The Journal ofof the Community Practitioners’ and Health Visitors’ AssociatioAssociationn DEC/JANDEC/JAN 2018 VVOLUMEOLUME 90 / NNO.O. 1122
ALL BY MYSELF Has loneliness become an epidemic?
The health divide Staying strong Period poverty Life expectancy remains Why resilience Tackling the social a postcode lottery is important and fi nancial taboo
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C R.indd 1 21/12/2017 0 :5 «¬ #CPHVA18
ANNUAL PROFESSIONAL CONFERENCE
17-18 October 2018, Bournemouth International Centre
Register your interest at: cphvaconference.co.uk
p02.CPJAN2018.indd 2 11/12/2017 11:05 Contents Volume 90 Number 12 24 34
EDITORIAL 5 We take a look at some of the content in this issue NEWS 6 A round-up of the latest stories in public health
10 The most recent research from the professions
12 Exploring the changing attitudes to ‘physical discipline’ for children OPINION 16 Royal recognitions for Unite 34 Could a treatment for members from the Queen’s LAST WORD peanut allergies be 48 Professor Ivan Nursing Institutes on the horizon? Robertson explains the importance of 18 The fi rst of regular updates 36 There are still clear gaps in resilience for both from the CPHVA Executive life expectancy and health health and work, and depending on where you how to strengthen it 19 Head of health Sarah live – what’s going on? Carpenter looks back on 2017 and ahead to an 40 Being unable to afford the NHS milestone in 2018 basic necessity of sanitary protection is sadly a reality 20 John Bird, co-founder for many girls in the UK 29 of The Big Issue empire explains how we can truly lift people out of poverty FEATURES 22 How to stay healthy in January and beyond
24 Loneliness doesn’t COVER 40 STORY discriminate, but has been labelled an epidemic, RESEARCH reports Phil Harris 44 The eff ectiveness of a 20 service which attempts to 29 Digestive disorders are tackle second pregnancies common, yet the symptoms among teenagers who can be confusing already have a child
December/January 2018 Community Practitioner 3
3 C n en s.indd 3 21/12/2017 0 :5 NEW NUTRITION CPD MODULE NUTRITIONAL VALUE OF THE WEANING DIET
The CPD module will:
• Nutritional value of the weaning diet • What do infants and young children really eat? • The latest research on nutrition • Dietary concerns • Portion sizes Visit: communitypractitioner.co.uk for further information on the module.
Wp04.CPJAN2018.indd 4 11/12/2017 11:07 EDITORIAL
Sticking together... Unite-CPHVA Existing Unite-CPHVA members with queries Welcome to our December/January issue. relating to their membership should contact 0845 850 4242 or see unitetheunion.org/ contact_us.aspx for further details. To join Unite-CPHVA, see Loneliness was once a plight highlighted at certain times of year such as Christmas, or as unitetheunion.org being mostly about elderly members of the community. But as we see on page 24, and Unite-CPHVA is based at 128 Theobald’s Road as you may have observed in your own professional practice, no one is immune from London loneliness, nor is it just a seasonal affl iction. Despite the persisting public misconceptions, WC1X 8TN 020 3371 2006 a person of any age can feel lonely, even when they’re surrounded by loved ones. It’s also sadly a rising issue among children. We’ve saved the startling stats for the piece itself, but Community Practitioner Unite-CPHVA members receive the journal free suffi ce to say, recognition of the problem and ensuing calls for action, have been gathering each month. Non-members and institutions pace. What’s also clear however, is that there are positive actions we can all take, and it starts may subscribe to the journal to receive it. by checking on your nearest and dearest. Non-member subscription rates Individual (UK) £135.45 In this edition, we also speak to the inspiring John Bird, co-founder of The Big Issue empire. Individual (rest of world) £156.45 On page 20, he talks about fi ghting social injustice, how to truly lift people out of poverty, Institution (UK) £156.45 Institution (rest of world) £208.95 and his future plans to tackle these issues. Subscription enquiries may The rest of the journal is packed with the usual thought-provoking features (are we really be made to Community Practitioner subscriptions still talking about health inequalities? Sadly yes, the need is still very much there – see Redactive Publishing Ltd our report on page 36 and related concerns on page 40). We fi nish on the importance of PO Box 35 Robertsbridge TN32 5WN developing resilience – in your career and for wellbeing. t: 01580 883844 We’d also like to take this opportunity to say a big ‘Happy New Year’ to all of you, and [email protected] to draw your attention to an exciting 2018 and beyond for Community Practitioner. From The journal is published on behalf of Unite-CPHVA by Redactive Media Group, February, your professional journal will have a new look and feel. You’ll fi nd the same quality 78 Chamber Street, London E1 8BL news, research, professional advice and insightful reports as you do now, but it will all be 020 7880 6200 within a refreshed publication. Expect a revamped design, new formats and even Editorial advisory board Obi Amadi, Lucretia Baptiste, a more portable size (270mmx210mm to be precise). The journal will also land 10 times a Toity Deave, Barbara Evans, year, with a summer edition in July/August and a winter edition at the end of the year. Gavin Fergie, Elaine Haycock-Stuart, Brenda Poulton, Janet Taylor We’re also delighted to welcome our new professional editor to the journal, Jillian Taylor, who will now be on board moving forwards. Jillian is a longstanding member of the CPHVA, Editorial team Emma Godfrey-Edwards, managing editor and has previosuly presented her work on these pages. She is currently a lecturer in public Aviva Attias, deputy editor health nursing (health visiting) at the University of the West of Scotland. [email protected] Hollie Ewers, assistant editor As always, if you have any feedback on the articles featured, or you’d like to suggest ideas Jillian Taylor, professional editor for the future (especially given the upcoming refresh) then please get in touch. Whether you Chloe Crisford, picture editor Nicholas Daley, senior designer want to share your practice experiences, you’ve been inspired by a news story, or you have a research paper you’re keen to submit – we want to hear from you. We really want to hear Unite health sector officers National officers: Sarah Carpenter and your thoughts and help drive the journal forward together. Please send an outline of any Colenzo Jarrett-Thorpe proposed features or papers to Aviva Attias at [email protected] Lead professional officers: Obi Amadi; Jane Beach; Gavin Fergie; Dave Munday; and Ethel Rodrigues Until next issue... Advertising queries Alex Edwards The Community Practitioner editorial team [email protected] 020 7324 2735 Production Jane Easterman [email protected] 020 7880 6248 Printed by Warners © 2018 Community Practitioners’ and Health Visitors’ Association ISSN 1462-2815 The views expressed do not necessarily represent those of the editor nor of Unite-CPHVA. Paid advertisements in the journal do not imply endorsement of the products or services advertised.
December/January 2018 Community Practitioner 5
5 Editorial.indd 5 02/01/2018 16:20 NEWS ROUND-UP NEWS ROUND-UP A look at the latest in public health
UK ENGLAND Welfare reform to push a million WALES Police see surge in more children into poverty sexting cases The number of children living in poverty The poorest parts of the country will see The number of children in England and in the UK will soar to a record 5.2 million the sharpest rise, with the largest increases Wales involved in sexting off ences – – or 37% of all children – over the next in the North East, East Midlands, Wales and sending or possessing sexual images of fi ve years, new research says. Northern Ireland. themselves or others – has more than The Institute for Fiscal Studies (IFS) But poverty rates for working-age adults doubled since 2014-15, police say. They predicts that freezing benefi ts, the without children and for pensioners would recorded more than 6200 incidents this introduction of universal credit and less remain largely unchanged, the IFS fi nds. year, up from 2700 two years ago. generous tax credits will play a major part The report also predicts that the gap Some cases involve children as in pushing one million more children into between rich and poor will widen further, young as 10, though incidents peak poverty by 2021-22. Families already at and that the country can expect four more with 14-year-old boys. But the number greater risk of poverty – including lone years of weak income growth. of children charged has more than parents, those with very young children, See page 36 for our report on health halved due to the new ‘outcome larger families and those with a disability inequalities in the UK. 21’, which allows forces to deal with – will be especially hard-hit. ● Read the IFS report at bit.ly/UK_IFS off ences without criminalising children if there is no evidence of exploitation or malicious intent. Chief constable Simon Bailey, National Police Chiefs’ Council lead for child protection, said: ‘Parents, carers and schools have a crucial role to play in talking to children about what a healthy relationship looks like, their boundaries, consent and the ramifi cations of sharing sexual imagery.’ ● Read more at bit.ly/EW_sexting
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KEY FIGURES
£6.87m The money the ACE programme has received
WALES Funding boost for 14% ACE programme The percentage of adults in An all-Wales programme to help police deal The three-year award from the Home Offi ce’s Wales who had four or more with vulnerable people via early intervention police transformation fund is a result of a ACEs before reaching 18 and root-cause prevention has received a collaborative bid between Public Health Wales, £6.87m boost. the four police and crime commissioners, four It follows a Public Health Wales adverse chief constables, and a range of criminal justice childhood experiences (ACEs) study that found and voluntary sector partners across Wales. 14% of adults living in Wales had experienced Tracey Cooper, chief executive of Public Health four or more ACEs before reaching the age of 18. Wales, said: ‘The studies have clearly shown the Compared to those with no ACEs, these link between early childhood harms and the people were 20 times more likely to have been risk of developing antisocial health-harming imprisoned, 16 times more likely to have used behaviours In adult life. These people are crack cocaine or heroin, 15 times more likely to ‘It is clear that we must all work together to have committed violence in the last 12 months, create sustainable, eff ective solutions.’ 20 times more likely to be and 14 times more likely to have been a victim of ● Read more about the programme at imprisoned violence in the previous year. bit.ly/WAL_ACE
NORTHERN IRELAND ENGLAND Video to reduce burns New eye-test resources for schools and scalds in the home Public Health England has produced a new set of resources to A video showing how easily children support the commissioning and delivery of local services for can be burned or scalded in the home screening children’s vision. has been produced by the Public Health Trained vision screeners carry out the tests on four to Agency (PHA) and local councils. fi ve-year-olds in primary schools. The tests aim to detect ‘Scarred for Life’ shows the dangers signifi cantly reduced vision as early as possible – somethingg of hot appliances, liquids and bath water, which cause more than young children rarely complain about, particularly half of all burns and scalds. It is the latest in a series of awareness- if it only aff ects one eye. raising activities to cut accidents in the home. The new resources comprise service Dr Carolyn Harper, director of public health at the PHA, said: ‘The specifi cation, screening competencies, teacher video aims to highlight how easy it is for a child to burn themselves information sheets, screening pathways, diagnostic or be scalded, and encourages parents and guardians to be aware pathways, a parent leafl et and six template letters. of the risks and how injuries can be reduced.’ ● Access the resources at bit.ly/ENG_vision
GETTY/ISTOCK ● To watch the video, go to bit.ly/NI_burns
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SCOTLAND WALES Family Nurse Partnership to expand in Scotland Lack of mental health All eligible mothers in Scotland are set to frequent home visits from nurses. By the mother and baby unit benefi t from the Family Nurse Partnership by end of 2018, the programme will recruit is ‘unacceptable’ the end of next year as ministers promise a up to 60 additional fully trained nurses signifi cant expansion of the service. so that all eligible teenage mothers can A specialist mother and baby unit The Scottish Government is investing benefi t, bringing the annual costs to must be re-established in Wales to another £5.5m in the programme, which around £16m. help women suff ering with mental ill supports young fi rst-time mothers from early Some 4500 mothers have benefi ted health, a report has concluded. pregnancy until their children turn two via from the programme since it was fi rst The mother and baby unit at the set up at a test site in NHS Lothian in University Hospital of Wales, which January 2010. Since then it has been included Cardiff ’s perinatal mental rolled out in more areas. health service, closed in November Last year the Scottish Government 2013, leaving mothers facing a trip to announced that the programme would England for specialist help. also start to be off ered to eligible 20- In a new report, the Welsh Assembly’s to 24-year-olds, with the aim of children, young people and education making it available to up to 8000 committee has branded the lack of mothers by 2018-19. specialist inpatient care for mothers with ● Read more about the Family Nurse severe mental illness after the birth of a Partnership at bit.ly/SCT_FNP child ‘unacceptable’ and is backing moves to reintroduce the service. The report found that women had been forced to travel as far as Derby, ENGLAND Nottingham and London – or received treatment in an adult psychiatric unit and were separated from their children. New antibiotics Committee chairwoman Lynne Neagle said while the Welsh Government was awareness campaign committed to develop specialist inpatient mental health support for new mothers A major new campaign to ‘Keep predict that in just over 30 years, antibiotic within Wales, ‘identifying a location for Antibiotics Working’ has been launched resistance will kill more people than cancer inpatient services that is suitable for by Public Health England in the face of and diabetes combined. women across Wales remains a challenge’. the antibiotic resistance crisis. The campaign urges the public to always The report contains a total of 27 Doctors warn that taking antibiotics trust the advice of their doctors, nurses recommendations, including a call for when they are not needed puts people at or pharmacists as to when they need a public awareness campaign around risk of more severe or longer infections. As antibiotics, to take them as directed if they perinatal mental health conditions and antibiotic resistance grows, the options for are prescribed, and to never save them for their symptoms. treatment decrease. later use or share them with others. ● Read the report at bit.ly/WAL_CYPEC At least 5000 deaths a year in England The campaign also provides self- are caused by antibiotics that no longer care advice to help individuals and work against some infections, and experts their families feel better if they are not prescribed antibiotics. Professor Dame Sally Davies, chief medical offi cer, said: ‘Reducing inappropriate use of antibiotics can help us stay ahead of superbugs. The public has a critical role to play and can help by taking collective action.’ ● Read more about the campaign at bit.ly/ENG_antibiotics
8 Community Practitioner December/January 2018
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NORTHERN IRELAND SCOTLAND Women delay having children until later in life Campaign targets adults buying Around a fi fth of children born in Northern tobacco for children Ireland last year had mothers aged over 35. Figures from the Northern Ireland A national drive to discourage adults Statistics and Research Agency show who give cigarettes to children and that women are waiting on average four teens has been launched in Scotland. years longer before starting a family and The #notafavour campaign seeks to are having fewer children. Since 1986 the change attitudes to family and friends average age of fi rst-time mothers has buying tobacco for under-18s. increased from 24 to 28. Developed by Action on Smoking The fi gures also show that 791 teenagers and Health Scotland and the Scottish ENGLAND had babies in 2016, down from just over Tobacco-free Alliance, and supported 2000 in 1985, and that there by the Scottish Government, it is part Children who have were 82 stillbirths, a rate of the eff ort to have a smoke-free of 3.4 per 1000 births, generation in Scotland by 2034. mental health making it the third While the number of children and problems struggle lowest rate on record young people smoking in Scotland is at in Northern Ireland. its lowest since records began, 36 still to access treatment take up smoking every day. ● To read the full Children wait up to 18 months for report, go to ● For more, see bit.ly/SCT_smoking treatment for mental health problems, bit.ly/NI_delay and four in 10 psychiatric services are failing to treat them quickly enough, according to a report by the Care SCOTLAND Quality Commission. It paints a picture of a ‘complex New plans to tackle Scotland’s and fragmented’ service that varies in quality, where families struggle to obesity crisis by helping children access appropriate support for children with mental health concerns. In one Giving children a healthy start is key to the opportunities for everybody to become case the wait was a year and a half. Scottish Government’s plans to tackle the more active. An extra £42m is available over The report also highlights a lack of country’s obesity epidemic. the next fi ve years to expand services. beds that sees children and young The new diet and obesity strategy Aileen Campbell, public health minister, people end up on adult psychiatric includes support for breastfeeding and said: ‘We are putting forward a package of wards and ‘repeatedly referred to helping children to eat well and exercise. bold measures designed to help people diff erent parts of the system after The report says the ‘preventative approach’ make healthier choices, empower personal several services tell them they fail to will involve engaging with families ‘through change and show real leadership.’ meet the threshold for support’. the health visitor pathway and wider early ● Read or download the consultation But when young people are able to years workforce’ to ‘promote healthy paper at bit.ly/SCT_obesity access specialist services, they often eating, portion control and mealtime get good quality care, the report adds. behaviours and, where appropriate, Dr Paul Lelliott, deputy chief off er referrals to family healthy living inspector and lead for mental health, and weight interventions’. said they listened to children and Other measures include a clampdown young people using services and will on junk food advertising and promotions now ‘make eff ective recommendations such as supermarket multi-buy off ers for an improved system’. on products high in salt, sugar or fat, Claire Murdoch, mental health and even portion limits on the size of director for NHS England said it would takeaway and restaurant meals. People ‘take years of concerted practical eff ort with type 2 diabetes will get more support to solve these service gaps’. ● ALAMY/ISTOCK to lose weight and there will be more The report is at bit.ly/ENG_struggle
