Healthy Child Wales Programme: for school aged children - Part 7: safeguarding

Our approach

As part of a wider NHS Wales and multi-agency response to safeguarding, school nursing services play an important role in in promoting, protecting, and safeguarding the health and wellbeing of children and young people. The approach to safeguarding for school nursing services was established through a set of minimum standards in the school nursing framework 2017 and health boards have monitored compliance with these standards and alignment to the subsequent multi-agency all Wales safeguarding procedures 2019.

School nursing services have a population health approach to delivery, which means they do not hold a case load in the same way that other health professionals do, such as health visitors or other public service practitioners, like social workers. What this means in practice is that a child / young person with a safeguarding concern might not be known to school nursing services. Therefore, it is important that NHS Wales identifies the correct health lead at an early stage to provide the best NHS Wales safeguarding response. For the purpose of this operating model, the following pathway has been developed to support the existing minimum standards in the school nursing framework. This will help to make clear what school nursing services will deliver in relation to safeguarding for those specific cases when school nursing services is correctly identified as the NHS Wales lead, due to their knowledge and/or ongoing involvement with a child or young person and their family.

In line with the Healthy Child Wales Programme, all children at 5 years of age with safeguarding concerns will be highlighted to the school nursing services, when they are transferred during the school entry health review.

Where new safeguarding concerns have been identified during a child or young person’s journey through school age, school nursing services will undertake a health assessment with the child or young person prior to the initial case conference to identify any health needs. If the notification to school nursing services is delayed and this cannot be done, the health assessments must be carried out no later than the first key stage. This is referred to by professionals as the "first core group" meeting.

This health assessment will inform the report submitted into the conference. It will be child centred and involve directly with the child or young person in advance. The report will include the child or young person’s feelings, desired outcomes, wishes and what matters to them, including any unmet health needs. A professional decision informed by the health assessment will then be made through the case conference as to whether any continued involvement is necessary at any subsequent reviews or core groups. Involvement will recommence if new concerns emerge.

The health assessment is vital in identifying potential health concerns and issues, ensuring timely interventions are planned and promoting prevention. It provides opportunity for health education in relation to core themes including:

• nutrition
• continence
• immunisations
• dental
• support for both the child / young person and their family

All school aged children regardless of educational setting will have the most appropriate health professional involved. For example:

• paediatrician
• nurse in special school
• general practitioner (GP)
• allied health professional
• community children’s nurse
• specialist community public health nurse (school nursing)
• a child and adolescent mental health service professional

The lead health professional role coordinating and attending all case conferences on behalf of NHS Wales must not default to school nursing services. The lead health professional attending the conference must have a meaningful and significant contribution to make around the family and child / young person. It is extremely important the lead health professional at the safeguarding conference knows the child or young person and family where appropriate, to deliver the best safeguarding outcomes for the child or young person.