Strategic Approach to Service Development in Derby

2 secondary schools in neighbouring Derbyshire have had on-site sexual health services for several years. One of these got adverse media coverage in 2002, which has generated ongoing nervousness amongst other schools. However the services have continued.

In 2003 a story in the Sun about 3 sisters who became teenage mothers and attended the same Derby school added to the sense of urgency to provide services but also to the media nervousness.  The Teenage Pregnancy Partnership Board gained support from the Director of Education(DE) to offer extended services to other schools and together they took a proposal to the 14 secondary school heads at the head teachers meeting.

The paper explained that services would be delivered in the context of holistic health needs and PSHE including SRE. The service would be an extension to the existing school-nurse role: in addition to advice on any health concern, a menu of options including emergency hormonal contraception (EHC), condoms and pregnancy testing would be available.  PR agency 'Diva', which is commissioned by the Teenage Pregnancy Partnership, was able to support head teachers in managing publicity if they went ahead with service development.

Head teachers appreciated the opportunity for discussion with the DE but remained nervous. Some invited further discussion with school senior management team or governors but none went ahead with a service. It was difficult to secure adequate time to explain the need for services to governors. In some cases heads and governors raised moral objections to service development and also expressed concerns about parents views.

Early in 2007 a school nurse and head teacher of the pupil referral unit (PRU) for key stage 3 & 4 expressed an interest in setting up a service in response to the needs of the students. To support this the teenage pregnancy partnership board agreed with the support of Director of Children and Young people's Services to take a report simultaneously to the Local Authority Cabinet and the PCT Trust Board with aim of demonstrating a partnership approach and gaining high-level strategic support in line with government policy (DfES, 2006) . The paper went as an 'open' paper and attracted interest from the local press.  It was the first time a paper had been taken to cabinet and PCT Board on this subject and the strategic principles were accepted. Further discussions took place with head teachers in advance of Cabinet/Trust Board meetings about the potential opportunities and range of services available and  preparing them for possible press interest.  

Although many still remained nervous the head teacher of Kingsmead School the pupil referral unit for key stage 3 & 4 asked to have a service.  Following a meeting with the governors and a letter to parents the service was set up in 2008. Young people are invited to access the school-nurse drop-in about any health concern and condoms, pregnancy testing and EHC can be provided where needed.  The service is well used and the Kingsmead staff and young people are very pleased with it.  The service is backed up by a comprehensive PHSE programme.

Publication by the Sex Education Forum of the national mapping survey generated further local media interest - and the PRU were prepared to speak to the media to try to achieve a positive story - however press interest was short-lived. As the Kingsmead service becomes embedded the head teacher of the school is in a good position to share learning with other secondary head teachers.

A 'school nurse task group' has now been set up to explore the possibility of extending services to other secondary schools. One option is to ask school nurses to carry out health needs assessments and generate a school health profile - thus generating more support and understanding from within individual schools.  Another option is to consult further with students - following the successful city-wide consultation with young people on issues linked to the Children's Plan in which young people identified school-based health services and sexual health as priority areas for development.

For more information contact:
Sheila McFarlane, Commissioner for Teenage Pregnancy