For the first time in three years, delegates gathered in person in Bristol to attend the hybrid Unite-CPHVA Annual Professional Conference 2022.
Opening the two-day event at the end of last October, Janet Taylor, chair of the CPHVA Executive and public health nurse manager in Northern Ireland, cited NHS England figures that show there are currently 7030 health visitors in England, down 37% from 2015, and an estimated shortfall of 5000.
The shortage of HVs in England has ‘huge implications’ for workforce management, caseloads and managing sick leave, delegates heard.
The withdrawal of funding from the Scottish Government for the SCPHN school nurse course from 2023 will also have an impact on school nursing services’ ability to deliver on existing pathways.
In Wales, there are still challenges resulting from a depleted workforce due to high sickness levels and retirement. However, the creation of the Band 7 clinical practice educator and new specialist HV roles, including specialists in perinatal mental health and refugees, is ‘all very positive’, Janet added.
And in Northern Ireland, an encouraging picture is emerging too, with HVs hugely excited to contribute to the review of the Healthy Child, Healthy Future Programme, and a great deal of interest in students choosing HV placements. ‘With 60 students per cohort, we find we are oversubscribed,’ and that is really positive,’ Janet added.
Wales and NI prioritise workforce planning
Numbers of health visitors and school nurses have increased in Northern Ireland following a £25m Department of Health investment, deputy chief nursing officer Mary Frances McManus revealed.The funding follows the Nursing and Midwifery Task Group report in 2020, which focused on achieving a service with the right skills and knowledge for the next 10 years
There is also an all-time high of pre-registration student nurses and midwives: 1335 started their training in September, delegates were told. ‘This helps us to balance inequalities within the workforce and for our services to the clients,’ said Mary.
Workforce levels are a priority for the sector in Wales too. The government has agreed to enhance its 10-year-old Flying Start programme for children in deprived areas, so that it becomes a universal provision, explained Karen Jewell, chief midwifery officer for the Welsh Government.
‘It looks at having more HVs and more skills mix,’ Karen told delegates. ‘We’re working with our stakeholders and service providers to look at what that could mean in terms of workforce modelling for the future.’
SCPHN standards are an opportunity for practitioners to consider representation
Community practitioners should consider how they want the new specialist community public health nursing (SCPHN) standards to reflect the communities they serve and specific challenges they face, said Anne Trotter, assistant director at the NMC.
Anne also said the profession should consider how to address under-representation. ‘The vast majority of people on our register with the SCPHN qualification are white,’ she said. ‘Does that reflect the populations that these professions serve? Is there more that we can be doing? Is there anything that you can do locally as well?’
‘The vast majority of people with the SCPHN qualification are white. Is there more we can be doing?’
The standards were published early this year following a two-and-a-half-year revision process. Universities will be expected to work in conjunction with their practice partners, students undertaking SCPHN qualifications now or who might want to in the future, those already with SCPHN qualifications, members of the public and users of the service to update their curricula to apply to the new standards by 31 August 2024.
School nurses embraced innovation during pandemic
Seventy-four per cent of UK school nurses faced an increase in their workload during the pandemic, despite the majority seeing a reduction in their contact with children and families, research has found.
In the survey of 78 school nurses, 86% said they had difficulty identifying safeguarding leads, and 80% reported difficulty working with children and other vulnerable service users, study co-author Dr Georgia Cook revealed.
‘School nurses had shifted to using telephone calls and a range of different online platforms,’ said Georgia, postdoctoral research assistant and associate lecturer at Oxford Brookes University.
The researchers may develop a toolkit that captures the range of practices school nurses utilised during the pandemic to connect with children and families. ‘We’d love to give back some best practice that was shared with us in the hope that we can benefit the school nurses who, along with health visitors and other healthcare professionals, did an amazing job in such challenging times,’ Georgia concluded.
Asha Day BEM @Thercal
Great day at #CPHVA22 networking, learning from others and sharing findings from School Nursing in the Time of Covid-19 study with @DanaSammut & @GeorgiaC_sleep. Wearing my QN badge with pride and waving the #schoolnursing flag high! Viki @viki98015881
Philosophy lessons aim to help children in socially deprived areas
Delegates heard from a primary school headteacher about the pastoral learning that helps children living in a socially deprived area. Kevin McArevey, headteacher of Holy Cross Boys’ Primary School in Belfast, explained why he is embedding philosophy into the curriculum. The school encourages children to think, read and write about philosophical themes including loneliness, racism, religion, aliens and happiness. ‘All the philosophical themes you can think of – children have questions about them,’ Kevin said.
Among more than 800 schools in Northern Ireland, Holy Cross is the 10th most socially deprived. ‘I have been principal at the school for 26 years and in that time I have seen 27 people die as a result of suicide,’ Kevin said.
As well as teaching philosophy lessons, the school arranges trips to the local old people’s home where the boys discuss philosophy with the residents. ‘I aim to challenge the belief systems that operate in a highly socially deprived area, by making children start thinking about philosophy at the age of four,’ Kevin added.
Autonomy missing from health visiting
‘I am sad to see that there is what I would call a melancholy among health visitors,’ Professor Dame Elizabeth Nneka Anionwu, CPHVA honorary vice-president, said in conversation with Obi Amadi, director of the CPHVA.
Dame Elizabeth qualified as a health visitor in the early 1970s and ultimately ended up specialising in sickle cell, helping to establish the UK’s first nurse-led sickle and thalassaemia screening and counselling centre.
She said that the joy of health visiting for her was being out in the community, home-visiting and having autonomy. ‘I really felt free to link up with anyone I saw fit and I didn’t have to ask permission,’ she said. ‘I get the impression that autonomy is not always there now.’
