A new core offer for community services, including special school nursing, has been agreed for Richmond upon Thames as part of a wider North West London Integrated Care System (ICS) initiative. The final service delivery model and timeline to achieve the core offer for special school nursing is scheduled for November 2025.

The North West London Joint Health Overview and Scrutiny Committee (NWL JHOSC) heard that the core offer aims to improve outcomes and reduce variation in community services across the ICS. Community providers have committed to developing a consistent core offer for any place to drive service consistency and reduce unwarranted variation across North West London.

The report presented to the committee outlined that all NHS-funded adults' and children's services are in scope of the core offer, with nine adults' services and two children's services included in the first tranche. The first tranche of the core offer includes the following adults' services:

  1. Community P2 beds for Rehabilitation
  2. Urgent Community Response
  3. Community Nursing for patients who are housebound
  4. Podiatry

One of these children's services is Special School Nursing.

The milestones for the special school nursing core offer include:

  • Undertaking demand and capacity mapping.
  • Agreeing outcome measures and KPIs.
  • Engaging key stakeholders on proposed changes, including staff, partner agencies, patients, carers, and the public.
  • Reviewing Special School Nursing (SSN) workforce capacity and skill mix, and agreeing further resource requirements per borough.
  • Agreeing a competency and training approach for school staff under the new model.
  • Finalising the service delivery model and timeline to achieve the core offer.

The service specification outlines a delegation model in line with national guidance in the Children and Families Act 2014, with delegation of tasks to healthcare assistants and school staff. All boroughs will be affected to some extent, most significantly in Ealing where a large proportion of work will be moved to school staff.

Map of NHS dental providers across NWL ICB by local authority
Map of NHS dental providers across NWL ICB by local authority
Map of NHS dental providers across NWL ICB by local authority

Key issues identified include potential resistance from some schools to the proposed changes and challenges in meeting the needs for future special school expansion and an increase in children with Special Educational Needs (SEN) and Health Care Plans (HCP) needs in mainstream schools.

Mitigation strategies include creating a delegation risk assessment and clear documentation for training and competency sign-off to increase confidence in the new model, and demand and capacity work to identify staff mix and numbers for a pupil quota to inform current and future staffing.

An engagement work plan is in place to ensure that Designated Clinical Officers for SEND, Directors of Children’s Services and Local Authorities, and Special Schools are all engaged in the process. All partners and stakeholders, including JHOSC, will contribute to the NWL ICB special schools needs assessment document.

The NWL JHOSC 2025/26 Work Programme outlines the committee's plans to review decisions and health policy areas during the municipal year, focusing on the implementation plans and actions by the North West Integrated Care System and their Integrated Care Board.