THE JOURNAL OF THE COMMUNITY PRACTITIONERS’ AND HEALTH VISITORS’ ASSOCIATION
FEBRUARY 2018
COMMUNITYPRACTITIONER.CO.UK
How to bring this vital public health role back from the brink
+ ASTHMA ATTACKS CLAMPING DOWN ON COMPLACENCY
MORE MEN, PLEASE WHY ARE THERE SO FEW MALE CPs?
SEXUAL ORIENTATION PROMOTING LGBT HEALTHCARE EQUALITY
01 r.indd 1 30/01/2018 18:21 COMMUNITY PRACTITIONER 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. W . 2018.indd 2 2 /01/2018 13:31 CONTENTS February 2018 | Vol 91 | No 01
30 COVER STORY 22
Asthma matters – let’s help others take it more seriously
25
Male CPs are outnumbered, 36 but why? 40
It’s time to The impact of spread the monitoring sexual word on orientation data immunisations
NEWS 14 BIG STORY 19 VOICE OF A STUDENT 22 CLINICAL Bribed to breastfeed – Louise Henderson: I’m Asthma matters: it must 7 NEWS IN NUMBERS are financial rewards not a research nurse am I? be taken more seriously, Your at-a-glance guide the best way forward? says Dr Andy Whittamore 20 RIGHTS AT WORK 8 PUBLIC HEALTH LATEST OPINION Where will we be in 2027? 25 IMMUNISATION A look at what’s new Head of health Sarah Health visitors can 17 THE BIG QUESTION Carpenter says members positively promote 10 PROFESSIONAL UPDATE What are the main have a chance to be heard immunisation goals Your round-up of professional challenges professional news for the year ahead? PRACTICE 28 DR GOOGLE WILL SEE YOU NOW 12 GLOBAL RESEARCH 18 FEEDBACK 21 24 HOURS WITH… Does researching Recent findings from Art as medicine, and the Clare Stiles, child health symptoms online help
COVER: ISTOCK COVER: around the world CPHVA Executive update team leader in Shetland or harm patients?
3 COMMUNITY PRACTITIONER | FEBRUARY 2018
3-5 CONTENTS/EDITORIAL.indd 3 31/01/2018 12:02 COMMUNITY PRACTITIONER 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. W 04. 2018.indd 4 2 /01/2018 13:33 FEATURES
30 COVER STORY Is school nursing DNR? The WELCOME profession’s future is unclear, as services thrive in some from Emma, Aviva and Hollie areas and face scrapping or underfunding in others A very warm welcome to your refreshed and redesigned professional journal, 36 A FEW GOOD MEN from all on the editorial team. As well as the usual high-quality news, research, Are more male community professional advice and reports you’re used to reading, you’ll fi nd some exciting practitioners needed? Phil new additions, a refreshed look overall, and even a positive subtraction. Harris reports on how gender For instance, we now have a clearer news section that’s divided into public health conventions and a lack of and professional as well as research news. We have a brand new opinion section earning power has put men with contributions from student CPs on student life, the different professions on off from applying pressing issues, and leading practitioners offering a peek into their working lives. And while all the content informs your practice, we also have a new dedicated 40 INTRUSION OR INCLUSION? practice section which focuses on some of the more practical aspects. You’ll fi nd Monitoring and collecting references for all articles at communitypractitioner.co.uk, to allow for more content. sexual orientation data On to the subtraction, Community Practitioner is now the only journal for CPs that can enable unique LGBT does not accept breastmilk substitute product advertising. Discover more on this healthcare needs to be met and all the reasons why you will benefi t from sharing your expertise and work in this journal in Professional pause (page 48). RESEARCH Two of the big issues covered this month are on the state of school nursing in the UK (page 30), and on the lack of men in community nursing roles (page 36). 44 SUPPORTING ASYLUM-SEEKERS More than ever, please get in touch to let us know what you think of the articles What do health visitors need featuredfeatur and to suggestgg ideas for the future. Until next month... to know in dealing with asylum-seeker families? JOIN THE PROFESSIONAL PAUSE CONVERSATION
aviva@ 48 THE VALUE OF CP communitypractitioner.co.uk How Community Practitioner is
leading the way in informing, facebook.com/CommPrac educating and connecting members in CP professions twitt er.com/commprac
Non-member subscription rates Editorial team Printed by Warners Individual (UK) £135.45 Managing editor Emma Godfrey-Edwards © 2018 Community Practitioners’ and Individual (rest of world) £156.45 Deputy editor Aviva Attias Health Visitors’ Association Institution (UK) £156.45 [email protected] Institution (rest of world) £208.95 Assistant editor Hollie Ewers ISSN 1462-2815 Unite-CPHVA Subscription enquiries may be made to Content sub-editor James Hundleby The views expressed do not necessarily Existing Unite-CPHVA members with Community Practitioner subscriptions Professional editor Jillian Taylor represent those of the editor nor of queries relating to their membership Redactive Publishing Ltd Senior designer Nicholas Daley Unite-CPHVA. should contact 0845 850 4242 or see PO Box 35 Picture editor Chloe Crisford unitetheunion.org/contact_us.aspx for Robertsbridge TN32 5WN Advertising Paid advertisements in the journal do further details. 01580 883844 Sales executive Alex Edwards not imply endorsement of the products [email protected] or services advertised. To join Unite-CPHVA, see [email protected] unitetheunion.org The journal is published on behalf of 020 7324 2735 Unite-CPHVA by Redactive Media Group, Any Unite-CPHVA member wishing Production to change their address or contact Unite-CPHVA is based at 78 Chamber Street, London E1 8BL Production director Jane Easterman 128 Theobald’s Road London WC1X 8TN 020 7880 6200 details must get in touch with their 020 3371 2006 Unite health sector officers local Unite office. Editorial advisory board National officers Sarah Carpenter and Community Practitioner Obi Amadi Lucretia Baptiste Toity Deave Colenzo Jarrett-Thorpe Unite-CPHVA members receive the journal Barbara Evans Gavin Fergie Elaine Lead professional officers Obi Amadi free. Non-members and institutions may Haycock-Stuart Brenda Poulton and Jane Beach Gavin Fergie Dave Munday subscribe to receive it. Janet Taylor and Ethel Rodrigues
5 COMMUNITY PRACTITIONER | FEBRUARY 2018
3-5 CONTENTS/EDITORIAL.indd 5 31/01/2018 13:22 COMMUNITY The Journal of the Community Practitioners’ and Health Visitors’ Association NOVEMBER 2017 VOLUME 90 / PRACTITIONER NO. 11
O. 12 OLUME 90 / NNO. 12 n DEC/JANDEC/JAN 2018 VOLUMEV 90 /
f the Community Practitioners’ and Health Visitors’ Associatio The Journal ofo the Community Practitioners’ and Health Visitors’ Association Read by more health visitors than any other journal From a 16,500 circulation the journal Exploring the eff ect of parental confl ict on children reaches: Call to action 2017 TheTThhee hhihighlights of iggghhhliligghts of Sepsis warning thisthhisiss year’syyeeea conference aarrr’s’s ccoconference Raising awareness Cutting violence and helping carers communitypractitioner.co.ukcommunitypractition John Carnochan on 80 early intervention | unitetheunion.org/cphva · % of the UK’s health visitors 01 .indd 1 ALL BY · 75 of all UK school nurses MYSELF % Has loneliness become an epidemic? · 50% of all UK community nursery nurses Period poverty Staying strong Tackling the social The health divide Why resilience and fi nancial taboo Life expectancy remains is important a postcode lottery | unitetheunion.org/cphva Community Practitioner is an ideal communitypractitioner.co.uk 21/12/201 08: platform to promote your product, service or vacancy as it reaches highly CONTACT skilled professionals who constantly refer to the title for information and If you want to reach this valuable audience, please contact: advice. [email protected] or call 020 7324 2735
