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Conference special 2020: the heart of public health

11 January 2021

Highlights from the Unite-CPHVA 2020 Virtual Annual Professional Conference.

Unite’s assistant general secretary Gail Cartmail opened this year’s virtual conference, saying health visitors, school nurses and nursery nurses are at the heart of public health today and their roles could not be more important.

‘As a trade union, Unite stands next to you in your work to reduce caseload and address workloads,’ Gail told conference delegates. ‘We don’t think you should be redeployed from the community environment to an acute setting. We think that grossly misunderstands the role of public health nursing.

‘Public health, disease promotion and health promotion should run through the heart of the government’s strategy in response to this pandemic, and you have our support.’

Gail said that as a lifelong trade unionist she had been very moved when the general public stepped outside their front doors and applauded all key workers on Thursday evenings during the first national lockdown, but added: ‘As a trade unionist, support from government is quantifiable and I would like to see concrete evidence of the government’s appreciation of your roles across the NHS workforce in bringing forward a pay award. I would like to see a pay award in place to back up the applause from the country at large.’

Gail said that in her 30-year involvement with health visitors, she had learnt that community practitioners were ‘irrepressible’ and ‘a force to be reckoned with’, adding: ‘I have met some amazing women, and at every opportunity I have now with government ministers and members of the opposition I raise the absolutely pivotal roles played by health visitors, school nurses and nursery nurses.

At every opportunity I raise the absolutely pivotal roles played by health visitors, school nurses and nursery nurses
Gail Cartmail, Assistant general secretary, Unite

‘What we now know is that you can’t compartmentalise public health into one government department, as it cuts across all government departments, and I have used those opportunities to make that point,’ said Gail. ‘We will continue to lobby politicians using the significant influence we have.’

She also praised community practitioners for being ahead of the curve, citing the campaign to erect a statue of the pioneering black nurse Mary Seacole as an example.

Gail added that not only were women hardest hit by austerity measures, but data also now suggested that women and young people are being hardest hit by rising unemployment caused by the ongoing pandemic.


Tweets:

#CPHVA2020 the conference was filled with positivity & commitment
Wendy nicholson 
@WendyJNicholson


More must be done to improve care for immigrant mums

Immigrant women largely report poor experience of UK maternity services, Professor Gina Awoko Higginbottom MBE told the conference when discussing the findings of her team’s systematic review of 12 studies (Higginbotham et al, 2019).

Gina, professor emeritus of ethnicity and community health at the University of Nottingham, said although the review had found examples of both positive and negative experiences of antenatal, intrapartum and postnatal care among immigrant women, the research revealed important issues that need addressing.

‘Factors contributing to poor experience included lack of language support, cultural insensitivity, discrimination and a lack of knowledge among healthcare professionals about welfare support and maternity care available to immigrants,’ said Gina.

She added that her fellow review authors probably hadn’t realised how topical their findings would become, as the publication predated the Black Lives Matter movement and research subsequently published on the disproportionate impact of Covid-19 on people from BAME communities. ‘Our review was carried out at the same time as the MBRRACE-UK study published in 2018, which found that black women were five times more likely to die from pregnancy and childbirth-related causes than white women, and Asian women were twice as likely to die,’ said Gina.

‘This is a shocking statistic for a developed nation and something that needs to be addressed.’

Gina explained the UK is now in a period of ‘super diversity’ when it comes to ethnic mix, with the Office for National Statistics identifying that, in 2016, 28.2% of all births were to foreign-born mothers.

Challenging racism and discrimination at all levels – individual, institutional, clinical and societal – is an urgent imperative
Professor Gina Awoko Higginbottom MBE, Honorary vice-president of Unite-CPHVA 

‘It’s been argued that these current levels of super diversity in the UK have resulted in a huge challenge for understanding and meeting individualised healthcare needs, providing individual care and appropriate maternity care. Most of you will know this from your health visitor practice,’ said Gina.

The authors of the review came up with a number of recommendations, including greater awareness of the legal rights of immigrant women in education for maternity care professionals, continuity in maternity caregivers and compulsory provision of interpreters, and setting up a national-level website with the option of translating information into a wide range of languages.

Gina concluded: ‘Challenging racism and discrimination at all levels – individual, institutional, clinical and societal – is an urgent imperative.

‘Interventions are required at the macro and micro levels, including organisation of services and staff initiatives.’


‘The most important profession’

Health visitors have a vital frontline role to play in breaking the cycle of how childhood trauma and the mental health of mothers affects future generations, the conference heard.

