Health Matters

Two words sum up what – or rather who – the new national clinical director for children, young people and maternity services sees as the key to improving the health of the nation’s children and young people: school nurses. In my half-hour interview with Dr Sheila Shribman she refers to school nurses, and the need to extend their role and swell their ranks, no fewer than eight times.

Specifically, Shribman believes school nursing has a major role to play in health promotion, in tackling pupils’ lower level mental health problems, in promoting emotional well-being, and in supporting the most vulnerable. 

And neither is this a recent obsession. Shribman’s interest in developing the role of the school nurse dates back about 15 years, as part of the work of the new integrated child health directorate she helped to establish in Northampton.

“The value of school nursing is enormous,” Shribman explains. “We believe that we need more school nurses so there are links with every secondary school, and they will have a key role in promoting health.

“I’m particularly pleased that there’s new emphasis on the role of the school nurse and opportunities to develop that role further because that was one of the things we started to do in the early 1990s.”

Shribman cites her pivotal role in the creation of the integrated child health directorate as one of her biggest achievements during the 20 years she has spent as a paediatric and child health consultant in Northampton. It involved working with colleagues in nursing, psychology and medicine to bring together all the local child health services under a single umbrella.

“That was unusual at that time and it was quite difficult to achieve because many people didn’t understand the need to focus on children and their families in a particular way,” she says.

“So we had a battle on our hands to create the new arrangements. And I think it is absolutely fascinating because, of course, the whole focus on children and families that there needs to be has been highlighted now through the development of the National Service Framework for children, young people and maternity services, and the Every Child Matters agenda.

“I like to think we were ahead of our time in Northampton.”

As well as being about delivering child-centred services, setting up the integrated directorate was also about developing multi-disciplinary teams, a subject close to Shribman’s heart.

“I am a great believer in multi-disciplinary teams and also in integrated working,” explains the medical director at Northampton General NHS Trust. “In my early years in Northampton, I was leading the child development centre team, dealing with often very young children in the early stages of finding out that there’s a disability. And you can’t do that work well unless you’ve got a full team – and that means people from social care, and then putting in early education support, and putting families in contact with other forms of support which sometimes come from voluntary sector organisations as well. The whole-team approach is where it’s at.”

Given this mindset, Shribman’s enthusiasm for the Every Child Matters agenda and its support for joint-working, pooled budgets, and shared service delivery hubs is inevitable.

But it is the children’s NSF and its implementation across the country that will be the main focus of Shribman’s attention during her three-year secondment to the Department of Health, which began at the beginning of December.

In particular, she is keen to see progress on standard 8 of the NSF, which covers services for children with complex health needs and disabilities.

“This is a 10-year programme so we have to be realistic about what can be achieved over what period of time, but there is a lot to do,” Shribman says. “I haven’t come along with a blank piece of paper saying ‘right let’s start’. I’ve come along to add to the value of the work that’s going on, and also to take forward key aspects.

“So, yes, standard 8 is a top priority for me. But there’s excellent work already going on. I would point to maternity services, for example. We’ve got a strong team looking at taking forward improvements in maternity care. Child and adolescent mental health is another area of enormous importance. We’ve made significant steps forward in terms of developing services for CAMHS, but we need to sustain that momentum and develop them further.”

Shribman also highlights the targets already in place around issues such as infant mortality, mortality in the under-5s, teenage pregnancy rates, and obesity. However, she does not expect to take the lead on all these issues but rather to work with colleagues in public health, and insists the government is committed to investing in such public health programmes despite recent media claims to the contrary.

She is also bullish about the plan to cut the number of primary care trusts and change the way they work, despite widespread criticism of the proposed reforms and warnings from the Association of Directors of Social Services that the move could weaken the influence of the Every Child Matters agenda within the NHS.

Explaining that she is “optimistic, not pessimistic” about the controversial proposals, Shribman adds: “I am sure that having fewer PCTs covering populations that are coterminous with the local authority – which is the direction of travel – will be a good thing. I think that we will still be able to maintain the momentum for children’s trust development and the inter-agency agenda, despite the reconfiguration.”

But the most important thing of all, Shribman argues, is to ensure that the children’s agenda remains a high priority within health services. She believes her role in achieving this is ensuring that plans for the implementation of the NSF are developing at a local level, and that joint working within and across government departments is working effectively at a national level.

However, her total lack of awareness of the meeting of the social care forum just three doors along from her office while she is being interviewed suggests she has some way to go before she can claim to have ticked that particular box.

Click HERE for full transcript of interview