that adolescents often prefer dedicated young people's clinics at convenient times and venues.
School nurses are valuable partners in integrated children's services, and teachers need to demand that their local primary care trust employs and trains them.
Ros Godson, Professional officer for school aged children's health for UniteCommunity Practitioners' and Health Visitors' Association.