Guest guest Posted October 4, 2010 Report Share Posted October 4, 2010 Thank you, and Margaret, The following are some observations about school nursing specifically. I don't need to bore colleagues with the serious nature of the wider political changes we are facing at the moment. But the economic and political context of change is probably more radical than has been the case since the formation of the NHS in 1948. In addition, the "spending cuts" already announced are not only serious but they are producing competition between every sector of British public life. For that reason, it is important that we understand both the wider context as well as our own local planning and delivery of services. This autumn will see a new local government bill as well as the comprehensive spending review. Our concerns with both school nursing and health visiting need to be analysed within that larger context. We don't yet know if GP commissioning consortia or local authority government will become the primary decision maker about the futures of both health visiting and school nursing services. It is possible that there will be different patterns in different parts of the country. At the planning level, we do not know if the Every Child Matters agenda will remain and we do not know if the HCP will remain. Effectively, both health visiting and school nursing services need considerable sophistication on a macro level of analysis (as well as locally) if we are to save and to enhance these services. The following are just a few observations about school nursing (and only about school nursing in England -- for the moment). First, there is a significant likelihood that the school nurse service could be transferred out of the NHS and into local government control. If that happens, we will see the already wide variation in service planning, workforce numbers, and delivery expectations become even greater in diversity across the country. This would take us back to pre-1974 and would locate school nursing within, probably, local authority education departments. If that is the case, it might be helpful to remember that most school nursing services around the world are purchased by schools and are not managed or resourced via health services. If we do see transfer of school nursing to local authority responsibility, I suggest that we need to be looking at the ways other countries deliver their services via the education sector. And also, if that happens, we also will be facing contractual, pension, and workforce planning questions. Second, I have personally always argued that school nursing should be located within a public health ethos (In a Class Apart, 1997). I think that argument has not only been won but is now embedded in the training structure. When we talk about joint training with health visitors (or not), it might be helpful to think about how far or how close the two services are willing to build their partnerships for the future. Third, I have also argued consistently that school nurses are best focused on either young school children (ages 5 to 12) or on adolescents. My arguments are simply based on the vast differences in the health profiles and skills needed by professionals across that vast age range (school entry to ages 17/19). That argument has never been operationalised but it does support the implicit argument that we need a workforce for the pre-natal, pre-school child population and a separate workforce for school-age children. In other words, it is an argument that does not support the notion that health visitors can do school nurse jobs or vice versa. This is an issue that will need monitoring. How much difference this implies in the training of the two workforces follows on from that observation and needs to be clarified. At the same time, children and families are complex and a pre-school child lives in a community and in a family of pre-school and school-age children. There is a fair bit of work involved in ensuring that health visiting and school nursing do not compete -- either for resources or for prestige. And that they share their ecological views of the public health tasks they both face. Fourth, in 2005, Alice Tomkins and I argued (Discovering the future of school nursing: The evidence base) that the most important (missing) research task for school nursing needed to be the identification of outcomes of the service. The research base for the service has articulated considerable descriptive evidence of individual and local initiatives but has not created strong measures of service outcomes. The new Government is arguing that outcomes are its primary focus (nb., not targets). In other words, much of the knowledge we have of school nursing derives from descriptive material. In addition, the previous government's focus was on targets -- e.g., the numbers of school nurses/population etc. Fifth, I have also argued against the use of caseload measures as a means of pressing for more resources. It is entirely understandable that caseload measures have always played a central role in arguing for school nurse resources. They are, for example, a measure used in workforce planning and they also focus the mind and provide us with targets. Nevertheless, we do need greater sophistication when arguing for school nursing services. Yes, caseload numbers give us a powerful and simple way of measuring activity. However, in school nursing they could easily become a justification for losing the service altogether. If no measurable harm has come to school-age children as a consequence of large caseloads, then perhaps the service itself could be questioned. In other words, if the service can function on less than 3,000 staff for a population of 11.3 million school-age children, then do we actually need this workforce at all? Do you see the problems here? A local authority employer could easily respond by suggesting that the very small number of school nurses in a locality should be focused (as a resource) only on children with significant disabilities. That would be one method of handling the paucity of staff available. And it would not develop a school nurse resource for a