Title Reference (Children s Services) CL/POL/207 Description of Document Scope Author and Designation Equality Impact Assessment (EIA) Associated Documents To enable Norwich Community Health and Care (NCH&C) School Nurses to provide an effective and valuable health service for Young people in high schools This policy applies to School Nurses within NCH&C Children s Services School Nurse Steering Group Supporting References See section 15 An EIA was carried out on 9.5.13 and was found to have no impact. NSCB Policies NCH&C Safeguarding Protocol Core Clinical Record Keeping Policy Supervision Policy DH (2012) Getting it right for children young people and their families. Maximising the contribution of the school nursing team. Vision and Call to action. DH, London DH/ DfCS&F (2009) Healthy Child Programme from 5-19 years old. DH publications, London NHSLA Risk Management Standards / CQC Requirements Consultation or Development Process Care Quality Commission (CQC)Regulation Requirements Outcome 4, 20 School Nurses, Area Senior Nurses, Lead Nurse for Safeguarding Children, Clinical Governance Team, Assistant Director of Children s Services (NCH&C), Learning Disability Lead Nurse, Community Paediatricians, Child Psychology Team, Integrated Governance Manager (NCH&C) Training Implications See section 13 Process for Monitoring Compliance See section 14 Duties, Accountability See section 4 and 5 NCH&C Page 1 0f 16 ver 2
and Responsibility Dissemination This procedural document is published on NCH&Cs Intranet. Staff are informed of this and any changes or updates via the Monthly Briefing Exchange, Weekly Messages or equivalent. Is there any reason why any part of this document should not be available on the public web site? Yes No This policy replaces the previous version of the Open Access Guidelines version October 2009 published on the NCH&C Intranet. Approval Process Clinical Policies Group on 15/10/13 Ratification Process Quality and Risk Assurance Committee on 15/01/2014 Review Arrangements Date of Issue October 2014 Archiving Arrangements October 2016 or sooner should legislation require it. This policy is archived in line with the Policy for Procedural Documents. NCH&C Page 2 0f 16 ver 2
Contents Section Page Summary 5 1 Introduction 5 2 Purpose 5 3 Scope 5 4 Individual/Team Duties, Accountability and Responsibility 6 5 Committee Duties, Accountability and Responsibility 6 6 Referral 7 7 Confidentiality 7 8 Safeguarding 7 9 Liaison 7 10 Record keeping 7 11 Clinical/case supervision 8 12 Data collection and activity reporting 8 13 Training 8 14 Monitoring 8 15 References 10 Appendices Appendix A Appendix B School Nurse Open Access Information Sheet for Schools School Nurse High School Open Access Clinic Activity Form 11 16 NCH&C Page 3 0f 16 ver 2
Version Control Version Number Date Name and title of author or committee Document Approval Status Description of change to document or status 1.0 16.10.09 Hannah Rose Quality and Compliance Officer 1.1 14.06.12 Karen Pope Integrated Governance Manager 1.2 9.5.13 Coralie Roll Team Leader Sarah Archibald SNPT and School Nurse Professional Champion Ratified Review Review Approved at Clinical Policies Group and sent for Publication. Reviewed policy against the standards set out within NCH&C policy for procedural documents and made amendments to format Reviewed policy. 2 15/10/13 Clinical Policies Group Approved 2 15/01/2014 QRAC Ratified NCH&C Page 4 0f 16 ver 2
Summary This document has been produced to enable all School Nurses working across NCH&C to provide an accessible and responsive public health service to Young People in high schools. The title Open Access is used to mean both drop-in and clinic appointments. 1. Introduction 1.1. This policy applies to all school nurses who are employed within Norfolk Community Health and Care Trust (NCH&C). 1.2. It is recognised that each School Nurse already offers accessibility to Young people in High School whether via Open Access, clinics or individual appointments, both according to local need. Services will be designed and delivered in collaboration with school management teams and Young people; The You re Welcome Quality Criteria document (DH 2011) has been used in the preparation of these guidelines. 1.3. Government documents detail the need for accessibility of health services for Young people within high schools. School based open access clinics give the opportunity for Young people to access health care at their point of occupation (DH 2004). 1.4 Definitions and Abbreviations 1.4.1 Fraser Guidelines : criteria outlined by Lord Fraser in 1985 in the House of Lords' ruling in the case of Victoria Gillick v West Norfolk and Wisbech Health Authority and Department of Health and Social Security (see references). 1.4.2 SystmOne : Computer Health Record system. 1.4.3 NMC: Nursing and Midwifery Council. 2. Purpose 2.1 These guidelines will act as a guide to good practice for all school nurses providing an Open Access service in mainstream high schools across NCH&C. These guidelines will provide each School Nurse with the overarching principles to use when planning and delivering this service. It is also intended that school management teams have access to this document so that they are aware of the scope of the School Nurse service provided within their school. 3. Scope 3.1 This policy applies to School Nurses who have the necessary skills and experience to provide an holistic face to face assessment, advice and support service for Young people. NCH&C Page 5 0f 16 ver 2
