Reducing waiting times in school health

Waiting times in school nursing have been reduced from 24 to 10 days, thanks to work to improve the service.

When there are concerns about a child or young person’ health, it is important these are addressed as soon as possible. Not knowing exactly what is wrong and not having access to the right support, can be an anxious time, as well as there being better health outcomes when things are seen to quicker.

With this in mind, the School Nursing Service at Kent Community Health NHS Foundation Trust (KCHFT) has been working to reduce waiting times, from when a child is first referred, to their first assessment. With general health, this has now gone down from 24 to 10 days. The team is now looking at how it could improve waiting times for emotional health too.

KCHFT Clinical Lead for School Nursing Allison Leigh said: “Making contact early and reducing waiting times has the potential to reduce anxieties and concerns for families. The purpose of making early contact is to prevent concerns escalating. It can also help reduce pressure on other services.”

Improvements were made by looking at how things were done and trying new ways of working. This included:

  • setting up group support sessions, including a webinar to help with toileting, so many families could be helped at the same time, rather than having to wait for individual appointments
  • looking at eligibility criteria, to make sure school nursing was the right service for a child or young person, so no-one was waiting unnecessarily
  • looking at the referral and assessment processes
  • administration, rather than clinical staff, booking initial assessments
  • making sure colleagues had clearly defined roles
  • having a simplified a rota
  • adding school nurses to a rota to increase capacity for initial assessments.

Allison said: “We involved parents and everyone in our team, every step of the way, so we could be sure the changes would work and lead to improvement. Discussions about how things are working now will continue and we will continue to analyse at the data.”

The difference the changes made were tracked weekly and the team sought the views of parents, to make sure their needs were being met. A survey found all parents felt involved.  They said response times were better than anticipated and staff were kind, caring, compassionate, knowledgeable and professional. One parent who said she was very satisfied with the service said: “My referral was only sent yesterday and I have an initial assessment booked already.” Another parent said: “Really appreciated a quick call. Much better than expected, I thought I would have to wait a long time.”

A staff survey found all specialist community public health nurses, school staff nurses and assistant practitioners, felt they had been involved in the quality improvement (QI) project.

School nursing in Kent supports children from reception year, to 19-years-old, including those who do not attend school. The team works with schools, parents and carers as well as other professionals like health visitors or community paediatricians to prevent ill health, provide support and address any health needs, to make sure every child reaches their potential. If school nursing is not the right team, they signpost families to other organisations.

The quality improvement (QI) project started in October 2021 and the work ended in July 2022. Improvements with general health waiting times have been sustained, but the service is keeping a close eye on this to make sure it continues.

QI is a way of working which uses tried and tested methods and tools. QI tools used include a fishbone diagram and a driver diagram. Allison has completed KCHFT’s five-day quality, service improvement and redesign practitioner (QSIR P) course.

She said: “I recognised an issue in practice and felt what I had learned during the QSIR P training would help me shape the project in a structured way and that by using the tools I would be able to easily show the outcome. Without the training, I would not have known where to start.

“What started as what I thought was a simple goal, in reality led to greater improvements, so not only working towards the reduction in waiting times, but reviewing initial assessment criteria, developing roles and responsibilities and amending the pathway of referral to initial assessment. It took longer than expected, I had initially planned six months, however it was closer to nine months and the good thing is this improvement is leading to other improvements so it’s like a continual journey and has not really ended.”

For more information, see the project on a page, below, by clicking on the link below the image.

The school nursing project on a page