December/JanuaryDecembe 2018 Community Practitioner 9
e s R nd .indd 03/01/201 12:35 RESEARCH NEWS
BELARUS US Breastfed babies run Child peanut allergy on the rise lower atopic eczema risk Childhood peanut allergy levels in the US have risen by 21% Breastfeeding could cut a child’s Results from more than 13,500 since 2010 and it may now aff ect nearly 2.5% of children, says risk of developing atopic eczema, 16-year-olds showed that 0.3% of new research presented at the American College of Allergy, says a study in the journal JAMA those whose mothers took part Asthma and Immunology annual scientifi c meeting. Pediatrics. It found that children in the breastfeeding programme The study surveyed more than 53,000 households between whose mothers attended had signs of eczema, compared October 2015 and September 2016. It also found that tree a breastfeeding support to 0.7% of those whose mothers nut, shellfi sh, fi sh and sesame allergies may be on the rise. programme had a 54% had standard care. While Lead author Ruchi Gupta said: ‘While 21% represents a lower risk of eczema 39% of mothers in large increase in the number of kids with a likely peanut as teenagers. It the programme allergy, the good news is that parents now have a way to is the result of breastfed potentially prevent peanut allergy by introducing peanut a project that exclusively for products to infants early after assessing risk with their began in Belarus three to six paediatrician and allergist.’ in the 1990s at months, just over US guidelines introduced in January 2017 are based on 31 maternity 6% in standard ground-breaking research that shows introducing foods hospitals and one care did the same. containing peanuts to high-risk infants (those with severe outpatient clinic. The authors say eczemaeczema and/or a history of egg allergy) was signifi cantly Of two groups, one eczema is less common in moremom re likelyli to prevent them developing a carried on as usual and the other Belarus than North America or peanutpep a allergy (see page 34 for a Q&A with had breastfeeding support. western Europe, so the eff ects a leading researcher on peanut allergy). Babies in the study were then of breastfeedingmight not be as ● For more, see followed to explore the impact clear in those countries. bit.ly/ACAAI_peanuts of the programme on lung ● Read the study at function, asthma and eczema. bit.ly/PED_eczema
US UK Neglect linked to Mental health gap opens up in primary school unemployment A Scottish Government-funded study has Health, have called for routine monitoring of Unemployment can cause an found a dramatic mental health inequality mental health for primary school children, and increase in child neglect as gap between the poorest children and their believe nursery staff should look out for signs of worse-off parents cannot provide wealthier peers in the fi rst three years of mental health diffi culties in pre-school children. for a child’s basic needs, says primary school. Dr Louise Marryat of Edinburgh University, new Oxford University research. Researchers at Edinburgh, Aberdeen who is coordinating the research, said: ‘We Looking at reports of abuse and Glasgow universities followed almost really need to be putting resources into those and neglect made in the US from 4000 children from Glasgow. Of primary very early years because there is this gap when 2004 to 2012, it found that a schoolchildren aged four or fi ve, 4.1%% ooff cchildrenhildren reachreach schools that just widens.’ single percentage point increase those from the most affl uent backgroundsrounds Professor PhilPhi Wilson of Aberdeen University in the unemployment rate raised displayed social, emotional or behaviouralvioural said the fi ndindingsn were dispiriting. reported neglect by 20%. It abnormalities, compared with 7.3% of ‘These cchildrenh in the abnormal range are found no link between children from the most deprived areas.eas. aalmostlmost cecertainlyr not going to be learning unemployment and other forms By the time they were seven, 14.7%% ooff ananything,’ything, he said. of abuse, but state-provided children from the deprived areas hadd ‘Whe‘Whenn you think about it that way and unemployment benefi ts and abnormalities, almost double. The yyouou tthinkh about what the implications health insurance were both number of affl uent children with are fforo the future of those kids, it mitigating factors. abnormalities had fallen to 3.6%. memeansa they are going to be failing The team is now replicating The experts behind the all throughth their lives.’ the study in the UK. study, published in the Journal ● ReadRe the full report at ● Read the full paper at of Epidemiology and Community bit.ly/JECH_mental-healthbit.ly bit.ly/OXF_neglect
10 Community Practitioner December/January 2018
10 11 Resea c e s.indd 10 03/01/201 0 :52 RESEARCH NEWS
NORWAY School nurses say pain has complex causes School nurses interpret chronic pain in adolescents as a social, physical and psychological phenomenon, a Norwegian study, published in BMC Nursing, has found. The research explored how 17 school nurses in fi ve junior high schools saw everyday pain in students. They believed that pain often refl ected teenagers’ high expectations, low tolerance of stress, diffi cult relationships and traumatic experiences, and unhealthy lifestyles. Up to 30% of children and adolescents report chronic pain. The nurses suggested that worries about grades or making presentations, AUSTRALIA for example, were related to physical ailments such as headaches, stomach pain Children raised by same-sex and sleep problems. Diffi cult relationships and events such as divorce or death, along parents do as well as their peers with bullying or alcohol or drug abuse at home, were also identifi ed as pain triggers. A study has shown that children raised the family – rather than family structures Inactivity and social media use were in same-sex parented families do as that make a more meaningful diff erence associated with headaches and neck, back well as children raised by heterosexual to children’s wellbeing and positive and shoulder pain. couple parents. development,’ the study said. Despite their biopsychosocial The review of three decades of peer- It also fi nds that young people who understanding of pain, nurses continued reviewed research from four child health expressed diversity in their sexual to deal with the issue byyg sending organisations was published in the Medical orientation or gender identity experienced adolescents Journal of Australia ahead of the country’s some of the highest rates of psychological for medical same-sex marriage equality vote. distress in Australia. examinations, with It found children raised in same-sex- Senior author Professor Frank Oberklaid the result that many parented families did as well emotionally, said: ‘Sadly, this is largely attributed to the children became socially and educationally as their peers. harassment, stigma and discrimination ‘shuttlecocks in the ‘It is family processes – parenting they and other LGBTIQ+ individuals and health system’. quality, parental wellbeing, the quality of communities face in our society.’ ● Read the full and satisfaction with relationships within ● The study is at bit.ly/MJA_same-sex study at bit.ly/ BMCN_pain
US Smartphone use linked to teenage sleeplessness
Teenagers now sleep fewer hours than It examined sleep-related data from two from around 2009 might be responsible. older generations, possibly because of time long-running surveys of more than 360,000 ‘It’s a suspicious pattern,’ she said. ‘Given spent on smartphones and tablets, says a US teenagers. Some 40% of adolescents in the importance of sleep for physical and new study, led by Jean Twenge, 2015 slept less than seven hours mental health, teens and adults should professor of psychology a night, which is 58% more consider whether their smartphone use is at San Diego State than in 1991 and 17% interfering with their sleep. It’s particularly University, and more than in 2009. important not to use screen devices published in Jean believes rising right before bed.’ ● GETTY/ISTOCK Sleep Medicine. smartphone use The full study is at bit.ly/SM_sleep
December/January 2018 Community Practitioner 11
10 11 Resea c e s.indd 11 21/12/2017 0 :00 THE BIG STORY
The end of As a campaign to help parents who don’t SMACKING? want to smack gets underway in Wales, hould parents be allowed to smack and Scotland moves their children? It’s a polarising question. Some consider it a closer to making it matter of parental choice, and others believe children should illegal for parents to Shave the same legal protection from hit a child, journalist physical assault as adults. What is clear is that attitudes are Juliette Astrup looks changing. Smacking is becoming less at changing attitudes prevalent, and those who do smack have increasingly ambivalent feelings about it to ‘physical discipline’ (Heilmann et al, 2015). An expansive and for children. growing body of evidence also shows that using physical punishment against children is harmful.
‘TAKE 5’ FOR PARENTS The shift in attitudes was demonstrated in recent research commissioned by the Welsh Government, which found that while 43% of parents in Wales said they may smack, only 5% said they were comfortable with it (Donbavand and Sills-Jones, 2016). This telling statistic has prompted the launch of ‘Take 5’, a new campaign by NSPCC Wales that will complement other advice and support programmes around positive parenting in Wales. With the tagline ‘Stop. Breathe. React Calmly’, it encourages parents to take a moment to regain their composure rather than acting out of anger and frustration. It includes a poster campaign, developed with the help of parents, which features commonplace trigger moments, such as when a child has a tantrum in the supermarket or refuses to get dressed in the morning. Viv Laing, policy and public
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aff airs manager at NSPCC Wales, explains: the NSPCC and Barnardo’s. ‘The focus is on the 38% of parents who In a bid to stimulate an informed debate, may smack but who are not comfortable 43% they jointly commissioned a review of the doing it. global evidence on physical punishment and ‘For a lot of parents that smack, it is when surveyed parents. they lose their cool, when they’re angry and The resulting 2008 report painted frustrated or tired. a picture of parents who use physical ‘This Take 5 campaign is aimed at those discipline ‘more often than not in situations of parents in Wales said parents who don’t want to smack, but who in which they felt frustrated just before they they may smack, don’t know what to do when they get to the used it and guilty and regretful afterwards’ end of their tether.’ (Bunting et al, 2008). She adds that the intended audience is only Following the decision in Scotland, all four parents with children aged between one UK children’s commissioners have spoken and four, ‘because they are still shaping out to back calls for a UK-wide change in the their parenting strategies, and toddlers are 5% law on smacking. said they were smacked more than any other group’. Koulla Yiasouma, Northern Ireland’s comfortable with it (Donbavand and Sills-Jones, 2016) commissioner for children and young THE EVIDENCE AGAINST SMACKING people, says: ‘I am confi dent that while This new campaign both refl ects and Scotland may be the fi rst in the UK to ban reinforces the sea change in attitudes to this, it most certainly won’t be the last. I disciplining children in the UK, and is backed will be doing everything in my power to up by a growing body of research. make sure Northern Ireland follows suit in A recent and extensive review of the CHANGE IS COMING due course and combines legal reform with evidence was clear, concluding: ‘The Scotland is set to become the fi rst country improved support for parents.’ evidence for harmful eff ects of physical in the UK to ban smacking after ministers Anne Longfi eld, children’s commissioner punishment is strong and consistent, and the confi rmed they would support MSP John for England, says the current legislation in decline in the use of physical punishment Finnie’s Bill to give children equal protection England is outdated: ‘It should be updated in countries where it is prohibited make a under assault laws. to refl ect what the vast majority of parents compelling case for the introduction of such Wales is expected to follow suit after believe: that hitting children is wrong and legislation’ (Heilmann et al, 2015). minister for children and social care Huw that there are better and more eff ective ways Viv says: ‘We have the evidence, and Irranca-Davies chose Universal Children’s of disciplining children and encouraging parents don’t want to hit their children. It Day in November to make a powerful positive behaviour.’ feels out of place in this time. The UK is one statement of intent, saying it can ‘no At the same time as reforming the law, of only fi ve countries in Europe that hasn’t longer be acceptable in a modern and says Viv, it is crucial to equip parents with given children the same protection as adults progressive society’ for children to be more eff ective approaches ‘to support those under assault laws – Sweden did it in 1979.’ physically punished. who want to make the change from physical ‘Some parents know that they can hit The Welsh Government has already punishment to positive parenting. without leaving a mark, so they might hit on been engaging with parents through an ‘Community practitioners and parenting the head for instance,’ online survey and programmes already recommend positive says Viv. ‘One of the the #TalkParenting parenting – praising the positive and paying dangers of physical WHAT IS THE LAW? campaign, and it less attention to the behaviour you don’t punishment is that Under current legislation is launching a want to see. You can still have clear sanctions it escalates. When it parents can face criminal formal consultation and boundaries – there doesn’t need to be doesn’t work, people charges if they hit their child in January. physical punishment.’ CP hit harder and harder. and leave a mark, but they have In Northern Ireland, REFERENCES ‘It is a small minority the legal defence of ‘reasonable pressure for change Bunting L, Webb MA, Healy J. (2008) The ‘smacking debate’ in of parents, but it is chastisement’ in England, Wales has for some time Northern Ireland – messages from research. See: nspcc.org.uk/ totally anachronistic and Northern Ireland, and come from, among globalassets/documents/research-reports/smacking-debate- northern-ireland-report.pdf (accessed 11 December 2017). in this day and age. others, the Northern ‘justifi able assault’ in Scotland. Donbavand S, Sills-Jones P. (2016) The attitudes of parents Having a clear law, As it stands, there is confusion, Ireland commissioner towards managing young children’s behaviour. See: gov.wales/ which is evidence for children and docs/caecd/research/2016/160317-attitudes-parents-towards- says Viv, but categorically managing-young-childrens-behaviour-en.pdf (accessed 11 based, sends a clear banning smacking through young people, as December 2017). message and it will legislature would send a well as the regional Heilmann A, Kelly Y, Watt RG. (2015) Equally protected? A review of the evidence on the physical punishment of children. See: nspcc. gradually change clear message to all. branches of the org.uk/globalassets/documents/research-reports/equally- public opinion.’ children’s charities protected.pdf (accessed 11 December 2017).
December/January 2018 Community Practitioner 13
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© Johnson & Johnson Ltd 2017 UK/JOB/17-9663
p14-15.CPJAN2018.indd 14 11/12/2017 11:08 Cleanse and protect newborn skin from day 1
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*Formulated to minimise the risk of allergies 1 Lavender T, Bedwell C, Roberts SA, et al. Randomised, controlled trial evaluating a baby wash product on skin barrier function in healthy, term neonates. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2013; 42, 203-214. JOHNSON’S® is a partner in the RCM Alliance Programme
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p14-15.CPJAN2018.indd 15 11/12/2017 11:08 FEEDBACK A royal achievement
Elizabeth began her nursing career early on in life after being inspired by a nun who cared for her eczema. She developed as a nurse pioneer and is now an icon in the nursing world. In recent years she has been honoured with a CBE for her services to nursing, and in the 2017 New Year’s Honours list became a dame for her continuing services to nursing and the Mary Seacole statue appeal. SCOTLAND’S NURSES Elizabeth’s recent accolade, A total of 20 community nurses have been Fellowship of the QNI, was awarded the title of Queen’s Nurse by introduced 20 years ago. The the Queen’s Nursing Institute Scotland. It aim of the fellowship is to create marks the fi rst time the honour has been a body of support that can made in Scotland for almost 50 years, with provide professional advice and nurses chosen for their high-quality and intelligence from the fi eld, on compassionate nursing care. practice, research, education, A huge well done to Unite members Gemma policy and health service issues. MacDonald – health visitor, NHS Fife (pictured ELIZABETH ANIONWU Over 300 nurses and guests above, left) and Clare Stiles – clinical team leader CPHVA honorary vice president Professor attended the QNI awards ceremony, (child health), NHS Shetland (above, right) who Dame Elizabeth Anionwu was made a which recognises and celebrates the were awarded the title of Queen’s Nurse. Fellow of the Queen’s Nursing Institute achievements in community nursing in Gemma became a health visitor after at their awards ceremony on 30 October. England, Wales and Northern Ireland. graduating as a midwife and now covers three general practices. She uses motivational interviewing to help parents make changes in their lives, and helped start a private social media group for local parents. SOCIAL (LEARNING) SKILLS Clare has been involved in community All our health is a framework of evidence, nursing since 1993, starting off as a midwife, published in December, by Public Health adding district nursing duties in 1994 and health England (PHE). The aim is to guide healthcare visiting in 2003, becoming a triple duty nurse. professionals in preventing illness, protecting Gemma and Clare were presented with health and promoting wellbeing. And it’s their awards by Prue Leith in a ceremony on going social! WeLearn – #AllOurHealth is a 1 December in Edinburgh. WeCommunities and PHE social learning
collaboration running throughout January. CLARIFICATION It will include four-hour long Tweetchats Regarding the October issue of Community Practitioner… In the Mothering with a mental illness research piece, it was implied that as well as shorter bursts of learning. Use it more than half of all parents have a severe and enduring mental illness. Rather, the statistic should have read: ‘Estimates suggest that between to network and support your revalidation. 50% and 66% of parents with a severe and enduring mental illness live with one or more children under 18.’ The amount of children this See bit.ly/allourhealth; and sign up at equates to, ‘about 17,000 children and young people in the UK’, was wecommunities.org/blogs/3332 correctly stated in the October issue.