Psychiatrist Dr Alain Gregoire, honorary president and founder of the UK Maternal Mental Health Alliance, said health visitors were the most important profession when it comes to perinatal mental health. ‘The highest-ever risk of developing psychosis is in the first few weeks after the birth,’ said Alain. ‘This is a critical time when health visitors are closely involved – or would like to be closely involved with mothers, as I’m aware of the cuts in health visitor numbers. There could not be a more critical time for both psychosis and depressive illnesses [to develop].

‘You are the people who strive to create a secure, happy relationship between mother and child, and this has an impact on the development of the child. This is big stuff – you are reinforcing, strengthening, supporting and fostering secure attachment. This is incredibly valuable, not just to the child at the time, but also for their long-term adult health.’


Put children and families first in ‘perfect storm’

The impact of Covid-19 on children and families and the need to prioritise them from now on were key themes in the conference session with nursing officers from England and Northern Ireland.

‘This is the perfect storm,’ said Wendy Nicholson MBE, England’s deputy chief nurse – children, young people and families, highlighting growth in domestic violence and children in poverty. ‘We’ve got children that are more vulnerable, we’ve got a workforce that is tired – but we’ve also got a workforce that is passionate and that we know will continue to work beyond the second wave.’

The ‘phenomenal’ impact of Covid would be ‘life-changing’ for children and young people, said Wendy, and had also badly affected the workforce.

Wendy drew delegates’ attention to Public Health England’s new childhood vulnerability framework, which has clearer definitions to help identify vulnerable children ‘more readily’ and will be ‘really helpful when we come to look at health visitor caseloads and stratification’.

Finally, Wendy praised how health visitors and school nurses had risen to the challenge of Covid and found innovative ways to deliver services. She urged delegates: ‘Continue with that grit – that determination and passion.’

Next, Mary Frances McManus, nursing officer for public health at the Department of Health in Northern Ireland, focused on the Nursing and Midwifery Task Group Report. She said that the report shows that ‘The value of nursing has clearly been recognised as we move forward in transforming the health and social care system within NI.’

The report includes plans to stabilise the workforce, strengthen the role of nurses and midwives in public health planning, and enhance their role within multidisciplinary teams. Key recommendations include increasing the number of health visitors, school nurses and family nurse partnership programmes across NI.

Like Wendy, Mary Frances highlighted the ‘increased pressure’ on families and children in her nation.’ But she added: ‘We are clear that children and young people need to be given the best start in life and we have a key responsibility to do that.’

Wendy also shared an update from Northern Ireland’s ‘Nightingale Challenge’, a global leadership and development programme which she felt was ‘crucial to keep going’ despite the pandemic.

Chief nursing officers Professor Fiona McQueen for Scotland and Professor Jean White for Wales, also gave an update – with support from Gavin Fergie, Annette Holliday and Amanda Holland.


Reflections on 2020 and the role of the NMC

NMC chief executive and registrar Andrea Sutcliffe used her conference session to praise the ‘tremendous’ response to Covid, and reflect on a year ‘which has indeed been the year of the nurse and midwife – but not quite in the way we expected’.

Looking back, she considered how health visitors, community nurses and school nurses were facing initial challenges, such as concerns over falling numbers and organisational change, which were then overlaid by a global pandemic.

Key elements of the NMC’s Covid response included establishing the temporary register and emergency education standards and introducing emergency measures for revalidation, said Andrea, as well as clear communication with registrants.

It was also the year in which the NMC was set to launch its 2020-25 strategy, with its focus on ‘promoting the highest professional standards’ enabling registrants to ‘do the best job that they possibly can’, added Andrea.

As well as praising the ‘amazing job’ done by registrants, she said: ‘There is an awful lot we need to learn and remember from that first wave, because we’re clearly now in the second – thinking about the impact of Covid-19 and lockdown on families and their communities and what we all need to do to support them.

‘We need to make sure we’re continuing to maintain services, particularly some of the community service, support for families and children and young people in vulnerable circumstances.’

Looking ahead, key work for the NMC will be around the sustainability of recruitment and retention to the register, and progressing a review of post-registration standards.

Andrea concluded with a thank you: ‘Your skill, your kindness, your compassion are recognised, are respected and valued by everybody at the NMC and so many more.’  


Vaccination uptake improving, but greater efforts needed

Declines in childhood immunisation uptakes have stabilised and are now improving, Professor Helen Bedford revealed to delegates.

