RCNi child health award win will 'enhance the nursing visibility in special schools'
A nursing service who changed commissioners' minds over the value of nursing in special schools wins the child health category of the RCNi Nurse Awards
A team that has transformed school nursing in special schools, helping children with complex needs get the most out of their learning opportunities, has won a prestigious award.
The Children & Young People's Community Nursing Service in West Sussex, led by Trudy Ward, was named winner of the child health category of the RCNi Nurse Awards at a ceremony in London on 4 July for its work to identify and meet the health needs of children in special schools.
Head of specialist and community nursing Ms Ward, who works for Sussex Community NHS Foundation Trust, developed a tool to improve the poor and inequitable access to nursing care of the 1,500 children and young people attending West Sussex special schools.
Enhancing the visibility of nursing
The nursing needs assessment tool has informed service model and skill mix and informed every child’s Education, Health and Social Care Plan (EHCP) across mainstream and special schools in West Sussex. An adapted community nursing complexity tool designed by matron Jane Mulcahy is helping nurses to manage their workload and assess clinical risks.
Ms Ward says: ‘Winning this award makes me even more proud of children and young people’s community nursing in West Sussex.
‘The award will significantly enhance the visibility, value and voice of nursing in special schools. It is national professional recognition of the work we have implemented in West Sussex and will raise awareness nationally of this area of health need.’
When Ms Ward was asked to review special school nursing with parents and headteachers, there was one special school nurse for 12 schools.
‘That nurse was just working in a corner of the county,’ she recalls. ‘There was no specialist clinical nursing input for the others.
‘With more than 1,500 children and young people, many of who had complex, fluctuating and/or everyday health needs and conditions, there was no critical understanding of the nursing requirements, other than the national public health nursing specification.’
She adds: ‘Children might have had pain or other symptoms and they are school for the majority of their day.’
Ms Ward developed the tool with parent and teachers before assessing all 1,500 children.
Commissioners misunderstanding the role
The result was the number of special school nurses increased to ten – meeting children and young people’s complex and continuing health needs during the school day.
‘Commissioners just had not understood what a special school nurses did,’ says Ms Ward. ‘All the three CCGs had financial problems at the time, but using the tool the evidence was so clear – the children’s needs were glaringly obvious.’
‘Special school nurses have a tool to assess and provide nursing advice for every child’s ECHP'
It encompasses physical, mental and public health and the nurse can assess the individual child and look at the whole school population. It assesses fluctuating health need and advises on medicines and the everyday care a child requires.
‘It is giving special school nurses a framework to articulate their professional role,’ says Ms Ward. ‘They have a tool to assess and provide nursing advice for every child’s ECHP and are used as pro forma for nursing reports on the clinical needs of children with complex needs and long-term conditions.
‘The headteacher can look at the report and assess what they can provide. They can see whether they need community nurse input or if there are needs that cannot be met by unregistered staff such as teaching assistants.
‘It is stuff the nurses know, but with the tool they can see exactly what need to articulate in the EHCP. In some cases, this has secured a child a place in a particular special school. That can make a massive difference to a child.’
Managing workload demands made easier
The workforce planning tool makes it easier for the special school nurse to work with the community nursing team to manage demand. ‘It gives them a framework to articulate specifics and express their need for support to manage fluctuating capacity and demand,’ says Ms Ward.
‘Staff feel confident that we are enabling them to maintain their pupils' health and feel empowered to manage their health needs.’
Oakgrove College deputy headteacher Sam Taylor: ‘The tool has enabled accurate reviews of need in each of the special schools to be taken and to see how it has changed over time. This has had a significant impact on resource allocation and ensures that resource follows need in an equitable way.
‘The tool is not just about having the support of two special school nurses – it has changed everything. We are all working together much more and better understanding each other.’
What the judges had to say
The RCNi Nurse Awards judges were impressed with the project’s success in increasing nursing provision for this vulnerable group of children. RCN professional lead for children and young people’s nursing Fiona Smith was on the panel.