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0 . 2018.indd 30/01/2018 10:01 NEWS
NEWS IN NUMBERS
1450children in Northern Ireland will benefit from a mental health programme in schools thanks to a £70,000 funding boost from Danske Bank. Charity Action Mental Health can now deliver its Healthy Me programme, training 450 teachers and parents
Up to of sexually active 16- to 24-year-olds have had % sex with a new partner of35 five-year-olds living in without using a condom poverty in Wales are falling % behind their peers across a 22.9 range of key milestones such of pupils in their first year at school in as language skills and problem Scotland are over a healthy weight, IN solving, says a report by Save new NHS figures show the Children. And they may 1sexually active10 young never catch up with classmates people have never even It is a rise used a condom. The survey of almost %since 2007 of 2007 young people The report2 by ISD Scotland reveals a was carried out to marked gap between the most and launch PHE’s camp aign least deprived children ‘Protect against STIs’
The value of the contract won by Virgin Care to 50,000 provide children’s (0-19) healthcare services in (more than a quarter of) Lancashire for the next five years. The programme children under five in Wales are covers services such as school nurses and health living in poverty, measured as visitors. Currently carried out by the Lancashire households with an income of Care Trust (who could still appeal) the contract less than £9804 a year runs out at the end of March
Find links to relevant reports and surveys highlighted in the news stories at bit.ly/CP_news_in_numbers
7 COMMUNITY PRACTITIONER | FEBRUARY 2018
7 News In Numbers.indd 7 30/01/2018 18:23 NEWS
PUBLIC HEALTH LATEST KEY
CALL FOR SCHOOLS TO HELP CHILDREN MANAGE SOCIAL MEDIA Video
SCHOOLS SHOULD PLAY as they move from a larger role in preparing primary to secondary children for social media’s school, when more emotional demands as of their peers have Report they move into secondary their own phones, and school, England’s children’s social media becomes more commissioner says. important in their lives. Anne Longfield said she Longfield suggested was worried many pupils compulsory digital literacy became anxious about their and online resilience lessons Campaign identity and craved ‘likes’ for Year 6 and Year 7 pupils and comments for validation. to educate them about She made the remarks the ‘emotional side of following a study by the social media’. office of the children’s Parents should also Poll commissioner, Life in ‘likes’, prepare their children by examining social media use helping them ‘navigate the among children aged eight emotional rollercoaster’ to 12. of the negative aspects of Although most social social media. media platf orms have a Website minimum age limit of 13, the MANY PUPILS report said three-quarters CRAVED ‘LIKES’ of children aged 10 to 12 AND COMMENTS already had accounts. The report also describes FOR VALIDATION Read the children’s commissioner’s report Government at bit.ly/ENG_social_media the ‘cliff edge’ children face website
GAMING ADDICTION RECOGNISED AS A DISORDER BY WHO
ADDICTION TO PLAYING COMPUTER new digital recurrent gaming behaviour so severe games will be listed as a mental addiction cases that it takes ‘precedence over other health condition for the first time by seen each year by life interests’. the WHO. Dr Richard Graham Symptoms include impaired control WHO’s 11th International classification 50 over gaming, increased priority given of diseases will include the condition to gaming, and escalating or continuing ‘gaming disorder’ when it is published gaming despite negative consequences. later this year. Dr Richard Graham, lead technology The draft document describes the addiction specialist at the Nightingale condition as a patt ern of persistent or Hospital in London, said he saw about 50 new cases of digital addiction each year.
For more information, visit bit.ly/WHO_gaming ISTOCK
8 COMMUNITY PRACTITIONER | FEBRUARY 2018
8 w i th.indd 8 31/01/2018 12:03 NEWS
MORE THAN 99% OF NEWBORNS UNDERGO BLOODSPOT SCREENING
THE FIRST ANNUAL REPORT FROM screening at PHW, said: ‘I am very pleased to LEGISLATION TO Newborn Bloodspot Screening Wales see that over 99% of babies in Wales have PROTECT MUMS shows 99.6% newborn babies were tested been screened for these potentially very WHO BREASTFEED in 2016-17. serious illnesses. The screening programme, managed by ‘Newborn bloodspot screening is carried NEW LAWS TO PROTECT Public Health Wales (PHW), sees babies at day out five to eight days aft er a baby’s birth. The mothers who breastf eed in five tested for 10 rare but potentially serious sample is usually taken by the midwife in the public are to be brought conditions including congenital hypothyroidism, home, or while the baby is in hospital. forward in Northern Ireland. cystic fibrosis and sickle cell disorders. ‘The midwife will take a small sample of blood The intention to introduce The new report shows that 33,505 babies from the baby’s heel which is sent for testing.’ the legislation was set out in were tested and 39 serious conditions identified the Department of Health between 1 April 2016 and 31 March 2017. Read the annual report breastf eeding strategy in at bit.ly/WAL_bloodspot Ruth Lawler, head of maternal and child 2013, Breastf eeding – a great start: a strategy for Northern Ireland (2013-23). However, health minister Michelle O’Neill announced in January her intention to ‘do it as quickly as possible’. She said: ‘It will ensure that breast- and bott le-feeding mothers are given equal access to feed their children 33,505 with confidence and without interruption in a public place.’ Laws protecting babies were tested and 39 breastf eeding are already in place across Great Britain serious conditions identifi ed and the Republic of Ireland. Breastf eeding rates in Northern Ireland are the lowest in the UK. NEW CAMPAIGN TO CUT UNHEALTHY SNACKING
‘TAKE CONTROL OF YOUR CHILDREN’S SNACKING’: THIS IS THE message of the new Change4Life campaign from Public Health England (PHE). The campaign encourages parents to look for 100-calorie snacks and give children a maximum of two a day. PHE figures show that half of children’s sugar intake comes from unhealthy snacks and sugary drinks. On average, children are consuming at least three unhealthy snacks and sugary drinks a day. The result is that they consume three times more sugar than is recommended. The ‘100-calorie snacks, two a day max’ tip applies to all snacks apart from fruit and vegetables – which children should be encouraged to eat.
