A ‘huge number’ of school nurses and health visitors are struggling to use their public health expertise because they are increasingly taking on safeguarding responsibilities, sector leaders have warned.
In a position statement published today, the School and Public Health Nurses Association (SAPHNA), Institute of Health Visiting (iHV) and the Association of Directors of Public Health (ADPH), called for action to ensure the public health function of 0-19 services was not lost.
They warned that the ‘paradox’ of child safeguarding and public health was ‘challenging to navigate’.
And stressed it was ‘vital’ that services worked together to ensure specialist nurses’ skills and resources ‘are utilised where they are needed most and can make the biggest difference’.
The statement follows a ‘significant rise’ in the number of babies, children and young people who need support for safeguarding issues and who fall below the threshold for children’s social care services.
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To ‘bridge the gap’, the sector leaders warned that health visitors and school nurses are ‘increasingly being called upon to support families with significant safeguarding and child protection needs that would previously have been within the remit of children’s social care’.
The statement highlights the impact this work is having on health visitors’ and school nurses’ capacity to carry out their public health function and outlines several measures that they believe will support the whole sector to ensure children and families are not only kept safe from harm, but also able to access a wide range of services that promote good health and wellbeing.
These included:
- Where a baby, child or young person has an identified health need, ensuring that discussions take place between health professionals and social care to determine whether a health professional is most appropriate to take on the role of lead practitioner and, if so, who it should be.
- Ensuring that any public health professional’s “duty to cooperate” in child safeguarding, does not interfere with the performance of their own public health functions. In particular, when taking on the lead practitioner role in line with Working Together (2023) guidance.
- Providing funding to offset the additional workforce and training costs associated with upskilling the 0-19 public health nursing service to ensure compliance with the Care Law.
- Exploring the option of providing additional health capacity in multi-agency safeguarding hubs.
Professor Tracy Daszkiewicz, ADPH spokesperson for children and young people, said: ‘Safeguarding children and young people is, of course, absolutely essential. However, so too is public health.’
She warned that public health funding for 0-19 public health nursing services had been consistently cut and that ‘at the moment, a huge number of professionals on the ground are saying they are unable to use their public health expertise as they are so frequently involved in safeguarding’.
‘This extra demand on an already stretched service is untenable,’ she warned.
Meanwhile, Alison Morton, iHV chief executive, said: ‘Our nation faces two urgent challenges, to improve the state of our children’s health, and safeguard the most vulnerable and those at risk of harm – they both require attention that cannot be ignored.
‘This joint policy position is intended to bring clarity to the roles of health visitors and school nurses as an important part of the solution.’
Ms Morton said the government’s committed shift ‘from sickness to prevention’ would not happen ‘by chance’ and that significant work is needed to build the school nurse and health visitor workforce to ensure all children get the support they need.
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Chief executive at SAPHNA, Sharon White, said safeguarding was ‘central to the role of school nurses’.
‘SAPHNA’s position is that school and public health nurses are most effective and impactful when able to use their specialist knowledge and skills at the promotion, prevention, and early intervention end of the safeguarding continuum,’ she added.
She pointed to the findings of a recent SAPHNA survey which saw an increase in school nurses supporting those on children protection plans.
‘School nurses shared their frustration about the impact that this has on their wider public health role,’ said Ms White.
‘They felt that they are “at the table” as the “health representative” however are not always best placed to be supporting the child.
‘SAPHNA welcome the clarification that this position policy will offer for both the workforce and partner agencies.’
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SAPHNA is currently running a campaign to demand ‘a school nurse in evert school’, following a significant rise in children’s physical and mental wellbeing challenges and a worrying decline in school nurse numbers.
Last month, the organisation released a report revealing that four in five nurses say there is not enough staff to deliver a school nursing service.
The move towards sickness-prevention and community health services are central to the government’s 10 Year Health Plan, but last week community care leads warned the government’s Autumn Budget fell short on addressing the rising demands in social care nursing.