16 Community Practitioner December/January 2018
1 eed ac .indd 1 03/01/201 12:3 FOR HEALTHCARE PROFESSIONAL USE ONLY ADVERTISEMENT Nutritional management of colic in formula-fed babies ColicLVHVWLPDWHGWRDƪHFWXSWR1 in 5 infants,1 and CALM is a stepped-care approach designed by Nutricia Early Life Nutrition to help healthcare professionals in the management of this common condition. Consider the signs The ROME IV criteria has defined that for clinical purposes, colic must include all of the following in infants from 0-4 months of age2: • An infant who is <5 months of age • Recurrent and prolonged periods of infant ZKHQ{WKH{V\PSWRPVVWDUWDQGVWRS crying, fussing, or irritability reported by • No evidence of infant failure to thrive, caregivers that occur without obvious cause fever, or illness and cannot be prevented or resolved E\{FDUHJLYHUV
Advise and offer parental support Suggest strategies that may help parents soothe their baby, such as:3 • A gentle swaying motion in your arms, And provide reassurance that: cot or pram • Their baby is not rejecting them • ‘White noise’ such as the sound of • Colic is a common condition a washing machine or running water • It’s ok to take some time out • Holding the baby throughout to look after yourself the crying episode • There are support groups • Bathing baby in warm water. IRU{SDUHQWV{DQGIDPLOLHV
Look at diet Comfort milk %HQHƬW ,ISDUHQWVDUHVWLOOILQGLQJLWGLIILFXOWWRFRSH{ ingredient with colic in formula fed babies, consider Unique blend of Shown to increase number D{GLHWDU\{DSSURDFK prebiotic galacto- and RIELƬGREDFWHULDLQWKHJXW9,10 Specialist Comfort milks are nutritionally fructo-oligosaccharides tailored in 5 ways to help support babies May help to produce softer with colic. Structured vegetable oil stools and aid the absorption 11,12 The precise cause of colic is not fully understood,3 RI{IDW{DQG{FDOFLXP but some of the implicated digestive factors Partially hydrolysed For easy digestion include these 5: whey protein 4 • Normal development of the gut microbiota In cases of lactose maldigestion, Reduced lactose compared 5,6 FDQKHOSWRUHGXFHƮDWXOHQFH • Issues affecting gut motility to standard formula and abdominal discomfort13 • Sensitivity to milk proteins7 • Lactose maldigestion13 Thickens the formula which 8 Contains starch may help reduce swallowed • Excess gas air during feeding
Encourage a full 14 Monitor compliance day trial Encourage parents to persist with their Parents may notice some minor changes practical strategies and monitor any after transition to a speciaist Comfort changes in symptoms. formula. Their baby may experience If using a specialist Comfort milk, please increased wind, softer or looser stools note they are thicker than standard that are lighter in colour. formulas, so it is recommended that a The greatest improvement in symptoms variable flow teat or a single-hole teat has been shown after 2 weeks of using with a medium or fast flow is used. a Comfort milk.14,15
Specialist Comfort formulas are available over the counter in most retail outlets and in pharmacies
www.eln.nutricia.co.uk /colic
Important notice: Breastfeeding is best for babies. Infant formula is suitable from birth when babies are not breastfed. We advise that all formula milks be used on the advice of a doctor, midwife, health visitor, public health nurse, dietitian, pharmacist or other professional responsible for maternal and child care. Foods for special medical purposes should only be used under medical supervision. Suitable for use as the sole source of nutrition for infants from birth, and/or as part of a balanced diet from 6-12 months. 1. Vandenplas Y et al. J Pediatr Gastroenterol Nutr; 2015;61(5):531-537. 2. Benninga MA et al. Gastroenterology 2016;150:1443–55. 3. NICE Clinical Knowledge Summaries. Colic – infantile [online]. June 2017. Available at: https://cks.nice.org.uk/colic- infantile [Accessed September 2017]. 4. Pärtty A, Kalliomäki M. Acta Paediatr 2017;106(4):528-9. 5. Gupta SK. Curr Opin Investig Drugs 2007;8(11):921-6. 6. Savino F et al. Acta Paediatr 2006;95:738–41. 7. Gupta SK. Curr Opin Pediatr 2002;14(5):588-92. 8. Lucassen P et al. Arch Dis Child 2001;84:398-403. 9. Moro G et al. J Pediatr Gastroenterol Nutr 2002;34:291-5. 10. Knol J et al. J Pediatr Gastroenterol Nutr 2005; 40:36-42. 11. Carnielli VP et al. J Pediatr Gastroenterol Nutr 1996;23(5):553-60. 12. Kennedy K et al. Am J Clin Nutr 999;70:920-7. 13. Kanabar D et al. J Hum Nutr Dietet 2001;14:359-63. 14. Savino F et al. Acta Paediatr 2003;91(Suppl 441):86-90. 15. Savino F et al. Eur J Clin Nutr 2006;60:1304–10. © 2017 Danone Nutricia Early Life Nutrition, [17-091] HCP589
p17.CPJAN2018.indd 17 03/01/2018 16:15 CPHVA EXECUTIVE Touching The CPHVA Executive is the Welcome to the fi rst of elected body representing new, regular updates from the 10 Unite regions, plus the CPHVA Executive. the CPHVA organising base professional committees. Members are public health nurses who give their time Hello and best wishes MAIN CHALLENGE to the committee on a WELCOME TO CARRIE from the CPHVA While Northern Ireland voluntary basis. They are: A big welcome our new CPHVA executive. During 2018 acknowledges public honorary president Carrie Grant, we will be keeping health as the foundation JANET TAYLOR (chair) broadcaster, presenter and vocal you informed here of a healthy society, and [email protected] coach. Carrie is the patient lead about the CPHVA work has policy that refl ects this, ASHA DAY (vice chair) for the College of Medicine, an plan. The work plan is it still faces the challenge East Midlands ambassador for three charities, formulated at the AGM of forming a government. [email protected] and actively campaigns for change and the professional Meanwhile, practitioners SARAH REDDINGTON- in healthcare systems. She also sits conference of Unite- in other administrations BOWES (vice chair) on the largest transforming care CPHVA. Based on are experiencing their South West; sarah.reddington- panel in the UK for mental health [email protected] delegate suggestion own national challenges. and learning disabilities. and discussion, its The impact of austerity ANNETTE HOLLIDAY Scotland purpose is to tackle the on public health budgets, [email protected] challenges and pursue a reduction in staff and the opportunities down-banding are most ELAINE BAPTISTE common in England. While London & Eastern members meet in their [email protected] practice. We will also ask Scotland and Wales face the you for your experience challenge of more SCPHNs SUJATA MAHENDRAN being required to fulfi l London & Eastern and wisdom – as it [email protected] is your innovation, aspirations of a proactive evidence base and public health agenda. LOUISE HALES Northern Ireland; [email protected] experience that ensure This is all set against our work is informed. the high expectation of MICHELLE MOSELEY communities, who hope Wales; moseleyME1@cardiff .ac.uk that their practitioners NEIL BARNHAM aand community nursery can deliver. West Midlands nursesn lobbied MPs to raise [email protected] thet issues facing the public SUSAN BLACK health workforce and the North West stark impact of cuts on the [email protected] most vulnerable in society. TRACEY YOUNG We hope to make this event ● To get involved, engage South East; [email protected] even bigger in 2018, and in the work plan, or share CLAIRE ELWELL we will inform you here any of your thoughts and North East, Yorkshire & of our plans and how you ideas, please check out Humberside; school nursing GET INVOLVED can get involved. Together the executive page or [email protected] Last year we had a successful with the membership we contact your regional chairs STELLA MANN Comm. nursery day at the House of Commons, hope to energise, educate and (cphva@unitetheunion. nurses; [email protected] when a 100-strong group of empower the workforce and org, or see opposite for MAGGIE COATES Education health visitors, school nurses, our clients into 2018. individual email details). [email protected]
18 Community Practitioner December/January 2018
18 CPHVA Exec.indd 18 21/12/2017 09:02 RIGHTS AT WORK 2018 – the year of the NHS Unite’s head of health Sarah Carpenter looks back at the key issues and campaigns of 2017, and ahead to a looming milestone in 2018.
will use August to campaign on issues for all community practitioners, so there is plenty of time for members to get involved in this work. The regional health committees will consider the quick fl ick through resources produced nationally the back issues from all groups (including of Community applied psychology in February, Practitioner reveals healthcare science in March, the huge variety of pharmacy in May, ambulance Atopics that the Rights at Work staff in June, the Medical pages have covered during 2017. Practitioners’ Union in July, We have considered how to speech therapy in September deal with the reorganisation of and mental health nursing in community services, workplace October), and a plan will be bullying, the fi ndings drawn up to celebrate and of the staff survey, campaign throughout the year. using the NMC code It’s true that lots of to raise concerns, the organisations – and the NHS public sector pay cap itself – will be celebrating this (and pay itself) in the big birthday, but Unite does NHS, how to handle it knowing that we are in the workload pressures, middle of a battle for our NHS. and job evaluation. The service is on its knees, only Alongside that, huge strain on all those who being held together by the sheer 2017 saw the CPHVA need and work in the NHS. bloody-mindedness of its staff lobby parliament, a Unite’s health sector will use who refuse to see patients suff er ramping up of the Love the 70th birthday as a pretext (often at the detriment of their Your Health Visitor/ to raise all of these issues, and own health). We want to see the Love Your School to fi ght for the future of the NHS continue looking after us Nurse campaign, a snap general So against the backdrop of NHS by celebrating it. With and our families for the next election, talk of industrial action 2017, we turn our minds to what that in mind, 2018 has been 70 years – and more. CP over pay, and a feeling of anger 2018 has in store. designated the ‘Year of the at the CPHVA conference about NHS’ for Unite in Health. ● If you want to be part of political leaders’ treatment of NEXT YEAR AND BEYOND Each health occupational the Year of the NHS, let your staff and patients in the NHS. We The NHS turns 70 on 5 July group in the union has picked rep or local regional offi cer also saw NHS leaders – including 2018. This milestone will come a month where it will focus on know. Alternatively you Simon Stevens, the head of NHS at a really diffi cult point in its its own key historic and future can email sarah.carpenter@ England – and chief executives history, as chronic underfunding, issues. They will all produce unitetheunion.org. And if you speak out about the need for increased demand and staffi ng materials and briefi ngs that have any great ideas, please more money for the NHS. challenges combine to place support this work. The CPHVA let Unite know!
December/January 2018 Community Practitioner 19
1 R sa .indd 1 21/12/2017 0 :03 ONE-TO-ONE bıTheg vision Co-founder of The Big Issue
here’s nothing empire John Bird talks wrong with about the way to lift people poverty, as long as you out of poverty, fi ghting can get out social injustice and his plans ‘Tof it,’ says John Bird, over a cup of coff ee in Notting Hill. to make it all happen. This now upmarket area was a post-war slum when John borstal, for petty crimes, before spending (including The Big Issue Foundation and now was born there, into a large Irish-Catholic long spells in prison. The Big Issue shop), he’s dedicated more family, 71 years ago. Luckily for him, he met some ‘useful’ than 25 years to helping the homeless help Poverty and fi ghting social injustice are adults on the way: like the reformer Baroness themselves, and giving the underprivileged two of John’s pet subjects. ‘If you can get Barbara Wootton. ‘A marvellous woman,’ ‘the opportunity of making their own money out of poverty yourself and start working he recalls. ‘When I was 10, she put me on – a hand up rather than a handout’. with others who are still in it, you can be probation; at 12, she made me a ward of quite useful. That is, providing you don’t court; at 13, put me in a remand home; at A HELPFUL LADDER get out of it by robbing other people!’ 14, sent me for a short, sharp shock.’ At 15, ‘There are diff erent kinds of poverty,’ he John himself has been no stranger to Baroness Wootton sent him from a boys’ points out. ‘The kind you can get out of, hardship – or crime. When he was appointed prison back into a reformatory ‘so I could because people hand you a ladder to get you as a peer in February 2016, his maiden learn to read and write’. When he left prison, out. Then there’s the really bad kind – you speech to the slumbering fellows went along John was taken on at Chelsea College of get a bit of social security, or a small handout, these lines: ‘Someone asked me how I got Art. He went on to train as a printer, set up then you’re on your own. Stuck.’ He says to be a Lord – it was by lying, cheating and a business, and found his feet. ‘I got out of members of his own family have got stuck in stealing.’ That woke up his audience. poverty and into the middle class – to me this way: ‘Not my children, they’re all posh, His early life was tough. He grew up in a that meant clean beds and clean underwear like me,’ he smiles, ‘but some of my brother’s family he’s described as ‘Catholic racist’ who – and people being nice to each other.’ kids are stuck in poverty.’ taught him to hate everyone except his own In his 40s he became one of the ‘useful’ He blames it on the lack of spend on kind. Made homeless at fi ve, he was sent to people himself: ready to help others out of education, and now in his role in the Lords an orphanage at 10, then was in and out of poverty. As co-founder of The Big Issue empire he plans to focus on education reform, early
20 Community Practitioner December/January 2018
20 21_1 1.indd 20 21/12/2017 0 :03 ONE-TO-ONE
intervention and literacy. Also as vice-chair of BRANCHING OUT the All-Party Parliamentary Group on Social John’s still full of big ideas; there’s the new Enterprise, he’s led debates on bookshops Big Issue shop – products with a social and libraries. conscience, such as T-shirts with ‘Say No to ‘We have campaigned about the state Racism’ but also a plug for John’s projects of our libraries – obviously austerity has like Big Issue Invest; and his book The 10 keys knocked the b******s out of local authorities to success. ‘Through Big Issue Invest, we have and their power to spend, so they look for developed social brokering; we get money soft savings, like the libraries. But you’ve [also] from high-net individuals or trusts and invest got to accept library usage has changed... We it in about 300 social businesses, charities, have to look at that so we can make libraries trusts and private business that give work, work for everyone.’ training and education. As a cross-bench peer, Some have criticised as part of his missions ‘to John for selling out, such get the underclass out of If you can get out as when he invited Trudie the grief’ and ‘dismantle Styler to guest-edit the root causes of of poverty yourself The Big Issue – the idea poverty in the UK, he and start working being she wasn’t ‘street’ will soon be launching enough. To this he says the Prevention Alliance, with others who are something unprintable, ALL ABOUT JOHN a cross-party group still in it, you can be and adds that some of of 40 or 50 MPs and those who put money ● Became a butcher’s boy in quite useful members of the Lords. into starting the title had his teens but got into trouble ‘We want to help ‘fi ve or six houses’. for stealing. people get out of the sticky stuff early,’ When asked about the NHS, and if he’ll ● Spent several years in prison he says. ‘We’ll be asking leading questions use his position to make changes, he reverts in his teens and 20s, learning like: does this social investment prevent to his boyhood memories: ‘I’m such an old to read and write, and the poverty? Does it help individuals face up git, I was born two years before the NHS was basics of printing. to the problems in their lives? Most money started. What I noticed as a slum boy was ● Attended Chelsea College doesn’t. So we’re trying to alert people to the us kids were given cod liver oil and organic of Art, but was homeless fact that when people remain dependent juice and we had exercise twice a day, and again at 31. on someone, it’s not good for them.’ the nurses did what they called “social ● Set up a small-scale printing He recalls how Lord Elton, after being medicine”. I was pretty grateful for that.’ business in London in the 1970s. minister for prisons in Mrs Thatcher’s era, Today he feels we need to reinvent the campaigned not for more prisons but for NHS. ‘The pressure to reduce costs means ● In 1991 he launched The Big more money so children didn’t turn to crime the mantra of governments – Labour as Issue with Gordon Roddick, co- and drugs in the fi rst place. much as Conservative – is to do that you founder of the Body Shop. Four ‘That is one of our focuses – children who have to outsource. But often they are hiding years later, he launched The are not being brought up correctly. It’s our the budget, making health profi table for Big Issue Foundation to further responsibility to sort them out, so they don’t some companies but giving them subsidies help the homeless and The Big go on to be people who are broken, on social in other ways, and that doesn’t work.’ He Issue vendors. security or god forbid, end up in prison. says: ‘We need to rethink the NHS and see off ● Was awarded an MBE in 1995; ‘The Prevention Alliance is saying you all this privatisation, because it doesn’t work.’ in 2015 he was made a cross- have to spend to save – and you’ll get back ‘I have an absolute passion for what I bench peer with the title Lord 10 times over what you’ve put in over the do. Maybe because I was such a user and Baron Bird of Notting Hill. course of someone’s life... If you can turn abuser of friends and everyone around me. ● Married to Parveen Bird, and someone into a taxpayer, you’ll get back all I was a mucked-up human being. So when has two young children. They the investment you made in their early lives.’ you get out of that – and I got out of it with live in Cambridge. He is also campaigning to change the revolutionary politics – you’re very grateful. ● Has two grown-up daughters credit rating rules. ‘In Britain it’s a crazy I feel strongly that we need to educate and a son, and is a grandfather. system – if you got a mortgage a year ago, people in all sorts of things. But in fact, you could have a really high credit rating. life is the greatest educator.’ CP ● Enjoys drawing, painting and But I could be a rent payer and never miss a art appreciation. payment for 10 years and still have a lower ● For more information about The Big
GETTY rating than you. To me that is social injustice.’ Issue Group, visit bigissue.com
December/January 2018 Community Practitioner 21
20 21_1 1.indd 21 21/12/2017 0 :0 NEW YEAR WELLBEING Healthy living made easy Your at-a-glance guide to helping everyone have a healthier 2018 and beyond.
