The data in this section is divided into the following sub sections.
a. Eligibility and population b. Capacity and resource
c. School nursing activity database d. School nursing activity audit
e. Activity at Community and Universal f. Activity at Universal Plus
g. Activity at Universal Partnership Plus
a. Eligibility and population
In addition to the school population currently served referenced in the main body of the document, there are three key vulnerable populations. They are: 16 to 19 year olds, those pupils attending independent schools and electively home educated pupils.
Year 12 and 13
2011-12 School Year Y12+ TOTAL
School Nursing Service
Mainstream & Manor, Egerton, Longford Park 2467 35046
PRUs 0 70 Sub Total 2467 35116 Special School Nursing Service Pictor 0 89 Delamere 0 54 Brentwood 98 98 Sub Total 98 241 FINAL TOTAL 2565 35357
An additional 2565 are attending year 12 and 13 within schools and this would constitute more than 7% of the current population that the School Nursing Service covers. In addition there are more than 3,000 students at Trafford College.
One of the key issues is that this age cohort has some additional needs which would place additional pressure on the service. In particular, increasing sexual health, mental health and substance misuse issues.
Independent schools
School Number of
Pupils
Primary Total 1386
Secondary Total 362
Secondary Special School Total 89
Total number of pupils attending independent schools in
Trafford 1837
1,837 pupils would be 5% of the current population that the School Nursing Service covers. There are nine independent schools in Trafford for a primary population and two for a secondary population.
35 The current provision for independent school pupils consists of:
Routinely offered immunisations
Support for any child that the service is made aware of at Child in Need or Child Protection level
Training is provided for adrenaline auto-injectors (Epi-pen) in relation to children with known anaphylaxis
Other services e.g. screening are only offered at parents / school request There is not any monitoring of migration into or out of these schools.
Electively home educated pupils
In addition to these, 37 pupils were being home educated in Trafford in the 2010/2011 school year which is an average of three pupils a year group.
There is a new protocol that covers the School Nursing Service for this population. It states:
In cases where a child has become Electively Home Educated the School Nurse will request the child health records. A letter should be sent to the child‟s parents offering them access to the School Nursing Service and providing relevant contact details. A copy of this letter should be sent to the child‟s General Practitioner (GP) and a copy filed in the child health record. Electronic Health Records should be updated and the child health record filed in the appropriate record store
This is currently being embedded in Trafford.
b. Capacity and resource
The School Nursing Service is small in terms of numbers and most staff are on term-time only contracts.
School nursing staffing by band:
Band Headcount Whole Time Equivalent
Band 7 2 1.66 WTE Band 6 11 7.1 WTE Band 5 7 3.53 WTE Band 4 1 0.75 WTE Band 3 5 3.34 WTE Band 2 2 1.23 WTE Total 28 17.61 WTE By cluster area:
Area Headcount Total Hours WTE Year Round Workers
South Area 13 352 8.35 0.75 WTE all year West Area 8 210.5 5.1 1.66 WTE all year North Area 7 176.5 4.16 1 WTE all year
36 Specialist Community Public Health Nurses
What is a Specialist Community Public Health Nurse?
School nurses or Specialist Community Public Health Nurses (SCPHN ) are qualified nurses or midwives with specialist graduate level education in community health and the health needs of school aged children and young people. The Specialist Community Public Health Nurse (SCPHN) qualification is recordable with the Nursing and Midwifery Council. School nurses lead and deliver the Healthy Child Programme (HCP) 5-19 and are equipped to work at community, family and individual levels. They are skilled in identifying issues early, determining potential risks, and providing early intervention to prevent issues escalating.4
According to the figures in the new guidance (DoH, 2012) the number of nurses with a SCPHN qualification working in schools in September 2011 was 1165 with the annual census from 2010 indicating an additional 3000 registered nurses. This is a ratio of approximately 3: 1.2 nationally.
