What’s the role of school nurses in supporting the ‘healthiest generation of children’?

What’s the best part of being a school nurse? ‘[Being] in schools immunising children… That's a part of the role I love” was the answer from one school nurse when asked (in one of several discussions on school nursing on mumsnet ) by someone considering the profession. Administering vaccinations is probably one of the first things people associate with school nurses – that’s certainly the clearest memory I have of mine. These days vaccinations are often delivered to school children by a specialist school aged immunisation service, but this association accurately reflects the public health role school nurses are intended to play.

School nurses are specialist community public health nurses who support school-aged children and young people (whether or not they attend school) to improve health and wellbeing outcomes and reduce health inequalities. School nurses lead the aged 5–19 element of the Healthy Child Programme, which brings together health, education and other partners to support young people. Given their public health expertise, school nurses should be well placed to contribute towards Labour’s commitment to create the healthiest and happiest generation of children ever. The government’s health mission and the ambition to shift from sickness to prevention are critical in delivering on this promise and will rely on a broad range of health (and other) professionals who focus on health promotion, prevention and early intervention – including school nurses.

Unfortunately, however, the story of school nursing in recent years does not support this direction of travel. Since 2009, the number of school nurses has fallen by 33%, and there is significant variation between areas, with some children receiving no school nurse support at all. This decline is linked to long-term pressure on public health budgets, which has also led to a significant reduction in health visitor numbers – another key role when it comes to children’s health and wellbeing. In addition, the role of the Chief Public Health Nurse (which has oversight for school nurses) has been vacant since 2022, sending a message that’s at odds with the promised shift to prevention.

At the same time, on a number of measures, children’s physical and mental health is declining. This includes significant numbers of children reporting mental health issues and increasing numbers of children who are obese. The growing number of children living in poverty is also not only a depressing development in its own right, but means that more children are now living in circumstances that make it difficult to live a healthy life.

For school nurses, all this means that their focus is being pulled away from prevention activities. One school nurse in the forum explained: ‘We are massively short staffed and our service does not seem to be able to retain staff. I miss delivering growing up talks and healthy eating talks in schools – this is not something we do at all anymore due to capacity.’ School nurses are increasingly finding that their time is focused on children with the most complex needs: another advised ‘…90% if not more of your job is going to be safeguarding, you’ll have a case load of the most vulnerable children either due to ill physical or emotional health or unfortunate factors around their home circumstances’. While this work is hugely important, it means school nurses have less time for prevention and health promotion activities. This supports the findings of a survey by the School and Public Health Nurses Association last year in which respondents overwhelmingly reported that the volume and nature of safeguarding was increasingly leading to a reactive school nursing service. As one respondent put it; ‘we concentrate more on fixing problems rather than offering early intervention and health promotion’.

One consequence of this shift is that a growing number of school nurses are reporting burnout, and that ‘the feeling of job satisfaction has reduced’. But it also means a critical opportunity to intervene in children’s health early is being missed. This risks health problems developing or becoming more complicated in adulthood, with knock on consequences for the health and care system (as well as the economy). It also means that health inequalities, which we know begin early, are more likely to become entrenched.

The School and Public Health Nurses Association highlighted many of these challenges in a key report last year, calling for ‘a school nurse in every school’. Unfortunately however, despite the recent increase to the public health grant, achieving this goal in the near future feels unlikely. Past experience shows us that all too often the long term, the preventive agenda is crowded out by short-term, urgent priorities that consume the vast majority of resources and attention – with school nursing another example of an area that loses out. As one school nurse put it, when money is tight, ‘health promotion… [is] the first thing to go’. Achieving the right balance between long-term goals and ‘keeping the show on the road’ is a longstanding challenge for government and current pressures have not made this any easier – but if the government is to deliver on its promise for the healthiest generation of children (and indeed, any of the promised shifts), finding a way to redress this balance will be critical.