School Nursing scrutiny panel 23 rd February 2012

1. School Nursing scrutiny panel 23rd February 2012

2. Challenges • Capacity to deliver services equitably • Expectations of schools • Responding to national agendas • Consistent data - information • Relationships with schools – impact on service delivery. • Inequitable staffing across the county – training concerns, no national workload tool. • Caseload complexity • Changing education ‘landscape’

3. 2 key challenges • Staff training • Complexity of workload • Safeguarding • CLA • Mental health

4. How the service prioritises…. • Priority Safeguarding, vulnerable children, LAC, immunisation programmes, School entry health assessments & screening, support for children with complex health needs, Domestic Abuse, targeted A&E work. • Core additional work to the priority work including the provision of open access Drop-in sessions, continence services, A & E follow up, support for children with complex needs at health reviews. • Non urgent new parent’s evening, secondary transfer, PSHE, NEET.

5. Staff • Recruitment - nationally low numbers of trained school nurses. • Number of training places in Hertfordshire. • Historically lower level of investment. • Frustration at level of National focus on HV recruitment. • Inability to offer full public health role for which they are trained because of capacity • Low Morale/High level of commitment.

6. Complex workload • Impact of loss of extended schools programme and level of outreach work. • Thresholds for social care involvement • Numbers of children in school with complex health and social needs.

7. Caseloads • South: 15095; Primary 31; Secondary 7; WTE SN 1:5.3 • East: 27123; Primary 73; Secondary 13; WTE SN 1:8.48 • North: 16121; Primary 49; Secondary 6; WTE SN 1:6.76 • Welwyn & Hatfield: 14129; Primary 41; Secondary 6; WTE SN 1:10 • Stevenage: 15661; Primary 33; Secondary 11; WTE SN 1:6.8 • Watford & 3R: 27081; Primary 62; Secondary 8; WTE SN 1:9.3 • St. Albans & Harpenden: 28886; Primary 47; Secondary 13; WTE SN 1:11.32 • Hertsmere: 16832; Primary 34; Secondary 6; WTE SN 1:7.54 • Dacorum: 20000; Primary 60; Secondary 8; WTE SN 1:11.5

8. Mental health • Increasing number of children with mental health issues are presenting in schools, ranging from anxiety related conditions as a result of family breakdown to diagnosed mental health conditions. • School nurses often support school staff in engaging strategies to help.

9. CLA • School nurses undertake health reviews on Children Looked After, working with colleague in CLA teams and local authority to promote the best health outcomes for these children. • School nurse teams ensure that CLA are up to date with their immunisations, this can be a real challenge as records etc are sometimes incomplete.

10. Safeguarding • School nurses work closely with schools to support children with protection plans. • School nurses are ideally placed to coordinate support. • School nurses attend case conferences for children in Hertfordshire schools even when the children may live outside of Hertfordshire.

11. CLA • School nurses undertake health reviews on Children Looked After, working with colleague in CLA teams and local authority to promote the best health outcomes for these children. • School nurse teams ensure that CLA are up to date with their immunisations, this can be a real challenge as records etc are sometimes incomplete.

12. Actions. • Development group to promote and standardise good practice • Capitalising on passion and commitment of school nurses to develop the service. • Ongoing training to support key areas of the role e.g. mental health • Improving local links with colleagues in social care • Working with commissioners to clarify specification.