‘Paradox’: nurses struggling to juggle prevention and safeguarding

A joint policy position, published today by leading public health groups, has laid out the pressures that nurses are facing in trying to juggle their public health function alongside dealing with families who have significant safeguarding and child protection needs.

"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"

Sharon White

The paper was published by the School and Public Health Nurses Association (SAPHNA), Institute of Health Visiting (iHV) and Association of Directors of Public Health (ADPH).

It comes as, in recent years, the number of babies, children and young people needing support for safeguarding issues has increased considerably.

The paper noted that health visiting and school nursing services were now regularly being called upon to support families with safeguarding and child protection needs, which would have previously been within the remit of children’s social care.

Previous research has shown that the threshold for children’s social care has grown so much that public health nurses now felt more like social workers who are having to deal with cases at crisis point, instead of delivering preventative care.

In its annual survey of health visitors for 2023, the iHV found that 81% reported an increase in children with safeguarding concerns who now fall below the threshold for children’s social care.

Meanwhile, SAPHNA’s inaugural survey of school nurses, carried out at the start of 2024, found that the majority were unable to fulfil their public health role, with 38% of them spending over half their time supporting children and young people on child-protection and child-in-need plans.

The new policy position described the challenge of balancing these equally important priorities as a “paradox”.

While school and public health nurses recognised that there would be instances where they are best placed to be the lead practitioner in a safeguarding case, they should not be seen as the “default”, according to the document.

It called for public health services to “work together” to ensure that a practitioner’s skills and resources were utilised “where they are needed most and can make the biggest difference”.

Overall, the paper concluded that it was “vital” that health visiting and school nursing services were able to play their fullest part in improving the health and wellbeing of babies, children, young people and their families.

This must be done through work to prevent, identify and treat problems before they reach crisis point, it said.

The document set out several measures that would support the whole sector to ensure children and families are kept safe from harm but are also able to access a wide range of services that promote good health and wellbeing.

The first was, where a baby, child or young person has an identified health need, ensuring that discussions took 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.

Meanwhile, any health professional’s duty to co-operate in child safeguarding – as set out in the Children Act 1989 – must not interfere with the performance of their own public health functions, the paper argued.

The public health groups also called for funding to offset the additional workforce and training costs associated with upskilling the 0-19 public health nursing service, to ensure compliance with care law.

In addition, they argued that alternative options should be explored to provide health input into the safeguarding system, such as additional health capacity in multi-agency safeguarding hubs.

Alison Morton

Alison Morton, chief executive of the iHV, 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 and 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 noted that the new Labour government had committed to shift healthcare from “sickness to prevention”.

“This will not happen by chance,” she said.

“It is therefore vital that we have a strong workforce with the capacity to focus on prevention and improve the health of babies, children, young people and families.”

Sharon White

Meanwhile, Sharon White, chief executive of SAPHNA, said: “Safeguarding is central to the role of school nurses and is a core thread through the healthy child programme.

“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.”

A Department for Health and Social Care spokesperson said: “The NHS has faced chronic workforce shortages for years, with staff being burnt out and demoralised, and too many children are not receiving the start in life they deserve.

"We will fix the health system and create the healthiest generation of children in our history by shifting focus from treatment to prevention.

“Health visitors and school nurses will play a critical role in this, and we will ensure we have the staff we need so that children and their families are cared for by the right professional, when and where they need it.”