School Nursing Campaign
The transfer of commissioning responsibilities for school nurses from central to local government in April 2015 has resulted in many local authorities withdrawing continence from the school nurses’ remit. School nurses provide a vital preventative, early detection and a first line treatment for many continence problems at pre continence service level (Level 1)
The impact of this withdrawal has already led to an overwhelming increase in the number of inappropriate referrals to emergency departments, outpatient clinics and tertiary care. Many children with continence problems, who would ordinarily have their problems addressed in a cost-effective manner in the community are now being transferred to secondary or tertiary units by their GP. As well as not always being clinically necessary, this is also less clinically effective; staff are not able to cope with the quantity of referrals and do not have the capacity to regularly follow-up the child or young person for a successful long term outcome. This problem seems to be particularly apparent in areas where there is not a strong Level 2 Community Paediatric Continence Service.
This situation is unnecessarily costing the NHS money as there is significant variation in costs between primary care and secondary/tertiary care. For example, a secondary or tertiary outpatient referral costs £160 to £220 for first appointments and £94 to £123 for follow-ups, with the risk of financial penalties being imposed as a consequence of breaching new consultation to follow up ratio targets. A&E attendances on average cost £108, with day case treatment costing an average of £693. This is compared to a specialist nurse in primary care, which costs on average £80 for an assessment appointment and £56 for each follow-up appointment (considerably less for a telephone follow-up).
The PCF’s response
The PCF is engaging with CCGs, directors of public health, civil servants, government ministers, parliamentarians, strategic clinical networks, and other health organisations to highlight this issue and to campaign for an urgent uptake of the integrated model of service delivery as outlined in the Paediatric Continence Commissioning Guide.
There needs to be a greater recognition of the valuable work school nurses do in this often neglected area of child health.
If you are a parent, carer or a clinician and would like to get involved, then please contact the PCF’s secretariat at firstname.lastname@example.org. You may find the PCF’s new lobbying toolkit helpful (link forthcoming).