She says: ‘It is an impressive achievement to convince commissioners to change their decisions and not just within health but within education and social care for children and young people. Some of this work will have traction for other areas of practice around care of children and young people.
‘It is an emerging area that needs to be clearly articulated to demonstrate the importance of appropriate health interventions to support these children and their families to attain the best life they possibly can.
‘Trudy makes clear the value of having a registered nurse and the difference that makes to the lives of these children and young people. It’s about every child mattering.'
The nursing tool has been shared widely across England, for example, in Surrey, Kent, Sheffield and Bradford. ‘It stopped Surrey pulling its funding for special school nurses,’ says Ms Ward.
She is soon meeting representatives from NHS England and the department of education to share the work.
‘The project has ensured there is a common understanding among commissioners, teachers, parents and carers and health services about the specific scope of the special school nurse. My hope for the future is that this can be taken further and the tool used to inform a national specification for nursing in special schools.’
Teachers and parents say that children and young people are learning more as their everyday healthcare needs are being met.
‘They tell us that children are enjoying school life more and are more receptive to their learning, understanding their world more and getting more out of their world,’ says Ms Ward.
‘This is only right – it is fundamentally their right to have the same level of care and being looked after wherever they are.’
Peace of mind for parents
One of these parents is Sarah Jones. Her child is a pupil at Queen Elizabeth II special school in Horsham. Before the project, the school did not have a special school nurse.
She is ‘very grateful’ to have the extra support of special school community nurse Stephanie Smith.
‘My daughter has complex health and feeding issues and knowing that there is someone onsite in case of emergency gives me such piece of mind,’ she says.
‘New staff are able to be quickly and efficiently trained in all the necessary medical aspects to ensure I have never had any problem with my daughter’s care at school as her condition and needs have changed.’
‘Knowing that there is someone there for me and my child during times which no parent should have to go through is priceless'
Ms Jones says the emotional support Ms Smith has given her when her daughter’s health has deteriorated, and having someone with the knowledge and expertise to explain to her what is happening has been invaluable.
‘Knowing that there is someone there for me and my child during times which no parent should have to go through is priceless,’ she adds.
Ms Ward says: ‘We know that a number of children that would have gone out of area have not, and that more than 30 who were not attending are now attending. We have some children with assisted ventilation, now accessing school and we are helping children return from illness.
‘Parents say they feel confident to leave their child at school because of the health provision and can switch off while they are there. Children with complex needs are surviving for much longer. As a society we have a duty to support families and build long-term resilience.’
Meet the other finalists for Nursing Children and Young People sponsored children's award
Hillingdon Hospital’s Paediatric Asthma Team, The Hillingdon Hospitals NHS Foundation Trust
This proactive specialist nurse-led community asthma service set up clinics closer to the child's home or school. The team works with schools and school nurses to highlight children and young people who are at risk due to poor control and ensures they receive appropriate care.
Nicole Bauwens, NHS Grampian
Nurse manager Ms Bauwens has introduced family integrated care and changed the culture at the neonatal unit of Aberdeen Maternity Hospital ensuring parents are partners in the care they receive. Parents are empowered and with support, take part in decision-making. Visiting hours have increased so parents have 24-hour access to their baby.
Sara Nelson and Tracy Parr, Healthy London Partnership
This small team is making a huge difference to London’s children by working with nurses in primary, community, schools and acute settings, as well as national and regional health and political organisations. The #AskAboutAsthma campaign has been viewed by almost 8 million people, resulting in increased downloads from asthmatoolkit.
Val Baxter and the Integrated Children’s Nursing Team, Blackpool Teaching Hospital NHS Foundation Trust
This team is reducing hospital admissions by ensuring children who are not traditionally seen by community children’s nurses, but frequently attend the emergency department, get appropriate care. An early evaluation of 20 children, showed admissions had reduced by 31% after a five-month intervention from the team and the parents’ feedback is positive.