locality. I am also suggesting that we need to think about scenario building -- My conversations with school nurses across the country over the last decade and a half indicate to me that we could now be facing even greater diversity of service profile than ever before. And all our evidence thus far has revealed considerable diversity of service profile even before we found ourselves confronting these new challenges. What to do about it? The strength of the SPCHN programme has been a major achievement in the past decade. I would suggest that this is an outcome that the school nurse service needs to use as its base for professional argument (i.e., the specialist expertise this workforce offers -- and what precisely are the outcomes of this expertise). In addition, the proliferation of local initiatives and of collaborative research work by school nurses needs to be brought together. There is serious skill, capability, and leadership amongst school nurses. From my perspective (outside of the service), it seems sensible to bring these leaders together. We achieved that in 2000 when we wrote the National Strategy. But that was ten years ago. Is Kiddy's working group a place to look in order to renew that collectivity? I think I've said enough to produce brickbats as well as agreement. My wish is to see the service recognising that we need new arguments and they need to be politically aware of: a) the implications of the radical changes in local government the implications of the comprehensive spending review c) the need for the service to focus on and report the tangible outcomes it produces in children's, families', and communities' health and well-being. I really will look forward to the debate that these thoughts might generate. All good wishes, Diane school entry health review In St Helens we are currently reviewing what is offered by school nurses at school entry. We are using the HCP to direct our service. We currently complete the NCMP as well as offering growth screening. Children whose measurements fall within a certain range are currently reviewed by the school nurse and then later reviewed or referred to Community Paediatricians or weight management services. I can not find anywhere in the HCP that indicates that we should be completing growth screening. Can anyone advise me what is being delivered in other PCT`s and if there is evidence to suggest we should still be completing growth screening at school entry as well as the NCMP. Team Co-ordinatorSchool Nursing ServicesSt Helens / span> Cowley sarahcowley183@... http://myprofile.cos.com/S124021COn Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 4, 2010 Report Share Posted October 4, 2010 Very kind of you, . Much for us to pursue. x Diane school entry health review In St Helens we are currently reviewing what is offered by school nurses at school entry. We are using the HCP to direct our service. We currently complete the NCMP as well as offering growth screening. Children whose measurements fall within a certain range are currently reviewed by the school nurse and then later reviewed or referred to Community Paediatricians or weight management services. I can not find anywhere in the HCP that indicates that we should be completing growth screening. Can anyone advise me what is being delivered in other PCT`s and if there is evidence to suggest we should still be completing growth screening at school entry as well as the NCMP. Team Co-ordinatorSchool Nursing ServicesSt Helens / span> Cowley sarahcowley183@... http://myprofile.cos.com/S124021COn Cowley sarahcowley183@... http://myprofile.cos.com/S124021COn Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2011 Report Share Posted March 23, 2011 Hello All Just scanning back on past emails from senate, this one highlights both the issues for HV and specifically School Nursing. Just wondering in view of current recruitments or not as I understand some places are not recruiting school nursing currently. Is this a common feature across ? Have some places advanced their integration with LA's and what is occurring there in terms of development? what types of structures are developing? Who is deciding between generalist/specialist? - what in the long run is in best interest of yp? To point out the obvious there are specific differences between children and adolescents realities have to manage dilemmas of who is in the pool Obviously more questions but these are some to consider regards http://www.bbc.co.uk/news/uk-12591591 From: [mailto: ] On Behalf Of CowleySent: 04 October 2010 14:43 Subject: Re: school nursing Hi Woody Thanks, that is interesting. The commentary piece recently from Jo Webber of NHS Confed was extremely helpful. When we ran the consultation conference about the UKPHA 'health visiting matters' report, there was both strong support and surprise/some opposition to a national employing organisation that could be commissioned by both NHS and LAs, and (we hoped) would still negotiate NHS terms and conditions of employment for health visitors and school nurses. The strong support came from public health, health promotion and similar in the room, who all said 'can we come too,' to which our answer was 'yes.' Somehow we have to get some stability into these services. We will see. . . On 4 Oct 2010, at 14:30, Caan, Woody wrote: Dear ,We had an NHS Confed seminar on September 23rd, about delivery of the new'public health service' - it was a joint meeting with the Local GovernmentAssociation, whose members had very interesting perspectives. I was fortunateto be sitting next to Mawle of the UKPHA/Regenerating health visiting.Overall, the main feeling was that the whole 'public health family' should becombined, at least in terms of co-location (the medical members seemedreluctant to be employed directly by local authorities, so we may see lots offudges involving 'joint appointments' which retain all the characteristics ofNHS employment with none of the accountability of local government).Personally, I decided I now want to see directly elected DPHs, on the linesof some English mayors or US district attorneys! However, many delegatesseemed keen to