1. Setting the Scene for the
School Health Nursing Contribution
Catherine Gleeson
Independent Consultant Nurse in
School Health and part-time Practice
Nurse
Every Person A Well Fed Person -
Socialist Health Association
29 June 2010
Manchester

2. Tackling Childhood Obesity
 3 aspects
– Identification and monitoring
– Treatment
– Prevention
 Where can school nursing fit?
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3. Foresight Report, 2007
 Strategic view of obesity
 Complex causes of obesity epidemic
 Obesity can’t be prevented by individual
action alone
 Population level measures required
 Partnership required between government,
science, business , civil society
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4. Foresight Report - messages
 Environment that supports healthy choices
 Synergies with other goals – social inclusion, reduce
health inequalities
 NHS staff training – identification and initial treatment
 Leadership - higher priority for prevention
 Acknowledgement - school choice may reduce
opportunities for walking, cycling i.e.
 – an ‘unintended consequence’
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5. School Health Nursing – Govt policies
 SN identified as key role in reducing health
inequalities
 National Healthy Schools Programme
 School Nurse Development Resource Pack,
DH/DfES, 2006
– Nutrition, childhood obesity and physical activity
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6. Obesity – School nurse role
 Scarce resource – how to prioritise?
 Effectiveness and efficiency
 Individual versus population – is there room
for both?
 Inclusion and obesity – disabilities catered
for?
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7. Programmes and Interventions
 Fit for Sport
 Jamie Oliver –role models
 Eat small
 MEND, Fit 4 life, Barnsley
 Drop-in advice in schools and towns
 Synergies – babies into books, oral health
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13. Scenarios linked with nutrition and
exercise in schools
 Parents of Ayisha, 5 yrs, ask for her to stay indoors during
playtime as running around makes her asthma worse.
Attendance - odd days off most weeks.
 Tracey, 15 yrs is asthmatic, rarely misses school. Not
particularly keen on sports. On a warm summers day she asks
if she can miss the cross country run – no-one else likes it,
pupils are resentful if anyone gets out of it
 Craig, 12 years seems unenthusiastic about football.
Attendance check - often absent on PE days. Teacher
enquires and Craig says his legs ache
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14. Young People’s views – nutrition and
exercise
 Balding, 2005: decline with age in most activities
 except 5-a-side football, basketball, soccer, weight training, walking
 Balding, 2007: >50% girls would like to lose weight
 But only 12% overweight using weight and height data
 25% of girls age 10-11 think they have been bullied because of the way
they look
 PHC study of adolescents, RCT
 approx one quarter want to discuss body shape / diet (Walker et al 2002)
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15. Pupils with disability in
mainstream schools
 Study of 33 pupils in mainstream secondary
schools, Lightfoot et al (1999)
 Only 3 (of 33) felt their condition made no difference
to PE participation
 Pupils valued written information to improve
communication
 Valued PE teachers who: allowed child to decide if able to
take part; made special arrangements ‘without making a fuss of child’;
were understanding
 But – teachers in same school react differently
 SN’s unavailable so not seen as source of support
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16. School nurse workforce
 Much smaller group – 10% of whole DN and
HV service (McDonald et al 1997)
 Variable provision (Cotton et al 2000)
 2008 – Two national studies of community
nursing workforce
– Storey et al, 2008 ‘older nurses’ study 1188 SNs
– Drennan and Davis, 2008 Trends over 10 years
approx 2000 working in school nursing
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17. National Child Measurement
Programme (NCMP)
 One element of Government’s work
progamme on childhood obesity
 Introduced 2005
 Operated jointly by DH and DCFS
 Non-statutory Guidance to PCTs –
performance managed on coverage
 Envisaged that school nurse teams would
deliver programme
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18. Purpose of NCMP
 inform local planning and delivery of services for
children
 gather population-level surveillance data to allow
analysis of trends in growth patterns and obesity
 helps to increase public and professional
understanding of weight issues in children
 useful vehicle for engaging with children and families
about healthy lifestyles and weight issues
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19. How is NCMP delivered
 Includes children aged 4 and 11 in state
schools (excludes Independent and Special
schools)
 Measure weight and height using DH
standard equipment
 DH Guidance (29 pages) - training
 No results given to children or anyone else at
school
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20. Logistics of measurement
 Equipment to be provided by PCTs –
transportation to schools
 Planning with schools: room availability, fit around
curriculum
 Paperwork – parent’s information (15 non-English
languages), can opt out
 Parent can request result within 1 month
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21. Can aims of NCMP be met?
 monitor population trends
– data available from other sources
– Evidence (Wake, 2009) could involve representative samples
 inform local service planning
– expert advice that multi-faceted interventions needed
 increase public and professional understanding
– unclear how?
 useful vehicle for engaging with children
– measurement process offers no opportunity for real engagement
– Disclosure to parents – NZ ref pre school to GP
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22. Potential contribution of school nurses
to reducing obesity
 DH/DFES, 2006 School Nurse Development Pack
 support Healthy Schools
 Food in Schools Toolkit
 increase overall daily exercise and healthy eating
 individual health plans for pupils with long term condition, disability,
obesity
 drop-in clinics
 identify and target groups of CYP with significant health
needs, reduce inequalities
 e.g. 60,000 CYP looked-after (TSA, 2005, Key data on adolescence)
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