Vaccine update for practitioners
The HPV vaccine for adolescents, Gardasil 9, has been phased in for use from next year and will provide protection against seven strains that cause cancer, five more than the previous Gardasil, Helen Bedford, professor of children’s health at the Great Ormond Street Institute of Child Health, told delegates.
Another change is that the 12-month dose of Hib/MenC vaccine is likely to be dropped and replaced with an 18-month vaccine visit when the 6-in-1 and the second dose of MMR will be given. In addition, the pre-school vaccines given at three years, four months, may be dropped, and the preschool booster dose may be given at six years of age.
‘We don’t know about [these changes] yet – they haven’t been confirmed,’ Helen said.
MDTs a ‘fabulous opportunity’ for health visiting
The roll-out of multidisciplinary teams (MDTs) across Northern Ireland has resulted in improved relationships between GPs and health visitors, the conference heard.
Piloted in the South Eastern Health and Social Care Trust (SEHSCT), the programme means each GP practice across the region has a ‘key link’ HV that GPs can refer to directly through their referral system. HVs are invited to practice meetings and surgeries publicise the presence of an MDT to patients.
HVs now have a higher profile among GPs and other healthcare professionals including mental health workers, physiotherapists and social workers. Smaller caseloads mean they have more time to bond with clients and run parenting programmes.
‘We were trying to get rid of barriers to GPs referring to HVs,’ said Helen Leigh, lead nurse (public health nursing) and health visitor lead for MDT, SEHSCT. ‘Now HVs are expected to feedback to GPs about what’s happened with referrals too.’
‘We were trying to get rid of barriers to GPs referring to HVs. Now HVs are expected to feedback to GPs about what’s happened with referrals too’
Andrea Barr, HV lead for MDT, Belfast Health and Social Care Trust, cited a case study of a 32-year-old woman, who at 30 weeks pregnant with her second child told her GP that her mental health was poor and was referred to the team. ‘[This mother] was impressed and felt very well supported by all the services she received. The baby is now six months old and they are both doing great,’ Andrea said. ‘This really demonstrates how positive outcomes can be achieved when everyone is working well to provide that wraparound care.’
Siobhan Slavin, nurse consultant (early and school years) at the Public Health Agency, said the programme is about HV services being ‘timely, accessible and transforming the way we are working. This has been a fabulous opportunity for health visiting.’
New pathways for perinatal mental health
A widescale review of perinatal mental health across Wales has led to the creation of 10 pathways for patients and families that will be introduced from 2023. The Wales Perinatal Mental Health Clinical Network takes a whole-system approach to providing care for mothers, babies and their families across the country.
‘It’s about assessing mums’ mental health and getting the right services for them, but also getting the right services for partners and dads in the family as well,’ said Martha Sercombe, a specialist health visitor for perinatal mental health in Wales.
A clinical network was set up in 2019 to review services. ‘Colleagues wanted to work in a service that was seamless,’ said Kim Jones, specialist HV in Wales. ‘They wanted clarity of their roles and responsibilities for themselves and for others and they wanted to make sure that everyone was very clear about the part that they were expected to play in the system.’
The pathways are based on five levels of a client’s need, and cover signposting; watchful waiting and later review; a set of structured contacts that offer emotional wellbeing support; referral to a GP or mental health professional; and routine or urgent assessment with admission to a mother and baby unit.
Practitioners ‘under greatest pressure’
How community practitioners (CPs) are treated has a direct impact on their ability to provide safely the services they are trained to provide to children and families. So Roger Kline, research fellow at Middlesex University Business School, told the conference during the 2022 Nick Robin Memorial Lecture.
‘The government is in breach of its duty of care to its citizens,’ he said. ‘Health visiting and school nurse services are under the greatest pressure they have ever been under.’
Roger advised CPs to keep their knowledge and skills up to date and provide a service of ‘no less quality than to be expected based on the skills, responsibilities and range of activities within your profession’.
Tell people the value of what you do, union urges
Colenzo Jarrett-Thorpe, Unite national officer for health, gave a rousing speech in support of community practitioners, reminding delegates of the battles the union is fighting on their behalf.]
‘Whether it’s the lack of staff, the morale, the integrated services, the running down of your services, we’ve got to stand up for your profession[s] because I believe it delivers every single day for our children and young people throughout the UK,’ he said.
Unite is campaigning on the practice teacher debates, third-party register and the new profiles that are being planned for nurses and midwives. ‘We think all health visitors should be Band 7 across the UK. That’s going to take a lot of work and it’s going to take all of us to make the case.’
He added: ‘I want to see more interactions between HVs, community nursery nurses, school nurses and politicians, whether local or national, to tell them the value of what we do.’
Your winning work
The following Unite-CPHVA award winners were announced at an awards ceremony during conference. Congratulations to all…
- Health visitor of the year: Sinead Toner
- School nurse of the year: Marie Thomas
- Community nursery nurse of the year: Michelle Broady
- Covid champion of the year: Asha Day
- Advocate of the year: Annie Hair
- Team of the year: Cornwall Council – Best Start Community Health and Wellbeing Team
Great conference, great company & great to be able to reconnect / share learning ‘in person’ following Covid. Thank you again @cphvaeddevtrust for my MacQueen award bursary enabling me to complete my MSc studies this past year & to @abiphipps for your support #CPHVA22 Bonnie Harley @BonnieHarley8
Closing the conference, chair of the CPHVA Executive Janet Taylor reminded members ‘Truly, you are valued.’ She continued: ‘Never undervalue or underestimate yourself, regardless of whatever you are doing. Against the odds, we are getting back to business.’