reduce local accountability, rather than increase this.... Nonetheless, most people seemed to accept that SNs and HVs were part of the'family', and so could be within the integrated public health service, housedwithin local authorities. If LA directors of family services retain theirroles, that would bridge children's centres and schools. The interfacebetween DH and DFE is still not worked out, although I would welcome SNs,educational psychologists, EWOs & SENCOs being within one system.....presumably speech and language therapists from both PCTs and LAs would be'integrated' too.Does anyone know if this Coalition will honour the long and winding CAMHSReview? In Diane's adolescent school health nursing, mental illness +/-substance use are prevalent and often neglected.Good luck, Woody. ________________________________From: on behalf of CowleySent: Mon 04/10/2010 13:53 Subject: Re: school nursingThank YOU Diane, for such a well considered and cogent comment. It is veryhelpful, if somewhat worrying! I think we are in agreement that there are different jobs to be done,depending upon where the children and/or families are found. My interest incombining the qualifications of health visiting and school nursing lies inunderstanding that this happens in many countries, without leading to anautomatic assumption that therefore one person can cover all ages at the sametime (although they might be able to, e.g., in stable rural communities,given a small enough caseload - that is the key thing!). To me, theunderlying skills are similar, but their application in practice isdifferent, and I think it is interesting that you suggest school nurses mighteventually be employed in local education authorities, whereas for all thetalk of such a shift involves the suggestion that health visitors might beeventually employed in local authority children's centres; a different partof the service. thanks again for your thoughtfulness and timeOn 4 Oct 2010, at 12:46, Diane DeBell wrote:Thank you, and Margaret,The following are some observations about school nursingspecifically.I don't need to bore colleagues with the serious nature of the widerpolitical changes we are facing at the moment. But the economic andpolitical context of change is probably more radical than has been the casesince the formation of the NHS in 1948. In addition, the "spending cuts"already announced are not only serious but they are producing competitionbetween every sector of British public life. For that reason, it is important that we understand both the widercontext as well as our own local planning and delivery of services.This autumn will see a new local government bill as well as thecomprehensive spending review. Our concerns with both school nursing andhealth visiting need to be analysed within that larger context. We don'tyet know if GP commissioning consortia or local authority government willbecome the primary decision maker about the futures of both health visitingand school nursing services. It is possible that there will be differentpatterns in different parts of the country.At the planning level, we do not know if the Every Child Mattersagenda will remain and we do not know if the HCP will remain.Effectively, both health visiting and school nursing services needconsiderable sophistication on a macro level of analysis (as well as locally)if we are to save and to enhance these services. The following are just afew observations about school nursing (and only about school nursing inEngland -- for the moment).First, there is a significant likelihood that the school nurseservice could be transferred out of the NHS and into local governmentcontrol. If that happens, we will see the already wide variation in serviceplanning, workforce numbers, and delivery expectations become even greater indiversity across the country. This would take us back to pre-1974 and would locate school nursingwithin, probably, local authority education departments. If that is thecase, it might be helpful to remember that most school nursing servicesaround the world are purchased by schools and are not managed or resourcedvia health services. If we do see transfer of school nursing to localauthority responsibility, I suggest that we need to be looking at the waysother countries deliver their services via the education sector. And also, if that happens, we also will be facing contractual,pension, and workforce planning questions.Second, I have personally always argued that school nursing should belocated within a public health ethos (In a Class Apart, 1997). I think thatargument has not only been won but is now embedded in the training structure.When we talk about joint training with health visitors (or not), it might behelpful to think about how far or how close the two services are willing tobuild their partnerships for the future.Third, I have also argued consistently that school nurses are bestfocused on either young school children (ages 5 to 12) or on adolescents. Myarguments are simply based on the vast differences in the health profiles andskills needed by professionals across that vast age range (school entry toages 17/19). That argument has never been operationalised but it doessupport the implicit argument that we need a workforce for the pre-natal,pre-school child population and a separate workforce for school-age children.In other words, it is an argument that does not support the notion thathealth visitors can do school nurse jobs or vice versa. This is an issue that will need monitoring.How much difference this implies in the training of the twoworkforces follows on from that observation and needs to be clarified.At the same time, children and families are complex and a pre-schoolchild lives in a community and in a family of pre-school and school-agechildren. There is a fair bit of work involved in ensuring that healthvisiting and school nursing do not compete -- either for resources or forprestige. And that they share their ecological views of the public healthtasks they both face. Fourth, in 2005, Alice Tomkins and I argued (Discovering the futureof school nursing: The evidence base) that the most important (missing)research