School nurses uneasy over condom duty; Royal College of Nursing calls

Plans for school nurses to provide sexual health advice and family planning services are being discussed by the government expert group charged with drawing up Scotland's strategy to reduce teenage pregnancies.

In June the Department of Health announced plans for school nurses to provide confidential advice and practical help with pregnancies in English schools. School nurses in England can even prescribe the morning-after pill. But the changing role of the school nurse is set to prove more controversial in Scotland facing opposition from religious and family groups.

And school nurses themselves are reluctant to hand out contraception unless this is part of a wider role providing relationship and emotional counselling. One nurse remarked that she did not want the school nurse's nickname to change from the "aspirin nurse" to the "condom nurse".

Evelyn Gillan, head of public affairs for the Royal College of Nursing Scotland, and a member of the expert group, says school nurses cannot deal with contraception without tackling emotional and relationship issues.

"If school nurses are going to be dealing with sexual health they need to take a holistic approach. Any role for school nurses should be built around relationships before we start talking about handing out condoms. Some school nurses don't want to be handing out contraception.

"The RCN has said that school nurses should be able to give out contraception but to only focus on contraception without having a discussion about the emotional and relationship role would be wrong. Nurses should not be giving out condoms if they are not doing other relationship work."

Much of the debate will focus on whether schools should be involved in the provision of contraception and sexual health advice or whether they should restrict their role to giving pupils information about where they can access family planning services. But members of the group have hinted that the fight against teenage pregnancies is more likely to succeed if services are available in schools.

Group member Dr Daniel Wight, a senior researcher at the MRC Social and Public Health Sciences Unit at Glasgow University, said: "The evidence is pretty clear that the most effective sexual health education involves programmes that are closely linked to the provision of services.

"There are many ways in which that can be done. In most sex education classes the teacher would at some point talk about what services are available, stating where family planning services can be found. That would be the minimalist approach.

"A more useful approach would be to give the skills to access these services, encourage pupils to find out where the services are and what times the clinics are held. At the further end of the spectrum would be to have school-based clinics where advice and counselling can be accessed depending on local policies within the school.

"The evidence from America and most reviews of sex education point to the need to link advice with service provision. I would say the minimalist end is the least helpful. Just telling kids that these services are available will go in one ear and out the other."

Dr Wight pointed out that discussions are at a very early stage but suggested that school nurses could offer one-to-one advice sessions to pupils. He said this would get round the problem of trying to give sex advice in classes full of pupils with differing needs.

"From our research we feel that one of the limitations of existing sex education is that, by its nature, it has to be delivered at a set time to a heterogeneous group. At any one time teachers are facing a class of people already engaged in sexual relationships, others starting romantic relationships and others a long way off any relationship and that is incredibly challenging.

"The challenge is how do we offer the sex education skills to handle their relationships at a time appropriate to them? One possibility would be for the school nurse to play a role. The school nurse could have a routine drop-in time in the school where there was an option of a one-to-one for the pupils to talk about issues that are bothering them. It would be resource intensive but it seems that it might be a possible way forward to allow pupils to get the help they need at a time suitable to them. Whether that help would include the provision of contraception is another issue and needs more discussion."

Professor Phil Hanlon, director of the Public Health Institute of Scotland and chairman of the Scottish Executive's sexual health strategy group, added: "If we look at the evidence from published studies it shows that the most successful approach to improving sexual health in schools is to combine high quality education with service provision. We cannot just tell kids what is necessary, we also need to be able to provide access to services when required."

But Father Joe Chambers, the Catholic Church member on the group, said any recommendations would not necessarily apply to denominational schools. He pointed out that the Catholic Church only recently launched its programme for relationship and moral education. School nurses did not play a part and he does not see their role changing.

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