4. Individual/Team Duties, Accountability and Responsibility 4.1 Chief Executive The Chief Executive is ultimately responsible for the quality of patient care. They ensure the correct resource, governance and assurance processes are in place to deliver care, monitor compliance with this policy and provide assurance to Trust Board that the provision of public health services to young people in high schools is managed effectively. In line with Trust practice this is delegated through relevant Executive Directors and designated Committees. 4.2 Director of Operations The Director of Operations has a duty to ensure that the appropriate structure is in place in the localities to support staff to provide safe and effective patient care. 4.3 Assistant Director The Assistant Director ensures processes are in place, as part of their locality management and governance structures, to ensure that these guidelines are implemented within Children s Services, that public health services to young people in high schools meets the standards within this policy and that the standards and the policy are monitored and reviewed 4.4 Locality Manager/Team Leaders Locality Manager /Team Leaders have responsibility for ensuring staff have undertaken appropriate training. 4.5 School Nurses School Nurses are responsible for following these guidelines. 5. Committee Duties, Accountability and Responsibility 5.1 Quality and Risk Assurance Committee The Quality and Risk Assurance Committee (QRAC) is responsible for ensuring that NCH&C policies provide safe, effective and high quality patient services. 5.2 The Clinical Audit and Effectiveness Committee The Clinical Audit and Effectiveness Committee (CAEC) is responsible for review of audits to ensure efficacy of the audit, lessons learnt, action taken and escalation of risk to the QRAC. Audits will also be reviewed at local Governance Meetings review learning and monitor action. NCH&C Page 6 0f 16 ver 2
5.3 School Nurse Steering Group The School Nurse Professional Champion, Team Leaders/Locality Managers and School Nurses are responsible for ensuring the policy reflects current National best practice guidelines. 6. Referral 6.1 Young people can self refer into the service, School information about the service is available in Appendix A. 6.2 Young people can be referred in by adults (parents; carers and education staff) with the consent of the Young Person; information about the service is available in Appendix A. 7. Confidentiality 7.1 School Nurses adhere to local, National and Professional protocols in relation to confidentiality issues within the Open Access service. Young People will always be advised by the School Nurse at the initial appointment of the issues involved in protecting their confidentiality, including the reasons when this may be breached e.g. in cases involving safeguarding concerns. 8. Safeguarding 8.1 School Nurses have mandatory yearly Safeguarding training including learning from Serious Case Reviews through discussion sessions provided by the NCH&C Safeguarding Team. 8.2 All School Nurses will have Safeguarding Supervision according to the Safeguarding Protocol. 9. Liaison 9.1 Where necessary the School Nurses will liaise with relevant multiagency professionals, with permission of the Young Person, within safeguarding guidelines (DfE 2013)./Norfolk Safeguarding Children s Board Protocols (NSCB 2012) 10. Record Keeping 10.1 All contacts with Young people whilst providing this service must be recorded in the child health records as per the NCH&C Core Record Keeping Policy, and in accordance with NMC guidelines (2009). 10.2 In cases where sexual health advice has been sought by the Young person School Nurses should record that they have assessed the Young Person as competent by completing the Fraser Guidelines template on SystmOne. NCH&C Page 7 0f 16 ver 2
