North West London is set to standardise nursing services across its special schools, aiming to improve consistency and equity for students with special educational needs (SEN). Community providers have committed to developing a consistent core offer for 'any place' to reduce unwarranted variation and drive service consistency across North West London.

The decision was made following discussions at the North West London Joint Health Overview and Scrutiny Committee (NWL JHOSC) meeting on Tuesday 18 November 2025, where members reviewed a report on the current state of special school nursing provisions.

The move will affect all boroughs in North West London to varying degrees, with the most significant changes expected in Ealing, where a large proportion of tasks could be delegated to school staff. The new service specification outlines a shared care/delegation model, aligning with national guidance in the Children and Families Act 2014, which involves delegating tasks to healthcare assistants and school staff.

The report presented to the committee highlighted several milestones and a special schools engagement work plan. Key milestones include:

  • Demand and capacity mapping (July - Sept 2025)
  • Agreement on outcome measures and KPIs (July 2025) - A first draft is proposed in July 2025, to be reviewed once the model is finalised.
  • Stakeholder engagement (July – Sept 2025)
  • Review of Special School Nursing workforce capacity/skill mix (Sept- Oct 2025)
  • Agreement on competency and training approach for school staff (Sept – Oct 2025)
  • Finalisation of service delivery model and timeline (Nov 2025)

Clare Miller, Deputy Director Clinical Services, West London NHS Trust, is the Senior Responsible Officer (SRO) for the project. Joe Robertshaw, CNWL, is the Project Manager.

The engagement work plan includes engaging with Designated Clinical Officers for SEND, Directors of Children’s Services and Local Authorities, Special Schools, and all partners and stakeholders including JHOSC.

Potential challenges include resistance from some schools to the proposed changes, difficulties in meeting the needs for future special school expansion, and an increase in children with SEN and Health Care Plans (HCP) needs in mainstream schools. There are also concerns that the 2016 Continuing Healthcare (CHC) Framework and packages may not be sufficient to cover in-school and home support sufficiently, leading to inconsistencies in care allocation, including impact on 1:1 in schools.

To mitigate these risks, a delegation risk assessment and clear documentation for training and competency sign-off will be created to increase confidence in the new model. This is particularly important as some schools may resist the proposed change which requires school staff job descriptions to include delegated health tasks. Demand and capacity work will also be undertaken to identify staff mix and numbers for a pupil quota to inform current and future staffing.