For more information, visit bit.ly/ENG_change4life See the original strategy at bit.ly/NI_ breastf eeding_strategy
9 COMMUNITY PRACTITIONER | FEBRUARY 2018
8 w i th.indd 31/01/2018 12:03 NEWS
PROFESSIONAL UPDATE
‘MSPs voted to block a bill designed to fi x the scheme’
GOVERNMENT INVESTS IN FRONTLINE NURSES SET TO NAMED PERSON BILL STAFF TRAINING BREAK PAY CAP IN TROUBLE AGAIN
THE NUMBER OF NURSE NURSES WORKING IN CONTROVERSIAL PLANS training places available Scotland will see their to appoint a Named in Wales next year will go up by 10%. pay increase by 2% or 3% in April. Person for every child in Scotland The Welsh Government said In his draft budget plans have run aground again, more than a newly announced £107m funding for 2018-19, finance secretary 18 months aft er they should have for healthcare professionals Derek Mackay revealed that been rolled out. represents an increase of £12m the 1% public sector cap will be The proposal – which would see over last year’s package. lift ed. Workers earning less than health visitors among those assigned The funding will allow more £30,000 a year will get a pay rise to children as a Named Person to act than 3500 new students to join of 3%, while those earning more as a conduit to services and support healthcare education programmes. than £30,000 will receive a – first hit the rocks in July, when the Nurse training places will rise by 161 2% increase. Supreme Court ruled elements of the to 1911 across Wales, and there will The budget document also scheme were unlawful. be additional training places for states the government’s intention In December, MSPs voted to block health visitors. to train 500 more health visitors, a bill designed to fix the scheme. Health secretary Vaughan and Scotland will also maintain free The education committ ee has said Gethin said: ‘The austerity policy university tuition for nursing and it will not support the scheme until pursued by the UK Government midwifery students. details of the rules set to be issued has significantly impacted our Derek Mackay said: ‘This to teachers, health visitors and other budget, and in those circumstances budget sets out how we will use Named Persons are published. training is oft en one of the first the devolved powers of our The move will delay the policy casualties. But this is a short-sighted parliament to mitigate further cuts for at least another nine months approach. Instead we are actually and to deliver a strong, dynamic because, according to parliamentary increasing investment in training, economy supported by investment rules, a law cannot proceed at despite the budget cuts, in order to in public services, education, Holyrood until the lead committ ee secure the long-term future of the business, infrastructure and reports that it agrees the general health service.’ tackling inequality.’ principles of the bill.
Read the full announcement at Read more on the draft budget For more on the scheme, go to bit.ly/WAL_funding at bit.ly/SCT_budget bit.ly/SCT_NPs ISTOCK
10 COMMUNITY PRACTITIONER | FEBRUARY 2018
10 11 r i n w .indd 10 30/01/2018 18:24 NEWS
1% £3.21bn BETTER LATE THAN NEW QUALITY RATINGS CUTS TO PUBLIC NEVER: NHS PAY RISE FOR INDEPENDENT HEALTH BUDGETS ARE FINALLY ARRIVES HEALTH VISITORS ‘SHORT-SIGHTED’
NURSES AND OTHER NHS INDEPENDENT HEALTH COUNCIL LEADERS health and social care staff visitors are to be given have called fresh cuts in Northern Ireland are to finally receive performance ratings by the Care to public health grant funding the 1% pay rise due to them for 2017-18. Quality Commission (CQC) aft er the ‘extremely counterproductive’ The uplift was recommended by the government extended its powers to and ‘short-sighted’. NHS Pay Review Body last year, but rate even more services. Publication of public health was delayed in the absence of a The move, announced by the allocations to local authorities in Northern Ireland public sector pay Department of Health, will bring England in 2018-19 and the indicative policy for 2017-18. all independent community health allocations for the following year The Department of Health said the services – including health visitor show further year-on-year cuts sett ing of that policy has now cleared services, vaccination clinics, – amounting to a £531m cut from the way for pay rises for more than community nursing and independent councils’ public health grant funding 55,000 health and social care workers doctors – within the scope of the between 2015-16 and 2019-20. in Northern Ireland. CQC’s ratings scheme. The total public health grant for The backdated pay award should The CQC already inspects and 2018-19 will be £3.21bn, which is down be fully implemented by the end of publishes reports on these services, from £3.30bn this year – a reduction the financial year. but this will be the first time it gives of 2.6%. The indicative total for the them a rating in the same way as grant in 2019-20 will be £3.13bn – NHS trusts, for example, which are also a 2.6% reduction. THE POLICY HAS CLEARED rated ‘outstanding’, ‘good’, ‘requires Izzi Seccombe, chairman of the THE WAY FOR PAY RISES improvement’ or ‘inadequate’. Local Government Association’s FOR MORE THAN 55,000 CQC chief executive Sir David community wellbeing board said: Behan said: ‘The CQC already ‘This is short-sighted and will HEALTH AND SOCIAL inspects and publishes reports for undermine the objectives we all CARE WORKERS these additional services. The ability share to improve the public’s health to award ratings to them will bring and to keep the pressure off the NHS increased transparency for the public.’ and adult social care.’
Read more at Find out more at See public health allocations at bit.ly/NI_pay_rise bit.ly/ENG_CQC bit.ly/ENG_allocations
11 COMMUNITY PRACTITIONER | FEBRUARY 2018
10 11 r i n w .indd 11 31/01/2018 12:04 NEWS
For more information on these studies, visit GLOBAL RESEARCH the bit.ly links
USA CHILDREN PLAY BETTER WITH FEWER TOYS Children play for longer and more creatively when they have fewer toys, a new study suggests. Researchers at the University of Toledo, Ohio, observed 36 toddlers playing for 30 minutes with either four or 16 toys. They found that the children with fewer toys played with each for twice as long, thinking up more uses for each toy. The study, published in Infant Behavior and Development, suggests that parents can encourage creativity and improve att ention spans by packing away most toys and rotating a small number regularly.