11. Clinical/case supervision 11.1 All School Nurses have access to clinical supervision in accordance with NCH&C clinical supervision policy, which includes supervision on an ad hoc and routine basis. One to One Case Supervision (including safeguarding supervision) will be documented on SystmOne computer records. 12. Data collection and activity reporting 12.1 Data will be collated via SystmOne in respect of clinical activity. A SystmOne template has been provided to specifically record School Nurse activity providing Open Access services. 12.2 Statistical information will be kept to report on the use of the service within each school (Appendix B). 12.3 Collating the views of Young people accessing the service in order to improve future service provision is an important activity. School Nurses/School Nurse Professional Champion will work with the Healthy Child Programme Clinical Lead to develop a method of service user engagement. 13. Training 13.1 All School Nurses must have the following specific training and updates at a minimum of 3 yearly. Chlamydia training updates should also be 3 yearly or as national developments dictate. 13.2 Starting Out and Condomotion (courses provided by Norfolk Sexual Health Promotion Unit or suitable equivalent course provided by another educational establishment). 13.3 Chlamydia Are You Getting it? Which is run by the Chlamydia team. 13.4 Level C Safeguarding Children training annually (as provided by NCH&C or Local Safeguarding Children Board) 13.5 Safeguarding training (level 3) is delivered as part of mandatory training schedule. Other aspects of training e.g. sexual health will be delivered locally to teams. 14 Monitoring 14.1 These guidelines will be monitored as a minimum, every 3 years as part of the NCH&C Universal Children s Services audit programme, by use of the attached monitoring tool in Appendix C. 14.2 The time frame will be dictated by legislation, best practice and a review of incidents relating to Open Access Clinics. Inclusion within the NCH&C Page 8 0f 16 ver 2
audit programme will be agreed by the NCH&C clinical audit committee using a priority matrix. 14.3 Sample groups will be selected and audit completed.this information will be analysed by the clinical audit committee, and reported to the Healthcare Governance Committee, Executive Management Team and the Board. 14.4 The clinical audit team will be informed of any monitoring which allows for a central record of monitoring to be retained for future reference. These guidelines will be monitored in accordance with NCH&C standards for clinical audit. This information will be analysed by the Clinical Audit Committee and reported to the Quality and Risk Assurance Committee. 14.5 Monitoring Table What will be monitored Young People s attendance at each open access clinic, gender, age, and main focus of support School Nurse training compliance How will the monitoring be carried out School Nurse audit tool Management supervision (according to Trust guidelines), and PDP When monitoring will occur Termly report to CCS Business Unit Meeting and then through performance meeting as necessary. Monthly to biannually Who will conduct the monitoring School Nurses Team Leaders Where results will be reported to School Nurse Professional Champion Locality Managers/HCP Lead How will the resulting action plan be progressed and monitored In conjunction with HCP Lead, the Professional Champion will coordinate learning and actions through Team Leader network and School Nurses forum Individual performance management. Professional Champion to manage training update provision Noncompliance is escalated to which Assurance Committee SN Steering Group and CAEC (as indicated by HCP lead). CAEC/ SN steering Group How will learning take place Locally through clinical supervision. Within service via Professional Champion learning forums. Locally through management supervision. Within service via Professional Champion learning forums and bespoke training sessions. NCH&C Page 9 0f 16 ver 2
15. References 15.1 DH (2004) (updated 2006) Standards for Better Health. London: Department of Health 15.2 DH (2007) (updated 2011) You re Welcome Quality Criteria: Making Health Services Young People Friendly, London: Department of Health 15.3 DH (2004) Every Child Matters: Change for Children in Health Services, London: Department of Health 15.4 Gillick v West Norfolk and Wisbech AHA (1985) 1 AC 12, 184 G (Lord Fraser Guidelines) 15.5 DfES (2006) (Updated 2013 - DfE) Working together to Safeguard Children: A guide to interagency working to safeguard and promote the welfare of children Norwich: The Stationary Office 15.5 NMC (July 2009) Record Keeping: Guidance for nurses and Midwives. London: NMC 15.6 Salmon, D and Ingram, J (2008) An Evaluation of Brook Sexual Health Outreach in Schools. Bristol: Centre for Public Health Research, University of the West of England. 15.7 OfSTED Report (2007) Time for Change: Personal, Social and Health Education. 15.8 DFES/DH (2006) Every Child Matters: Extended Schools and Health Services Working together for better outcomes for children and families. Bristol:CSIP 15.9 NICE (Consultation 2009 Due Feb 2010) School Based Interventions Smoking 15.10 NICE (2007) PH007 School Based Interventions Alcohol London: NICE 15.11 NICE (2005) Depression in children and young people: identification and management in primary, community and secondary care. Clinical Guideline 28. London: NICE 15.12 DH (2009) Healthy Child Programme 5-19DH (2012) Getting It Right for Children, Young People and Families - Maximising the contribution of the School Nursing Team: Vision and Call to Action. NCH&C Page 10 0f 16 ver 2