CHRISTMAS CALORIES SMART EATING IN 2018 There’s no need to have a miserable January to make amends for The average person ate up to festive fun. Try these small tweaks for long-term healthy goals:
GO LOW ADD H20 5241 We should be drinking at least calories on 25 December, including snacks and alcohol
Eating low energy density foods such as fruit, vegetables, soups and fi bre-rich foods 6-8 glasses means you can actually eat more and still lose weight. For of non-alcoholic fl uids per day to stay hydrated instance, add more fi bre to and be at our best. Water is a great choice, meals by using wholegrains but other fl uids such as tea, coff ee, and unsweetened fruit juices also count And it’s easy to To work that all off , such as brown rice see how. Just a you would have had glass of mulled to run around wine can MAX OUT YOUR VEG SNACK HAPPY be around ● Steam rather than boil ● Ramp up your fi bre with fresh 245 vegetables to retain fruit, vegetable sticks, rye calories more of the vitamins crackers, or oatcakes ● Leave the skins on ● Enjoy sweet things? Forgo a potatoes to benefi t blueberry muffi n and enjoy a most from their currant bun on its own or 52 nutrients with some reduced-fat ● Try adding herbs rather spread, instead than salt to cooked ● Opt for smart swaps: plain miles vegetables raisins instead of yoghurt- – that’s two coated; unsalted nuts marathons! Thankfully, instead of salted, rice it’s not necessary to cakes with lower-fat go quite that far to get cream cheese instead back on track… of cheese straws
(Forza Supplements, 2017 - looked at (British Nutrition Foundation, 2016; NHS the habits of 1000 people) Choices, 2015a, 2015b)
22-23 Healthy Festive season.indd 22 21/12/2017 09:41 NEW YEAR WELLBEING
COUGHS AND COLDS – ARE THEY INEVITABLE? STAY MOVING
Exercise to help lift mood and feel energetic during the winter, as well as maintain a healthy weight
If new to exercise, slowly build the amount of exercise you do. If you Adults catch There is no foolproof way can’t manage 30 minutes in one go, to avoid a cold, except if break it up into 2 – 5 you were to colds a year, school children can suff er up to avoid other 10 people entirely! 10-minute chunks Help prevent colds For a quick and by washing hands easy remedy for a frequently and sore throat: gargle avoid touching your with warm salty nose or eyes with water; dissolve one your fi ngers. Find teaspoon of salt in a the step-by-step glass of part-cooled routine at boiled water. While bit.ly/hand_hygiene it won’t heal the infection, it can have a soothing eff ect (NHS Choices, 2017; Professor Ron Eccles, former director of the Common Cold Centre at Cardiff University, as told to Wales Online, 2011)
KNOW YOUR UNITS Handy numbers for any time of year… You don’t automatically have to stop exercising in winter if you have a cold ‘If symptoms are not severe and you generally feel OK, you can exercise’ One unit of alcohol = (NHS Choices, 2016)
REFERENCES British Nutrition Foundation. (2016) Christmas and New Year. See: bit.ly/2AnsBGG (accessed 12 December 2017). Forza. (2017) Christmas dinner blowout – over 5000 calories consumed in 24 hours. See: bit.ly/2Aq58EB (accessed 12 December 2017). 48% 13% 40% 4% 4% Department of Health (2016) UK chief medical offi cers’ low risk drinking guidelines. See: bit.ly/2krI5mf (accessed 12 December 2017). Drink aware. (2016) What is an alcohol unit? See: CIDER WINE WHISKEY BEER ALCOPOP bit.ly/2Cmzolg (accessed 12 December 2017). NHS Choices. (2017) 10 winter illnesses. See: bit.ly/2kugzEv 218ml 76ml 25ml 250ml 250ml (accessed 12 December 2017). NHS Choices. (2016) Exercising in winter. See: bit. ly/2j3Qrjp (accessed 12 December 2017). The low-risk guidelines are now the NHS Choices. (2015a) How to get more fi bre in your diet. same for men and women: both are See: bit.ly/2j5Jtuz (accessed 13 December). advised not to drink more than NHS Choices. (2015b) Healthy food swaps. See: bit.ly/2AFGDr8 (accessed 13 December). 14 units a week Wales Online. (2011) How to survive the common cold. See: bit.ly/2ytq3VJ (accessed 12 December 2017). (Department of Health, 2016; Drinkaware, 2016)
December/January 2018 Community Practitioner 23
22-23 Healthy Festive season.indd 23 21/12/2017 09:41 COVER STORY ALL BY MYSELF Loneliness doesn’t simply hit at Christmas, or solely affl ict a certain age group. In fact it’s been called an epidemic that aff ects all ages, all year round, reports journalist Phil Harris.
24 Community Practitioner December/January 2018
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aley Minns couldn’t study (Co-op and British Red Cross, 2016), for understand why she instance revealed that more than nine million had started to feel people in the UK – across all adult ages – are so lonely. She had a either always or often lonely. healthy and happy And the Action for Children survey (2017) newborn son and a supportive husband. additionally found that nearly two-thirds of She also had her parents living close by and parents worry their child is lonely some or all lots of friends. the time. Also, more than a third of children Despite all this, ‘the feeling of isolation grew themselves (more than 500 were polled) said until I felt completely alone,’ says the 34-year- they had felt lonely in the previous week. old from Norfolk. ‘Before I had my son Lewis, Childline also reports there were 4063 I felt like everything was under control and counselling sessions carried out with children that life went according to plan. But I had last year specifi cally about loneliness (NSPCC, anxiety during pregnancy, and after my son 2017). The charity started recording it as a was born, things felt out of control. specifi c issue of concern because it was being ‘I worried that I wasn’t doing things well, but cited by so many children. I didn’t want to fail so I didn’t feel I could tell More than anyone. I put up a front and said I was fi ne. WHAT’S UP? ‘I ended up being home alone every day, So what’s behind the startling fi gures? and dreading it, but also made excuses not to 9 million ‘In psychological research, loneliness is people in the UK across go out to things like baby groups, as I didn’t viewed as a person’s dissatisfaction with the all adult ages want to break Lewis’s routine. I began to quality and quantity of relationships, explains are either always or wonder how long I could carry on like this.’ Professor Rotenberg. ‘It comprises his or often lonely her perceptions of the inadequacy of his A UNIVERSAL ISSUE or her relationships and the accompanying Haley’s story is not an unusual one. A very negative emotions. In that fashion, most recent survey by the charity Action for people experience loneliness either in a given Children (2017) found that more than situation (such as after losing a loved one) or two-thirds of UK parents feel ‘cut off ’ from even across periods of their lives.’ friends and family since having children Indeed the Trapped in a bubble study (more than 2000 were polled). It also found by the Co-op and the British Red Cross (2016) that more than half of UK parents have found that life transitions can be key triggers suff ered from loneliness. for loneliness. These included becoming a Nearly Though ask people to describe loneliness, new parent (as already noted), empty nest and most will likely say it is about being syndrome or retirement, long-term health two-thirds physically alone, separate from others. The issues or mobility limitations, bereavement, of [2000+] parents worry word conjures images of unhappy older and divorce or separation. their child is lonely some or all the time people living a solitary existence with just ‘Some clients may not be on their own, the TV for company. And while this is sadly but they are not socially “connected” for the case for more than half a million people various reasons,’ adds Obi Amadi, Unite- Childline reports (Siddique, 2017), loneliness is much more CPHVA lead professional offi cer and former there were nuanced, and, as it is increasingly being health visitor. ‘This could be due to language, revealed, widespread. literacy or culture, which prevents interaction 4063 ‘People often think that loneliness is limited with others. Also some may be in abusive to older people, but it is not,’ says Ken J relationships that leave them without any Rotenberg, professor of psychology at Keele contacts – which could even mean no contact counselling sessions University and loneliness researcher. ‘It is with other family members. carried out with children found in people of all ages and walks of life.’ ‘I’ve also come across fathers who are last year specifi cally In fact there is a wealth of research to carers,’ Obi continues. ‘They become isolated about loneliness (Action for Children, 2017; NSPCC, 2017; suggest that loneliness in society is at because they feel uncomfortable at female Co-op and British Red Cross, 2016)
ISTOCK epidemic levels. The Trapped in a bubble carer-dominated playgroups.’
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Children can be aff ected by moving schools, fi nding it hard to make friends, or if they are victims of abuse (Childline, 2017). Childline also says the rise in counselling sessions was driven by pressures of modern life including social media. Mandy Bancroft, senior lecturer in mental health nursing at the University of the West of England, adds that the way we live today has contributed to the problem: ‘Our society has drifted away from an extended family model of support to a nuclear one. This has happened for a whole host of reasons but particularly because of trends in employment.’ Mandy argues that the fact many families rely on two incomes in order to survive often means the time for supporting each other and doing activities together is reduced. And that the IT revolution has also engendered a generation who are linked more to the virtual world, where engagement happens online rather than in real time. ‘It could be argued that the fundamental support of families has been corroded and lost over time, and has in itself resulted in the loneliness many people feel and experience,’ she adds. The Trapped in a bubble study (Co-op and response. Looking at the studies on the British Red Cross, 2016) found that health eff ects of loneliness, it’s clear to see loneliness is made worse by diffi culties Loneliness should be the reasons behind this view. accessing public services and support, Research has shown that the eff ect disappearance of social spaces and seen as a serious public of loneliness and isolation on mortality inadequate transport infrastructure. health issue, like obesity exceeds the impact of well-known risk Loneliness is clearly a complex issue, and smoking, say factors such as obesity, and has a similar but over recent years there has been a infl uence as cigarette smoking (Holt- growing recognition of the problem – and campaigners. Research Lunstad and Layton, 2010). calls for action. off ers a clear rationale It’s been shown to increase the risk of Health secretary Jeremy Hunt has called high blood pressure (Hawkley et al, 2010), loneliness a ‘national shame’, and even Pope and lonely individuals are at higher risk of Francis has called it one of the ‘most serious the onset of disability (Lund et al, 2010). of the evils that affl ict the world’. What’s more, lonely adults are more likely to visit their GP, have higher use of medication, a higher incidence of falls and also have increased risk factors THE TRUE COST for long-term care (Cohen et al, 2006). They are also likely to be more frequent Across all age ranges, without the users of accident and emergency services (Geller et al, 1999). right support, loneliness can transition In terms of mental health, loneliness puts individuals at greater risk of from transient to chronic. Its impact can cognitive decline (James et al, 2011), and one study found that older lonely be profound, aff ecting physical and people have a 64% increased chance of developing dementia (Holwerda et mental health. al, 2012). The Campaign to End Loneliness, a In addition, lonely people are more prone to depression (Cacioppo et al, campaign group set up by charities and local 2006), and loneliness and low social interaction are predictive of suicide in older authorities, says loneliness should be seen as age (O’Connell et al, 2004). a serious public health issue, like obesity and Mandy says: ‘The human species is in essence a “pack animal”, in other words smoking, which deserves a comprehensive many of us require others to make us feel connected. A sense of belonging
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FIGHTING BACK There is lots of work happening in the third sector on loneliness, both to address stigma and make practical improvements for those aff ected. One such example is the Jo Cox Commission on Loneliness. The MP had identifi ed loneliness as a serious problem in her Yorkshire constituency, and set out to investigate what could be done and raise awareness. She had said: ‘Young or old, loneliness doesn’t discriminate... it is something many of us could easily help with.’ After her death, the project she started was taken on by a number of organisations, including Age UK, the British Red Cross and Action for Children, who now all work to promote and challenge thinking about the problem. For example, the Co-op and the British Red Cross have introduced new Connecting Communities services in 39 areas of the UK to tackle loneliness and social isolation. HOW ELSE CAN YOU HELP? This involves trained staff and volunteers providing practical and emotional support, Obi Amadi says it’s important that often through community groups, to community practitioners are alert build people’s confi dence, resilience to the possibility of loneliness and independence. or connecting to other human beings is in the families and individuals Colin Brown, UK director of independent fundamental to many for survival. [So] they encounter. living and crisis response at the British Red loneliness can lead to fear and anxiety Cross, says: ‘Responding to emergencies is alongside isolation and depression, while ‘They need to support the individual at the heart of what the British Red Cross connectedness can lead to enjoyment and a in the best way possible. This may does and the epidemic of loneliness we are feeling of worth.’ involve accompanying them on fi rst currently experiencing is no diff erent. Professor Rotenberg, co-author of the visits to access services, and they ‘The public perceptions of who book Loneliness in childhood and adolescence need to be able to link them into experiences loneliness is out of sync with (1999), says there are specifi c eff ects for services and groups that can provide the reality... We want to help adults of all children. ‘Persistent loneliness in childhood further help and support.’ ages experiencing loneliness and/or social is a predictor of depression in adolescence isolation reconnect with their communities.’ (Qualter et al, 2010), and there is a variety Obi adds that for children, schools Meanwhile everyone in society can play of other psychological consequences and have a crucial role to play in creating their part in fi ghting loneliness, according to physical problems, including poor health.’ a positive environment, where Eleanor Briggs, head of policy and research Mothers’ and fathers’ loneliness also has young people can feel valued, are at Action for Children. negative eff ects on children, impacting on able to make friends and be part ‘We need to consider our own families or their social competence, motivation to learn of a community. relationships and what we can do to build and academic skills. If a child is raised in a and maintain these and how we can support socially isolated family, there is a higher risk School nurses can play an important initiatives that address loneliness in the of the child becoming chronically lonely part in this, ‘working to spot wider community,’ she says. (Rotenburg, 1999). problems and build resilience among ‘We can start to help parents and children There is a fi nancial as well as human cost. children and young people. But this feeling cut off from their community if we all It has been estimated that loneliness in the is clearly a challenge when staff are start with a simple “hello”. In doing this, we elderly alone costs £6000 per person (over now spread so thinly across multiple can help to build a connection for people to a 10-year period), when considering direct schools in their patches’. start to take the steps needed to reduce their
ISTOCK health costs and societal costs (LSE, 2017). experience of loneliness. However you say it,
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whether it’s a “hi, hiya, alright or an alreeet”, RESOURCES we want the nation to say hello to each other in support of beating loneliness.’ ● The Campaign to End loneliness involves multiple organisations working Haley was fortunate in that she got the together to improve services and tackle stigma, particularly among older support and treatment she needed. She people. They off er guidance for public health teams, adult social care and ended up being diagnosed with postnatal clinical commissioning groups bit.ly/end_loneliness depression, and has eventually got her life ● back on track. Her journey also illustrates the Mental health charity, Mind, off ers practical advice for people who are feeling positive impact community practitioners lonely bit.ly/mind_lonely can have: ‘My health visitor was wonderful,’ ● Find information on the Jo Cox loneliness campaign, including a range of says Haley. ‘After my diagnosis she referred community and volunteer activities across the UK bit.ly/Jo_Cox_loneliness me for extra support, which was provided by ● Discover advice on loneliness for people with disabilities from charity Sense Action for Children. She gave me her number bit.ly/Sense_advice and would call me and talk to me about ● Point parents concerned about their or their children’s loneliness towards things I was worried about. She helped me practical help from Action for Children, including a search facility for local to tackle the problem, and now I don’t feel support services bit.ly/parental_tips lonely any more. ● Advice and help for young people from Action for Children, developed with the ‘I’m so grateful health visitors are out mental health charity YoungMinds can be found at bit.ly/tips_for_young_people there, doing a brilliant job. Without them, things would be much worse for families.’ CP
REFERENCES
Action for Children. (2017) Charity reveals ‘devastating impact’ Journal of Family Practice 48(10): 801-4. 23 November 2017). of loneliness on UK parents, children. See: bit.ly/2ArnNnd Holt-Lunstad J, Smith TB, Layton JB. (2010) Social relationships Lund R, Nilsson CJ, Avlund K. (2010) Can the higher risk of (accessed 23 November 2017). and mortality risk: a meta-analytic review. PLoS Medicine 7(7): disability onset among older people who live alone be British Red Cross. (2016) Lonely life stages: new study reveals e1000316. alleviated by strong social relations? A longitudinal study of non-disabled men and women. Age and Ageing 39(3): 319-26. triggers for loneliness epidemic in the UK. See: bit.ly/2zZwEeS Hawkley LC, Thisted RA, Masi CM, Cacioppo JT. (2010) (accessed 23 November 2017). Loneliness predicts increased blood pressure: fi ve-year cross- NSPCC. (2017) Loneliness: a key concern for thousands of children. Cacioppo JT, Hughes ME, Waite LJ, Hawkley LC, Thisted lagged analyses in middle-aged and older adults. Psychology See: bit.ly/2A04uke (accessed 23 November 2017). RA. (2006) Loneliness as a specifi c risk factor for depressive and Aging 25(1): 132-41. O’Connell H, Chin A, Cunnigham C, Lawlor B. (2004) Recent symptoms: cross-sectional and longitudinal analyses. Holwerda TJ, Deeg DJH, Beekman ATF, van Tilburg TG, Stek developments: suicide in older people. British Medical Journal Psychology and Aging 21(1): 140-51. ML, Jonker C, Schoevers RA. (2012) Research paper: Feelings 329(7471): 895-9. Childline. (2017) Why people feel lonely. See: of loneliness, but not social isolation, predict dementia onset: Rotenberg KJ, Hymel S. (Eds.). (1999) Loneliness in childhood bit.ly/2hM75DF (accessed 23 November 2017). results from the Amsterdam Study of the Elderly (AMSTEL). and adolescence. Cambridge University Press: Cambridge. Journal of Neurology, Neurosurgery and Psychiatry 85(2): 135-42. Cohen GD, Perlstein S, Chapline J, Kelly J, Firth KM, Simmens Siddique H. (2017) Half a million older people spend every day alone, S. (2006) The impact of professionally conducted cultural James BD, Wilson RS, Barnes LL, Bennett DA. (2011) Late-life poll shows. See: bit.ly/2iLiip8 (accessed 15 November 2017). programs on the physical health, mental health, and social social activity and cognitive decline in old age. Journal of the Qualter P, Munn P, Brown SL, Rotenberg K. (2009) Childhood functioning of older adults. The Gerontologist 46(6): 726-34. International Neuropsychological Society 17(6): 998-1005. loneliness as a predictor of adolescent depressive symptoms: Geller J, Janson P, McGovern E, Valdini A. (1999) Loneliness LSE. (2017) The loneliness epidemic: research reveals loneliness in an eight-year longitudinal study. European Child and Adolescent
as a predictor of hospital emergency department use. The older age ‘more likely than ever’. See: bit.ly/2A5cJZT (accessed Psychiatry 19(6): 493-501. ISTOCK
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not indicate much more than a passing issue that clears up on its own. But if they persist or combine with each other, they could indicate a digestive disorder, and in that case, will require a visit to the GP. Digestive disorders divide into two broad categories. The fi rst is infl ammatory bowel disease (IBD), which consists largely of just two key conditions, Crohn’s disease and ulcerative colitis. According to the charity Crohn’s & Colitis UK, these diseases aff ect more than 300,000 people in the UK. The second category is irritable bowel syndrome (IBS), which is more a collection of symptoms than a defi nable disease, but it can add up to a chronic and debilitating long-term condition. According to the charity Core, IBS may aff ect up to a third of the population to some degree.
