The School and Public Health Nurses Association (SAPHNA) presents a report calling for more nurses in UK schools to the House of Lords.

Dr Sarah Bekaert, Senior Lecturer in Children’s Nursing at Oxford Brookes University was invited to Parliament with members of SAPHNA for the official launch of ‘The Forgotten Frontline’ report.

Dr Bekaert contributed to the report which highlights the growing health needs of school-aged children and the workforce shortages that have left the school nursing sector struggling to meet demand. 

Dr Bekaert said: “It was a privilege to attend Parliament this week with SAPHNA. I’ve led research that has supported SAPHNA’s ‘A School Nurse in Every School’ campaign, highlighting the vital role school nurses play in preventing issues that are likely to have a negative impact on children as they grow up. I hope this latest report will help support the case for more school nurses who can work with the emerging and ongoing health needs of young people.”

Baroness Frances D'Souza, Honorary President of the Children's Alliance, hosted the event in partnership with SAPHNA. The launch focused on raising awareness of the increasingly urgent challenges school nurses face in the UK, as outlined in the newly released report.

‘The Forgotten Frontline’ reports the findings of SAPHNA's inaugural survey of school nurses and their teams across the UK. The average English school nurse now cares for over 4,000 pupils.

Key Findings:

• 82% of survey respondents report insufficient staffing to deliver critical health services.

• Mental health concerns in young people have surged, with a 96% increase in cases reported.

• The growing postcode lottery of school nursing services leaves many children without access to timely care.

• Significant workforce reductions - the survey report indicated that 37% of school nurse respondents plan to retire with most not planning to return to the profession.

Sharon White, OBE, SAPHNA

School nurses (SN) play a crucial role in promoting the health of children and young people. With widening health inequalities and increases in prevalence of illness and mental health problems, the SN is essential. This panel showcases research evidencing the vital role of the SN. Starting with key messages from a study with SNs during the pandemic to capture the creative and responsive practice to emergent need during, and beyond, the pandemic; the development of two resources identified as needed by SN in this study are presented: a new modes of practice teaching tool, and a restorative reflective resource. The panel concludes with an overview of findings from the inaugural national School and Public Health Nurses survey; and developments from the School and Public Health Nurses Association (SAPHNA), Queen’s Nursing Institute and College of Medicine’s joint evidence-based proposition on the impact of SN in improving school aged children’s health.

Dr Sarah Bekaert, Oxford Brookes University

This presentation will showcase the findings of two phases of research: an e-survey of SNs across England and Wales to identify innovative practice in front-line SN work with vulnerable children and young people; and a qualitative study to examine SN’s views about new practices used with vulnerable children and young people, and work with partner agencies. Findings show: swift adaptation of practice; increased challenges in accessing, supporting and representing children and families; benefits for multidisciplinary working; reduced opportunity for preventative work, resulting in more complex issues later on; variability in SNs reporting of the usefulness of different methods used to engage with children and their families - with concerns about an increasing reliance on virtual platforms for service provision. The following needs for SN were identified: to explore new practices that have been beneficial and how these be could be continued post-pandemic, and for restorative work with the SN workforce.

Dr Georgia Cook, Oxford Brookes University

The second presentation will detail two resources developed in response to needs identified by SNs. The first is the co-production of training materials with and for School and Public Health Nursing (SCPHN) students, focused around the practice modes available to work with children and young people. These will comprise self-contained materials and practical activities to encourage critical reflective practice in a format that can be provided to SCPHN educators nationwide to implement with their cohorts.

The second is to develop a restorative reflective resource for SN. This resource, offers guidance through a restorative process for SN teams who have been exposed to emotional stress and trauma, focusing on the impact of practicing both during and in a post Covid landscape. There is a need to ‘pause and reflect’, acknowledging the impact on school health teams and consider the way forward in a climate that continues to evolve and challenge.

Sallyann Sutton, SAPHNA

The final section will present key findings from the inaugural School and Public Health Nurses’ Association (SAPHNA) ‘School nursing: where are we now?’ Survey Report 2024 and developments from the SAPHNA, Queen’s Nursing Institute, and College of Medicine’s joint evidence-based proposition on the impact of SN in improving school aged children’s health. The key findings from this first UK wide survey of SN teams, will give a picture of school nursing in the UK from a practitioner intelligence perspective. This will include an overview of: what SN are doing, what services they are providing, the innovative approaches undertaken to delivery, and also the challenges in practice. The presentation will link the results of the survey to how this evidence is being used to underpin policy and partnership work, specifically through the joint evidence-based proposition, to help promote the role of the SN and advocate for investment in school nursing.

A School Nurse in Every School: Sector Leaders call for Action 

A new report published today (20.3.24) calls for action to address the steep decline in the number of school nurses in England.  Link to the report on the SAPHNA website here.

The report is based on a round table meeting of nursing leaders, charities and government on 15th December 2023.The round table was a joint initiative by The Queen’s Nursing Institute (QNI), the College of Medicine, and the School and Public Health Nurses Association (SAPHNA), funding was provided by Sanofi. The report brings together evidence and insights about the decline in school nurse numbers since 2009, summarises the impact on the health and wellbeing of children and young people, and offers a range of solutions. 