task for school nursing needed to be the identification of outcomesof the service. The research base for the service has articulated considerabledescriptive evidence of individual and local initiatives but has not createdstrong measures of service outcomes.The new Government is arguing that outcomes are its primary focus(nb., not targets). In other words, much of the knowledge we have of schoolnursing derives from descriptive material. In addition, the previousgovernment's focus was on targets -- e.g., the numbers of schoolnurses/population etc.Fifth, I have also argued against the use of caseload measures as ameans of pressing for more resources. It is entirely understandable thatcaseload measures have always played a central role in arguing for schoolnurse resources. They are, for example, a measure used in workforceplanning and they also focus the mind and provide us with targets. Nevertheless, we do need greater sophistication when arguing forschool nursing services. Yes, caseload numbers give us a powerful andsimple way of measuring activity. However, in school nursing they couldeasily become a justification for losing the service altogether. If nomeasurable harm has come to school-age children as a consequence of largecaseloads, then perhaps the service itself could be questioned. In other words, if the service can function on less than 3,000 stafffor a population of 11.3 million school-age children, then do we actuallyneed this workforce at all? Do you see the problems here? A localauthority employer could easily respond by suggesting that the very smallnumber of school nurses in a locality should be focused (as a resource) onlyon children with significant disabilities. That would be one method ofhandling the paucity of staff available. And it would not develop a schoolnurse resource for a locality.I am also suggesting that we need to think about scenario building --My conversations with school nurses across the country over the lastdecade and a half indicate to me that we could now be facing even greaterdiversity of service profile than ever before. And all our evidence thusfar has revealed considerable diversity of service profile even before wefound ourselves confronting these new challenges.What to do about it?The strength of the SPCHN programme has been a major achievement inthe past decade. I would suggest that this is an outcome that the schoolnurse service needs to use as its base for professional argument (i.e., thespecialist expertise this workforce offers -- and what precisely are theoutcomes of this expertise).In addition, the proliferation of local initiatives and ofcollaborative research work by school nurses needs to be brought together.There is serious skill, capability, and leadership amongst school nurses.From my perspective (outside of the service), it seems sensible to bringthese leaders together. We achieved that in 2000 when we wrote the NationalStrategy. But that was ten years ago. Is Kiddy's working group aplace to look in order to renew that collectivity?I think I've said enough to produce brickbats as well as agreement.My wish is to see the service recognising that we need new arguments and theyneed to be politically aware of:a) the implications of the radical changes in local governmentb) the implications of the comprehensive spending reviewc) the need for the service to focus on and report the tangibleoutcomes it produces in children's, families', and communities' health andwell-being.I really will look forward to the debate that these thoughts mightgenerate.All good wishes,Diane school entry healthreviewIn St Helens we are currently reviewing whatis offered by school nurses at school entry. We are using the HCP to directour service.We currently complete the NCMP as well asoffering growth screening. Children whose measurements fall within a certainrange are currently reviewed by the school nurse and then later reviewed orreferred to Community Paediatricians or weight management services.I can not find anywhere in the HCP thatindicates that we should be completing growth screening. Can anyone advise mewhat is being delivered in other PCT`s and if there is evidence to suggest weshould still be completing growth screening at school entry as well as theNCMP. Team Co-ordinatorSchool Nursing ServicesSt Helens/ span> Cowleysarahcowley183@...http://myprofile.cos.com/S124021COn Cowleysarahcowley183@...http://myprofile.cos.com/S124021COnEmail has been scanned for viruses by Altman Technologies' email managementservice <http://www.altman.co.uk/emailsystems> ~-- EMERGING EXCELLENCE: In the Research Assessment Exercise (RAE) 2008, more than 30% of our submissions were rated as 'Internationally Excellent' or 'World-leading'. Among the academic disciplines now rated 'World-leading' are Allied Health Professions & Studies; Art & Design; English Language & Literature; Geography & Environmental Studies; History; Music; Psychology; and Social Work & Social Policy & Administration. Visit www.anglia.ac.uk/rae for more information. This e-mail and any attachments are intended for the above named recipient(s)only and may be privileged. If they have come to you in error you must take no action based on them, nor must you copy or show them to anyone please reply to this e-mail to highlight the error and then immediately delete the e-mail from your system. Any opinions expressed are solely those of the author and do not necessarily represent the views or opinions of Anglia Ruskin University. Although measures have been taken to ensure that this e-mail and attachments are free from any virus we advise that, in keeping with good computing practice, the recipient should ensure they are actually virus free. Please note that this message has been sent over public networks which may not be a 100% secure communications Email has been scanned for viruses by Altman Technologies' email management service - www.altmanco.uk/emailsystems <winmail.dat> Cowley sarahcowley183@... http://myprofile.cos.com/S124021COn Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 12, 2012 Report Share Posted March 12, 2012 Dear Senators, I am writing from the United States