School nursing services in Wales: scoping report

Main findings

• The research demonstrates the value of school nursing services in Wales, although there is variation in the service being provided.
• The national immunisation programme is a successful element of school nursing services but is reported to be time consuming. 
• The screening programme is helping to identify children with vision or hearing issues at an early stage. 
• Skill-mix in delivering such programmes is variable, with clarity needed over what activities should (and should not) be delegated.
• There are questions around the clarity of the rationale for the Child Measurement Programme.
• The school nurse role in safeguarding was questioned, given the resource implications and limited knowledge of those involved in cases.
• It was suggested school nursing services should have a greater health promotion focus, in order to fulfil a more preventive role.
• There is no system in place to target areas of deprivation with more intensive school nursing services.
• The need to invest in school nursing was reported, given increasing demand and the commitment set out in Welsh Government policies.

Implications for future school nursing services

Key measures for Welsh Government and partners to consider include:

• revisiting the rationale for the Child Measurement Programme
• working with social services and other stakeholders to consider the relevance and value of school nurses’ involvement in safeguarding cases
• defining an appropriate minimum programme of health promotion activities to be undertaken by school nursing services
• conducting an audit of school nursing teams to clarify the extent of staffing, resource gaps and shortages
• defining an ideal staffing structure based around appropriate skill mix and the principles of Prudent Healthcare
• introducing a formal system of monitoring and evaluating school nursing services, including relevant and meaningful key performance indicators
• exploring options for ensuring health boards invest in the staffing and resources necessary to deliver key programmes
• considering opportunities for a national programme providing more intensive support via school nursing services in areas of high deprivation.