CROHN’S DISEASE This is a lifelong condition that can develop at any time. It manifests as an infl ammation of the lining of the digestive system, anywhere from the mouth to the anus, but most usually in the small or large intestine, leading to malabsorption, scarring and constrictions. The cause is unclear, though it’s suspected it may be linked to the immune system and to the genes. Digestive disorders The main are more of an issue symptoms are persistent diarrhoea, Time to than we like to admit, sometimes with and can also be blood and mucus in the stools, stomach confusing. So how and abdominal cramps, severe can you help families fatigue, weight DIGEST tell IBD from IBS, and loss, anaemia and mouth ulcers. These igestive disorders are among discuss it (YouGov when’s the right time symptoms can occur the most common health and Core, 2010). to see a GP? Journalist individually or all at problems, but also one of those While many of those once. They can we least like talking about. who stay away from John Windell reports. also go into While estimates suggest that their surgery say remission for long DGPs spend around 10% of their time dealing it’s because they managed or resolved the periods, then suddenly fl are up. with patients who have digestive disorders symptoms themselves, 18% of those with a There is no cure, but it can be managed (Jones et al, 2009), this may be far from the problem didn’t think a GP could help, and with medication, such as steroids and full picture: as many as 43% of the people 5% just didn’t want to talk to anyone about immunosuppressants. In severe cases, in the UK (a representative sample of 2287 their bowels (YouGov and Core, 2010). surgery might be needed to repair or even adults) say they have experienced a digestive Individually, symptoms such as remove parts of the intenstine. problem, but up to 41% of those have never abdominal pain and discomfort, diarrhoea, Dr Kevin Barrett, a GP at a practice near
made an appointment with their GPs to bloating, fl atulence and constipation may Watford, has Crohn’s disease and is leading ISTOCK
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the RCGP’s spotlight project on IBD. His key advice to community practitioners is: ‘Be aware of persistent symptoms that don’t go away. Anybody who has these symptoms or changing bowel habits for more than four weeks should see their GP. The symptoms can also overlap with other diseases, particularly in older people and women. Bowel cancer is one, so is ovarian cancer and endometriosis.’
ULCERATIVE COLITIS This is also a long-term incurable condition, the diff erence being, it infl ames the colon and the rectum, often leading to small ulcers that bleed. Again the cause is uncertain, though ulcerative colitis has also been linked to problems with the immune system and may be hereditary. The symptoms of colitis are similar to Crohn’s, so diarrhoea, abdominal cramps and pain, tiredness, reduced appetite, weight loss and anaemia. Ulcerative colitis aff ects around 146,000 people and can aff ect anyone, but most often appears between the ages of 15 and 25, say Crohn’s & Colitis UK. As the two diseases are so alike, the same blood tests and faecal calprotectin test are used during the initial investigation. The only real way to tell them apart is with a colonoscopy and biopsy. Treatments for the two are broadly interchangeable as well. So for colitis it’s also medication, and surgery in the most severe cases. For Dr Barrett, the early onset of ulcerative colitis can present other issues. ‘If you are in your 20s you are probably in education, or starting a job or family, so to be diagnosed with a lifelong relapsing condition can be a in the stools, or constipation. People with IBS blow. People can need support not just with may also feel tired. The symptoms will vary treatment and diet, but also employment Dr Kevin Barrett between individuals, and may come and go. rights, fi nancing and counselling.’ IBS is more prevalent among the 20 to 40 On a more positive note, research into advises community age group and women, say charity Core. IBD is widening to look at the potential of practitioners to be The cause is uncertain, but it has been linked probiotics and fecal transplants. The early aware of persistent to stress and diet. The key problem appears signs are encouraging, says Dr Barrett. ‘The to be increased sensitivity to movement role of good bacteria in the guts is coming symptoms that don’t within the bowel. to the fore in IBD treatment.’ go away, and that Dietitian Priya Tew says she sees a lot of people with IBS: ‘I think it is often related IRRITABLE BOWEL SYNDROME symptoms can overlap to stress. The people I see tend to have IBS is defi ned by a series of uncomfortable with other diseases, busy lifestyles, and often don’t sit down and painful symptoms. These include particularly in older and take time over their meals. They inhale stomach and abdominal cramps, bloating their food. I’ve also seen it in people who and colic, diarrhoea, sometimes with mucus people and women have chronic fatigue.’
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CARRIE TALKS CROHN’S Broadcaster and honorary president of the CPHVA Carrie Grant talks about her experience of Crohn’s disease, which began at 18. A COMMON ISSUE ‘It took two years to get diagnosed. I saw so many doctors, but nobody could tell me anything. Then a dentist saw the ulcers in my mouth and asked if I also had diarrhoea and skin rashes. I did, and he said: “I 43% 41% think I know what the problem is.” It’s a big thing when you’re are 20 to be told you have an incurable disease. It took me fi ve of (2287) people say they have of those have never
years to adapt. I had surgery, experienced a digestive problem seen their GP about it (YouGov and Core, 2010) and was in and out of hospital. My whole life was consumed So treatment for IBS often begins by damages the lining of the small intestine. with being a sick person. looking at an individual’s lifestyle and diet. Coeliac UK (2017a) says one in 100 people ‘For me stress is a trigger. ‘I start with stress management, relaxation have the disease, but that nearly half a I try to be laid back, but I lead and exercise,’ says Priya. ‘Then it’s how and million people are undiagnosed (2017b). a stressful life. I also stick to a where they are eating their meals. I would So for community practitioners, it’s useful limited diet. At the moment I am off er diff erent advice depending on whether to know the signs of the various digestive dairy-free and carb-free. So I eat somebody has diarrhoea-prominent or disorders, and vital to encourage people to meat, fi sh, fruit and vegetables. constipation-prominent IBS. For example, see their GPs when those symptoms become For others it might be diff erent. with the diarrhoea form I might get them stubborn. You can also point people to the ‘Health professionals could to reduce their soluble fi bre, but if they various charities, where specialist help is be more aware of Crohn’s. It has have constipation I might ask them to often on hand (see resources, below). CP a clear group of symptoms. The increase their fi bre.’ initial investigation is also about For anyone with IBS, it’s key that they REFERENCES listening. It may be, on one visit identify and then avoid the foods that Coeliac UK (2017a). About coeliac disease. See: www.coeliac. org.uk/coeliac-disease/about-coeliac-disease-and-dermatitis- the person mentions one thing, trigger their symptoms. Plenty of over- herpetiformis (accessed 6 December 2017). and adds something next time, the-counter medicines are also available Coeliac UK (2017b). Is it coeliac disease? See: bit.ly/2ACSrHx so it’s about joining the dots. – GPs or pharmacists can provide advice. (accessed 6 December 2017). Cognitive behavioural therapy and even Core (2017). Irritable bowel syndrome. See: bit.ly/2iAWbRM ‘Community practitioners (accessed 5 December 2017). can help people to fi lter out antidepressants may be prescribed in Crohn’s & Colitis UK (2017). For Journalists. See: crohnsandcolitis. thethe rubbishrubbish theythey see onlineonline andand severe cases.ca Some people also turn to org.uk/news/for-journalists (accessed 5 December 2017). helphelp them getget to the heart ofof alternativealternati therapies, such as acupuncture Crohn’s & Colitis UK (2017). Ulcerative Colitis. See: bit.ly/2CL1dDh (accessed 5 December 2017). whatwhat they’rethey’re strugglingstruggling with.with. andand aromatherapy,arom though there is little Jones R, Hunt C, Stevens R, Dalrymple J, Driscoll R, Sleet TheThe great thing about being evidenceevidence they work. S, Blanchard Smith J. (2009) Management of common in someone’s househouse is you can If symptomssym are persistent, a trip to the gastrointestinal disorders: quality criteria based on patients’ views and practice guidelines. The British Journal of General taketake a more holisticholistic approachapproach GP is advised,adv especially as they could also Practice 59(563): e199-208. than ifif just in a GP surgery.’surgery.’ signifysignify coeliacco disease. This is where the YouGov and Core. (2010) Digesting the facts: what people are immuneimmune system reacts to gluten, a protein thinking about their digestive health. See: http://corecharity.org. uk/wp-content/uploads/2016/08/DigestingTheFactsReport. foundfound in wheat and other grains, and pdf (accessed 5 December 2017).