bit.ly/IBD_toys
USA EATING FISH EVERY WEEK LINKED TO BETTER SLEEP AND A HIGHER IQ Children who eat fish at least once a week sleep bett er and have higher IQ scores on average than those who eat litt le or no fish. The findings from the University of Pennsylvania, published in Scientific Reports, a Nature journal, followed a study of 541 children in China aged nine to 11. The team found that children who reported eating fish weekly scored 4.8 points higher in IQ exams than those who did so ‘seldom’ or ‘never’. Those who ate fish ‘sometimes’ scored 3.3 UK points higher. In addition, eating more fish FINGER FOODS FROM SIX MONTHS was associated with fewer sleep disturbances. ‘DO NOT INCREASE CHOKING RISK’ Professor Jennifer Pinto-Martin, of Lett ing babies feed themselves solid foods from as young as six months the university’s Center for Public Health does not increase the risk of choking, a new study suggests. Initiatives, said the Researchers at Swansea University found that, among 1151 mothers of health benefits of babies aged between four and 12 months, there was no difference in fish should be more the reported frequency of choking between babies allowed to wean heavily promoted themselves and those who were mainly spoon-fed. and children should The study, published in the Journal of Human Nutrition and be introduced to fish Dietetics, supports the Department of Health by the age of two. recommendation that babies can have finger bit.ly/SR_fish foods from six months old. bit.ly/JHND_choking
12 COMMUNITY PRACTITIONER | FEBRUARY 2018
12-13 Research News.indd 12 31/01/2018 12:04 NEWS
UK FINLAND ONE IN SIX PARENTS ALLOW RESEARCHERS FIND STRANGE PATTERNS OF CHILDREN ALCOHOL AT 14 TYPE 1 DIABETES AND ASTHMA IN CHILDREN One in six UK parents have let their children drink Children with asthma are more likely to develop type 1 diabetes; alcohol by the age of 14, a new study shows. but asthma develops less frequently in children with existing type 1 Researchers from the UCL Institute of Education diabetes, suggesting a complex link between the diseases. and Pennsylvania State University looked at data According to a study published in the International Journal of from more than 10,000 UK children born at Epidemiology, a nationwide review of children born in Finland the turn of the century as part of the Millennium between 1981 and 2008 showed that prior diagnosis of asthma Cohort Study. was linked with a 41% increase in the subsequent risk of type 1 They found that employed, white, bett er- diabetes. But prior diagnosis of type 1 diabetes decreased the educated parents who drank alcohol themselves risk of developing asthma by 18%. were more likely to allow their adolescent children to drink than unemployed parents, those with bit.ly/IJE_asthma fewer educational qualifications and ethnic minority parents. Those who abstained tended not to allow their children to drink; but among those who did, heavy drinkers were no more likely to let their children drink than light or moderate drinkers.
bit.ly/UCL_alcohol
UK AIR POLLUTION HARMS UNBORN BABIES Air pollution from road traffic is linked to an increased risk of low birthweight babies, says a study led by Imperial AUSTRALIA College London. PROBIOTIC’S POTENTIAL Increases in traffic-related air TO HELP BABIES WITH COLIC pollutants were associated with 2% to 6% Researchers have found evidence to increased odds of low birthweight and support the use of a probiotic in babies a 1% to 3% increase in the likelihood of with colic or excessive crying. being small for gestational age. The Murdoch Children’s Research Institute, The research, published in The BMJ, in collaboration with 11 other institutions, found that looked at 540,000 single, full-term births the probiotic Lactobacillus reuteri has the potential in Greater London between 2006 and to provide some reduction in crying in exclusively 2010, taking into account the mother’s breastf ed babies less than three months old. home address at time of birth and traffic- The research, published in Pediatrics, combined related pollution levels. raw data from four placebo-controlled trials using bit.ly/BMJ_pollution L. reuteri from Italy, Poland, Canada and Australia. Researchers found that, compared with a placebo group, the probiotic group was twice as likely to reduce crying by half by the 21st day of treatment in babies who were exclusively breastf ed.
bit.ly/PED_colic
13 COMMUNITY PRACTITIONER | FEBRUARY 2018
12-13 Research News.indd 13 30/01/2018 18:25 NEWS
BIG STORY BRIBED TO BREASTFEED? A study has shown that offering financial rewards can encourage new mums to breastf eed, but is this the right way reports. forward? Journalist Juliett e Astrup
reastfeeding rates with education and support programmes visitors. Th e intervention group in the UK are having varied success. was also offered shopping vouchers persistently among So it’s clear to see why another worth up to £120 if babies received the lowest in the approach was assessed. Financial breastmilk – either by breastfeeding B world (Unicef, 2016). incentives have long been used in the UK or with expressed milk – at two days, While the number of women to encourage health-related behaviour 10 days and six weeks old. A further starting to breastfeed has been change such as smoking cessation and £80 of vouchers were given if babies increasing – 81% of babies across weight loss. But when a pioneering study continued to receive breastmilk at up the UK are breastfed at birth adopted this approach for breastfeeding, to six months. (McAndrew et al, 2012) – there it proved another controversial element in Th e scheme was tested in areas are large social and demographic a highly emotive area. with low breastfeeding rates, where variations, and a rapid drop-off in just 28% of babies were receiving any numbers across the board. ONE STUDY ESTIMATED THE NOSH breastmilk at six to eight weeks. In all, By six weeks, just over half of AN ANNUAL SAVING TO STUDY 46% of all eligible mothers signed up babies (55%) are receiving breastmilk Behind the to the scheme and over 40% claimed (McAndrew et al, 2012), and that falls THE NHS OF AT LEAST headlines on at least one voucher for breastfeeding to 34% by six months – compared £40M IF MORE MOTHERS ‘bribing mums (Relton et al, 2017). with 49% in the US and 71% in BREASTFED FOR LONGER to breastfeed’ Th e trial fi ndings, published in Norway (Unicef, 2016). was a major piece JAMA Pediatrics, report the mean And only around 1% of UK babies POKHREL ET AL, 2014 of research, led breastfeeding prevalence at six to are exclusively breastfed until by academics at eight weeks was 38% in members six months, as recommended by the University of of the intervention group compared WHO, Unicef and the UK health Sheffi eld and the University of Dundee. with 32% in the control group – six departments (Unicef, 2016). Th e Nourishing Start for Health percentage points or 20% higher. Th e health benefi ts of breastfeeding (NOSH) study involved more than 10,000 What the authors called a ‘modest to both babies and mothers are new mothers across South Yorkshire, but signifi cantly greater prevalence’ of course well documented – Derbyshire and Nottinghamshire. suggested fi nancial incentives could and have massive public health Participants were divided into two improve breastfeeding rates in areas implications. Despite the evidence, groups by randomising electoral ward with a low baseline prevalence our breastfeeding rates have been areas. Th e control group received standard (Relton et al, 2017).