Specialist Community Public Health Nurses (SCPHN) in Trafford by Cluster Area West Area: 2 Band 7 (1.66 wte)
North Area: 1 Band 6 (1 wte) South Area: 1 Band 6 (0.7 wte)
In Trafford there are a total of 20 registered nurses in the School Nursing Service. This results in a ratio of 4:1 of registered nurses to SCPHN qualified registered nurses.
c. School nursing activity database
As can be seen by the core programme, and the new government model, the School Nursing Service carries out a wide variety of activities including Universal provision including health promotion sessions, Universal Plus provision including drop ins for children and young people with emerging needs, and Universal Partnership Plus support such as working as part of a multiagency team to work with children with complex needs.
The graph below shows the weekly activity for the School Nursing Service for four months (June, July, August, and September 2012). This shows the variety and volume of activity that the service carries out. It also demonstrates the lack of activity in August due to school holidays.
The service as a whole can be carrying out more than two hundred face to face meetings with professionals within a week, and more than two hundred face to face meetings with children (on a week in September). The variation is important to note in relation to term time only working. During the long summer holidays, this work is mainly not being carried out.
4
Department of Health (2012) Getting it right for children, young people and families: Maximising the contribution of the school nursing team: Vision and Call to Action (p. 16 and 17)
37
d. School nursing activity audit
In order to fully explore the capacity, priorities and activities of the service, an activity audit was carried out with the staff over two weeks in November (the weeks commencing the 12th and the 19th of 2012). All staff completed detailed timetable of their activities over the two weeks. This has allowed a detailed view to be taken of what types of activity members of the team are under taking and how much time they are taking.
Activities
Please see the graph below for more detail. The largest amounts of time were spent on the following six specific activities:
Record keeping
National Child Measurement Programme (this includes follow up as well as the actual measurements)
Travel
Child focused meetings Screening of records
Face-to-face or telephone conversations with professionals
The central importance of an effective records system is illustrated by the amount of time spent on record keeping. Also we can see the wide variety of activities and priorities that the school nurse team carry out. In terms of the top six activities, we can see that most of these do not necessarily involve direct time spent in schools.
0 500 1000 1500 2000 2500
School Nurse Activity June - September 2012 Weekly Figures
24th Sept 17th Sept 10th Sept 3rd Sept August 30th July 23rd July 16th July 9th July 2nd July 25th June 18th June 11th June 4th June
38
Activity by area
When the activities are grouped by category (agreed in collaboration with the School Nursing Service), and analysed by cluster area, we can see that there is a similar picture across the piece with “individual client work” and “records and follow up” being the two largest categories. It is clear that there were some differences between the cluster areas in these two weeks.
It is probably a result of the size of the south area cluster that travel makes up more than 10% of the school nursing team time and the additional time in the north area on service organisation and development was mainly due to case allocation meetings during those two weeks.
We can see that in these two weeks, the south and north Area had more proportion of their time dedicated to individual client work (including assessments, measurements, and direct targeted input) and the west area had more proportion of their time spent on health education and promotion (including drop-ins and lessons) as well as more client focused meetings. This could be due to naturally shifting work priorities but it is important to see how when demand rises in one area, this takes time and resources from other areas.
Activity & Time
South Area North Area West Area Overall
Individual Client Work 34.3% 30.6% 24.2% 30.1%
Records and Follow Up 30.1% 22.3% 31.6% 29.0%
Travel 10.4% 5.9% 7.6% 8.5%
Client focused meetings 7.2% 5.7% 10.1% 7.9%
Health Education and Promotion 5.3% 6.0% 10.9% 7.3% Resources and Office Work 5.8% 10.0% 4.8% 6.3%
Professional Development 4.2% 7.9% 7.9% 6.2%
Service Organisation and
39 0 1000 2000 3000 4000 5000 6000 7000 8000
School Nursing Two Week Activity Audit: Standard Activities
West Area North Area South Area
40
e. Activity at Community and Universal
There is a need for public health interventions which is compromised due to the limited resources.
