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A qualified service
Following the failure to meet the governments 2010 school nurse target, Unite/CPHVA is looking ahead to how to improve training and recruitment
Kin Ly
Assistant editor

undertake the course, but is awaiting a decision from the SHA. Ros states: There is a need for the universities to offer more flexible courses. In some places, the training is spread over two years, but nurses would like it to be over three or four years. There is also a need for Open University-type distance learning courses, as nurses with young families find travel to university campuses difficult.

visitor practice teachers. This can be difficult in terms of really understanding our role. Our team lead is a health visitor and it is hard for her to fully understand the needs of school-age children, especially teenagers.

Primary care trusts (PCTs) and strategic health authorities (SHAs) have not met the Department of Health (DH) goal to provide every secondary and cluster of primary schools in England with one qualified school nurse by 2010, despite funds being allocated for this. The DH said that the 2008 workforce census showed there were 2 634 full-time equivalent qualified nurses working within school nursing, an increase of 1 025 or 63% since 2004. Of these, 1 062 were qualified specialist community public health nurses (SCPHNs).

ment resource pack (2006) to support the expansion and development of the school nursing service. Ros Godson comments: Only with a step change in our public health provision for school-aged children will we be able to use our skills of early detection and prevention

There are nine months to go before the end of 2010 and enough time to improve numbers
to reduce teenage pregnancy, sexually transmitted diseases, obesity and depression so that young people do not suffer the later problems of heart disease, stroke, cancers and other long-term illnesses.

Ros Godson comments: SHAs are meant to and need to ensure that PCTs do not spend the money inappropriately. She adds: It would probably have been a good idea to have ring-fenced this as a permanent budget, which would have enabled school nurses to do the job they are trained to do and make a difference to the health outcomes of school-aged children. Then the public would understand and appreciate the service.

Looking ahead Unite/CPHVA professional officer Ros Godson states: This shows the lamentable state of the school nurse provision. There are 3 361 secondary schools in England, and only 1 062 full-time equivalent qualified school nurses. That means that we are short of 2 299. However, there are nine months to go before the end of 2010 and enough time to improve numbers. We will collate information on how many fulltime equivalent school nurses with a postregistration qualification and community staff nurses there are in each and every PCT in order to identify those areas that cause the greatest concern. We can then meet with these PCTs to discuss ways of improving the situation. She adds: Unite workplace representatives must continue to work with members to put pressure onto SHAs and PCTs to train more SCPHN school nurses and practice teachers. Despite the target not being met, health minister Ann Keen states: Working in partnership across health and education, we have made good progress in increasing the numbers of school nurses with a school nurse qualification. In addition to the five-to-19 Healthy Child programme (HCP), the DH and Department for Children, Schools and Families have published Looking for a school nurse? (2006) and School nurse: practice develop-

Lack of appreciation In 2004, the DH published Choosing health: making healthy choices, which stated: We are providing new funding so that by 2010 every PCT working with childrens trusts and local authorities will be resourced to have at least one full-time, year-round, qualified school nurse working with each cluster or group of primary schools and the related secondary schools taking account of health needs and school populations. While funds were made available, it is unclear exactly how this has been spent. The DH confirmed that this budget had not been ring-fenced: PCT allocations are deliberately not ring-fenced or broken down into funding for individual policy streams. It is for PCTs to decide how best to meet national and local priorities as set out in the NHS Operating Framework in the light of their local circumstances, including how much resource to invest. Ann Keen adds: Each school population is unique, with its own health needs, which is why PCTs are responsible for determining how to use the funding allocated to them to commission services to meet the health needs of their local population.

Time to improve training Many school nurses tend to blame the low numbers of qualified SCPHN school nurses on inadequate investment in SCPHN education. At the time of going to press, 59 out of 152 PCTs in England had provided figures for the number of student school nurses so far enrolled on SCPHN courses beginning in September 2010. Of these, 29 had not confirmed places for September, six had enrolled two students, eight only one student and 13 had no students. Ros Godson stressed: Not all PCTs have advertised for SCPHN education posts, and some SHAs have not agreed budgets there is time to improve the situation. Talking about SCPHN school nursing pathway education posts, Southampton Community Healthcare said: We are hoping to get three staff nurses to undertake the public health course for school nursing, but this will be limited by the number of practice teachers. NHS Hounslow states: We plan to sponsor at least five to six students next year to do health visiting or school nursing training. It has been difficult to recruit into school nursing positions and also to get nurses interested in doing their school nurse training. Lincolnshire Community Health Service has made a bid for four student nurses to
March 2010 Volume 83 Number 3

