October 2016: The clocks have gone back, time marches on; child and adolescent public health remains in focus.
In this issue we look at the recently published NCB report on school nurses and their role in supporting pupils with long-term health conditions. We also present a summary of publications of interest and updates on our website development. Thank you for following us on twitter (@bacaph) and for all your email contacts. Its great to hear from you. We welcome your thoughts on how we can continue to improve BACAPH's offer to you, our members.
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School nurses - a precious (and diminishing) resource
Nursing in schools: how school nurses support pupils with long-term health conditions’ –a review
Louise Condon, October 2016
School nursing is widely recognised in policy literature as a key preventive health service for children aged 4-19 years, however the role remains underexplored. In 2014 a statutory duty was placed on schools to support pupils with recognised long-term medical conditions. As a consequence the National Children’s Bureau (NCB) conducted research exploring school nurses self-reported confidence in respect of 5 health conditions that affect children at school; these were asthma, epilepsy, diabetes, anaphylaxis and eczema (Edwards et al 2016). The survey achieved a response of 344 completions, approximately 13% of the school nursing workforce. Of those who responded 208 (60%) either had or were working towards the post-graduate specialist community public health nursing (SCPHN) qualification, the remainder had no formal school nursing qualification.
Findings were that over 90% had experience of supporting pupils with long term health needs, and over 60% had experience of all five health conditions. The most common activities were educating staff about long term conditions (91%), making and receiving referrals (82%) and creating individual care plans (79%). Confidence varied between conditions, with 82% confident in supporting pupils with anaphylaxis, but only 42% confident in supporting those with diabetes. Challenges identified were high caseloads (98%), limited resources (91%), limited time (90%), low levels of understanding about the school nursing role among parents (88%) and pupils (85%), and not being aware of all pupils with long term conditions (70%).
Recommendations include recruiting and training more school nurses to meet the needs of the school population, training school nurses with the skills to support children with long term conditions and educating the public about the role of the school nurse. Importantly the authors also add that the Department of Health should maintain funding for public health services at a level that enables local authorities to commission the required levels of school nursing alongside other services.
When interpreting the findings the small numbers of respondents must be taken into account. Similarly the amalgamation of qualified and non-qualified school nurses could have an influence upon confidence in supporting pupils with long term conditions, which is not fully drawn out in this report. However, the report is timely in highlighting the scope and capacity of the school nursing role. Policy documents continues to emphasize the importance of the role (DoE 2014, PHE 2016), yet the school nurse workforce remains small.
The aspiration to raise numbers to one qualified school nurse to every secondary school and its feeder primary schools by 2010 (DoH 2004) was never achieved. Health visiting received a boost to numbers by the Health Visitor Implementation Plan in England, and Scotland is seeking to increase numbers of health visitors. By contrast the school nursing service has received no such investment, and numbers of school nurses continue to decline (RCN 2016).
Cuts to the public health grant pose a threat to school nursing as well as health visiting (Nursing Times 2015). This puts into questions the ability of school nurses to effectively support school pupils with long terms conditions, despite the evidence to suggest tangible benefits. School nurses report themselves to be a dedicated and motivated workforce, but the capacity to meet pupils’ needs is inevitably limited by workforce numbers, and the extent of real financial and policy support that the profession receives.
The treatment of young adults in the criminal justice system :Principal conclusions and recommendations are presented in Chapter 4 of this Report. They take the form of a blueprint for a strategic approach to the treatment of young adults, under the ownership of the Ministry of Justice (MoJ) but with the involvement of a range of criminal justice agencies.
Concluding that there is overwhelming evidence that the CJS does not adequately address the distinct needs of young adults, despite assurances given by the Government, our blueprint has the following main components:
- Overarching principles to inform a step-change in policy and practice in relation to young adults and to underpin a strategic approach “founded on the clear philosophy that the system should seek to acknowledge explicitly [young adults’] developmental status, focus on [their] strengths, build their resilience and recognise unapologetically the degree of overlap of their status as victims and offenders” (paragraph 142)
- Understanding risks and needs including “through a policy of universal screening by prisons and probation services for mental health needs, neuro-developmental disorders, maturity and neuro-psychological impairment” (paragraph 143)
- A distinct approach with specialist staff in prison and probation services and other criminal justice professionals dealing with young adults underpinned by more in-depth training (paragraph 144)
- Building the evidence base for the treatment of young adult offenders, in part through expanding the availability of promising programmes and robustly evaluating them, and examination by MoJ of whether the case can be made for investment to facilitate interventions aimed at young adults, including by the creation of an equivalent to the pupil premium for prisons and Community Rehabilitation Companies (paragraph 146)
- Cross-departmental reform to extend statutory support provided to under-18s by a range of agencies to people up to the age of 25, and consideration of legislative change to recognise the developmental status of young adults (paragraphs 147 and 148)
- Courts and sentencing: further work to evaluate the impact of maturity as a mitigating factor in sentencing and the inclusion of age and maturity in the Code for Crown Prosecutors, and the testing of young adult courts (paragraphs 150 and 152)
- Prisons: use of the forthcoming prison reform bill to extend for those up to the age of 25 the sentence of detention in a young offender institution for 18 to 20 year olds, together with testing various models of ways of holding young adults in custodial institutions, revision of the Incentives and Earned Privileges Scheme, and other measures to reduce violence in prisons (paragraphs 154 and 155).
SYSTEMS, NOT STRUCTURES: CHANGING HEALTH & SOCIAL CARE in NORTHERN IRELAND
While the need for financial sustainability is indisputable, it is far from the only reason a new service model is required. Generally, people in Northern Ireland are living longer, and with increasingly complex needs that require more support from health and social care services. The health and social care system here (the HSC) is currently unable to meet these needs in a responsive way and maintaining the current configuration of services is tying up resources in the acute sector which would have a greater impact if they were invested in primary and social care.
Moreover, there are still striking health inequalities across Northern Ireland and reducing these in a systematic way will require more investment in the prevention of ill-health and promotion of good health and wellbeing needs. Long term solutions will therefore require a fundamental reshaping of HSC service delivery to put in place a new model of care designed to meet the needs and challenges of today and this century.
These reforms are ambitious, and they need to be ambitious. The Panel has no doubt that Northern Ireland has both the people and the energy to deliver a world class health and care system. There is no better time to start than now.
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See you next month
Dr. Stacy John-Legere
Communications Lead - BACAPH