Leading the way

10 January 2022

All the highlights from the latest Unite-CPHVA 2021 Virtual Professional Conference, held in November.


You have risen to the challenge of public health nursing. You have faced redeployment, staff shortages and yet you have continued to deliver care and support your clients.’

This was the message Janet Taylor (pictured right), chair of the CPHVA Executive, delivered to members as she opened this year’s Unite-CPHVA Professional Conference. ‘I’m immensely proud of our members and the wider public health nursing colleagues, and I want to thank every one of you for your commitment throughout the pandemic.’

Janet said that choosing the title of this year’s conference, ‘Leading the way: setting the direction’, was easy because that was exactly what CPHVA members have been doing during the Covid-19 crisis.

‘You have demonstrated compassionate leadership and expertise in all that you do and yet you make it look so easy,’ she said.

‘We are asking and asking for better pay, for staffing levels to go up and nothing is changing. I want to put Unite in a position where the government has to listen very carefully to what we are saying’

She also welcomed Sharon Graham (left), the newly elected general secretary of Unite: ‘You are the first female general secretary, and we are absolutely delighted at this amazing achievement.’

In her speech to conference, Sharon said the pandemic has emboldened employers to ‘think they can get away with things they would never have got away with’ before. ‘For example, redeployment, spreading people too thin – that is happening across the NHS. We are also seeing people being asked to work on bands that are lower than what they are performing,’ she said.

She outlined plans to introduce ‘combines’ to the union – committees with budgets set by the union executive that bring together all of the reps for a particular industry to work together on their own biggest bargaining agendas.

‘In CPHVA, you have got very particular issues that you will want to talk about,’ she said. ‘For example, in Scotland you’re Band 7 and in England and Wales you’re a Band 6. Every time you try and go for an uplift in Scotland they are going to say, “Hang on a second, you’re better off than in England and Wales.” And in England and Wales we have a situation where people are not getting paid the rate for the job.’

‘We are not being listened to currently,’ Sharon added. ‘We are asking and asking for better pay, for staffing levels to go up and nothing is changing. I want to puT Unite in a position where the government has to listen very carefully to what we are saying.’

See here for a New Year message from Sharon Graham.

Observatory work to focus on racial bias

An independent review of the Improving Access to Psychological Therapies programme from a race and ethnicity perspective will be conducted for the first time by the NHS Race and Health Observatory, its director told the conference.

Dr Habib Naqvi also outlined plans for the Observatory to examine racial bias when assessing newborns with the Apgar score. ‘This work enables us to focus on some of the deep-seated entrenched health inequalities in society, keep the agenda high on the radars of senior leaders and healthcare systems, and be reactive to things that emerge, such as the pandemic,’ he said.

For more from Dr Habib Naqvi, see ‘Embedding equality’ in the November/December 2021 issue of Community Practitioner. 

CPs’ role in vaccine take-up crucial, for Covid-19 and beyond

Health visitors and school nurses have a vitally important role in communicating the benefits of immunisation with parents, addressing their concerns and making sure that children receive immunisations on time, the conference heard.

Helen Bedford, professor of children’s health at the UCL Great Ormond Street Institute of Child Health, told delegates that community practitioners are well-placed to have one-to-one discussions because of the trusting relationships they have with families.

‘I was involved in a study last year in which interviews were conducted with parents who had rejected vaccinations,’ she said. ‘One thing they said was that they’d had some really difficult discussions with health professionals but the one group they’d had good discussions with, the people who were empathic, listened to their concerns and took them seriously were health visitors.’

‘The one group parents had good discussions with, who listened to their concerns, were health visitors’

Helen also outlined details of the current evaluation of adding screening for severe combined immunodeficiency disease (SCID) to the newborn screening programme. The evaluation of screening for this very rare condition is currently taking place at Birmingham, Great Ormond Street Hospital, Manchester, Newcastle, Sheffield and South East Thames.

‘It’s important to check if you are working in an area where this is evaluation is going on for a result of the SCID screening test,’ she added. ‘That might be in the red book, it might be a notification from the child health information system, it might be a letter from the immunologist.’

CNOs outline leadership role for CPs in Northern Ireland and Wales

Building back better and fairer and the leadership role of community nursing were the messages for delegates from Northern Ireland’s deputy chief nursing officer (CNO) and Wales’ CNO.

Mary Frances McManus (pictured right), deputy CNO for Northern Ireland, told the conference that the development of primary care multidisciplinary teams in Northern Ireland has created a real opportunity for health visitors to ‘lead the way within public health’.

One of the aims of the Nursing and Midwifery Task Group 2020 report was to enhance the role nurses and midwives play within multidisciplinary teams that have been rolled out across Northern Ireland, Mary explained.

‘There has been additional investment into health visiting across multidisciplinary teams. We are aiming to reduce caseloads within the teams so that outcomes for mothers and families will be increased and health visitors will have time to identify health and safeguarding needs, and work in partnership with others to address them,’ she said. ‘[Community practitioners] are in a unique privileged position as we, at the heart of our communities, are invited into people’s homes and are afforded the opportunity to get to know our families and advocate for our children.’

‘We are aiming to reduce caseloads within the teams so that outcomes for mothers and families will be increased and health visitors will have time to identify health and safeguarding needs’

Sue Tranka (pictured left), CNO for Wales, told delegates her team is pulling together an all-Wales succession and talent-spotting programme to secure the future generation of leaders in the community nursing professions. ‘

Part of my vision is that we have the right workforce doing what they do best, so investing in recruitment, how we fill the gaps in the meantime, what strategic direction will we take to ensure we have the right workforce. All of these discussions are up for grabs at the moment in Wales.’