Practice teacher shortage Increasing the number of school nursing SCPHN students may be difficult with too few practice teachers who have a school nursing background. Of 59 respondent trusts, 10 had no practice teachers with a school nursing background, eight had two, five had three, and a further 18 did not provide figures. An SCPHN educationalist, who did not want to be named, states: The greatest problem is a lack of senior level school nurses to train as practice teachers. As a result, there are insufficient numbers of practice teachers to train and supervise potential SCPHN school nurses. Consequently, student school nurses are being trained at a distance by practice teachers with a health visiting background. Talking about some PCTs, The SCPHN educationalist states: The problem is that PCTs are seeing everything as the noughtto-19 agenda, and therefore they are looking at how many practice teachers they have across both disciplines. So if there are six practice teacher with a health visitor background, their view is that they can potentially train six school nurses on the SCPHN course through a long-armed, long-distance approach. But if there is a student who is struggling, there is no way that a long-armed approach from a health visiting practice teachers will provide the required level of support and monitoring. She adds: The NMC states that a nurse ought to be trained by a practice teachers of their own specialism. Although there is due regard that allows health visitor practice teachers to temporarily train school nurses, if this is used as a long-term measure then this could contravene NMC regulations. Other trusts have experienced a similar situation. A band-6 SCPHN school nurse who did not want to be named states: We only have four practice teachers and we are struggling big time. We have had to allocate school nurse students to a health
March 2010 Volume 83 Number 3

School nurses must promote their role everybody needs and wants a qualified school nurse
As a result, some senior school nurses are training student school nurses on the SCPHN course, and the SCPHN educationalist notes: One of the PCTs locally has said that they do not think it works for the senior school nurse to cover both the practice teacher and management role. There need to be staff within the team leadership position and staff free to take on students in the practice teacher role.

when people associate the school nurse although we are SCPHNs with the historical school nurse role. Despite this, there is enthusiasm to deliver on health outcomes. The school nurse notes: There is the motivation, and we want to make the difference, but we feel frustrated at the lack of support.

Motivated despite workplace pressures The national shortage of school nurses has had a negative impact on some who are delivering the service. Talking about the workplace pressures that have accumulated as a result of an under-resourced service, one school nurse states: A lot of my time is spent on child protection and serious case conferences it is not unusual to go to three in one week. All we are doing is safeguarding and immunisation work. It is difficult to deliver on other commitments such as drop-in sessions. There are extremely high stress levels, and there is not one day where I am not taking work home. She adds: There are only 10 qualified school nurses in my PCT. Im dealing with four secondary schools and my colleague is dealing with three. We also have two special secondary schools, which have their own staff nurse but is supported by the school nursing team. People tend to forget about the pupil referral units, where children excluded from school and who usually have behavioural problems are referred to. This is a very demanding area of work, and is in addition to our usual caseload. We only have one part-time community staff nurse who covers all the primary schools roughly 20 in our area. Some members are experiencing the downfalls of a service that they say is not appreciated. The school nurse states: The government has made clear that school nurses can lead the HCP for five- to 19year-olds, but in reality this is difficult

What can be done Progress has been noted in some trusts, but despite these efforts, the long-standing problem of having too small a pool of qualified school nurses from which to recruit remains a big issue. Central London Community Health (CLCH) (Westminster) senior school nurse Jessica Streeting states: We have made big strides in developing the school nurse service by working to improve communication between schools and health. School nurses must promote their role everybody needs and wants a qualified school nurse. She adds: We are now working toward the governments target. It is not simply a question of not having the money, the problem is not being able to recruit qualified SCPHN band-6 school nurses because of a national shortage. We are on the road to providing one SCPHN school nurse per secondary and cluster of primary schools, but we are not quite there yet. It has been difficult to recruit qualified school nurses, despite that CLCH (Westminster) has improved retention and built a reputation as being a good place to work. Elsewhere in the UK Similar problems have been expressed in Scotland and Northern Ireland (NI), but there are hopes that the recently formed Community Nursing Board will help to tackle these problems in Scotland. Unite/CPHVA professional officer Gavin Fergie states: School nursing is within the remit of the new Community Nursing Board, and along with the Health and Wellbeing in Schools Project, it is hoped that these issues would be addressed. He adds: In NI, we are still awaiting the decision from the government on the Review of Health Visiting and School Nursing and how this will affect school health practice. In Wales, an implementation group is due to meet this month to discuss the Community Nursing Strategy, which was out for public consultation last year.