School nurses: the backbone of neighbourhood health we can no longer afford to ignore

England’s health and care system is undergoing one of the most significant transformations in a generation. As Integrated Care Boards (ICBs) embed Neighbourhood Health Models across the country, the NHS is shifting decisively toward prevention, early intervention, and community based support. The ambition is clear: to create a system that is proactive rather than reactive, joined up rather than fragmented, and rooted in the places where people live, learn, and grow.

Within this shift, one profession stands out as uniquely positioned to lead the transformation for children and young people: Specialist Community Public Health Nurses, School Nurses (SCPHN-SN). They lead the Healthy Child Programme for ages five to 19 (up to 25 years for additional needs), recently refreshed to ensure consistent, equitable care across England and address modern public health concerns for school-aged children and their families. School nurses lead skill mixed teams, far from being a peripheral service, school nursing is emerging as a core pillar of neighbourhood health, the bridge between systems, and the population level intelligence hub that neighbourhood teams depend on. Their role is expanding, not shrinking, and the future of integrated care for children and young people will be shaped by how effectively ICBs work with local authority public health to embed school nursing into the heart of neighbourhood working.

At the centre of this evolution is the recognition that school nurses are trained specifically in population health and are the only health professionals with universal access to all five- to 19-year-olds, making them the natural children and young people’s public health anchor for neighbourhood teams. Their insight into emotional wellbeing, attendance related health issues, safeguarding patterns, immunisation uptake, lifestyle trends, and emerging risks gives children and young people a level of visibility in neighbourhood teams that simply cannot be replicated elsewhere. Without school nursing, neighbourhood teams lack the intelligence needed to understand the health and to hear the voice of their school aged population.

Neighbourhood models depend on integration, not just within health, but across the entire system. School nurses, commissioned by local authority public health and delivered by health providers, are the only health professionals who work in schools and their local communities. This positioning makes them system leaders and connectors, the bridge between health, education and social care that neighbourhood teams urgently need. School nurses connect health partners including GPs, SEND services, Early Help, social care, and youth organisations bringing their clinical insight and safeguarding expertise. This bridging role is not incidental; it is foundational. Without school nursing, neighbourhood teams risk becoming adult centric, missing the critical interface where children spend most of their time: education. Their contributions are wide ranging; early identification of risk, mental health triage, brief, targeted interventions, support for long term conditions in school, safeguarding leadership, and the coordination of care for complex families. They become the core multi-disciplinary team function that ensures school-aged children and young people are not an afterthought in neighbourhood planning.

The NHS is shifting resources upstream, from treatment to prevention, and school nurses are already experts in this space. In neighbourhood models, this expertise becomes even more critical. They are positioned to lead the prevention and early intervention agenda for school-aged children and young people, shaping local priorities and designing interventions that reduce future demand on acute services. Their work is not only clinically valuable; it is economically essential.

Safeguarding is an essential element of neighbourhood working, and school nurses are often the first professionals to identify signs of neglect, exploitation, or emotional harm. Their visibility within schools and communities gives them unparalleled access to children and young people, including those not in mainstream education, who may not present to GPs or hospitals. In neighbourhood teams, they can act as lead professionals for vulnerable families, contribute to multi agency safeguarding meetings, coordinate health input into Early Help and Child in Need plans, and provide expertise in contextual safeguarding. Their role in safeguarding coordination is indispensable.

Neighbourhood models also require a single shared care record across health and social care. School nurses contribute essential data: health assessments, care plans, immunisation status, mental health concerns, and risk indicators, ensuring school-aged children and young people are visible across the system. As digital transformation accelerates, school nursing will increasingly lead digital public health for children and young people, using digital health needs assessments to support population health interventions, and providing digital drop ins to support face to face interventions, remote monitoring and AI supported triage. This evolution strengthens accessibility and ensures that school nursing remains relevant in a digital-first NHS.

Many ICBs are developing neighbourhood hubs, family hubs, and youth health hubs. School nurses are often co located with MHSTs, Early Help, youth workers, and community health teams. This co location strengthens integration, improves accessibility, and supports a seamless experience for families. School nursing becomes a visible, embedded presence in the community, not a service that operates in isolation.

There are already examples of how school nurses are working as part of multi-disciplinary teams.

• In the East of England, school nurses are part of the multi-disciplinary team bring secondary and primary care together and integrated with family and youth hubs. Webinar recording and presentations - East of England Children and Young People Transformation Programme - Futures
• In Somerset, school nurses are part of multi-agency teams, alongside colleagues from primary care, mental health services, education and community provision. They meet to consider the needs of children and young people where school attendance is a concern. A holistic overview of the needs of a child and their family, with medical, psychological, social, emotional, and educational needs being simultaneously considered and responded to, developing plans in collaboration to provide support.

Building capacity and capability: what needs to happen next

For school nursing to fulfil its potential within neighbourhood models, the system must invest deliberately in capacity and capability. This is not optional; it is foundational to the success of integrated care for children and young people.

First, the workforce must grow. Many school nursing teams are operating with caseloads far beyond recommended levels, limiting their ability to deliver proactive public health work. Long term workforce plans are needed that expand the number of SCPHN qualified nurses, protect time for training, and create clear pathways into advanced practice and consultant level roles. Without this, neighbourhood teams will lack the specialist leadership required to drive prevention and early intervention. Second, school nurses need protected time for system leadership. Too often, urgent demand crowds out strategic work. To lead population health, school nurses must be able to participate fully in neighbourhood MDTs, contribute to population health dashboards, shape local priorities, and influence commissioning decisions. This requires a shift in mindset: school nursing is not just a clinical service; it is a strategic public health asset.

Third, digital capability must be strengthened. School nurses need access to shared care records, digital health needs assessments, triage tools, and data dashboards that support population health management. Investment in digital skills, infrastructure, and interoperability is essential. Without it, the intelligence School nurses hold cannot flow into neighbourhood systems where it can drive change.

Fourth, school nursing must be integrated into local governance. ICBs should ensure school nursing has a seat at neighbourhood boards, transformation groups, safeguarding partnerships, and public health planning forums. This is how the profession’s expertise becomes embedded in system design rather than added as an afterthought. To achieve this the profile of school nursing must be elevated. Public health for children and young people is often overshadowed by adult services, yet the long term impact of early intervention is profound. ICBs must champion school nursing as a core component of neighbourhood health, articulate its value clearly, and invest in its future.

Conclusion: School nursing is foundational to neighbourhood health

Neighbourhood models are reshaping the NHS around prevention, integration, and community based care. For children and young people, school nursing is the profession that makes this possible. School nurses are the public health anchor, the bridge between systems, the eyes and ears of the neighbourhood, and the leaders of prevention. But to realise this potential, the system must invest in capacity, capability, digital transformation, and leadership development.

For neighbourhood models to succeed for children and families, school nursing must be placed at the centre, not the margins, of integrated care.