Helen, professor of child health at University College London, Great Ormond Street Institute of Child Health, said the latest figures showed that the uptake for three doses of the infant vaccine given at 12 months was 93% in the UK, with rates varying between 73.2% and 97.8% across local authority areas in England, with a 87.4% uptake in London. The MMR uptake rate at 24 months was 91.3% for the UK, but varied between 74% to 97.1% across local authorities in England, while the rate in London was 83%.

She cited research showing that uptake for the MMR vaccine did drop in the three weeks from February 2020, when social distancing measures were first introduced after the Covid-19 pandemic hit, and were 19.8% lower than the same period in 2019.

‘This means we now have children who need to be caught up – health visitors should be asking parents if their children are up to date with their vaccinations. It’s never too late for these children to have them,’ Helen added.


Compassion is the key...

Compassionate leadership is crucial to the health and wellbeing of the NHS workforce and their patients, Professor Michael West explained to delegates.

Michael, from Lancaster University’s Management School and a visiting fellow at the King’s Fund, said the compassion healthcare staff had shown to their patients and to their colleagues was what has enabled everyone to deal with immense and sustained pressure. ‘What’s been impressive and more significant during the past eight months of the pandemic is the level of compassion that has been shown by NHS staff to their patients and to their colleagues, and from the community towards key workers – including the 700,000 who signed up as volunteers to help the NHS,’ said Michael.

‘It’s astonishing to see in some areas that health visitors are responsible for 750 children on their caseload. It’s just an extraordinary burden, so I think compassion has been key to enable us to cope during this really difficult period.’

Michael said there were four key elements to compassion: attending to patients and being present with them; listening with fascination; seeking to understand another’s pain and fear through dialogue; and empathising with, and helping or serving others.

The most important step in our collective pathway from this pandemic is to have the courage to be compassionate to ourselves in the moment Michael West, The King’s Fund

‘Chronic, excessive workload has almost become the pattern on the wallpaper we no longer notice in healthcare, but it’s the number one predictor of staff stress, it’s the number one predictor of staff intention to quit, and the number one negative predictor of patient dissatisfaction,’ said Michael.

He said nurses, health visitors and midwives needed to have regular compassionate supervision so that excess workload activities and other issues can be identified and ensure people are continuing to grow and develop.

In summing up, Michael said compassionate leadership was about how we create psychological safety for those delivering health and care services; team working; clear vision and direction and objectives; reflection and learning and innovation rather than fear and blame; regular supportive contact between staff and leaders; and managing conflict in a positive, mutually supportive and compassionate way.

‘I think the most important step in our collective pathway from this pandemic is to have the courage to be compassionate to ourselves in the moment, and in the challenges we face in our work and lives generally, and to take intelligent action to help ourselves, so that we can be the best we can be.’


Roadblock, recognition and resilience

Professor Gina Awoko Higginbottom MBE gave the Nick Robin Memorial Lecture, ‘Roadblock, recognition and resilience’, drawing on her own trailblazing experiences and battles for career progression as a nurse, midwife, health visitor, university academic and professor.

In 2017/18, Gina said official figures revealed only 0.6% of British university professors were black, 1.2% were mixed race, 2.2% Chinese, 3.5% Asian and 91.2% white. In the same year, the number of BAME female professors was 2.1%.

‘In your career you have to run your own race,’ said Gina, who is now co-convenor of the International Collaboration for Community Health Nursing Research. ‘I feel we’re all unique and you don’t have to fill anyone’s shoes. However, you might not be able to do it alone and sometimes you’ll need support.’

Gina concluded: ‘Be kind and inclusive, especially to people less powerful than you, as that is a true measure of a person.  

‘You will need to fight battles but choose your battle wisely, otherwise you will become exhausted.’


Services asked not to redeploy healthcare workers

Professor Viv Bennett, Public Health England (PHE) chief nurse and the government's principal adviser on public health nursing, thanked health visitors and school nurses for everything they have done in continuing to care for babies, children and young people during the ongoing Covid-19 pandemic.

But she quoted the UN’s warning that although children are not the face of the pandemic, they risk being its biggest victims.

‘Early years younger children are rarely seriously affected by the Covid-19 virus and at least one third don’t show symptoms, and while complications are rare, for the majority of children it’s the indirect impact and hidden harm caused by Covid-19 that’s causing most concern,’ she said.