notoriously diffi cult to improve, care and advice from midwives and health Th e study’s co-author Mary ISTOCK
14 COMMUNITY PRACTITIONER | FEBRUARY 2018
14 1 t r .indd 14 31/01/2018 12:0 NEWS
Renfrew, professor of mother and infant health at She says women need ‘a lot of UK and devolved governments. the University of Dundee, says the incentive scheme mentorship and a lot of encouragement It appeals for four key actions – a had been designed with women and staff to ensure it was on a one-to-one basis’. national strategy, policy measures, feasible and appropriate, and that breastfeeding support ‘I know from the audits I do with evidence-based initiatives in the services were widely available in all the areas where the women, when I ask them what health service, and compliance with trial took place. made a difference, what comes restrictions on formula advertising ‘Th is is the fi rst large-scale study to show an increase through over and over was that a – to create a supportive, enabling in breastfeeding in communities where rates have been health visitor came and stayed with environment for women who want to low for generations, and where it can be particularly them, really encouraging them, and breastfeed (Unicef, 2016). diffi cult for women to breastfeed without strong family reminding them of all the benefi ts of Francesca Entwistle, professional and community support because of strong societal breastfeeding,’ she adds. adviser, Unicef UK Baby Friendly barriers,’ she adds. Initiative, says: ‘Valuing women, Critics of the study pointed out that the scheme was DEEP-ROOTED CHANGE valuing breastfeeding and babies open to abuse – a limitation the authors were aware Gavin Fergie, lead receiving breastmilk, of. Others said it unfairly penalised mothers who were professional offi cer MULTILAYERED, whatever shape unable to breastfeed or who chose not to. Th ere were also within the health SUSTAINABLE that takes, is a those who questioned the use of fi nite resources on an sector at Unite the positive thing. incentivisation scheme, rather than investing in education Union, also refl ects SERVICES, ‘Th is is just or support programmes. on the bigger picture. PLUS ONGOING one study, but it ‘We need to make it SUPPORT, ARE saw an increase VALUING BREASTFEEDING completely normal in breastfeeding However, principal investigator Dr Clare Relton, from that a woman NEEDED TO HELP over a very short the University of Sheffi eld’s School of Health and Related can choose to put MOTHERS MAKE AN space of time with Research, says the vouchers were ‘a way of acknowledging her child to her INFORMED CHOICE limited resources. the value of breastfeeding to babies and mothers and the breast, and not feel ‘But there is work involved in breastfeeding’. embarrassed or a bigger issue And that concept is crucial, believes Helen Gray, one stigmatised,’ he adds. here, about the of the coordinators of the World Breastfeeding Trends ‘And that involves robust legislation to culture within the UK and how the Initiative UK Working Group. ‘Society simply doesn’t value ensure all women’s rights are protected, government is getting behind local breastfeeding and in some circumstances people feel it has empowering women to feel more services, and how society is getting negative connotations,’ she says. comfortable, and we defi nitely need behind and supporting women.’ ‘Th is was a way to redress that – to say society does value more appropriately qualifi ed staff to She says a ‘strategic approach’ this. It was a little token of appreciation, not in the bribery support women and the families around with national leadership is needed to sense, but as something of tangible worth that other people them to continue breastfeeding.’ change the cultural landscape of the can relate to in their community.’ His words refl ect Unicef’s UK from a ‘bottle-feeding country to Chair of the CPHVA Executive committee Janet Taylor breastfeeding ‘Call to Action’ to a breastfeeding country’. says anything that ‘gets women who wouldn’t have otherwise considered it to start breastfeeding’ is a good thing. For full references, visit bit.ly/CP_news_big_story But it takes ‘multilayered and sustainable services’ to help mothers make an informed choice about feeding their baby – and then ‘provide them with ongoing The NOSH research in numbers support’, she adds. Janet is also nurse manager of children’s services at South Eastern At the start, Over 40% Health and Social Care Trust in of mothers Northern Ireland, where she is a Unicef Baby Friendly Initiative lead. She says: ‘You have to look at the bigger picture, and when you have down-banding and cuts to the number of health visitors, how are £ 6 you going to have those qualifi ed, 28% percentage point rise experienced staff to do the additional of babies were receiving claimed at least one in breastfeeding
visits that breastfeeding requires?’ breastmilk at 6 to 8 weeks voucher for breastfeeding in intervention group Relton et al, 2017
15 COMMUNITY PRACTITIONER | FEBRUARY 2018
14-15 BIG story.indd 15 30/01/2018 18:26 1 . 2018.indd 1 2 /01/2018 13:3 OPINION
THIS MONTH WE ASK THE BIG What are the main challenges you foresee in your profession QUESTI? N during the coming year?
MICHELLE MOSELEY MARGARET BUNTING STELLA MANN Programme manager for SCPHN Lead nurse for school nursing, Community nursery nurse, (health visiting), Cardiff University Southern Health and Social Dorset HealthCare and CPHVA and Wales chair, CPHVA Executive Care Trust Executive member
he last year started as ow is an has seen I a school N important year T continued nurse (SN) in for the NHS cuts to the health October 1992. Over the and we need to look at visiting service, last 25 years, school the changing workforce. especially in England. nursing has changed In particular, the role We are already seeing considerably. It has and challenges of the the impact on children’s moved from a position community nursery health and wellbeing (RCPCH, 2018). of being the ‘handmaid’ to the clinical nurse (CNN). In some parts of England, Health visitors (HVs) need to remain medical offi cer to one of autonomy skill mix teams have already been lost. In positive and passionate about their role and leadership. Unfortunately despite others, CNNs have been down-banded. – diffi cult, I know in such trying times. these advances, public health nursing We also have areas where CNNs are being Th e health visiting service in Wales is is under severe pressure to deliver the asked to work above the scope of their job a little brighter but comes with issues. core universal services to school-aged description – a lot of the time this work is Fortunately, we have a government who children. Currently there is a shortage of being completed by the CNN as they fear value our service. However, HV capacity SNs in Northern Ireland. job losses if they don’t comply. Th is may and service provision is challenged to There needs to be investment in the lead to unsafe practice. deliver the key contacts recommended training and employment of SNs to For clients and colleagues across via the Healthy Child Wales programme deliver on the full Healthy Child, Healthy all four UK countries, the variety of (Welsh Government, 2016). With rising Future programme and to infl uence and staff they come into contact with is workloads, a retiring workforce and affect change with the current health proving complicated due to the variety evidence highlighting the impact of crises of obesity and poor mental and of job titles. As we are working more adverse childhood experiences (Public emotional health among our children. collaboratively with staff from local Health Wales, 2018; 2015), the need for A policy response for Northern authorities, children’s centres and so greater numbers of HVs has never been Ireland to the State of child health report on, we need to be able to distinguish the more apparent. We need to remember 2017 (RCPCH, 2017) states that early work that the CNN completes as part of why we ‘love’ health visiting, what intervention and prevention can reduce the HV/SN team from that of the children brought us into it, and our HV principles. and resolve issues before they become centre worker. Plus how we can all jointly infl uence more diffi cult and expensive to treat later Th e other challenge to the CNN is policy and advocate for children and on. School nursing plays a proactive role the role of the nurse associate. Once families who require early intervention. in early identifi cation and prevention qualifi ed,the nurse associate will be on Let us think about developing resilience and additional investment in this service a Band 4 and they will be regulated. while keeping the children and families would offer invaluable long-term benefi ts. Will employers choose to recruit Band 4 we serve as our focus. HVs are key in Last July I had the privilege of attending regulated staff to work in an HV/SN team forming therapeutic relationships and the International School Nursing over Band 4 CNNs? With this in mind, working in partnership with families Conference. Sharing our experiences was the CNN expert reference group will be and agencies. I love our profession. Our great, but the main point I took away investigating the possibility of CNNs challenge is promoting it to enhance the was that we offer a very high standard of being regulated with a similar rationale to service. Challenge accepted. school nursing in Northern Ireland. that of the nurse associate.
