Richard Armitage is a GP, MPhil student at the University of Cambridge, and Honorary Clinical Assistant Professor at the University of Nottingham’s Academic Unit of Population and Lifespan Sciences.
The UK Government has committed to raising the healthiest generation of children in history.1 Yet the workforce essential to delivering this ambition – school nurses – has been substantially depleted. Reversing this decline is not merely a workforce planning issue but a public health imperative, with direct consequences for child mental health, poverty-related morbidity, and health inequality.
The contrast between this expanded mandate and the reality of the workforce is stark.
School nurses are specialist community public health nurses who lead the ages 5-19 element of the Healthy Child Programme (HCP), the national delivery model for public health nursing services in England.2 The recently refreshed HCP guidance, published in February 2026, sets out a vision in which school nursing teams deliver four core health needs assessments at school entry, year 6, year 8, and year 10, spanning physical health, emotional wellbeing, safeguarding, and preparation for adulthood.3 School nurses are described as essential to promoting health, reducing inequalities, and supporting school attendance.3
The contrast between this expanded mandate and the reality of the workforce is stark. The number of full-time equivalent qualified school nurses in England fell by 27.3% from September 2009 (1,135) and November 2025 (825),4 many of whom are no longer practicing in this role.5 In some areas, school nursing services have been entirely decommissioned, creating a postcode lottery in which children’s access to preventive care depends on where they live.5 This erosion has been driven by sustained reductions in public health grant funding following the transfer of commissioning responsibilities to local authorities under the Health and Social Care Act 2012.5
Warm words in policy documents are insufficient.
The consequences fall disproportionately onto the most disadvantaged children. Rising child poverty, increasing prevalence of mental illness, and widening health inequalities demand precisely the kind of early identification, targeted intervention, and proportionate universalism that school nurses are trained to deliver.2,3 The Royal College of Paediatrics and Child Health has documented worsening indicators across mental health, obesity, oral health, substance misuse, and youth violence.5 Without a visible, accessible school nursing workforce, these children are left without an essential safety net.
The Government’s own guidance acknowledges that the HCP can only be as strong as the priority local authorities attach to it in funding allocations.2 Warm words in policy documents are insufficient. Ring-fenced investment in school nurse training places and posts is urgently needed, supported by mandated delivery of the full HCP and robust national data on workforce distribution and outcomes. England’s children cannot wait.
References
- Starmer pledges the healthiest generation of children ever as Labour launches Child Health Action Plan [Internet]. The Labour Party. 2024 [cited 2026 Feb 13]. Available from: https://labour.org.uk/updates/press-releases/starmer-pledges-the-healthiest-generation-of-children-ever-as-labour-launches-child-health-action-plan/
- Department of Health & Social Care. Introduction to delivery of the healthy child programme – GOV.UK [Internet]. [cited 2026 Feb 13]. Available from: https://www.gov.uk/government/publications/delivery-of-the-healthy-child-programme/introduction-to-delivery-of-the-healthy-child-programme#about-the-healthy-child-programme
- Department of Health & Social Care. Part 3: school nursing (ages 5 to 19) – GOV.UK [Internet]. [cited 2026 Feb 13]. Available from: https://www.gov.uk/government/publications/delivery-of-the-healthy-child-programme/part-3-school-nursing-ages-5-to-19#health-needs-assessment-summaries
- NHS England Digital [Internet]. 2026 [cited 2026 Feb 13]. NHS Workforce Statistics – November 2025. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/november-2025
- College of Medicine and Integrated Health, School and Public Health Nurses Association, The Queen’s Nursing Institute. A School Nurse in Every School: Report from a Round Table discussion held on 15 December 2023 [Internet]. 2023. Available from: https://saphna.co/wp-content/uploads/2024/03/Round-Table-Report-A-School-Nurse-in-every-School-FINAL.pdf
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