Appendix A : (For School Nurses to provide information to Schools): School Nurse Open Access Information Sheet for Schools Your School Nurse is: name and qualifications It is widely acknowledged that Young people find it hard to access general health services in the community. This may be due to a number of factors such as fears and over breaches of confidentiality in local health clinics, transport and timing of clinics, or perceptions that the clinic is not for Young people School based open access clinics give the opportunity for Young people to access health care at their point of occupation (DoH 2004). The School Nurse is well placed to let students know about the services on offer, and the confidentiality boundaries in place. Every time the School Nurse is included in the delivery of PSHE, they provide a face to the drop in service, and as such the best inducement for Young people to use the service. Good practice features of drop in /School Based Health Clinic or appointment sessions are: Information has been prepared utilising the You re Welcome Quality Criteria document (DH 2007 updated 2011). Accessibility Young People are able to self-refer to the School Nurse or can be referred by School staff (by appropriate referral route,) or their parents. Drop-in s/school Based Health Clinics Clinic Appointments These are generally held during school break times within the school day. After schools sessions exclude those who use provided transport, or who access extra-curricular activities. At many schools where School Based Health Clinics have been launched, other agency workers may also see the Young Person. Therefore the Young Person has greater choice of professional they wish to access. When the support for Young People, is planned and regular appointments can be held during lesson time. The rationale being that if that Young Person has a concern on their mind, they are less likely to learn; therefore taking them out of lessons will not impact upon their education. NCH&C Page 11 0f 16 ver 2
Venue The school management and the School Nurse need to liaise to provide an area where confidentiality can be maintained, in a part of the school accessible by all students. Quieter areas of the school are most favoured away from busy corridors, which might be frequented by teachers and students. It is also good to avoid proximity to staff rooms, the Head Teacher s offices or detention rooms. Drop-in s/school Based Health Clinics Clinic Appointments For a drop-in adjoining rooms are ideal as students dislike being seen queuing on corridors to visit the Nurse or other agency representatives if in the case of School Based Health Clinics. Young people can self refer, or can be advised by school staff or parents/carers to see the School Nurse. Appointments can be booked by entering the Young Person s name on the booking form. The form is usually kept in a place where Young People can access it (for example a pupil reception). Any Young Person who attends an appointment in lesson time will be issued a permission slip to inform the teacher where they have been. (See below for examples of both forms). Confidentiality Students may choose to bring a friend along if they feel they need support, but this will alter the nature of the consultation. In such cases a follow up individual appointment is useful to enable the student to be more open about their circumstances, and for the nurse to ask more searching questions. The School Nurse starts every consultation with the ground rules on confidentiality with the disclaimer that information has to be shared in cases of suspected abuse (Working Together DfES 2006 updated DfE2013). Young people are reassured that in the event of information being shared, where possible, they will know who is to be told and be part of that process. Young People Involvement Young people will inform the provision of the service through consultation with school councils, peer groups etc in accordance with the You re Welcome Quality Criteria. Young People who have attended the service will be asked NCH&C Page 12 0f 16 ver 2