17 COMMUNITY PRACTITIONER | FEBRUARY 2018
1 i .indd 1 31/01/2018 12:0 OPINION
UPDATE FROM THE CPHVA EXECUTIVE FEEDBACK ART AS This month, the committ ee explains Expert Reference MEDICINE Groups and how you How can the creative arts help our NHS? can get involved
Nicky Goulder from charity Create explains. THE CPHVA EXECUTIVE IS looking to re-establish and STUDIES HAVE SHOWN the most marginalised rigorously evaluated populate Expert Reference that the creative arts participants in inspiring, programmes. But we are Groups in the following topics: have a measurable impact sustainable arts programmes paving the way for a future health visiting, equalities (with on decreasing hospital in areas where provision is where the creative arts are a focus on race equality), admissions. So why are poor and engagement in the seen as not just benefi cial, informatics, community nursery there not more programmes arts is low. We prioritise our but vital to a healthy lifestyle nursing, and research. throughout the health and work with seven participant and wellbeing. A number of places are social care system? groups: young patients, available in each group, and it Delivering creative arts disabled children and adults, Nicky Goulder is co-founder is envisaged that these groups workshops is often a hard young and adult carers, and chief executive will be made up of members who sell for NHS trusts and schoolchildren in areas of Create. have particular expertise that local authorities as the of deprivation, enables them to participate and accepted forms of medicine vulnerable older widen the debate, and formulate are doctors and pills, not people, young and and produce resources for the artists and paint brushes. adult offenders, guidance,g advancement and It’s easy to placate critics by and marginalised educatione of the membership. announcing extra funding children and adults. Each group will have up to or more doctors without any For now, charities threet meetings a year, with some real thought given to other such as Create conductedc digitally. working options. However, rely on voluntary we need to take advantage donations to run Email [email protected] of new, effective methods projects and deliver ifi you would like to be instrumental of treatment. in the progress of the profession. Create is a UK charity For more iinformationnfformation aaboutbout CCreate,reate The closing date for applications is empowering lives through visit createarts.org.uk Friday 2 March 2018. the creative arts. We engage
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18 COMMUNITY PRACTITIONER | FEBRUARY 2018
18 d .indd 18 31/01/2018 12:0 OPINION
VOICE OF A STUDENT ‘I’M NOT A RESEARCH NURSE… AM I?’ LOUISE HENDERSON PhD student and nurse lecturer at Robert Gordon ‘EVIDENCE TO INFORM University, Aberdeen, further study, revisiting inform practice’ and NHS Grampian why I felt it was important PRACTICE’ BECAME became a @Lou_Henderson2 and what I had hoped A CLEAR POINT OF clear point of to achieve. ENGAGEMENT IN MY DAY- engagement in I came to the realisation my day-to-day that I had gone back to TO-DAY CLINICAL WORK clinical work fter studying for the books primarily to and from there, A a master’s degree improve the service that my passion and in nurse-led I was delivering for my linked to quality, safety drive for research practice, I remember having patients. I understood the and improvement. Th ese fl ourished. I actively sought a conversation with a very relationship between policy were areas of my own diversity in my career, good friend, explaining and guidelines clearly, practice that were of high looking to nurture this. that I felt that I ‘wasn’t a recognising that one must importance: striving after In recent months, I research nurse’. Little did use these to help inform improved care for patients have undertaken PhD I know! practice. Th is was an area on a daily basis with study, combining my love During a period of I particularly enjoyed, research underpinning my of district nursing and refl ection, after achieving translating policy into drive for improvement, research to understand my master’s and having practice and achieving gold- knowledge, quality the experiences of patients recuperated from my climb standard care for patients. and understanding. within primary care. to the top of ‘Dissertation So how did research fi t into Th is is something I Mountain’, I was able to the equation? AGENT OF CHANGE would not have even examine my innermost Exactly how research As I explored the principles comprehended when I fi rst feelings about research fi ts with clinical practice of research, I became started refl ecting on my and why I felt I hadn’t was becoming clearer. increasingly interested study journey. However, my enjoyed that element of Within practice, I had in bridging the gulf that I understanding of research my course. I had struggled felt somewhat detached had encountered between has developed over time and to grasp the key concepts from research at times, clinical practice and I have become an agent of of the theory at the time; understanding the research. ‘Evidence to change, in many ways. and the challenges of importance of balancing work, home life, it but only on a and parenting had proven superfi cial level. What I’ve learned about research diffi cult. I had dutifully However, during resigned myself to the belief this period of It provides evidence to inform practice – we are all that, in fact, research just refl ection, I ‘research nurses’ wasn’t one of my strengths. began to realise This understanding helps to bridge the gap between So I examined my that research research, policy and clinical practice drive and motivation for is intrinsically It’s intrinsically linked to quality, safety and improvement.
19 COMMUNITY PRACTITIONER | FEBRUARY 2018
1 i t d nt.indd 1 30/01/2018 18:2 OPINION
RIGHTS AT WORK WHERE WILL WE BE IN 2027? Unite’s head of health Sarah Carpenter encourages you to shape a bett er future for NHS staff by having your say on the new draft workforce strategy.
