The importance of school nurses in championing children’s healthcare

Writing for Nursing in Practice, the Children’s Commissioner for England, Dame Rachel de Souza, discusses the difference that school nurses make. 

‘All children need access to free healthcare, not just mental health, and I think this is the biggest thing the government can work on to help us’ Girl, age 17, The Big Ambition

As a former teacher, headteacher and Trust leader, I know the vital role school nurses play in the health and wellbeing of children and young people, helping them to build solid foundations in childhood on which to progress to healthy adult lives.

Since becoming Children’s Commissioner, I’ve heard from a million children and young people who have told me about their hopes and ambitions for the future, as well as their concerns. Unsurprisingly, mental health was a major theme raised by children, and there’s no doubt more is needed to address their concerns.

While I was pleased that most children in The Big Ambition survey – 84% – agreed they could access good health care when they needed it, there were particular barriers for some groups of children. Children with special educational needs and disabilities (SEND) were less likely to agree with their peers.

Ensuring children are healthy – both their physical and mental health – is so fundamental it almost feels unnecessary to say – but I am concerned that far too many are not. It’s clear from speaking to children about a range of health issues they need access to early intervention services – like school nurses.

I have long believed in the role of school nurses – every school-aged child should have access to a qualified school nurse so they can seek support and advice about their health and wellbeing in a familiar and trusted environment. They are a fundamental building block of public services that work for children, so I have been alarmed by the continued reduction in the number of school nurses – and the huge regional variation in access to school nurses across the country.

We see concerning statistics when it comes to young people’s mental health, dental decay, obesity, children vaping and the number of young people being diagnosed with sexually transmitted diseases. These are all issues that could be tackled with the right information, early intervention and through the support of trusted adults, like school nurses. I strongly believe that we could see improvements in these areas with the right help and resources.

School nurses can make a huge difference. They are one of the key groups of frontline professionals who can support children with a whole range of issues

School nurses can make a huge difference. They are one of the key groups of frontline professionals who can support children with a whole range of issues, from mental health, to understanding of respectful relationships, to healthy eating.  They are trusted by children, parents and families, and the benefit of this support extends well beyond the school gates.

Their pastoral, supportive role is needed now more than ever as we move out of the shadows of the pandemic, which has had a profound impact on an entire generation of children and young people. The pandemic reminded us, if we needed reminding, not only for the immense value of public health, but also that school is the gateway to so much more than education.

School nurses are in a unique position. They can see the ‘whole child’: they have the full picture of what’s going on in a child’s life, if they’re being bullied at school, if they have moved into temporary accommodation and can consider how this might impact a child’s health and wellbeing. And children know this themselves. As one 11-year-old girl told me in The Big Ambition: ‘A school nurse could come and ask if you want to talk about school life or if you just want to talk.’

One of my biggest focuses has been children not in school and children missing from education. As I have done this work, from analysis to working directly with schools and local authorities, I have heard time and again about how important school nurses can be.

They work creatively so that children who are home educated also have full access to services. School nurses proactively approach families to invite them for an appointment, encourage engagement through being flexible about when and where the appointment takes place. They knock on doors to find children – for instance, those who arrive here as unaccompanied asylum seekers. They work closely with schools when children are missing school, so they can visit them. They make sure children are referred to specialist services and help schools be better placed to support children directly.

The government needs a plan to increase the number of school nurses

But in order to do this important work, the role needs to be properly resourced – and it needs to sit within a system that is properly resourced. Their role is to intervene early, make timely referrals and reduce the cost of late and crisis intervention that are so often where resources go in the current system.

It’s impossible to see a route to the healthiest generation ever – a manifesto commitment – that doesn’t include a school nurse in every school. I will continue to use my role to speak up about how important school nurses are.

The government needs a plan to increase the number of school nurses – if we don’t properly provide the right support and care now, we’re only setting up future generations to fail, which will put a further strain on our health systems in years to come.