The School Nursing Service carries out three key universal prevention sessions to pupils as part of their core offer. These are:
A hand washing lesson delivered to all reception classes. The purpose of this is to introduce the school nursing team to the children and to promote hand hygiene which is aimed at reducing the spread of infection and promoting school attendance.
All year 6 pupils received a lesson on healthy eating and body image prior to the NCMP measurements being carried out.
The School Nursing Service delivers the part of the Crucial Crew programme that is aimed at raising awareness about the risks of alcohol consumption. Crucial Crew is a multi-agency safety event aimed at primary school children in year 6 (10 to 11 year olds). In 2011/2012 Crucial Crew was delivered to 2619 pupils.
The service delivers other health education sessions on a variety of issues and these tend to be carried out at the request of schools. During the 2011/2012 academic year:
Health Education Session Primary Age
Children Health Education Session Secondary Age Children Puberty 1404 Alcohol 1024
Personal Hygiene 511 Sexual Health 1991
Dental Health 206 Men‟s Health 281
Medicine Safety 151 Immunisations 2801
Healthy Eating 145 Cancer Awareness 129
Transition to Secondary
School 18
Transition 55
Sun Safety 120
Total 2555 Total 6281
f. Activity at Universal Plus
The graph below shoes the numbers of pupils supported by the School Nursing Service by the need presented. Unsurprisingly, the needs of primary and secondary school age children are very different, though behaviour and emotions are key issues for both groups.
Many of issues that school nurses work with children and young people about are priorities for Trafford CYPS.
41 There is a demand for targeted interventions for certain conditions (including asthma and other long term conditions, as well as emotional health issues).
The table below shows the number of pupils with a statement for either medical or physical difficulties in November 2012. The numbers for medical and physical difficulties have been put together because of the small number of pupils.
Statement Independent Primary Secondary Special Total
Medical or Physical
Difficulties 3 31 24 7 66
Long term conditions
School nurses support schools to ensure that children with additional medical needs have an appropriate care plans in place. The table below shows the numbers of pupils with a care plan with the School Nursing Service in 2011/12.
Health Issue Primary Age
Children Secondary Age Children Total Anaphylaxis 59 48 107 Diabetes 11 19 30 Epilepsy 14 16 30 Asthma 4 7 11
Other medical conditions 9 4 13
Grand Total 97 94 191
The low numbers of children with care plans for asthma has been identified as an issue by the School Nursing Service in particular when compared to the numbers of children who have asthma ( 1 in 11 in the UK - Asthma UK, 2012)5
.
g. Activity at Universal Partnership Plus
There are increasing numbers and complexity of high tier safeguarding demands.
In spring 2012 an audit was carried out of the safeguarding supervision by school nurses. In total they discussed 290 cases. Of these, 115 were Child Protection cases and 143 were
5 Asthma UK (2012) Asthma and your child. Available from http://www.asthma.org.uk/about-asthma/my-
42 Children in Need. The table below shows these numbers broken down by area team and level of safeguarding concern.
The School Nursing Service has recently introduced a holistic health assessment that is undertaken with children who are subject to a child protection plan or vulnerable in other ways. During the academic year 285 health assessments were carried out. Following the identification of health issues, the school nurse is able to ensure that they are addressed. This has enabled school nurses to contribute in a meaningful way to child protection plans.
Additional safeguarding work
In 2011/12, school nurses completed health assessments for Children in Care whose placing authority was outside Trafford. This was approximately 59 per year.
Health reports are completed on all school aged children who are discussed at new case strategy meetings and Multi Agency Risk Assessment Conferences (MARAC). This is approximately 35 per month.
0 10 20 30 40 50 60
Child protection Child in need Professional Concern
Child in Care
Number of children by safeguarding need seen by School Nursing Service: Spring 2012 Audit
South North West