to complete an evaluation in order to inform future service provision. Parental Involvement All parents/carers are informed of the service in a manner to be negotiated with their child s particular school. Some schools have used a formal letter generated by the NHS, explaining the service. This letter can be sent home with the students at the start of each new school year. The letter should give details of who to contact in the NHS if there are any objections or for clarification of the service. Nurses may also wish to explain the service on the school website, or at parent/carer meetings. The Nurse is not required to seek parental consent for the Young Person attending clinic, as the Young Person has a right in law to access health services for themselves, however parental support, guidance and involvement is always encouraged. The 1985 House of Lord s ruling established the current guidelines that Young people under 16 years of age who are fully able to understand what is proposed are competent to consent to medical treatment regardless of age. (Gillick v West Norfolk and Wisbech AHA 1985). Service Offered includes, but is not limited to: Anger management advice and support Bereavement Bullying/self esteem issues Drugs/alcohol/smoking cessation Eating Disorders Emotional Issues/Self harm Intervention within the school system offers mental health services to Young people who might otherwise not obtain help. All School Nurses are qualified to assess emerging mental health issues such as self harm, depression, eating disorders etc giving support or referral to CAMHS or other therapeutic services accordingly. Students can receive advice on general health worries, support on bullying or relationships issues and even help to avoid or give up smoking (DH 2006). Information and leaflets on a wide range of health issues Managing a health condition in school Relationship problems (family, peers, partners etc.) Sexual health/contraceptive advice & suspected or confirmed pregnancy, advice and support - With regard to promoting sexual health, all School NCH&C Page 13 0f 16 ver 2
Nurses aim to help Young people acquire a range of skills such as negotiation, decisions making, assertiveness, resisting pressure and understanding the reasons to have sex within a relationship. School Nurses are further trained to be able to intervene clinically to address sexual health issues. Nurses with specialist additional training are able to dispense condoms after an assessment of the individuals needs and according to the Lord Fraser Guidelines. Emergency contraception can also be dispensed within the strict guidelines of a Patient Group Directive- a legal agreement drawn up at Trust /consultant level to enable the nurse to assess and dispense within a health clinic setting. Chlamydia screening and pregnancy testing may also be available. These additional services, which meet priorities within the Norfolk Teenage Pregnancy Strategy, are offered to schools after negotiation and agreement with the governing body of the individual school. The School Nurse can offer ongoing support to the Young Person and their family outside the school setting. In the event that a School Nurse is not able to deliver these additional services their role is then to signpost Young people to the appropriate agencies. In extenuating circumstances a School Nurse may accompany a Young Person to a health related appointment without the knowledge of the parents/carers (see Fraser Guidelines), following consultation with their line manager. In these circumstances the Young Person s wishes will be respected but they will always be encouraged and supported to inform their parents/carers. What the Service is not: The School Nurse cannot routinely attend to sick or injured students in school (although they will support school staff that are trained in this role as applicable AND respond in an emergency e.g. anaphylactic reaction). The School Nurse is not a trained counsellor and cannot enter into therapeutic counselling with students. References: DH (2007) (updated 2011) You re Welcome Quality Criteria: Making Health Services Young People Friendly, London: Department of Health DH (2006) School Nurse Practice Development Resource Pack, London: Department of Health. DH (2004) Every Child Matters: Change for Children in Health Services, London: Department of Health NCH&C Page 14 0f 16 ver 2
Gillick v West Norfolk and Wisbech AHA (1985) 1 AC 12, 184 G (Lord Fraser Guidelines) DfES (2006) (updated 2013) Working together to Safeguard Children: A guide to interagency working to safeguard and promote the welfare of children Norwich: The Stationary Office NCH&C Page 15 0f 16 ver 2
Appendix B: School Nurse High School Open Access Clinic/School Based Health Clinic Activity Form ACTIVITY FORM SCHOOL NURSE CLINIC & DROP-IN (DROP IN) DATE Number Attending M F Year Group 7 8 9 10 11 General Health Sexual Health Mental Health/ Emotional Health Behaviour Relationship Issues/ Bullying Child in Need/ Safeguarding Total Attendees Half Term Totals TOTAL NCH&C Page 16 0f 16 ver 2