THE NHS IS impacts on children and families of a 12.2% NHS STAFF looking ahead to vacancy rate in clinical psychology, and a 2027, recently 14.3% vacancy rate in mental health nursing, VACANCY RATES putting out a draft and the challenges are all too evident. workforce strategy – Facing the facts, A CHANCE TO BE HEARD shaping the future So is this report too little too late? Of – for consultation course, but at the moment it’s the best we Mental in England. For the have. Currently in draft form, it is out for health fi rst time in more consultation until 23 March, so you have a nursing than 20 years, it chance to have a say on its contents. 14.3% seems the message But the report will have an unintended about the lack consequence too. At the moment, public of workforce planning – and the resulting health budgets, which sit with local impact on the NHS – has authorities, are being Clinical fi nally hit home. WHAT IMPACT WILL slashed and slashed again. psychology Facing the facts paints By using the workforce 12.2% a picture of the NHS as it AUTOMATION HAVE, strategy, which highlights stands today. Social care OR LEVELS OF the need for ‘a greater and health together make FUNDING, OR focus on prevention’ that up the largest workforce ‘will require development HEALTH NEEDS? Children’s in the country, yet the of the public health nursing lack of any planning for workforce’, we can begin (including recruiting, training and to get the public health health supporting staff has plainly contributed to voice heard at the highest levels. visitors) today’s crisis. Th e strategy grapples with Th e other UK countries do not face many of what is needed by 2027 – and clearly we the structural challenges that England does. 10.9% need a crystal ball to see the world our health Th e different approach to bursaries for health services will be operating in. What impact students is a key aspect of their planning will automation have, or levels of funding, or – and keeping those bursaries puts them in Average health needs? Maybe the inherent diffi culties a much better place to recruit new staff. clinical of prediction have been the reason for the lack Th e document is dense, and often focuses vacancy of planning – it’s just too hard. on the medical workforce. But you should rate Th e failure of NHS leaders to deal with this take your chance to have your say – either in 8.6% situation has seen some stark outcomes such your organisations, Unite-CPHVA branches as the 10.9% vacancy rate in children’s nursing or as individuals. It’s about standing up and (including health visitors). Add to that the speaking out for the future of your NHS.
The workforce strategy and details about the consultation can be found at consultation.hee.nhs.uk SAM KERR 2017 England, Education Health
20 COMMUNITY PRACTITIONER | FEBRUARY 2018
20 Rights At Work.indd 20 31/01/2018 12:07 PRACTICEPRACTICE
24 HOURS WITH CLARE STILES
Clare is the team leader for child health in NHS Shetland and recently became a Queen’s Nurse. She lives on the island of Yell.
MY ALARM RINGS… days can involve a 16-mile drive MANAGEMENT DAYS allows me to try out changes, and at 6am. After watering seedlings to catch a ferry to the more CONSIST OF… know how far resources will go. and vegetables in the greenhouse remote islands of Unst or Fetlar. appraisals and supervision and feeding my pet tortoise, I On management days, I walk meetings with staff and include LOCATION CHALLENGES… usually leave home at 7.30am. the half-mile to get the Shetland caseload management. As include when I’m on an island mainland ferry, and then well as team meetings, I all day with no mobile phone I AM RESPONSIBLE FOR… drive 30 miles to attend groups on areas coverage or emails. Our remote managing a team of health my offi ce in the such as transport, and rural position also makes visitors (HVs), including one Gilbert Bain food poverty and recruitment hard, but we’re community children’s nurse, Hospital, Lerwick. perinatal mental addressing that. Travel can easily a hospital children’s nurse, health. Other be disrupted by weather: if the a small children’s outpatient ON CLINICAL aspects I look after winds are too high, the Aberdeen department, a school nurse (SN) DAYS… include payroll, ferry can be cancelled, and we and three part-time school staff I arrive at the recruitment, risk could be without fresh fruit and nurses. My role is divided evenly relevant health centre management, and veg. Most of us have supplies (2.5 days per week) between at 9am, hold a short clinic service redesign. in the freezer for such times. managing the team, and clinical then set out on home visits. Th is Professional isolation can be an practice as a health visitor can involve driving on roads with THE BEST PART OF issue, so we make strenuous with my own caseload sheep and Shetland ponies, and MY JOB… efforts to support each other by across fi ve remote islands off walking across fi elds. I’ll munch is being able to help sharing learning. Shetland mainland. an apple in my car as I may be 10 and support families miles from the health centre by with a variety of POST-WORK… I ENJOY THE lunchtime. I may lead meetings problems. I also love after eating together, my JOURNEYS TO WORK… and could have a student HV providing learning husband and I spend as I can chat with friends, read with me as I’m currently the opportunities to time gardening or doing a book or use the time to refl ect. only practice teacher in Shetland students, and enjoy chores before watching I also get to see otters and seals, for HVs and SNs. I use any spare supporting staff. Masterchef or Gardeners’ and occasionally watch killer minutes to liaise with colleagues Working clinically World. We go to bed
ISTOCK/ALAMY whales from the deck. Clinical such as resident GPs. and in management between 11pm and 12am.
21 COMMUNITY PRACTITIONER | FEBRUARY 2018
21 24hr with....indd 21 31/01/2018 12:08 PRACTICE
hile asthma is very common – the UK has among the W highest prevalence of asthma in Europe (European Respiratory Society, 2003) – it’s a complicated condition that varies tremendously and is different for everyone. Some people have good weeks, good months or even good years with few or no symptoms. It has many different causes, can be triggered by different things and can change over time. Variation is perhaps a reason why there is existing complacency surrounding asthma, leading many people to stop taking their preventer medication and being unprepared for a recurrence of their symptoms. Asthma is a long-term condition that affects the airways. Someone with asthma has sensitive airways that are infl amed and ready to react when they come into contact with a trigger, which can include cold and fl u viruses, pollen, pollution and second- hand cigarette smoke. When this happens, it sets off a chain of events in the airways: the muscles around the walls of the airways tighten, the lining becomes infl amed and starts to narrow, and sometimes mucus also builds up, which can narrow the airways CLINICAL even more. Preconceptions of what asthma is and looks like make many people play down the severity of their own asthma. Community practitioners may often hear people, with or without ASTHMA asthma, saying ‘it’s only asthma’. Yet even people with asthma sometimes don’t realise that the consequences can be fatal. MATTERS THE DANGER OF IGNORANCE Too many people, including children, Dr Andy Whitt amore from die each year from asthma. In the UK, 1410 people died from asthma Asthma UK reveals the in 2016 (Asthma UK, 2017), and in need-to-know facts about the many cases their deaths could have been prevented. common lung condition, and Crucially, two-thirds of people who how you can help people take it die from asthma attacks could have
survived if they had received better more seriously – and save lives. ISTOCK
22 COMMUNITY PRACTITIONER | FEBRUARY 2018
22-24 Asthma.indd 22 30/01/2018 18:31 PRACTICE
