“More Than Missing School” SCPHN school nurses play a vital role with the potential to enhance both academic achievements and future opportunities for vulnerable children and young people across their lifespan and reduce inequalities.

The findings of this important health-led initiative, led by Shona Gray SCPHN School Nurse NHS Grampian Scotland, in collaboration with education, to improve school attendance and academic outcomes for children and young people with health issues, has been recently published by Shona and Melanie Hayward Associate Professor of Education (Health and Social Care) Buckinghamshire New University, Wycombe, England Improving school attendance through health support: A test-of-change project in a deprived Scottish primary school | Journal of Family and Child Health (Gray and Hayward, 2026).School attendance serves as a critical indicator of long-term educational, health, economic, and social outcomes that shape the future opportunities of children and young people. The COVID-19 pandemic has intensified this issue, making school attendance a significant public health concern, with absenteeism presenting substantial challenges (McDonald, B.et al., 2023).

• Across 2024/25, the overall absence rate was 6.78%, a reduction from 7.15% in 2023/24, but higher than pre-pandemic rates (4.73% in 2018/19).
• The overall absence rate increased throughout the year, from 6.38% in autumn term, to 6.92% in spring and to 7.15% in summer.
• The majority of absence was due to illness, accounting for 3.22% of possible sessions in 2024/25.
• 18.14% of pupils were persistently absent in 2024/25 (i.e. missed 10% or more sessions), a decrease compared to the previous year when it was 19.95%. In 2018/19, 10.86% of pupils were persistently absent.
• The percentage of severely absent pupils (i.e. missing 50% or more sessions) was 2.39% in 2024/25, an increase from 2.30% in 2023/24. In 2018/19, 0.85% of pupils were severely absent (Department for Education (DfE) 2024/25)

Poor attendance, particularly when associated with health concerns, is strongly correlated with diminished literacy and numeracy skills, which may adversely influence the long-term health and employment prospects of children and young people and is therefore a public health and social justice issue (McDonald, B. et al., 2023). A recent test-of-change project, led by Shona, in partnership with education, evaluated whether health-focused support could boost attendance among school-aged children and young people whose absences were attributed to medical reasons. Out of 30 participants identified, 25 completed the 16-week program. Interventions included connecting with families, assessing unmet health needs, providing information about resources, and offering an anxiety management programme informed by CBT. The project saw positive results: attendance improved for 23 out of 25 participants, with the average rate increasing from 74% to 80%. This 6% rise equates to an extra 18 hours spent at school over four months. Barriers such as poor sleep habits, emotionally driven school avoidance, and difficulties with family routines were commonly observed. The findings indicate that early health intervention may help tackle challenges to school attendance, especially in areas facing deprivation and greater educational and health inequalities, ultimately supporting better educational outcomes. This initiative supports the Scottish Government’s Getting It Right for Every Child framework (Scottish Government 2012), which emphasizes early action and holistic assistance. The study acknowledges the limited sample size and scope; however, the findings suggests that school nurse-led health interventions can benefit academic success among children and young people. However additional research is needed to determine long-term effects and the potential for broader implementation across additional schools.

References
Department for Education (DfE) (2024/25) national statistics release titled "Pupil absence in schools in England"

McDonald B, Lester KJ, Michelson D. (2023) 'She didn't know how to go back': School attendance problems in the context of the COVID-19 pandemic-A multiple stakeholder qualitative study with parents and professionals. British Journal of Education Psychology. 2023 Mar;93(1):386-401

Scottish Government (2012). A Guide to Getting It Right for Every Child. Edinburgh, United Kingdom: Scottish Government; 2012.