‘We can’t do any of this well if we don’t have investment in training,’ she added. ‘We’ve got to think boldly and courageously about our funding schemes to get students into training.’

We can’t invest [in recruitment] well if we don’t have investment in training. We’ve got to think boldly and courageously about our funding schemes to get students into training.’- Sue tranka, Chief nursing officer, Wales

Multidisciplinary approach to homelessness ‘vital’

The government’s Everyone In strategy, which moved about 37,000 rough sleepers from the streets into hotels and other accommodation at the beginning of the lockdown, has been ‘transformational and a real affirmation of a multidisciplinary response to meet complex needs’, the health and homelessness adviser to Department for Levelling Up, Housing and Communities told delegates.

Jane Cook, who is also a nurse and health visitor, said that about 22,000 of those moved into empty accommodation because of the Covid-19 pandemic have now moved into longer-term accommodation and some are now employed.

‘We have seen that people who have moved into a hotel, with the right support, have actually accessed mental health and substance misuse services, and there has been a real transformation in their lives,’ she said.

‘People who have moved into a hotel, with the right support, have accessed mental health and substance misuse services’

‘The people we see are extremely vulnerable. They are 2.5 times more likely to have asthma, high rates of tuberculosis, and six times more likely to have heart disease. Forty-two per cent of people in London who are rough sleepers report using alcohol to excess and 50% report mental health issues.’

The Everyone In initiative reflected a change in language that saw homelessness viewed as a public health issue rather than a housing issue alone. ‘Leadership was at all levels – strategic, national, local authorities – making sure that all the agencies that needed to be involved were involved, and bringing those agencies together in areas in which they hadn’t often worked together. That was key,’ Jane added.

Reflect on how you are looking after yourself

‘I want you to think about mental health and physical health as being one and the same,’ Stephen Hamilton, psychiatric nurse and associate lecturer at Queen’s University Belfast, told delegates. ‘We talk about holistic care for ourselves and for our clients and we should not make the distinction.’

He used the analogy of flight attendants telling passengers to fit their own oxygen mask before they help anyone else in the event of flight difficulties to apply to community practitioners’ own health.

‘If we are not on our game and we are not maximising our health, how can we provide the best, most effective safe service for the folks we are looking after?’

Stephen talked delegates through the ‘7 Ss’ of effective care, which he has developed through research and talking to healthcare professionals. They are socialisation, solitude, safety, support, sleep, sensitivity and stimulation.

See page 32 for more on preserving your wellbeing.  

Crucial role for CPs in research

Delegates heard from a number of speakers about the importance of getting involved in research. Ruth Endacott, newly appointed director of nursing and midwifery at the National Institute for Health Research (NIHR), told the conference that community practitioners (CPs) should generate ideas for research.

‘Sometimes there are things we do with the people in our care that either work really well and we have no idea why they have worked so well, or they don’t go well,’ she said. ‘Sometimes those initial ideas will result in absolutely amazing research studies. Somebody needs to ask that question, and these are not people sitting around a table in a university, but the people who are interacting with the public day in, day out.’

Ruth pointed out that CPs are often already involved in promoting NHS studies and actively recruiting clients, including for research into the Covid-19 vaccine in pregnant women. ‘Our vision at NIHR midwifery is to inspire nurses in all settings to get engaged with research, to make a difference to health outcomes,’ she added.

Another initiative to start community practitioners off in research is the International Collaboration for Community Health Nursing Research (ICCHNR), a platform where any nurse working in the community can be present and learn about others research from around the world.

‘There aren’t many organisations that only focus on community health,’ said Sally Kendall (pictured above), professor of community nursing and public health at the University of Kent and co-convenor of the ICCHNR.

‘We are there to demonstrate the value of community health care nursing, to improve the quality of healthcare, to advance and share knowledge of community healthcare nursing practice through research, and to increase the personal commitment of community nurses to evidence-based practice.’

‘Everything I do is underpinned by human rights and valuing that human being sitting there in front of me’

Domestic abuse consultant Clare Walker was two months pregnant when she was placed in a battered wives hostel in 1990 in the middle of the Peak District, with ‘no services, no community, no infrastructure, no lighting, no public transport’.

‘The only agencies that came there were the police to drop off another woman and her children, or the child exploitation teams when they came to talk to one of the women about the sexual abuse that they had learned their child or children had experienced,’ said Clare, who was delivering the Nick Robin Memorial lecture.

‘It felt very punitive, and I had a sense that I needed to come back to that point in my life journey to do what I could to help other women fleeing domestic abuse have a better experience going through the service,’ she added.

After leaving the hostel and working in hospitality, Clare started volunteering in social care, eventually getting a job in 2001 as a part-time children’s worker in a women’s refuge. A full-time family support role followed, and Clare set up a number of programmes for women experiencing domestic violence.

Clare is a practice educator for social work students to inform and improve their practice in their understanding of domestic violence and has become a domestic violence expert witness. ‘It tends to be when the victim has a disability, physical or learning, health need, or they are older,’ she says.

Among her other roles is running an ongoing support programme for women experiencing domestic abuse. ‘The key thing we have throughout the programme is looking at everything through the lens of intersectionality so that it isn’t just [thinking] in terms of stereotypical middle-class white British couples,’ she said.

Clare concluded: ‘Everything I do is underpinned by human rights and valuing that human being sitting there in front of me – seeing them, hearing them and giving them that validation.’

Attending delegates can exclusively access event resources. Simply use the current conference app, or keep an eye on the website cphvaconference.org

Image credit | CPHVA | iStock

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