1. Caring for you...closer to home School Nursing scrutiny panel 23 rd February 2012

2. Caring for you...closer to home Challenges Capacity to deliver services equitably Expectations of schools Responding to national agendas Consistent data - information Relationships with schools – impact on service delivery. Inequitable staffing across the county – training concerns, no national workload tool. Caseload complexity Changing education ‘landscape’

3. Caring for you...closer to home 2 key challenges Staff training Complexity of workload Safeguarding CLA Mental health

4. Caring for you...closer to home How the service prioritises…. Priority Safeguarding, vulnerable children, LAC, immunisation programmes, School entry health assessments & screening, support for children with complex health needs, Domestic Abuse, targeted A&E work. Core additional work to the priority work including the provision of open access Drop-in sessions, continence services, A & E follow up, support for children with complex needs at health reviews. Non urgent new parent’s evening, secondary transfer, PSHE, NEET.

5. Caring for you...closer to home Staff Recruitment - nationally low numbers of trained school nurses. Number of training places in Hertfordshire. Historically lower level of investment. Frustration at level of National focus on HV recruitment. Inability to offer full public health role for which they are trained because of capacity Low Morale/High level of commitment.

6. Caring for you...closer to home Complex workload Impact of loss of extended schools programme and level of outreach work. Thresholds for social care involvement Numbers of children in school with complex health and social needs.

7. Caring for you...closer to home Caseloads South: 15095; Primary 31; Secondary 7; WTE SN 1:5.3 East: 27123; Primary 73; Secondary 13; WTE SN 1:8.48 North: 16121; Primary 49; Secondary 6; WTE SN 1:6.76 Welwyn & Hatfield: 14129; Primary 41; Secondary 6; WTE SN 1:10 Stevenage: 15661; Primary 33; Secondary 11; WTE SN 1:6.8 Watford & 3R: 27081; Primary 62; Secondary 8; WTE SN 1:9.3 St. Albans & Harpenden: 28886; Primary 47; Secondary 13; WTE SN 1:11.32 Hertsmere: 16832; Primary 34; Secondary 6; WTE SN 1:7.54 Dacorum: 20000; Primary 60; Secondary 8; WTE SN 1:11.5

8. Caring for you...closer to home Mental health Increasing number of children with mental health issues are presenting in schools, ranging from anxiety related conditions as a result of family breakdown to diagnosed mental health conditions. School nurses often support school staff in engaging strategies to help.

9. Caring for you...closer to home CLA School nurses undertake health reviews on Children Looked After, working with colleague in CLA teams and local authority to promote the best health outcomes for these children. School nurse teams ensure that CLA are up to date with their immunisations, this can be a real challenge as records etc are sometimes incomplete.

10. Caring for you...closer to home Safeguarding School nurses work closely with schools to support children with protection plans. School nurses are ideally placed to coordinate support. School nurses attend case conferences for children in Hertfordshire schools even when the children may live outside of Hertfordshire.

11. Caring for you...closer to home CLA School nurses undertake health reviews on Children Looked After, working with colleague in CLA teams and local authority to promote the best health outcomes for these children. School nurse teams ensure that CLA are up to date with their immunisations, this can be a real challenge as records etc are sometimes incomplete.

12. Caring for you...closer to home Actions. Development group to promote and standardise good practice Capitalising on passion and commitment of school nurses to develop the service. Ongoing training to support key areas of the role e.g. mental health Improving local links with colleagues in social care Working with commissioners to clarify specification.