Viv said 700 million days of education could be lost this school year, and more children were facing food insecurity as job losses take their toll. The conference heard that a stretched system means children have less access to healthcare and other essential services. Thousands of children are at greater risk of abuse and the voices of children and young people have been absent from decisions made about their lives.

For the majority of children it’s the indirect impact and hidden harm caused by Covid-19 that’s causing most concern’
professor Viv Bennett, PHE chief nurse

‘NHS England, PHE and the Local Government Association have written to services underlining the importance of the community frontline for children and young people and [asked them] not to redeploy health visitors, school nurses and safeguarding nurses to the adult frontline in the second surge.’

Viv said to meet the challenges of the second surge, PHE was looking at a blended approach to delivering services – ‘not diktats from the centre but guidance and advice’ – with clinical judgment being used to balance whether virtual or face-to-face appointments are required.

She added that priorities in the second surge include safeguarding, perinatal mental health, the mental health needs of young people, immunisation and reducing home accidents to keep children out of A&E.


Tweets:

#CPHVA2020 congratulations on a fabulous conference! @Unite_CPHVA members are amazing and you all make such a difference!
Su Lowe
@saffie


Tiny Happy People tackles ‘word gap’

Community practitioners should take advantage of new resources aimed at helping parents support their children’s language and communications skills.

Following the official launch of the BBC’s Tiny Happy People in July (which Community Practitioner highlighted in an Enews and feature earlier this year), executive producer Joe McCulloch gave delegates an update on all the progress so far.

The project aims to halve the UK’s ‘word gap’ and give children from a disadvantaged background a better start in life. ‘In the light of Covid, and the disruption that has brought, [this] is needed now more than ever,’ explained Joe.

At Tiny Happy People’s heart is a comprehensive suite of short films and resources centred around activities parents and carers can use in everyday interactions with their young children to help develop their language and communication, as well explanations of the evidence base to support them.

The BBC worked with the target audience to get the tone and feel of the resources right, said Joe, alongside professional bodies and practitioners including health visitors, community nurses and nursery nurses.

Tiny Happy People has already developed official partnerships, with ‘hyperlocal hubs’ in five local authority areas in the UK, where they are working with early years professionals to connect with the target audience in that area.

‘We see working with you as a real opportunity to get Tiny Happy People resources to the audience that would most benefit from them,’ added Joe.

The project is supported by the Duchess of Cambridge and a number of celebrity ambassadors. Tiny Happy People is estimated to have already reached 24 million people – with 64,000 followers on Instagram and 1.3 million unique visitors to the website since it launched in October last year .

For more, see bbc.co.uk/tiny-happy-people    


Tweets:   

Loving my 1st virtual #CPHVA2020 especially #tinyhappypeople can’t wait to share this amazing resource with my fellow #HealthVisiting colleagues 
Jen Smith
@jenjensmith84


On reflection: a message from your Executive chair

Now that our annual professional conference is over, I thought I would take a bit of time to share my reflections with you.

We made the decision to do what we, the executive committee, have never done before, and that is to plan and run the conference virtually. We were determined not to cancel our annual national professional conference, as there is so much rich learning from bringing the four countries together. We were determined to deliver for you, our members, the access to professional content and learning that you have come to expect, while taking the opportunity to address a wide and diverse programme of relevant topics. We hope you think we delivered – for those who were able to attend!

Please take the time to access the website and provide evaluation and view the presentations, which are all available in this space. You can look at your favourites again, or see what you missed, as we know there are often times when your preferred sessions clash. My personal favourite was Michael West presenting compassionate leadership (see page 25). This is a topic I passionately believe in, and in this current climate of a pandemic and the immense pressures on our national health service and public health agenda, it has never been more important.

There were many other excellent sessions, the NMC; immunisation update; the ‘Being There’ workshop presented by lead professional officer Ethel Rodrigues; and the inspirational session by Professor Gina Awoko Higginbottom to name just a few. Those of you who missed it this year, don’t worry, we hope to bring you a series of professional events throughout the next 12 months in the run-up to the next event, so keep watching this space!

We want to thank you all for adapting to this new world of communication we now live in. I would like to take this opportunity to give special thanks to lead professional officer Obi Amadi, the CPHVA Executive, Irene Fynch and Amanda Cass for admin support and, of course, the Unite IT team, in particular Nathan and Mik.

We are required to do things differently but we will continue to adapt and innovate to deliver to you, our members.

I hope we will have a future opportunity to come together for our conference again. Thank you for your ongoing support – we truly appreciate it.

Janet Taylor, chair of the CPHVA Executive         

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