Memorandum submitted by the Royal College
of Nursing
INTRODUCTION
With a membership of over 380,000 registered
nurses, midwives, health visitors, nursing students, health care
assistants and nurse cadets, the Royal College of Nursing (RCN)
is the voice of nursing across the UK and the largest professional
union of nursing staff in the world. The RCN promotes patient
and nursing interests on a wide range of issues by working closely
with Government, the UK parliaments and other national and European
political institutions, trade unions, professional bodies and
voluntary organisations.
The RCN welcomes the opportunity to contribute
to the committee's inquiry and will focus on the White Paper's
implications for health, and in particular school nursing. For
the Committee's information, a summary paper outlining the role
of the school nurse is enclosed.
1. Choice in a specialist system (chapter
1)
In order to enable parents to choose a school,
the White Paper outlines a series of measures to allow parents
access to information on individual schools, such as a "school
profile" and "choice advisers". Whilst the RCN
recognises that information on educational performance will be
of primary concern to parents, we feel that information on a school's
health policies, such as school meals and health promotion and
education should also be made available. Doing so reflects the
importance of health in the school setting and enables parents
to make a fully informed choice.
2. Extended schools: support for all children
(chapter 3)
2.1 The RCN believes the principle behind
the Government's proposal on extended schools is to be applauded.
Providing a range of services to children and young people through
greater collaboration between the school, parents, local health
services, social services and voluntary groups is an objective
the RCN fully supports.
2.2 However, the RCN has concerns about
staff capacity within local health services to fulfil the Government's
commitment for all schools to provide access to extended services
by 2010. In particular we have concerns about the capacity of
school nursing services to meet the commitment to promoting good
health, given that they are the primary provider of health care
in the school setting. A recent RCN survey revealed that there
are 2,140 whole time equivalent school nursing staff in the UK.
In England this equates to approximately one school nurse for
every 14 schools, with over 90% feeling that they are too busy
to provide the service required. [59]
In addition, school nurses reflect the profile of nursing more
generally with one in five nurses about to reach retirement age.
The RCN strongly believes that until the Government double the
number of school nurses they simply will not be able to take on
extra workload such as supporting extended schools.
3. Healthy School Food (chapter 3)
3.1 The RCN supported the Children's Food
Bill introduced by Mary Creagh MP and is encouraged by the Government's
intention to widen the scope of legislation to enable nutrient
based standards to apply to tuck shops and vending machines in
schools. School nurses play a crucial role in enabling children
to make healthy life choices, providing information and advice
on nutrition and diet. We therefore look forward to seeing the
full detail of these proposals.
4. Identifying and helping vulnerable children
(chapter 3)
4.1 Schools play an important role in identifying
and helping vulnerable children. Whilst this is recognised in
chapter 6 there is a need to emphasise the role of the school
nurse who is central to providing guidance and support to schools
educating children with special needs, and looked after children.
In particular, the school nurse has a fundamental role in enabling
learning and modelling behaviour for special needs children.
5. School Nurses (chapter 3)
5.1 We are delighted that the Government
recognises the importance of the school nurse in supporting schools
to promote good health. The role of the school nurse is integral
to the health and wellbeing of children and young people, providing
information, support and advice on issues such as sexual health,
obesity, smoking, bullying, drug and alcohol misuse. In addition
they play a pivotal role in child protection, health promotion
through personal, social and health education and the development
of school health policies. The impact of the school nurse is clear
with a reduction in teenage pregnancies and a decrease in sexually
transmitted infections. In the RCN's survey, almost half of school
nurses reported an impact on the ability of children to make choices
and adopt a lifestyle more conducive to good health. [60]
5.2 However, as previously stated, the RCN
is seriously concerned about how the Government will meet their
target of one full-time, year-round qualified school nurse working
with each cluster of primary schools and the related secondary
school. Not only is there a shortage of school nurses to meet
this commitment but the RCN is also aware of difficulties in accessing
specialist school nurse practitioner courses. This means that
those who wish to train as a school nurse, often cannot and until
this problem is addressed the target of every school having access
to a "qualified" school nurse will be difficult to achieve.
5.3 Problems in recruiting and retaining
school nurses are a particular concern at the moment, with the
Government's proposals to reconfigure Primary Care Trusts and
Strategic Health Authorities. It is as yet, unclear who will directly
employ school nurses and this uncertainty has caused anxiety among
school nurses about their future employment status. Such uncertainty
is yet another pressure on an already overstretched service.
5.4 In addition, the RCN has concerns that
the £1 billion extra funding, allocated to Primary Care Trusts
through the Public Health White Paper60 [61]for
services such as sexual health and school nursing is not reaching
the frontline. Without this funding there will be insufficient
numbers of school nurses available to schools to carry out the
health improvement proposals outlined in the Schools White Paper.
The RCN believes there is a currently a lack of transparency about
how this funding is being spent at local level, which the Government
must address by holding PCTs to account. Unless it does so the
Government's objectives on public health targets such as sexual
health, smoking and obesity risk being undermined. If school nurses
are to harness the potential envisaged for them in the White paper,
action must be taken to address current problems with capacity,
training and funding.
RECOMMENDATIONS
— The RCN recommends that the Government
double the number of school nurses in order to ensure there is
capacity to fulfil the role envisaged in the white paper
— The RCN recommends the Government
take action to hold PCTs to account on the funding allocated for
school nursing as part of the Public Health white paper.
November 2005
59 "School Nurses: Results from a census survey
of RCN school nurses in 2005", Employment Research Ltd 2005. Back
60
"Results from a census survey of RCN school nurses in 2005",
Employment Research Ltd, July 2005. Back
61
"Choosing Health: Making Healthy Choices Easier", Department
of Health November 2004, chapter 3. Back
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