but I understand that the new Department of Health School Nursing Model goes "live" in the press today. Keep "an eye out" for news. All v best, Diane (DeBell) Emeritus Professor of Policy in Health & Social Care Anglia Ruskin University United Kingdom Visiting Professor of Policy in Health & Social Care Elon University United States 07801-262-454 00-1-336-675-1667 ddebell@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 12, 2012 Report Share Posted March 12, 2012 Hi Diane Was on the breakfast news this morning but seems to have been taken over by other events on the other news. Sounded good so will look out for the Implementation plan and the care pathways which I guess will be available on the web today/tomorrow. Hope you are having a good time and catch up on your return. Margaret From: [mailto: ] On Behalf Of Diane DeBellSent: 12 March 2012 08:59 Subject: School Nursing Dear Senators, I am writing from the United States but I understand that the new Department of Health School Nursing Model goes " live " in the press today. Keep " an eye out " for news. All v best, Diane (DeBell)Emeritus Professor of Policy in Health & Social CareAnglia Ruskin UniversityUnited KingdomVisiting Professor of Policy in Health & Social CareElon UniversityUnited States07801-262-45400-1-336-675-1667ddebell@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 17, 2012 Report Share Posted March 17, 2012 HI Diane Have now had the opportunity to read the School Nurse Implementation Plan and I am impressed at how it has developed and changed and will be emailing N to say so. I think school nurses may be disappointed that it does not have numbers like the HV one and that there is no mention of money but knowing where it started and where it is now – I think it is excellence. It so clearly shows how they have worked with children and young people and their parent to develop the plan as well as working with school nurses themselves and relevant stakeholders. And the other thing that I feel so positive about is the link across from health vising to school nursing and the obvious view that we have to look at children and young people from 0 – 19 years and not just stop at 5years. It is going to be down to all of us now to make this happen. So I want to congratulate everyone who has been involved on producing such a good and positive document for school nursing. And just as an aside – there was a lot of other really relevant information put out at the same time around health visiting and pathways so everyone do look at and inwardly digest and use back in practice to encourage the development of school nursing and health visiting. Margaret From: [mailto: ] On Behalf Of Diane DeBellSent: 12 March 2012 19:43 Subject: School Nursing Colleagues, The full and detailed work is now on the CNO's website. There is also a press release but I feel that it is important for colleagues to read and study the report carefully before commenting. It is a complex piece of work and it has been in " the making " for more than a year. We will not do school nursing any favours if we respond before we have reflected on the document. Senate has an important role to play in the next stages. All v good wishes, Diane Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 17, 2012 Report Share Posted March 17, 2012 Dear Margaret, Your response is invaluable. Yes, there is not a reference to numbers and that is difficult. However, the commitment of the Department to this considerable amount of work by the Committee but mainly the leadership of N, could well be a serious step forward. I am pleased that you feel the conceptual framework is strong. Quite frankly, the numbers and the investment are the next step and may be possible now that the Department has committed itself to the principles behind the model. It is all the more hopeful from the perspective of the USA, where I am at the moment, because the functions of school nursing here are so very, very different. In fact, the role of school counselors (a social work model) is the dominant framework in this country. Am much relieved to hear from you. All v good wishes, Diane From: Margaret Buttigieg Sent: Saturday, March 17, 2012 10:50 AM Subject: RE: School Nursing HI Diane Have now had the opportunity to read the School Nurse Implementation Plan and I am impressed at how it has developed and changed and will be emailing N to say so. I think school nurses may be disappointed that it does not have numbers like the HV one and that there is no mention of money but knowing where it started and where it is now – I think it is excellence. It so clearly shows how they have worked with children and young people and their parent to develop the plan as well as working with school nurses themselves and relevant stakeholders. And the other thing that I feel so positive about is the link across from health vising to school nursing and the obvious view that we have to look at children and young people from 0 – 19 years and not just stop at 5years. It is going to be down to all of us now to make this happen. So I want to congratulate everyone who has been involved on producing such a good and positive document for school nursing. And just as an aside – there was a lot of other really relevant information put out at the same time around health visiting and pathways so everyone do look at and inwardly digest and use back in practice to encourage the development of school nursing and health visiting. Margaret From: [mailto: ] On Behalf Of Diane DeBellSent: 12 March 2012 19:43 Subject: School Nursing/ span> Colleagues, The full and detailed work is now on the CNO's website. There is also a press release but I feel that it is important for colleagues to read and study the report carefully before commenting. It is a complex piece of work and it has been in "the making" for more than a year. We will not do school nursing any favours if we respond before we have reflected on the document. Senate has an important role to play in the next stages. All v good wishes, Diane Quote Link to comment Share on other sites More sharing options...
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