RESOURCES
● Core is the national charity for all digestive diseases corecharity.org.uk ● Crohn’s & Colitis UK is the national charity for IBD crohnsandcolitis.org.uk ● The IBS Network is the national charity for supporting people with IBS theibsnetwork.org ● The British Dietetic Association has a factsheet on IBS bit.ly/BDA_IBS ● Coeliac UK is the national charity for people with the disease coeliac.org.uk ● NHS Choices covers all the conditions. ALAMY/ISTOCK
December/January 2018 Community Practitioner 31
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p32-33.CPJAN2018.indd 33 11/12/2017 11:10 FOOD ALLERGY Q&A Peanut allergies
ALLERGY IN THE UK
cracked? ● An estimated 1% to 2% of adults and 5% to 8% of children have a uring the summer a small Researchers in Australia food allergy – that’s around two glimmer of hope appeared on million people the horizon for people with a have made a discovery peanut allergy when researchers that raises hopes for the ● Up to 1 in 55 children has a at the Murdoch Children’s peanut allergy Research D Institute in Melbourne, Australia, treatment of peanut ● Hospital admissions for children said they had made a breakthrough in with food allergies have risen managing the condition (Hsiao, et al, 2017). allergy – a potentially 700% since 1990 The researchers, led by Professor Mimi lethal threat to many. (Food Standards Agency, 2016) Tang, set out to test the potential of oral immunotherapy (giving small doses of an We delve deeper allergen in a bid to desensitise the immune with lead researcher, individuals. One of the most researched system) as a treatment. They changed tack approaches in food allergies has been when they wondered what would happen if Professor Mimi Tang. oral immunotherapy. This involves giving they added a probiotic. So in the 2013 study, patients increasing amounts of the food. But which involved 62 children with a peanut later in 48 of the children, found that 80% while it seemed to be good for desensitising allergy, they gave one group a probiotic of the children who responded to PPOIT people, it was uncertain that it could induce and peanut oral immunotherapy (PPOIT) initially were still eating peanuts in varying any lasting remission. treatment, and the other a placebo. After 18 amounts as part of their normal diets (16/20). months, 82% of the children given the PPOIT And 70% who had a further challenge test What is the diff erence between developed short-term tolerance to peanut, demonstrated long-term tolerance. desensitisation and lasting remission? compared to just 4% in the placebo group. The study is now changing the way Desensitisation is where you suppress the Vitally, the recent follow-up study four years clinicians think about managing peanut reaction without changing the underlying allergy, and Professor Mimi Tang, is hoping it allergy. You just change the immune will have far-reaching consequences: reactivity. So if treatment is stopped for a while and then the patient eats the allergen, What was the impetus for the research? they are likely to have an allergic reaction. We have seen some immunotherapy On the other hand, ‘tolerance’ is a word treatments achieve lasting eff ects for we use with caution. True tolerance would other allergic conditions. You could mean permanent removal of the allergy almost call them a cure. For example, without the need to continue in taking the immunotherapy for insect stings or allergen. We don’t know if that is achievable grass pollen appears to have achieved in food allergy. So for now we prefer the term long-term remission for a large number of ‘sustained unresponsiveness’. This means
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that you still have a degree of protection the probiotic peanut even if you stop treatment for weeks, AT A GLANCE: therapy in the fi rst months, or longer. Oral immunotherapy THE PPOIT STUDY instance was likely seems to be good for desensitisation, but to have retained we wanted to fi nd something that could protection four years induce a long-lasting remission (sustained later. Nobody would unresponsiveness) or switch off the claim this is a cure, but disease altogether. 62 it’s exciting because it’s children were given increasing the fi rst time any treatment Is that how the idea of the probiotic amounts of either a probiotic and has demonstrated long-term remission peanut compound or a placebo once came about? a day for 18 months after immunotherapy. I think that immunotherapy just reminds the immune system to react in the usual Where do you go from here? At the end of the trial, way to the allergen like a booster vaccine. We are now running a large trial that We thought we needed to do something compares probiotic and peanut therapy with else to encourage the immune system to just peanut therapy alone. We’re also running respond diff erently. So we added an immune 82% an open study to confi rm the findings of modifying agent. We combined the standard of children who received the our 2013 trial. If our data are repeated and oral immunotherapy for peanuts with a compound developed short-term confi rmed, and we show it’s as eff ective probiotic. Both were taken at the same time, tolerance to peanut in other forms of food allergy, this therapy as a powder, every day for 18 months. The could be rolled out into a clinical setting in probiotic was a fi xed dose, whereas the the next decade. It could change the way peanut immunotherapy started very low we manage food allergy. And we really need and gradually built up to the equivalent of something, because the food allergy burden around eight peanuts. At the end we tested Just 4% is out of control. Fingers crossed, if it pans for desensitisation. We then stopped the of the placebo group had out, this will be a major breakthrough. CP treatment for between two to six weeks, and developed any tolerance ● Professor Mimi Tang is group leader of tested again for sustained unresponsiveness. allergy and immune disorders, Murdoch Children’s Research Institute, Australia. Four years later, 48 children How reliable were the impressive results? were follwed up, and REFERENCES That two- to six-week period between FSA. (2016) Allergy basics and stats. See: bit.ly/2AtiPUb (accessed stopping treatment and the sustained 4 December 2017). unresponsiveness test was relatively short. NHS Choices. (2014) Food allergy and intolerance myth buster. Some individuals may just have been 80% See: bit.ly/2ByJRc5 (accessed 4 December 2017). of children who had initially Tang ML, et al. (2015) Administration of a probiotic with peanut desensitised. So we did the 2017 follow-up oral immunotherapy: a randomized trial. The Journal of Allergy study of children from the 2013 trial to see responded to PPOIT (and went home and Clinical Immunology 135(3): 737-44. eating peanuts) were still eating if the original protection had persisted. We Hsiao KC, et al. (2017) Long-term clinical and immunological peanuts, and 70% of those who eff ects of probiotic and peanut oral immunotherapy after asked them about their peanut intake, their agreed to a further challenge test treatment cessation: four-year follow-up of a randomised, reactions to peanuts, and gave them a skin- demonstrated long-term tolerance double-blind, placebo-controlled trial. The Lancet Child & Adolescent Health 1(2): 97-105. prick test. They also had the option to take part in a food challenge where they stopped eating peanuts for at least eight weeks. This FOOD ALLERGY FACTS revealed that anybody who responded to ● Food allergies may trigger anaphylactic shock, which can be fatal if not treated immediately, usually with an adrenaline injection ● There is currently no cure for food allergies. Treatments are being tested, but the only reliable way to prevent a reaction is to avoid the food ● Most children grow out of allergies to eggs, milk, wheat and soya by about the age of fi ve, as their guts and immune systems mature ● They are unlikely to grow out of allergies to peanuts, seafood, fi sh and tree nuts ● Allergies run in families: children whose parents or a sibling have an allergic condition are at a higher risk of developing one. Though it may not be the same one. (NHS Choices, 2014) GETTY/ISTOCK
December/January 2018 Community Practitioner 35
34-35 ALLERGY.indd 35 04/01/2018 12:00 HEALTH INEQUALITY THE BIG Previously, life expectancy improvements at birth had been about a one-year increase every fi ve years for women and every three- and-a-half years for men (Institute of Health HEALTH Equity, 2017). Professor Andrew Hayward, director of University College London’s Institute of Epidemiology and Health Care, says that initiatives to tackle the underlying causes of inequalities are likely to take decades to have DIVIDE an impact, ‘but at the extreme end of social exclusion things seem to have worsened’. Fellow epidemiology academic Professor There are still clear gaps in Kate Pickett, deputy director of the Centre ix months after the life expectancy and health for Future Health at the University of York, Grenfell Tower fi re in says health inequalities shrunk between 1997 London, MP Emma depending on where you and 2010 because the Labour government Dent Coad has live, reports journalist pursued a ‘comprehensive programme of compiled a report progressive social and economic policies,’ that S highlights, among other Anna Scott. What’s going on? such as the national minimum wage, disparities, dramatic health increased spending on education, housing, inequalities across Kensington and Chelsea. health and urban regeneration and the Sure Life expectancy there is the highest in the A GROWING PROBLEM Start programme. ‘Since 2010, inequalities country: a man living in Hans Town near This is by no means a new issue. In 1980, have started to increase again,’ she adds. Knightsbridge can expect to live to 94. But if the Black report spelt out the clear social ‘A growing body of evidence verifi es the he were to live in Golborne, where Grenfell inequalities in health, and proposed ways of impact of austerity on population health, Tower is, he could expect to reach only 72 reducing them. There were accusations that including a shocking rise in infant mortality (Dent Coad, 2017). the Thatcher government suppressed the among the lowest social class.’ report. And 37 years later, research has found Community practitioners tend to agree. A FAMILIAR SNAPSHOT that a consistent gap in life expectancies ‘Facilities [in urban areas with social housing It’s a London microcosm, but also a picture between people living in the north and and low-quality spaces] are becoming refl ected in other cities. Across Glasgow’s 56 south of England is apparent across fi ve limited in number and size due to austerity neighbourhoods, for instance, there is a 15- decades of data – from 1965 to 2015 cuts,’ says Rekha Vijayshankar, health visitor year gap in male life expectancy (between (University of Manchester, 2017). with Central London Community Healthcare 66.2 and 81.7 years) depending on where Evidence also suggests the gap is NHS Trust. you live, and an 11-year gap in female life widening. In 2010, life expectancy for men expectancy (between 73.1 and 84.3 years) living in England’s poorest areas was 9.1 SOCIAL GRADIENTS (Glasgow Centre for Population Health, 2016). years lower than for those in the wealthiest Health inequality is not a simple case of rich Inequalities are also refl ected across locations and for women 6.8 years, but by and poor says Sir Michael Marmot in The diff erent regions within England, Northern 2015 those average life expectancies had health gap (2015). It is about social status, as Ireland, Scotland and Wales, and across the risen to 9.2 years and 7.1 years respectively highlighted in Fair society, healthy lives: entire UK in both life expectancy and healthy (Public Health England, 2017a). ‘There is a social gradient in health life expectancy – the number of years people Life expectancy across the entire UK – the lower a person’s social can expect to experience good health during also appears to have stalled, according to position, the worse his or their lives (see Tables 1 and 2). In England, for the latest Marmot Indicator (Institute of her health,’ it stated. instance, the stark diff erence in healthy life Health Equity, 2017), which regularly tracks ‘We can classify expectancy between the poorest and richest the government’s progress on key policy individuals areas is over 18 years for men, and 19 years recommendations made in Fair society, not by
GETTY for women. healthy lives (The Marmot Review, 2010).
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where they live but by their level of education, occupation, housing conditions – and see similar gradients.’ This statement underlines government policy approaches to the issue. ‘Health inequalities are infl uenced by the broad social and economic circumstances into which people are born, live, work and grow old,’ says Dr Ann Marie Connolly, deputy director, Health Equity and Mental Health at Public Health England (PHE). ‘There are many diff erent factors, from housing, jobs and worklessness, to geographical disparity that aff ect health and life expectancy.’ The Northern Ireland Government has the same view. ‘Health is an outcome which results from a wide range of factors which interact to infl uence health and wellbeing at various stages of the life course,’ says a TABLE 1 spokesperson from HEALTHY LIFE EXPECTANCIES ACROSS THE UK (YEARS SPENT ENJOYING GOOD HEALTH) the Department of Health. POOREST AREAS WEALTHIEST AREAS DIFFERENCE
MEN WOMEN MEN WOMEN MEN WOMEN
ENGLAND 51.9 52.2 70.6 71.3 18.7 19.1
NORTHERN 51.2 53.4 63.4 68 12.2 14.6 IRELAND EAST ORKNEY GLASGOW CITY DUNBARTONSHIRE ISLANDS DIFFERENCE
MEN WOMEN MEN WOMEN MEN WOMEN SCOTLAND 55.9 58.5 68.3 71 12.4 12.5 BLAENAU GWENT MONMOUTHSHIRE GWYNEDD DIFFERENCE
MEN WOMEN MEN WOMEN MEN WOMEN
WALES 59.6 59.3 69.8 71.1 10.2 11.8
(Public Health England, 2017; Information Analysis Directorate, 2016; The Scottish Public Health Observatory, 2017; Welsh Government, 2016)
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TABLE 2 LIFE EXPECTANCIES ACROSS THE UK (YEARS)
POOREST AREAS WEALTHIEST AREAS DIFFERENCE
MEN WOMEN MEN WOMEN MEN WOMEN
ENGLAND 74 78.9 83.1 86.1 9.1 7.2
NORTHERN 74.1 79.7 81.1 84.1 7 4.4 IRELAND GREATER GLASGOW WESTERN AND CLYDE BORDERS ISLE DIFFERENCE
MEN WOMEN MEN WOMEN MEN WOMEN SCOTLAND 75.3 80.1 78.8 82.9 3.5 2.8 BLAENAU GWENT MONMOUTHSHIRE NEWPORT DIFFERENCE
MEN WOMEN MEN WOMEN MEN WOMEN
WALES 76 80.2 80.5 84.1 4.5 3.9
(Public Health England, 2017; Information Analysis Directorate, 2016; National Records of Scotland, 2016; Welsh Government, 2016)
HOW CAN CHANGE OCCUR? Making life better (2014), which puts in place structures, Wendy Mallon, a health visitor in mid-Ulster for the relationships and processes to encourage a partnership Northern Trust, says that addressing health inequalities is approach to improve public health. It also has programmes a complex process: ‘Biological, lifestyle, socioeconomic, and joint initiatives to tackle poverty, alcohol and drug and cultural and environmental factors all play a part in misuse, and other issues, at regional and local levels. contributing to or helping prevent inequalities occurring.’ ‘Improving health and reducing health inequalities However, funding is the big one that community needs long-term sustained and collective action between practitioners would like to see – for training, in-school government, statutory, voluntary and community and education, vulnerable clients, increased workforces, other sectors,’ says a spokesperson. ongoing public campaigns to target problems and more The other devolved governments have their own community-led initiatives, among other things. programmes in place. Transforming health improvement Wendy would like to see a continued commitment from in Wales has sought to integrate health improvement government to reduce inequalities via action to improve initiatives across health and other sectors, particularly local living conditions, such as housing for families in deprived government and the third sector (Public Health Wales areas, improved access to aff ordable leisure activities and (PHW), 2013). This means focusing on a small number ongoing provision of services such as Sure Start. of high impact areas, such as obesity and smoking, and Rekha says: ‘Government commitment to the value of monitoring the programmes focused on mental health, health visiting – in the form of a strategy paper committing HIV, breastfeeding and other areas of health (PHW, 2013). to stemming the fall in health visitor numbers and/or In Scotland, the government has three main social suggesting a way forward to invest in the workforce – will policy frameworks to tackle health inequalities, which be very reassuring and boost confi dence.’ are reviewed every few years: Equally well tests new PHE has published guidance for local authorities on approaches to transforming public services and a range of healthcare issues, held national marketing encourages joint working between NHS, local campaigns and published a health equity report (PHE, government, the third sector and community 2017b) to bring contradictory data together, among other planning partnerships (Scottish Government, measures. ‘Reducing these health inequalities is a key 2008a); The early years framework focuses priority for PHE and action on inequalities is on agencies working together to deliver 10 embedded into projects,’ says Dr Connolly, key elements of transformational change in adding that community practitioners children’s early years (Scottish have a ‘vital role to play in identifying Government, 2009); and inequalities and providing early support’, Achieving our potential for which PHE also provides guidance. seeks to reduce In Northern Ireland the Department income inequalities
GETTY of Health has a strategic framework, with long-term
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measures to tackle poverty and low income A school nurse with community child community practitioners to ‘step in creatively (Scottish Government, 2008b). health at the Belfast Health and Social and render our core message for a robust But there are also calls for legislative Care Trust says that children who live in and healthy childhood.’ In other words, change across the UK. Andrew Hayward deprived areas can be diffi cult and require to use the time with clients to give says: ‘The government should reconsider more follow-up to gain consent, and helpful ideas, assess family needs, welfare reforms that increase the likelihood getting parental engagement for health help them stay involved, and importantly, of homelessness, for example, aspects interventions can off er this early on. As well as to collaborate of the unifi ed credit scheme and caps on be a challenge. with relevant organisations. housing benefi t that increase the risk of And a health visitor with community child Professor Pickett adds that ‘perhaps the eviction. It should ensure child poverty is health at the same trust says: ‘There is a lack most important role that health professionals reduced through adjustments to welfare and of professional time to dedicate to tackling can undertake is as campaigners and taxation policy, and ensure adequate funding health inequalities within community advocates for political and policy of specialist services supporting socially agencies and to referral pathways to support solutions/change that can improve excluded groups.’ statutory services.’ population health’. CP Sir Michael Marmot, also professor of epidemiology and public health at UCL’s HOW YOU CAN HELP REFERENCES Institute of Health Equity, says in The Andrew Hayward suggests Black D. (1980) Inequalities in health: Assessing and report of a research working group. health gap that the key to reducing health making yourself aware Department of Health and inequalities is: ‘Creating the conditions for of the Homelessness identifying Social Security: London. people to lead fl ourishing lives, and thus Prevention Act and health needs Buchan IE, Kontopantelis E, Sperrin M, Chandola T, Doran T. (2017) North-South empowering individuals and communities.’ helping to signpost socially and reducing disparities in English mortality 1965-2015: excluded groups to other longitudinal population study. See: bit. ly/2Bj33hZ (accessed DAY-TO-DAY IMPACT specialist services. inequalities is 7 December 2017). Health inequalities directly aff ect the You can take a range a key principle Dent Coad E. (2017) After Grenfell: housing service community practitioners are able of other steps to help and inequality in Kensington and Chelsea, ‘The most unequal borough in Britain’. to provide. ‘Assessing and identifying tackle health inequalities. of the health See: bit.ly/2yOWJMQ (accessed 8 health needs and reducing inequalities is The suggestions below visiting service December 2017). Glasgow Centre for Population Health. a key principle of the health visiting service are provided by the (2016) Glasgow: health in a changing and targeted interventions are delivered community practitioners city. See: bit.ly/2ju30oU (accessed 8 for families identifi ed as most in need,’ spoken to here: December 2017). Department of Health. (2014) Making life better – a whole system says Wendy. ● Use assessment tools such as the family strategic framework for public health. See: bitly/2ju3dZe (accessed Community practitioners face many health plan and school health needs 8 December 2017). challenges in dealing with these families, assessment to identify health inequalities Information Analysis Directorate. (2016) Health inequalities: regional report 2016. See: bit.ly/2jbdUCX (accessed 8 December 2017). such as: adult and infant mental health, and address areas of concern. Institute of Health Equity. (2017) Marmot indicators briefi ng. housing problems, drug and alcohol ● Collaborate in work streams with clinical See: bit.ly/2Bh28yD (accessed 10 November 2017). misuse, high teenage pregnancy and low commissioning groups and commissioners Marmot M. (2015) The health gap. Bloomsbury. breastfeeding rates, domestic abuse, poor to address health inequalities. Marmot Review. (2010) Fair society, healthy lives. See: bit.ly/2kHi71X (accessed 8 December 2017). dental health, poor education and literacy, ● Help local people get involved in decision- National Records of Scotland. (2016) Life expectancy for areas poverty, delayed child development and making in their area using tools such as the within Scotland 2013-2015. See: bit.ly/2y8kmfy (accessed speech, obesity, poor diet, lack of exercise. school health needs assessment. 8 December 2017). PHE. (2017a) Health profi le for England – chapter 5: inequality in ● ‘These issues are often generational and Work in partnership with local health. See: bit.ly/2AIHTsr (accessed 8 December 2017). deep-seated,’ says Fiona Tyldesley, team stakeholders to create learning and PHE. (2017b) Public health outcomes framework. Health equity report. leader at the Children and Young People’s development opportunities for local See: bit.ly/2j8vBDk (accessed 14 December 2017). Wellbeing Network at Lancashire Care NHS families and children. PHW. (2013) Transforming health improvement in Wales. See: bit.ly/2kE7Jrv (accessed 8 December 2017). Foundation Trust. ‘Intense work is often ● Network with statutory and charitable The Scottish Public Health Observatory. (2017) Healthy life required to undo thoughts and feelings, and organisations and local communities to expectancy: local authorities. See: bit.ly/2y7Tlc2 to re-educate families. Health inequalities promote services and how to access them. (accessed 14 December 2017). Scottish Government. (2008a) Equally well: report of the ministerial ● have a direct infl uence upon safeguarding Constantly highlight unmet needs and task force on health inequalities. See: bit.ly/2y7UGj1 (accessed and, unfortunately, community healthcare current demands to line managers. 8 December 2017). professionals often get entrenched in ● Collaborative partnership working Scottish Government. (2009) The early years framework. See: bit.ly/2j9Bf8m (accessed 8 December 2017). reactive practice to support safeguarding with the voluntary sector. Scottish Government. (2008b) Achieving our potential: a framework concerns instead of proactive ● Focus on early to tackle poverty and income inequalities in Scotland. See: bit. activity that enhances intervention. ly/2iEZp6L (accessed 8 December 2017). Welsh Government. (2016) Life expectancy and healthy life the health and lifestyle And so, says Rekha, it is expectancy at birth by local health board and local authority. of the community.’ a ‘golden opportunity’ for See: bit.ly/2BhnQlQ (accessed 8 December 2017).
