The big question: what will be the main challenges in community health for 2018?

06 February 2018

Three members offer their insight on the challenges ahead for health visitors, school nurses, and community nursery nurses.

Michelle Moseley

Programme manager for SCPHN (health visiting), Cardiff University and Wales chair, CPHVA Executive

The last year has seen continued cuts to the health visiting service, especially in England. We are already seeing the impact on children’s health and wellbeing (RCPCH, 2018). Health visitors (HVs) need to remain positive and passionate about their role – difficult, I know in such trying times. The health visiting service in Wales is a little brighter but comes with issues. Fortunately, we have a government who value our service. However, HV capacity and service provision is challenged to deliver the key contacts recommended via the Healthy Child Wales programme (Welsh Government, 2016). With rising workloads, a retiring workforce and evidence highlighting the impact of adverse childhood experiences (Public Health Wales, 2018; 2015), the need for greater numbers of HVs has never been more apparent. We need to remember why we ‘love’ health visiting, what brought us into it, and our HV principles. Plus how we can all jointly influence policy and advocate for children and families who require early intervention. Let us think about developing resilience while keeping the children and families we serve as our focus. HVs are key in forming therapeutic relationships and working in partnership with families and agencies. I love our profession. Our challenge is promoting it to enhance the service. Challenge accepted.

Margaret bunting

Lead nurse for school nursing, Southern Health and Social
Care Trust

I started as a school nurse (SN) in October 1992. Over the last 25 years, school nursing has changed considerably. It has moved from a position of being the ‘handmaid’ to the clinical medical officer to one of autonomy and leadership. Unfortunately despite these advances, public health nursing is under severe pressure to deliver the core universal services to school-aged children. Currently there is a shortage of SNs in Northern Ireland. 

There needs to be investment in the training and employment of SNs to deliver on the full Healthy Child, Healthy Future programme and to influence and affect change with the current health crises of obesity and poor mental and emotional health among our children.

A policy response for Northern Ireland to the State of child health report 2017 (RCPCH, 2017) states that early intervention and prevention can reduce and resolve issues before they become more difficult and expensive to treat later on. School nursing plays a proactive role in early identification and prevention and additional investment in this service would offer invaluable long-term benefits.

Last July I had the privilege of attending the International School Nursing Conference. Sharing our experiences was great, but the main point I took away was that we offer a very high standard of school nursing in Northern Ireland.

Stella Mann

Community nursery nurse,
Dorset HealthCare and CPHVA Executive member

Now is an important year for the NHS and we need to look at the changing workforce. In particular, the role and challenges of the community nursery nurse (CNN). In some parts of England, skill mix teams have already been lost. In others, CNNs have been down-banded.We also have areas where CNNs are being asked to work above the scope of their job description – a lot of the time this work is being completed by the CNN as they fear job losses if they don’t comply. This may lead to unsafe practice.

For clients and colleagues across all four UK countries, the variety of staff they come into contact with is proving complicated due to the variety of job titles. As we are working more collaboratively with staff from local authorities, children’s centres and so on, we need to be able to distinguish the work that the CNN completes as part of the HV/SN team from that of the children centre worker.  

The other challenge to the CNN is the role of the nurse associate. Once qualified,the nurse associate will be on a Band 4 and they will be regulated. Will employers choose to recruit Band 4 regulated staff to work in an HV/SN team over Band 4 CNNs? With this in mind, the CNN expert reference group will be investigating the possibility of CNNs being regulated with a similar rationale to that of the nurse associate.


Royal College of Paediatrics and Child Health. (2018) State of child health, England – one year on. See: https://www.rcpch.ac.uk/system/files/protected/news/RCPCH_State_of_Child_Health_A4_England_R5_INT.pdf (accessed 24 January 2018).

Royal College of Paediatrics and Child Health. (2017) State of child health, 2017 recommendations for Northern Ireland. See https://www.rcpch.ac.uk/system/files/protected/page/SOCH-recommendations-NI.pdf (accessed 24 January 2108).
Welsh Government. (2016) An overview of the Healthy Child Wales programme. See: http://fis.ceredigion.gov.uk/wp-content/uploads/2016/09/HCWP-Welsh-Gov-document-FINAL-published-version1.pdf (accessed 29 January 2018).
Public Health Wales. (2018) Sources of resilience and their moderating relationships with harms from adverse childhood experiences. See: http://www.wales.nhs.uk/sitesplus/documents/888/ACE%20&%20Resilience%20Report%20(Eng_final2).pdf (Accessed 29.01.18).

Public Health Wales. (2015) Welsh adverse childhood experience study. Adverse Childhood experiences and their impact on health-harming behaviours in the Welsh adult population. See: wales.nhs.uk/sitesplus/888/page/88504 (Accessed 29 January 2018).