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School nursing

Debbie, Alison and Sarah

Delivering high quality relationship and sex education in schools

Names: Debbie Hughes, Alison Payne and Sarah MacKenzie

Job titles: School Nurse Specialist Practitioners

Specialty: School Nursing

Organisation: Walsall Healthcare NHS Trust 

What is the initiative and or project you are involved in? 

This initiative involved School Nurses co-producing a Relation and Sex Education (RSE) Toolkit and delivering training to school staff to support schools to delivery high quality RSE.

The School Nursing service and the Teenage Pregnancy Team worked with Brook to develop RSE Toolkit, consisting of a set of micro sessions, for the key stages in primary and secondary school. The toolkit is hosted on Walsall’s website and is a free resource for health, education and social care professionals in Walsall. School nurses received training about how to use the resource and train to school staff to use the toolkit. In addition, the service offers co-delivery of RSE sessions in school to help school staff gain confidence in delivery.

What prompted you to do this work?

There is a high incidence of teenage pregnancy within our local area. High quality RSE in schools combined with accessible and effective services for young people has shown to reduce the teenage pregnancy rate significantly in this country over the last 18 years (Public Health England 2018). However, the evidence suggests that teachers often highlight confidence as a barrier to delivery and value the expertise of health professionals to support delivery. School nurses are ideally placed to provide this support. 

The School Nursing service increasingly received requests to provide RSE sessions to pupils however we had few up to date resources and lacked resources which covered current issues such as CSE, FGM, internet safety. The Toolkit was designed to increase teachers’ capacity and confidence to deliver the sessions themselves by offering a series of lesson plans and co-facilitated team-teaching session supported by school nursing staff.

How did you initiate the work?

Supporting delivery of RSE is a key performance indicator in the commissioning contract and therefore a core element of our delivery. The development of the toolkit to support this was undertaken with additional investment via the Teenage Pregnancy Strategy. 

The teacher training sessions were promoted to schools via a variety of methods, Twitter, flyers on the school links intranet and promoted by the named nurse during their termly school liaison and planning visits. 

The sessions were delivered in the autumn term which allowed staff to use the toolkit to plan SRE sessions which tend to be delivered in the summer term, especially within the primary schools. Schools were offered the option for a co-delivery team teaching with a member of the school nurse team. Our school nurses support delivery in secondary schools covering topics such as contraception, law and consent, relationships. Our nursery nurses deliver the sessions about puberty and growing up to pupils in primary schools. 

What have the challenges to implementing the service/intervention been? And what has enabled the implementation of the service/intervention?

Encouraging all schools to engage in the training has been a challenge. At this moment not all aspect of RSE are mandated. Some schools indicated that they struggle to release teachers for training sessions due to capacity and cost of cover teachers.  

Although the sessions evaluated well some schools still express a preference for the school nursing team to deliver the sessions. Capacity of the service to deliver in classrooms within the core offer of the service is a challenge however, this has provided an opportunity to develop a traded service option which allows schools to commission additional support.

Has the initiative or project made a difference to patients/service users and or staff? 

The teacher training sessions were evaluated qualitatively and received positive responses about the usefulness of the training and staff perceptions about how he trainting has benefitted them and how they intend to use the training in their settings. Staff able to identify how they will use the resource, feeling more confident about delivery and more knowledgeable. Comments from this year’s training include ‘Informative, useful and a great resource’ and ‘the session was delivered by competent staff who clearly had knowledge of the subject topic’. 

Locally the teenage pregnancy rates have fallen, It could be argued that the delivery of high quality RSE, as part of the wider Teenage Pregnancy Strategy has contributed to these improvements.

What are the long-term aims for the work?

More elements of RSE become mandated in 2020 and it anticipated that a greater number of schools will take up the training offer in order to meet the new requirements. As more schools take up the offer of training and use the resource increase we will move a step further to ensuring that more pupils receive RSE from knowledgeable and confident teachers who use high quality resources.

We are developing a workshop for parents to support them to talk to their children about RSE, this will be based on the resource and help parents to continue the conversations with their children after schools have delivered the curriculum.

Evaluation highlighted that teachers felt that the resource did not consider the needs of children and young people with special education needs (SEN), The school nursing service was approached by a trainee educational psychologist who had also identified the need for an additional resource for SENDi. School nurses are now part of a multi-agency and disciplinary working group who are scoping and developing a resource.


Public Health England (2018) Teenage Pregnancy Prevention Framework. London. PHE

Local Teenage pregnancy outcomes 

CYP case studies

Children and young people: career stories and case studies