‘It is really important CPs bring their voice to bear’

During the first panel session of the Unite-CPHVA Annual Professional Conference 2024 in Birmingham, November 6, the message from UK’s chief nursing officers was clear: health visitors, school nurses, community nursery nurses and all community practitioners (CPs) must join forces and use their voice to face up to the challenges that lie ahead.

The CNOs and representatives addressed CP workforce issues, as well as solutions, across England, Scotland, Wales and Northern Ireland. There were many similarities, but also some issues unique to each country.

All four CNO representatives referred to recruitment and retention difficulties in the CP professions, complex demands on the health system and how calls for efficiency savings put productivity and effectiveness into sharp focus.

The importance of CPs also remained clear, a fact that was formally highlighted in the recent Darzi review, as Deputy CNO for England Acosia Nyanin pointed out to delegates. The CNO speakers were quick to thank CP delegates for all that they do and for truly making a difference.

‘Without you, children would not have the best start in life,’ said Sonia Glendinning from the Department of Health, Northern Ireland, while first to speak, Paul Labourne, described CPs as unsung heroes, before spelling out the challenges they face.

Paul Labourne, a Queen’s Nurse and nursing officer within the Welsh government, working with CNO Sue Tranka, called for all practitioners to be prepared for the changes coming. He referred to an ageing population, the complexity of health and social care cases and advances in technology, genomics and AI as matters that the professions need to have on their radar.

Paul highlighted that health and social care in Wales is delivered across seven partnerships for a population of 3.2 million, with a big emphasis on simplifying and integrating person-centred services. He saw workforce issues as one of the biggest priorities for Wales as there was a shortfall of nurses and that “doing more of the same is unsustainable.”

The CNO office is working with the NMC and Health Education Improvement Wales on future nurse and midwifery standards, including introducing a scaled-up, regulated band 4 nursing role.

Anne Armstrong, interim CNO for Scotland, spoke of the positive recent investment in the region which had led to recruiting more health visitors and school nurses, but was concerned that the undergraduate pipeline in registration was not achieving the required targets going forward.

A taskforce, chaired by the Cabinet Secretary in health and social care, had been set up to look at how to make it a more attractive career route. Recommendations from the taskforce will be made later this year and are likely to include different ways of recruiting, such as apprenticeships and a new pipeline from Band 2-4. Anne said practitioners in Scotland were moving to a 36-hour working week and that the health visiting pathway set a minimum standard of 11 visits per family.

She highlighted that development needs and assessment of children in Scotland still needs improving, alongside significant health inequalities across communities. The diverse landscape and geography of Scotland was cited as a challenge for practitioners as one type of service does not fit everyone.

Sonia Glendinning, Nursing Officer with the Department of Health, Northern Ireland, working with CNO Maria McIlgorm, spoke of the specific challenges facing professionals in Northern Ireland. The region has a large number of looked after children, numbers on the child protection register are rising and outbreaks of measles and pertussis are on a scale not seen in years.

Northern Ireland also has the highest prevalence of mental health issues in the UK. Sonia pointed to a marked difference in life expectancy depending on where a person lives. For example, children growing up in deprived areas of Northern Ireland are likely to live 7.5 years less than others. Northern Ireland’s troubled political past, she said, had left a legacy of challenges, including long delays in decision-making.

However, she said that with the return of the governing Northern Ireland Executive, there was a real energy to reform health and social care, including the Health and Wellbeing 2026: Delivering Together programme, a Review of Maternity Services in NI and the Live Better initiative.

Deputy CNO for England Acosia Nyanin detailed the difficulties of funding and resourcing in England and the need to work better in a joined-up complex system spanning several different regions. She asked where does the role of the community practitioner start and stop?

‘It doesn’t open at 9am and shut at 5pm, does it?] she said. ‘We need to be really mindful of managing caseloads and how you manage your own health and wellbeing. How you feel and are supported is key to retaining you and key to you providing the best care. Restorative supervision is definitely needed consistently across England.’

She welcomed the Darzi report into the NHS and saw it as crucial to helping drive the move from hospital care to community services, self-management and a focus on health promotion.

‘The Darzi review was clear about the importance of community practitioners,’ she said.

‘It is really important CPs bring their voice to bear. There are 15 events in the next few months talking to professionals about what you think will make the most difference. Be clear about what you think the solutions are not just the problems. The solutions are sitting in this room among you. A genuine, huge engagement exercise is needed. Be part of it.’

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