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Decline in school nurse numbers raises risk to neglected older children – RCN

Shortage of school nurses is hampering their efforts to help neglected older children

Neglected older children are ‘falling through the cracks’ because of declining numbers of school nurses, the RCN said.

The college was responding to publication of an official report called Growing up neglected: a multi-agency response to older children, which examined inspections by six local authorities covering children aged 7 to 15. Its aim was to learn lessons from these inspections to help improve practice.

The report, which was led by regulators including Ofsted and the Care Quality Commission, found school nurses were important in identifying neglect, but there were disparities between areas.

Highly stretched

‘Although the role of the school nurse was seen to be highly effective in identifying neglect in older children in some areas, this role is highly stretched in other areas,’ the report states.

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Neglected older children are ‘falling through the cracks’ because of declining numbers of school nurses, the RCN said.

The college was responding to publication of an official report called Growing up neglected: a multi-agency response to older children, which examined inspections by six local authorities covering children aged 7 to 15. Its aim was to learn lessons from these inspections to help improve practice.

The report, which was led by regulators including Ofsted and the Care Quality Commission, found school nurses were important in identifying neglect, but there were disparities between areas.

Highly stretched

‘Although the role of the school nurse was seen to be highly effective in identifying neglect in older children in some areas, this role is highly stretched in other areas,’ the report states.

‘Some school nurses were not undertaking health needs assessments that would support them to identify unmet health needs, including those resulting from neglect,’ the authors added.

The number of full-time school nurses fell by 16%, from 3,026 in 2010 to 2,553 in 2017, according to NHS Digital.

They also identified areas where the work of school nurses could be improved with increased support and better inter-agency communication, such as the forging of better links with GPs.

Critical role

RCN professional lead for children and young people Fiona Smith said school nurses were critical in spotting children at risk.

‘School nurses play an important role on the front line, spotting signs of neglect among older children,’ she said.

But Ms Smith said school nurses’ ability to help vulnerable children was in jeopardy.

Vulnerable older children

‘It’s saddening that vulnerable older children often fall through the cracks. To tackle this, better information-sharing between health professionals is crucial,’ she said.

‘Falling numbers of school nurses and decreased resources are affecting school nurses’ ability to provide care and undertake health assessments. As public health funding continues to dwindle, the government must provide school nurses with the investment they need.’

The report, the third in a series of joint publications by Ofsted, the Inspectorate of Constabulary and Fire and Rescue Services, the Care Quality Commission and the Inspectorate of Probation, also found:

  • Neglect of older children sometimes goes unseen.
  • Work with parents to address the neglect of older children does not always happen.
  • Adult services in most areas are not effective in identifying potential neglect of older children.
  • Tackling neglect of older children requires a coordinated strategic approach across agencies.

Supportive to parents

The report used two case studies to show what school nurses could achieve.

In the first, a school nurse developed a trusting relationship with a parent.

‘One school nurse showed an impressive level of commitment in supporting a mother to attend health appointments for her child, who had unmet health needs,’ the report said.

‘The mother has gained confidence and now ensures she takes her child to all appointments,’ the report stated.

Dogged and determined

In the second case study, the nurse took extra steps to ensure a child with poor school attendance received care.

‘The school nurse took medicated products to treat ongoing head lice to the child’s home,’ the report said.

‘She persisted with announced and unannounced home visits to check on the child’s well-being, to refer concerns and to access support for the child through child and adolescent health intervention.’

Best placed

A Department of Health and Social Care spokesperson said the government was already supporting school nurses through local government.

‘Local authorities are best placed to make choices about services for their community, which is why decisions about public health funding sit with them,’ the spokesperson said.

‘To help, we are investing more than £16 billion in local government public health services over the current spending period, and will continue to support schools in their duty to make arrangements for pupils with medical needs.’


Further information


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