December/January 2018 Community Practitioner 39
3 3 i ide.indd 3 03/01/201 0 :55 CHANGING CONVERSATIONS PERIOD
Being unable to aff ord POVERTY the basic necessity of sanitary protection is a reality for many women and girls in Tackling the UK. There’s also a compounding stigma around menstruation. Journalist Juliette the taboo Astrup investigates.
ace a day at school with only a sock and health concerns that go with it. on free school meals. Her petition now has to protect you from leaking, or stay ‘We have teachers telling us that they more than 80,000 signatures. at home and miss school? supply sanitary products to 10 or 15 girls on Amika says: ‘Girls have told me that they This is the grim choice facing a regular basis,’ she says. ‘We know school don’t even ask their parents for money for some girls when they get their nurses are having to distribute them, and menstrual products, because they know period F every month, and one of the realities from our work around the UK we know there isn’t food for dinner, so they choose to behind a recent survey which reveals 1 in 10 some girls are using one tampon or one stay home. Others have said that they make 14 to 21-year-olds have been unable to aff ord pad all day, or using tissues or socks in their their own protection, and, for those who go sanitary wear (Plan International UK, 2017a). underwear to stop the blood.’ to school, the entire day is spent in a state of The survey of 1000 women and girls, The issue was thrust into the spotlight stress and anxiety.’ published by charity Plan International UK in earlier this year when Freedom4Girls, a Amika also spoke about her campaign October, also shows that 15% have struggled charity set up to provide sanitary products to in the July issue of Community Practitioner, to aff ord towels and tampons, one in seven Kenya, decided to operate in Yorkshire after saying: ‘Girls should not have to choose have had to ask their friends it was approached by a between their education and their period.’ to help due to aff ordability Leeds secondary, where issues, while 12% said they teachers had noticed THE SILENT WALL have had to improvise It’s social as girls were skipping But poverty is not the only factor at play – it’s sanitary protection for school each month combined with the stigma and taboo around the same reason (Plan well as fi nancial while on their period. menstruation which silences girls and leaves International UK, 2017a). poverty. Girls The resulting media them uninformed about what to expect and Kerry Smith, head of girls are not given reports shocked A-level how to manage their periods, adds Kerry. rights and youth at the student Amika George, ‘It’s not just a picture of fi nancial poverty, charity, says that while data the information 18, so much that she it is social poverty – and almost all girls are on period poverty is scarce, or the space launched #freeperiods, socially poor in that way,’ she says. ‘They are they know a ‘signifi cant a campaign calling for not given the information, the space or the minority’ are facing the to talk about sanitary supplies to be encouragement to talk about menstruation issue, and all the social menstruation given to all schoolgirls as a normal bodily function.
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PERIODS BY NUMBERS
‘Girls might get one lesson in year fi ve or six and another in year nine. The boys are separated [during those lessons] – the message is “this is your dirty secret”. ‘That conversation around the fact that everyone’s period is diff erent – some people have pain, some have heavy fl ow – is not happening. They need that ability 1 IN 10 to share experiences. girls and women aged 14 to Indeed, nearly half of (1000) girls aged 21 said they hadn’t been able to aff ord sanitary protection 14 to 21 said they were embarrassed (out of 1000) by their periods, found another Plan International UK survey (2017b). One in seven said that they did not know what was happening when they started their period, and more than a quarter said that they did not know what to do. 5% Plan International UK is calling for the VAT payable on tampons is due new Relationships and Sex Education to be cut to zero curriculum – currently under in 2018 consultation and due to be rolled out in September 2019 – to incorporate lessons which teach girls and boys, together, about the physical, personal and social aspects £10m of menstruation. has been pledged by Labour to end period poverty if it ‘We need to encourage open forms the next government discussion and better equip girls with tools and information to manage their periods eff ectively, without shame or embarrassment,’ says Tanya Barron, the Plan International UK’s chief executive. a consultation on her proposed Member’s ‘Institutionalised stigma’ including Bill to introduce a legislative duty to provide schools’ policies which restrict girls’ access to free sanitary products for anyone who needs the toilets must also be tackled, adds Tanya: them. Her proposal also includes a statutory 49% ‘A girl might miss school because she’s duty on schools, colleges and universities worried that if her period comes, she won’t to provide free sanitary products on site for be allowed access to the toilet.’ their students (Lennon, 2017). And a £42,500 pilot project, giving out free MEETING A BASIC NEED sanitary supplies to women and girls in need, of 14- to 21-year-olds have Some argue that sanitary products are as is up and running in Aberdeen. Scottish missed an entire day of school because of their basic a need as toilet paper so should be equalities secretary Angela Constance period – of which 59% made made freely available in schools. In Scotland heralded it a ‘fi rst step’ to ‘help us develop up a lie or an alternative steps are already being taken along this road. a sensitive and dignifi ed solution to making excuse (out of 1000)
In August Monica Lennon MSP, Scottish these products easily accessible to those (BBC, 2017a; 2017b; Plan International UK,
ISTOCK Labour’s equalities spokesperson, launched who need them’. 2017a; 2017b)
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The pilot scheme is already making a diff erence, says Dave on board – we’d need the pastoral support to Simmons, chief executive of Community Food Initiatives North East, be able to do it. We are not always there – at the social enterprise and food bank running the project. ‘We are best twice a week.’ already getting that qualitative data,’ he adds. ‘People are saying And she says more needs to be done to it makes such a diff erence – it removes a signifi cant anxiety they support parents to talk to their children. experience every month.’ Refl ecting on the puberty talks she gives Under the Aberdeen scheme, as well as working with voluntary year six pupils, she says: ‘This is information and church groups to distribute supplies to those in need in the that some of the girls are hearing for the fi rst community, sanitary products are being made universally available time. They can get quite worried about the at three academies and one college. bleeding and if they’ll be alright. ‘You get the sense the conversation stops after we’ve left.’ THE POLITICS OF PERIODS Amika agrees: ‘Women have to talk about Elsewhere politicians are paying attention. The Green Party and their periods much, much more, and I spend Liberal Democrats both pledged to address period poverty in their much of my time doing just that, to make it election manifestos (Green Party, 2017; Liberal Democrats, 2017) an everyday topic of conversation.’ She adds: and Labour has said it would spend £10m to end period poverty in ‘As community practitioners, I think you’re schools in England if it forms the next government (BBC, 2017a). really well-placed to facilitate conversations However, when pressed to match Labour’s commitment, education and you can help to normalise it.’ CP secretary Justine Greening told the House of Commons in October it was a matter for schools and parents. Philip Hammond was also silent REFERENCES on the issue of period poverty in the budget (HC Deb, 2017). BBC. (2017a) Labour’s £10m pledge to tackle ‘period poverty’. See: Change is also beginning to be felt in the wider cultural context, bbc.in/2k0lvAI (accessed 30 November 2017). BBC. (2017b) Tampon tax: How much have you spent? See: perhaps best demonstrated by the watershed moment in October, bbc.in/2AcMxjn (accessed 6 December 2017). when Bodyform used a realistic red liquid for a sanitary towel advert. Green Party. (2017) The Green Party for a confi dent and caring At the same time the leading brand also started the #bloodnormal Britain. See: bit.ly/2jjFDOK (accessed 6 December 2017). HC Deb. (2017) Financial statement 22 November Volume 631. campaign, seeking to challenge taboos around menstruation. See: bit.ly/2Ag0sFh (accessed 6 December 2017). It is one of a plethora of similar campaigns, including Amika’s Liberal Democrats. (2017) Changing Britain’s future: Liberal #FreePeriods, activist Chella Quint’s #PeriodPositive, and Plan Democrat manifesto. See: bit.ly/2AdyoTc (accessed 6 December 2017). International’s #WeAllBleed, demonstrating the part social media is Monica Lennon. (2017) Ending period poverty. See: playing in bringing menstruation into the light. bit.ly/2it5xyJ (accessed November 30 2017). But long-held stigma is no easy thing to shake off , and we all Plan International UK. (2017a) 1 in 10 girls have been unable [practitioners and society] have a part to play in supporting the to aff ord sanitary wear, survey fi nds. See: bit.ly/2kq3Bvd (accessed 30 November 2017). groundswell against it, believes Victoria Button, a school nurse Plan International UK. (2017b) Almost half of girls aged 14 to 21 working in the north east of England. are embarrassed by their periods. See: plan-uk.org/media-centre/ almost-half-of-girls-aged-14-21-are-embarrassed-by-their- She says: ‘It’s about having those conversations yourself with periods (accessed 30 November 2017). other professionals and with the children and young people you know; having those conversation in schools, asking about the facilities, and if staff are aware there might CALLS TO ACTION be children and young people missing out on their education. It’s about talking more ● Visit freeperiods.org where you can sign the #Freeperiods petition and not being shy and timid about the ● Talk to teachers, children and fellow healthcare professionals about periods subject. School nurses have a vital role in ● Join the debate on social media, using hashtags such as #bloodnormal and encouraging people to discuss this and be #periodpositive more open about it.’ ● Write to your local MP to raise awareness of period poverty in your area On the role of school nurses distributing ● Lobby Education Secretary Justine Greening at [email protected], or products, she says: ‘It would be a really good send her a tweet at @justinegreening
system to have, but the school needs to be ISTOCK
42 Community Practitioner December/January 2018
0 2_ e i d e .indd 2 21/12/2017 0 :53 NEW WEANING CPD MODULE AGE-APPROPRIATE WEANING FOODS
The CPD module will:
• Examine how age-appropriate weaning can contribute • Consider how to tackle problems arising during to child health weaning, such as pressures around the timing of • Discuss official advice on weaning, also called food introduction, avoidance of certain foods, fussy complementary feeding eating, or poor cooking skills • Look at the steps involved in successful introduction • Address common food myths which lead to confusion of complementary feeding, including which foods and amongst families textures to introduce when
Visit: communitypractitioner.co.uk for further information on the module.
Wp43.CPJAN2018.indd 43 11/12/2017 11:11 RESEARCH
SHORT VERSION Second pregnancy prevention among
teenagers KEY POINTS
A service in north England attempts to tackle ● Be fl exible in providing second pregnancies among teenagers who the service to meet the needs of as many already have a child. Catriona Jones and her clients and potential colleagues explain the fi ndings of a recent study clients as possible ● Have a willingness to into the eff ectiveness of the service. communicate in the way that suits the clients. Speaking on the The UK has the highest rates of teenage second unplanned pregnancies are an important phone may be a more pregnancy in Western Europe (FPA, 2016). element in promoting teenage sexual health and traditional means of The impact of pregnancy in adolescence on the safeguarding of children (Viner et al, 2012). making contact, but the health of mothers and their babies is well The UK has seen major changes in sexual health the client group may documented: teenage pregnancy is associated services provision, including service integration prefer to text with higher neonatal morbidity and mortality, and innovation. Local authorities have been ● A successful service low birthweight babies, and a higher risk of some mandated to take the lead in reducing teenage needs to be able to obstetric complications (Azevedo et al, 2015). pregnancies, having been given the ‘freedoms respond to a Current estimates suggest that around one-fi fth and fl exibilities to do what fi ts to reduce teenage referral quickly of births among under-18s are repeat pregnancies pregnancies in their area’ (Department of Health ● Healthcare professionals (Aslam et al, 2015; Teenage Pregnancy Advisory (DH), 2013: 38). Yet, the features of successful involved may be less Group (TPIAG), 2010). The problems associated initiatives aimed at preventing secondary interested in the with these teenage mothers are more severe unplanned pregnancies in teenagers remain outcomes in statistical than for those who are parenting just one child relatively unknown. NICE guidance (2007) calls terms and more focused (Rowlands, 2010). In addition to exacerbating the for more evidence of rigorous evaluation of the on providing access to cycle of poverty and lack of education, teenage eff ectiveness of one-to-one interventions in the client group mothers pass on risk to their babies (LGA, 2013). outreach settings. ● An eff ective service These children may be more likely to suff er from Exploring the experiences of health will require an child abuse or placed in foster care (Rowlands, professionals directly involved in preventing element of awareness- 2010). The risks of low birthweight, increased second pregnancy (PSP) service delivery, and raising among mortality rate and poor health outcome increase those who play a part in the referral processes, other healthcare for babies born to teenagers who already have will provide evidence on features of an eff ective professionals. a child. As such, services designed to reduce intervention especially designed to prevent
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unintended repeat pregnancies to inform the future of NHS sexual healthcare. While the data on preventing repeat teenage THE UK HAS conceptions is limited (Hayter et al, 2016), Hadley and Evans (2013) suggest that secondary prevention programmes are more likely to be successful if they include individualised counselling, home visits, a multidisciplinary youth-oriented approach, contraception THE HIGHEST teaching and easy access to services. Furthermore, the ways in which outreach nurse practitioners help teenagers develop responsible social and sexual relationships is under-researched. RATES OF PLUGGING THE RESEARCH GAPS To address some of these under-researched areas, a study to TEENAGE evaluate the eff ect of a home-based sexual health outreach service for teenage mothers – the P2P service – was undertaken in the north of England. It sought to explore the views and experiences of professional stakeholders who work with teenage mothers to PREGNANCY inform guidelines or the development of similar services. P2P works by referral. Within the fi rst few weeks after childbirth, new teenage mothers are informed about P2P by a visiting IN WESTERN health professional, either a midwife, health visitor or family nurse partnership worker. If agreeable, a referral is made for a home visit from a P2P nurse. When the P2P nurse attends the EUROPE home, information on contraception and safe sex are provided. Contraception can and, in most cases, is provided during the visit. Health professionals referring into or delivering the P2P service (FPA, 2016) participated in focus group discussions (FGDs), which were then analysed. The analysis identifi ed four characteristics that were perceived to be important for eff ectiveness: a flexible and responsive service; a commitment to breaking down barriers; sorted it for them. Whereas it’s quite hard, isn’t it, to ring the GP and awareness raising; and timely service provision. then you’ve got the receptionist saying, “Oh, what do you need to The fl exibility within the roles and responsibilities of P2P nurses see the doctor for?”’ was seen as crucial to eff ective delivery and uptake. Staff used other Another barrier to be overcome was communication. Many services as a platform to achieve the service aim and were open to P2P nurses reported that they tried to contact their referrals by helping new clients, who happened to be visiting the home during telephone, but realised that they had to be willing to try other a P2P visit, access contraception and sexual health advice. As one means, such as texting. If the young mother did not recognise the P2P nurse explained: ‘I can sometimes manage to get more than one number, there was often a reluctance to answer. person covered for contraception in one visit, if they are in the same ‘They’ll see your number on the phone, they don’t recognise it, house and ask for it, and I’ve got the right contraception with me.’ so they don’t pick it up. But then if you text them and say who you Respondents highlighted a desire to help those disadvantaged by are... they’re quite happy to text,’ said one nurse. present services. In many cases, they felt a sense of responsibility to A key element to the success of P2P was awareness-raising among all women in need of sexual health services. Nurses, midwives and both other professionals and service users. An important aspect of health visitors of the P2P service strive to be fl exible and inclusive, this was maintaining the initial impetus of ‘getting the word out’, tailoring their approaches to meet the needs of the service user. The and ensuring that there was a sustained commitment to awareness- proactive eff orts they make in reaching the most vulnerable young raising. A health visitor said that P2P had been widely known about mothers are necessary to signifi cantly reduce the risk of unintended but this had fallen away. A midwife said that funding cuts had pregnancy – a key priority identifi ed in theFramework for sexual resulted in a reduction in information packs. A P2P nurse said: ‘We health improvement in England (DH, 2013). used to have really good leafl ets, with names and numbers. I know it’s a cost thing, but now people are photocopying those and it’s not MEETING NEEDS very professional looking. They’ll just throw it away.’ Practitioners also identifi ed the importance of being committed to Keeping other healthcare professionals informed was recognised breaking down barriers. It was discussed that sexual health remains as key to an eff ective P2P service, such as sending six-monthly a sensitive topic for many women and this can create a barrier to updates about the service to midwives and health visitors. But seeking contraception, especially for young women. P2P helped to increased workloads and reorganisations could be a barrier to this break down these perceived obstacles. As one P2P nurse pointed type of awareness-raising happening. In addition, collaborative out: ‘I think for a lot of them, the P2P nurse comes in... [and] we’ve working was identifi ed as a cornerstone to service uptake.
