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Service reorganisation puts school nurses under pressure to close gaps in provision.

THE PUBLIC HEALTH system in England underwent its biggest revolution in a generation last year. As part of the wider NHS reforms, responsibility for commissioning services returned to local government after an absence of nearly 40 years. But for children and young people – perhaps more than any other age group – the system is still in a state of flux. Preventive services, including vaccinations, development reviews and screening tests, are grouped together under the Healthy Child programme, but split into two age groups. As yet, responsibility for only one group, the five to 19 year olds, has been transferred to councils. The under-fives are the responsibility of NHS England until 2015, along with Family Nurse Partnerships, which provide intensive support to first-time teenage mothers and young families. This staggered approach was taken because the government is in the middle of increasing the health visitor workforce by 4,200 – a rise of more than 50% from the 2010 baseline of 8,000 – with the aim of making the maximum impact on the crucial early years. ‘It was a difficult decision,’ says Department of Health (DH) professional lead for 0 to five year olds Pauline Watts. ‘A lot of thought that went into that, but in the end we didn’t want to harm the growth in the health visitor workforce. It was essential we got that right.’ Ms Watts says that the increasing numbers are allowing health visitors to make contact with families earlier during the antenatal stage and helping to ensure they see children at all the key age points – after birth, at six to eight weeks, at one year and at the two to two-and-a-half year point.