There has been a 33% fall in the number of school nurses since 2009 across England, though this headline figure hides great variation: in some local authority areas school nursing is no longer commissioned at all. This is a clear instance of a postcode lottery with very serious consequences for families and for child health. 

While the Healthy Child Programme 5-19 offers a plan for good child health, local authorities, which have commissioned school nursing since 2012 do not have the resources to deliver on the plan. School nurses are unable to work as true public health professionals, instead being limited to predominantly concentrate all nursing work on safeguarding for the most vulnerable. 

The round table called for a range of actions to address the issues, including building national political will and encouraging Integrated Care Boards to prioritise school nursing within healthcare strategies for children and young people. Organisations such as SAPHNA and the QNI must also continue to support school nurses to raise their voice and demonstrate their value and impact on the health and wellbeing of children and young people within the system. 

Dr Crystal Oldman CBE, the QNI’s chief executive commented, “It is remarkable that we are talking about building political will to improve the health of children in this country. School nursing services have been allowed to atrophy since they were transferred to cash-starved local authorities. We urgently need to invest in school nursing services that have a proven positive impact on the physical, mental and emotional health of children and young people at a crucial time in their lives. We have a duty of care that must be enacted today.” 

Sharon White OBE, CEO at the School and Public Health Nurses Association added, “The downward trajectory of our children’s health is nothing less than horrifying. Re-emergence of Dickensian diseases such as rickets, scurvy and malnutrition, hospital admissions for teeth extractions, rises in vaping, in sexually transmitted diseases, all of this and more can be positively impacted by urgently resourcing the school nursing workforce, who, trusted and respected by parents, children and schools alike and for relatively low investment, can change this picture and restore hope and respect for our children’s futures.” Dr 

Michael Dixon OBE, the College of Medicine, who chaired the round table, welcomed the report saying: “A school nurse for every school is an ambition in the College’s Hope for the Future manifesto (2021) and this is an important step in making it happen. Participants pledged to move into action to help ensure school nursing is prioritised with investment in this highly skilled workforce.” 

Oxford Brookes researchers contributed as key partner in a Round Table event to develop a strategic evidence based approach to ensuring children and young people are supported through the expertise and skills of school nurses. We were invited by Sharon White, OBE, CEO of the School and Public Health Nurses Association (SAPHNA) as a result of our partnership and findings from the Brookes-led School Nursing in the Time of Covid study.  

The event was hosted by SAPHNA, the College of Medicine, and the Queen’s Nursing Institute (QNI). It was chaired by Dr Michael Dixon, chair of the College of Medicine, also a QNI Fellow.  With Vice-chair, Sir Sam Everington, founding member of the Bromley by Bow Centre (an early exemplar of an integrated health and community hub), and Professor Dame Donna Kinnair, particularly known for her work as nurse assessor in the Victoria Climbie inquiry. The event culminated in a discussion and planning session with Ann Keen, nursing advisor to the Labour Party and former health minister.

This marks the beginning of focused work to ensure that specialist public health nursing for school aged children is recognised and mandated for 

in national policy. Potential plans include encouraging the health minister to shadow a school nurse, a ministerial visit to an example Scandinavian school health provision, mandating aspects of the Healthy Child Programme for school aged children as for Health Visiting and pre-school children, and mapping the provision of school health services across the country – including UK wide comparisons. Oxford Brookes researchers will be a key partner in building this evidence base to underpin the strategic plan.

The initiative started with the publication of the Royal College’s Hope for the Future manifesto two years ago in which Professor Sir Sam Everington’s, College vice-chair and QNI vice president, and Trustee Professor Dame Donna Kinnair co-authored a chapter on Health Equalities including the aim: Every school should have a school nurse who sits on the Board of that school. This was followed by Sir Sam’s presentation at the QNI 2021 conference named ‘A School Nurse in Every School’; and a similar presentation to SAPHNA’s conference in the same year. These manifestos reflect SAPHNA’s vision for school nursing set out in the publication School Nursing: creating a healthy world in which children can thrive.

SAPHNA conference 

12th September 2023

Delighted to present the study and resource development at the SAPHNA conference.  We made a call for teams who would be interested in piloting and evaluating the reflective resource which received a great response. Next steps evaluate, revise, and launch!

Resource Development

Two MSc Nursing students, Maisie Rawlings and Dominic Shariff, have been revisiting the qualitiative data from the study to identify practical learning that can inform a practitioner-facing resource.  The findings from this exercise highlighted learning in three areas: practice with children, young people and families; working with the multi-disciplinary team; and working in the school nursing team.  A prototype reflective resource has been developed.  This resource was taken to one of the Oxford School Nursing Teams (pictured, with the researchers) for consultation.  This event was funded by a Public Engagement in Research  Associate Dean for Research and Knowledge Exchange grant (ADRKE PER). The resource will be revised according to these suggestions and recommendations.  Next steps are to evaluate the resource with 3-4 teams across the nation.  This will be in the autumn.  The study and resource development will be presented at the September 2023 School and Public Health Nurses' Association conference. 

Please email: sbekaert@brookes.ac.uk for further details about this resource.