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EFFECTIVE SERVICE face-to-face access to sexual health services. It is hoped that this Another element of success was in providing an effi cient service. research will inform how services are developed. CP There was a positive response to the referral process and praise for the speed at which the P2P nurses respond to women who CATRIONA JONES are referred. Eff ective services from a P2P health professional’s Senior research fellow in maternal and reproductive health, perspective appear to be based around accessibility, particularly Univeristy of Hull in terms of speed and confi dentiality. Previous research of this service indicates the aspects that were found to be most satisfying PROFESSOR MARK HAYTER to young women were the confi dential nature of the encounter Professor of sexual and reproductive health, Univeristy of Hull between client/health professional, convenience of access, the fl exibility of health professionals alongside the non-judgemental DR JENNY OWEN attitude of staff and the ongoing support (Hayter et al, 2016). Honorary senior lecturer, University of Sheffi eld From both a service user and stakeholder perspective, the service appears to be eff ective in terms of meeting the contraceptive needs RITAH TWEHEYO of young mothers. Yet, during the FGDs, there was little evidence Research associate, Univeristy of Hull of numerical detail of the eff ectiveness at reducing unplanned pregnancies. This suggests that the prevention of unintended CHRISTINA HARRISON pregnancies is of less importance to staff and service users – what Assistant director for children, young people and families, seems to be more of a priority in terms of measuring eff ectiveness is Doncaster Community Integrated Services, Rotherham Doncaster the access to sexual health advice in a discreet and timely manner. and South Humber NHS Foundation Trust Research by Regmi (2012) suggests that ‘eff ectiveness’ of health services is complex in nature as it can be diffi cult to measure, with SALLY COLEMAN diff erent stakeholders having diff erent interpretations of what Contraceptive and sexual health nurse, Doncaster Community makes a service eff ective. This study refl ects that complexity. Integrated Services, Rotherham Doncaster and South Humber There is a growing call from policy and research for services NHS Foundation Trust to adapt themselves to support young people seeking sexual healthcare. Interventions are expected to include behaviour change REFERENCES and health promotion activities, which address other determinants Aslam RW, Hendry M, Carter B, Noyes J, Rycroft Malone J, Booth A, Pasterfi eld D, Charles JM, Craine N, Tudor Edwards R, Ives Ntambwe L, Williams N, Whitaker R. (2015) Interventions for preventing of ill health, such as smoking, drug use, and alcohol abuse (Slater and unintended repeat pregnancies among adolescents. Cochrane Database Syst Rev 1: CD011477. Robinson, 2014). Although P2P is about reducing rates of unintended Azevedo WF, Diniz MB, Fonseca ESVB, Azevedo LMR, Evangelista CB. (2015) Complications in conceptions, the ongoing support provided to those less likely to adolescent pregnancy: systematic review of the literature. Einstein (São Paulo) 13(4): 618-26. engage with sexual health professionals indicates a service that is Department of Health. (2013) A framework for sexual health improvement in England. See: gov.uk/ government/publications/a-framework-for-sexual-health-improvement-in-england (accessed adapting itself to support young people in a broader sense. 12 December 2017). There are some limitations of the study, such as omitting to seek Family Planning Association. (2016) UK has highest teenage birth rates in Western Europe. See: fpa. the views of professionals who did not refer into the service. They org.uk/news/uk-has-highest-teenage-birth-rates-western-europe (accessed 12 December 2017). Hadley A, Evans D. (2013) Teenage pregnancy and sexual health. See: nursingtimes.net/ could have highlighted gaps in the reach of P2P. Nevertheless, Journals/2013/11/15/w/y/m/Teenage-pregnancy--and-sexual-health-201113.pdf (accessed the study has shown that P2P provides a fl exible enablement 12 December 2017). approach to service delivery, which in turn facilitates positive Hayter M, Jones C, Owen J, Harrison C. (2016) A qualitative evaluation of home-based contraceptive and sexual healthcare for teenage mothers. Primary Health Care Research & engagement through reducing barriers to a young person’s Development 17(3): 287-97. Local Government Association. (2013) Tackling teenage pregnancy: local government’s new public health role. See: cdn.basw.co.uk/upload/basw_104235-7.pdf (accessed 12 December 2017). NICE. (2007) Prevention of sexually transmitted infections and under-18 conceptions: prevention. See: nice.org.uk/guidance/ph3 (accessed 12 December 2017). Regmi K. (2012) Eff ective health services: perspectives and perceptions of health service users and healthcare practitioners. Primary Healthcare: Open Access 2: 117. Rowlands S. (2010) Social predictors of repeat adolescent pregnancy and focused strategies. Best Practice and Research. Clinical Obstetrics and Gynaecology 24(5): 605-16. Slater C, Robinson AJ. (2014) Sexual health in adolescents. Clinics in Dermatology 32(2): 189-95. Teenage Pregnancy Independent Advisory Group. (2010) Teenage pregnancy: you can make a real of births among under-18s diff erence to teenage pregnancy. See: fpa.org.uk/sites/default/fi les/teenage-pregnancy-briefi ng. are repeat pregnancies pdf (accessed 12 December 2017). Viner RM, Ozer EM, Denny S, Marmont M, Resnick M, Fatusi A, Currie C. (2012) Adolescence and (Aslam et al, 2015; TPIAG, 2010) the social determinants of health. The Lancet 379(9826): 1641-52.
To view the full version of this research paper, entitled Preventing teenage pregnancy through home-based sexual healthcare: a qualitative study of practitioners’ experiences, go to bit.ly/CP_research_jones
46 Community Practitioner December/January 2018
44-46 Research Paper.indd 46 21/12/2017 09:54 THE BIG STORY YOUR JOURNAL NEEDS YOU Why not help shape the direction of the journal by contributingcontributing to thehe content or suggestingsuggesting some ideas?
he heart of Community Practitioner is all about you – refl ecting your life and work as healthcare professionals. We’re always striving to produce the bestT journal for you – and here’s where you can help make it even better. We would love to receive your feature ideas, written stories and research papers for future publication. Perhaps you’ve been working on a research paper you’d love to see published? Or you’re passionate about a subject you’d like to write about? And if you’ve had an experience or insight you feel would make an informative read and you don’t want to write about it yourself – you could simply tell us about it. In short, Community Practitioner needs your input! We’re always on the look-out for interesting, incisive and relevant material. Examples of what we’re looking for include: ● Research papers – recent topics published in the journal include the increase in childhood obesity, and health visiting in honour-based communities ● Standalone features or ideas – stories published recently include how to make the transition from student health visitor to practitioner; improving breastfeeding rates; health professionals and the digital revolution ● Feedback – items on professional events and insider information. If any of these are appealing to you, please don’t hesitate to get in touch.
Send your research papers, features and ideas to the deputy editor, Aviva Attias, at [email protected] and you could see your work and/or ideas in the refreshed journal in 2018 or beyond.
December/January 2018 Community Practitioner 47
7 in se ad call c n en .indd 7 21/12/2017 0 :5 LAST WORD
n the past few years, resilience has PERSONAL become a widely used term. People have been talking about the resilience of organisations, the resilience of transport systems and the resilience of I individual people or groups of people. This article focuses specifi cally on RESILIENCE personal resilience. foremost, compromised wellbeing is Dictionary defi nitions of resilience Professor Ivan likely to lead to physical health problems. usually refer to the capacity to recover Robertson explains the Extensive research evidence, based on quickly from diffi culties or the ability to well-designed longitudinal studies, reveals bounce back. Recovery is an important importance of resilience that lower psychological wellbeing is aspect but doesn’t really cover the full for health, work and linked to cardiovascular risk, obesity, extent of personal resilience. I believe diabetes and immune system functioning. there are two major components. sustaining performance Importantly, it is also the case that better First, resilience protects psychological under pressure. levels of psychological wellbeing provide health and wellbeing. In other words, protection against developing physical being resilient enables people to stay health problems. In fact, there is evidence psychologically positive and healthy that positive psychological wellbeing in the face of signifi cant challenge and protects against cardiovascular disease over adversity. The second aspect of resilience and above typical cardiovascular risk factors is more behavioural than psychological, such as lack of exercise or poor diet (Boehm and enables people to retain a focus on and Kubzansky, 2012). what is important and to cope eff ectively As well as being linked to physical health, with challenges, including recovery from psychological wellbeing is also linked to trauma or intense negative experiences. behaviour and work performance. There It’s important to recognise that is clear evidence that people with higher whether someone can behave resiliently levels of psychological wellbeing behave or not will also depend on the type of diff erently, for example responding better challenge they are faced with. In other to unfavourable feedback and showing words, people may cope well with some greater fl exibility and originality (see box). things but fi nd it diffi cult to retain their In light of these behavioural diff erences, it wellbeing and behave eff ectively when is perhaps unsurprising that psychological faced with a diff erent challenge. So it’s wellbeing is also linked with productivity best not to ask if someone is resilient or and performance at work. People with not but to ask: ‘Resilient for what?’ Of higher levels of psychological wellbeing course, some people are resilient to a are judged to be more productive with wider range of challenges than others. higher levels of performance, according to themselves, peers and supervisors (see Ford et al, 2011). The positive emotions that are associated with higher psychological wellbeing are also CONSEQUENCES OF LOW important and help individuals to build and broaden their range of psychological resources, PSYCHOLOGICAL WELLBEING enabling them to cope better with work pressure and challenges (see chart, right). As noted, resilience protects psychological wellbeing, and it follows DEVELOPING RESILIENCE that low personal resilience, or resilience What all of this shows is that protecting psychological wellbeing is important for both to a narrow range of challenges, is likely health and work performance. As resilience protects wellbeing and supports eff ective to be linked to low levels of psychological behaviour, how people develop resilience becomes an important question. It is clear that wellbeing. Even a very brief review of life experiences have an infl uence on resilience levels. For example, research has revealed the research on the consequences of that people who have had to deal with signifi cant adversity in their childhood develop poor psychological wellbeing shows good resilience. There is also evidence from occupational areas to show that dealing with how damaging this can be. First and challenging situations can help to develop resilience, but there is an important caveat here.
48 Community Practitioner December/January 2018
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PEOPLE HIGHER ON PSYCHOLOGICAL WELLBEING
The adversity needs of psychological ● Professor Ivan Robertson is co-founder, ● Show greater fl exibility to be challenging, but health and wellbeing; with Cary Cooper, of Robertson Cooper. and originality not so much that the otherwise, any The company provides psychological ● Respond better to person feels unable benefi cial eff ect is wellbeing and engagement solutions to unfavourable feedback to cope with it. When likely to be short- organisations, and its goal is to help as ● Observe safety behaviour things become too lived, or even many people as possible to have a good rules more eff ectively much, there is likely to completely ineff ective. day at work. Ivan was professor of work ● Make more positive be damage to resilience Formal training is and organisational psychology at the judgements about others and psychological not the only, or maybe University of Manchester Institute of ● Are less distracted from work wellbeing, rather even the best, way to Science and Technology for more than tasks due to psychosomatic than enhancement. improve resilience. 20 years, and is now emeritus professor. complaints On the positive side, Being exposed ● Are more productive anyone has the capacity to challenging ● Are likely to live longer, REFERENCES to strengthen their experiences can help be sick less often and Boehm JK, Kubzansky LD. (2012) The heart’s content: the resilience. For instance: people to develop association between positive psychological wellbeing and have a happier work and ● Aim to take regular psychological cardiovascular health. Psychological Bulletin 138(4): 655-91. home life. Ford MT, Cerasoli CP, Higgins JA, Decesare AL. (2011) resources and provides exercise, it’s good for Relationships between psychological, physical, and (Lyubomirsky et al, 2005) psychological as well a sense of achievement behavioural health and work performance: a review and as physical wellbeing and self-effi cacy. So as meta-analysis. Work & Stress 25(3): 185-204. Gilbreath B, Benson PG. (2004) The contribution of supervisor ● Ensure you get long as you feel able to behaviour to employee psychological well-being. Work & Stress enough respite – a break from work cope, taking on a tough challenge, is likely to 18(3): 255-66. – even if you love what you do help grow your resilience. Lyubomirsky S, King L, Diener E. (2005) The benefi ts of frequent positive aff ect: does happiness lead to success? Psychological ● Try to remember why what you do is Maybe getting through the festive season Bulletin 131(6): 803-55. important and matters to other people and being sweetness and light to all friends Robertson IT, Cooper CL, Sarkar M, Curran T. (2015) Resilience ● Try Robertson Cooper’s online i-resilience and family would be a good challenge at this training in the workplace from 2003 to 2014: a systematic review. Journal of Occupational and Organizational Psychology questionnaire and get a free personal time of year! CP 88(3): 533-62. report (robertsoncooper.com/iresilience). Resilience training has become an increasingly popular option for EXPERIENCE OF POSITIVE EMOTIONS AT WORK AND PRODUCTIVITY organisations, and many employees have now experienced some form of resilience training. A recent study of resilience training 100% at work has provided evidence that resilience training helps to build psychological 95%
resources, especially in aspects of mental 90% health (Robertson et al, 2014). But resilience training is not always 85% the best option, especially when senior 80% leaders and managers in an organisation 75% do not recognise the value of psychological wellbeing. Managers have an impact 70% PRODUCTIVITY on psychological wellbeing even when 65% controlling for ‘age, health practices, support 60% from other people at work, support from home, stressful life events and stressful work 55%
events’ (Gilbreath and Benson, 2004). Before 50% embarking on a programme of resilience VERY SLIGHTLY A LITTLE MODERATELY QUITE A BIT VERY MUCH OR NOT AT ALL training, it is important to ensure that the PRODUCTIVITY 63.6% 75% 83% 89.1% 93% culture, work design and management practices of the organisation are supportive
December/January 2018 Community Practitioner 49
48-49 LAST WORD.indd 49 21/12/2017 09:55 Recruitment & Courses TO ADVERTISE COMMUNITY PRACTITIONER CONTACT: 020 7880 7621 e [email protected] communitypractitioner.co.uk | unitetheunion.org/cphva
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Available in most retail and pharmacy outlets
For Healthcare Professional use only Healthcare Professional Helpline 0800 996 1234 www.eln.nutricia.co.uk
* National Institute for Health and Care Excellence REFERENCES: 1. Vandenplas Y et al. J Pediatr Gastroenterol Nutr 2015;61(5):531–537. 2. Wenzl TG et al. Pediatrics 2003;111:e355-9. 3. Danone Research (data on fi le). † Important Notice: Breastfeeding is best for babies. Breast milk provides babies with the best source of nourishment. Infant formula milk and follow on milks are intended to be used when babies cannot be breast fed. The decision to discontinue breast feeding may be diffi cult to reverse and the introduction of partial bottle-feeding may reduce breast milk supply. The fi nancial benefi ts of breast feeding should be considered before bottle feeding is initiated. Failure to follow preparation instructions carefully may be harmful to a babies health. Infant formula and follow up milks should be used only on the advice of a healthcare professional. Cow & Gate anti-refl ux is a food for special medical purposes for the dietary management of refl ux and regurgitation. It should only be used under medical supervision, after full consideration of the feeding options available including breastfeeding. Suitable for use as the sole source of nutrition for infants from birth, and as part of a balanced diet from 6-12 months. Date of preparation June 2017
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