Examination of Witnesses (Questions 692-699)
MS JOY
WINKS AND
MS SARAH
DAY
7 MARCH 2007
Q692Chairman: Could I thank you both for coming
today. I am Lady Finlay and I chair this Sub-Committee and this
is our tenth evidence session. I wonder if I could start by asking
you to introduce yourselves. As you may have heard at the beginning,
there is a document with our declared interests so we will not
be going over those again today. Would you like to introduce yourselves
and then we could proceed with the questions.
Ms Winks: I am Joy Winks and I am a school nurse
advanced practitioner in the north of the country and I am also
the chair of the RCN School Nurses Forum.
Ms Day: I am Sarah Day and I work in an independent
school in Eastbourne. I stand on the RCN School Nurses Forum representing
independent schools.
Q693 Chairman: Can you tell us which
allergies cause the most problems for children in schools and
how the needs of these children are taken into consideration?
Ms Winks: All the allergies actually cause work
and problems for children in schools. As far as school nurses
are concerned, food allergies with an ensuing EpiPen actually
cause us more work in terms of time but they are very much done
on an independent basis, so one care plan for asthma might take
you a week to sort out and another one might be a very short space
of time so it is very individual.
Ms Day: Any allergy in school is going to affect
a child. It may be that they have got to have medication in school.
There is an element of body image with eczema and how it is going
to affect that. Children do not like to be different to other
children so this can really have an effect. They may be missing
a lot of school either because of bad management or because their
condition is not under control. Again management is down to trying
to plan care. In independent schools we are fortunate enough to
have a large number of school nurses actually attached to schools
so we can liaise closely with parents and things are much easier
whereas with the state school nurses we are signing up one nurse
to 14 schools so they cannot work quite so easily.
Q694 Chairman: Is enough being done
to help children manage allergy, particularly hay fever sufferers?
I am thinking of the examination season. Is there anything that
the Government should be doing centrally for such children?
Ms Day: I just look at it, having listened to
our professionals speak, we work down on the ground level and
if the management is not coming from higher up then at ground
level we are picking up the bits and pieces. You could say that,
no, the management is not as efficient as it could be and we have
to work with the resources we have.
Ms Winks: I do feel that the school nurse, as
a health professional in school, and one of the very few health
professionals in school, is ideally placed to help schools and
head teachers and staff deal with these children, but, as Sarah
says, there are not enough of us on the ground as health professionals
in schools.
Q695 Baroness Platt of Writtle: We
are told that because the season for hay fever is the exam season
children with hay fever quite definitely are achieving considerably
less than their fellow students. What do you think ought to be
done to combat that problem?
Ms Winks: I think the variations are huge. In
some areas a child will be allowed to sit an exam at a different
time or consideration will be taken of the fact that they have
taken medication and in another area that does not happen. There
is no consistency and I think that is the major problem. Listening
to the four allergists previously it is obvious that there is
a problem with standardisation.
Q696 Lord Haskel: There was a study
published in 2003 showing that children with peanut allergy suffered
a poorer quality of life and they had higher anxiety levels than
those suffering from, for instance, insulin-dependent diabetes.
What is being done to reassure food-allergic children and their
parents about their safety while they are at school?
Ms Day: I would say, yes, there probably is
a greater level of anxiety because we do seem to have diabetes
more under our control and yet the evidence you have heard with
allergies is that there is a problem with actual diagnosis or
getting hold of specialist treatment. Again, the anxiety levels
from parents being unable to access specialist treatment means
that they will turn to alternatives where they can pay and access
the facilities. Obviously I am talking about those who can afford
to pay for those services, and in the independent schools we do
see alternative medicines being used quite a lot. To reassure
them again from our point of view in independent schools, they
have a nurse on the premises, so that is reassuring to them that
we do have some knowledge and are able to care and look after
their children while they are at school.
Ms Winks: The burden of our practice in the
state side is on training and supporting school staff in dealing
with the allergies so we will have things like school agreements,
whole-school training, protocols, and individual care plans for
children and it is a very individual thing. A child in a huge
comprehensive school will maybe carry their medication with them
and for a child in a small primary school it will be kept in one
place and all we could do is support and train, but again it is
not a standard across the board because of the numbers.
Q697 Lord Haskel: Is there any conflict
between the Government's current Transforming School Food initiative
and the needs of food-allergic children?
Ms Winks: There is some writing about the conflicts.
They are going to provide nuts instead of chocolate and things
like that. I do not feel that I can comment particularly on that,
I have not read any papers or anything about it, but it would
obviously be a conflict if that arose.
Q698 Lord Haskel: Can you deal with
it just by common sense?
Ms Winks: A lot of it is common sense certainly.
Again we have heard the experts saying that to deny all contact
is not good so there is not even a consensus of opinion there.
Q699 Viscount Simon: How are children
with asthma and anaphylaxis monitored during school hours?
Ms Day: They are managed mainly on an emergency
basis. The children all have a care plan so that we know what
they need to do in the school day and you hope that it goes well
and you deal with any emergencies. Again, in independent schools
they have access to nurses and boarders are obviously monitored
by the school nurses, maybe with peak flows for asthma, who can
look at skins for eczema and rashes and refer easier. This is
a problem again for the state schools who do not have health care
professionals on a daily basis.
Ms Winks: It is exactly the same, as I said
before, that there will not be a nurse on site in the majority
of the mainstream schools and so it is about training the staff
and helping them, supporting them, making sure that they have
the knowledge and the skills. There was an Audit and Healthcare
Commission report about how schools deal with obesity in February
last year, and I know obesity is different but it is still a health
problem and the heads there recognised that they do not have the
knowledge and the skill to deal with that and teachers said in
that report that the lack of health professionals in school was
a barrier, and it is exactly the same for the allergic children;
it is a barrier at ground level.
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