basic care (NRAD, 2014). Th is includes using a written ENCOURAGING PEOPLE Spot red flags asthma action plan that explains how someone with TO PAY ATTENTION TO Ask your clients how well they asthma can manage it on a day-to-day basis and what to do ONGOING SYMPTOMS think their or their child’s preventer if their condition gets worse. Everyone with asthma should medication is working, and whether/ also have the plan reviewed every year by their GP or IS SO CRUCIAL: IT CAN how often they need to use their asthma nurse to ensure they have this knowledge. Th e plan ENABLE THE EARLY reliever inhaler. Th is is the perfect can be downloaded from asthma.org.uk and is designed to opportunity to see whether their be fi lled in with a GP or asthma nurse. TREATMENT AND asthma is as controlled as it should be, Community practitioners, including health visitors and EVEN PREVENTION OF and whether they need to see their nursery and school nurses, play a vital role in ensuring ASTHMA ATTACKS GP. If you spot any warning signs, that everyone with asthma is receiving this basic care (see you can recommend they make an below for how you can help). And of course people with appointment urgently and within asthma, and parents of children with asthma, need to be 24 hours for a full asthma review with proactive about their own care - booking and turning up their GP or asthma nurse. Warning signs include needing to appointments, taking medicine as prescribed, sharing to use their reliever inhaler – usually blue – three or more written asthma plans with people involved in their care and times a week, worsening symptoms such as coughing, seeking help if they’re using their reliever inhaler too often breathlessness, wheezing or a tight chest, or waking at (see box below, right). night due to asthma. All of these could be an early warning While many people think that asthma attacks happen of an asthma attack. suddenly, there are often warning signs days or even weeks before (Covar et al, 2008). Th is is why as a community Help manage common triggers practitioner, encouraging people to pay attention to It’s impossible for people with asthma to avoid all triggers ongoing symptoms is so crucial: it can enable the early but there are ways to help manage some of them. For treatment and even prevention of asthma attacks. example, if you’re visiting clients’ homes, you can help to address household smoking and signpost people to local HOW YOU CAN HELP cessation services. You can also speak to them about how to Th is is just a whistle-stop tour of asthma, but you might help with seasonal triggers such as cold weather. Make sure already have spotted some ripe opportunities for you to they know they can reduce their risk of an asthma attack support your clients with their asthma. Every contact with by wrapping a scarf loosely around their nose and mouth to a healthcare professional is an opportunity to monitor a warm up the air before they breathe it in. person’s asthma, and these are just a few ways in which Find more information about asthma attacks in winter you will be helping them: at bit.ly/AUK_scarf and for other seasonal triggers at bit.ly/AUK_weather_triggers Increase understanding You can help people of all ages – or their parents where appropriate – to increase their understanding of asthma, and emphasise that it’s a chronic condition that needs GP OR A&E? treatment every day. It can be difficult for someone with asthma to know Explain medicines whether they should see their GP or they need to call 999. Your clients and families may have varying degrees of An ambulance should be called if: knowledge about asthma, so you’re ideally placed to help ● Their reliever inhaler isn’t helping or not lasting four hours answer any questions or worries they might have about ● Their symptoms are gett ing worse their medicines. You can help them understand what ● They’re too breathless to speak, eat or sleep the medicine does, how and when to use it, as well as ● They’re feeling exhausted checking their inhaler technique. Th is will not only make ● Children may additionally complain of a stomach ache sure they’re getting the most of their medicines, but also and/or chest ache, but if parents are worried at any time reinforce good self-management practice. by their child’s breathing, they should call an ambulance. Most people with asthma are prescribed the two main types of asthma inhaler: reliever inhalers help to relieve For more information on managing an asthma att ack, see symptoms when they happen, and preventer inhalers bit.ly/AUK_manage_att ack (in adults) or bit.ly/AUK_children help to protect the airways and reduce the chance of getting asthma symptoms. For more on inhalers, You can also direct people to the Asthma UK risk checker, including technique, medicines and treatments, visit which gives a clear picture of whether they need to take bit.ly/AUK_inhalers. You can of course also refer clients bett er care of their asthma atbit.ly/AUK_risk_checker to this information.
23 COMMUNITY PRACTITIONER | FEBRUARY 2018
22-24 Asthma.indd 23 31/01/2018 12:09 PRACTICE
Th e UK Help to implement basic asthma care ASTHMA IN BRIEF Everyone with asthma should have an has among Asthma is a complicated up-to-date written asthma action plan that the highest and variable condition that includes all of the information they need is different for everybody. to look after their asthma well. Research prevalence rates shows that people who use a written Asthma att acks rarely asthma action plan are four times less likely of asthma come out of the blue. There to be admitted to hospital for their asthma are oft en warning signs (Th orax, 2000). If your clients don’t have in Europe days or weeks beforehand a plan, you can direct them to the Asthma that could indicate an UK website and encourage them to fi ll it out Around asthma att ack, including with their GP or asthma nurse. Find details frequency of reliever on helping people get the right basic care at 5.4 million inhaler use. asthma.org.uk/for-professionals people in the UK are currently 75 of people with asthma receiving treatment for asthma: % Stay aware for children say that cold weather It can be diffi cult for under-fi ves to get an triggers their asthma asthma diagnosis because confi rmation symptoms (Asthma UK, 2004). tests are not possible on the very young, which can be frustrating for parents Good daily self- and GPs alike. If a child is said to have management is key to ‘suspected asthma’ they will still be given living well with asthma: asthma medicines to see if they reduce people who use a writt en symptoms, so require the same care as if it 1.1 million 4.3 million asthma action plan are were confi rmed. children (1 in 11) adults (1 in 12) four times less likely to be admitt ed to hospital for PROMISING DEVELOPMENTS their asthma. Th e NHS and healthcare in general is changing rapidly, bringing both challenges Every 10 Community practitioners and solutions. As the use of technology play a vital role in helping increases, this will help both healthcare seconds ensure people with professionals and people with asthma to asthma are gett ing the be more responsive to the needs of their someone in the UK is right basic care. having a life-threatening asthma. Th is may range from simple asthma attack, and three reminders to take medication on a phone people die every day or computer, to electronic asthma action Dr Andy Whitt amore is Asthma plans and using apps to monitor symptoms Asthma UK, 2017; European Respiratory Society, 2003 UK’s in-house GP and clinical and medication use. lead. He is a practising GP based One of the major developments that in Hampshire and specialises in we will see in coming years is a greater For full references, visit respiratory care. He also has a keen interest in healthcare policy uptake of ‘smart’ inhalers with technology bit.ly/CP_P_features that can help monitor inhaler use for the and strategy. patient or their healthcare professional. We are now seeing new medications for some people with more severe allergic FURTHER RESOURCES asthma. Th ese aren’t suitable for everyone Education for Health provides free online training for anyone who works but are life-changing for many. with children. See supportingchildrenshealth.org/asthma-module We need to ensure more people with asthma have access to new treatments and Asthma UK’s helpline is run by asthma expert nurses who can offer technologies, and Asthma UK is supporting advice to healthcare professionals such as community practitioners and efforts to help make sure that people with to people with asthma. Call Monday to Friday, 9am to 5pm on asthma will be able to benefi t. 0300 222 5800 One thing’s for sure, it’s time to end Asthma UK’s website has a wealth of information, on subjects such as any complacency around asthma by managing asthma, medications and triggers. Download free copies helping people to take this potentially of resources for clients and families at asthma.org.uk/advice fatal condition seriously.
24 COMMUNITY PRACTITIONER | FEBRUARY 2018
22-24 Asthma.indd 24 30/01/2018 18:32 PRACTICE IMMUNISATION
Health visitors are mmunisation is a key HEALTHY FOUNDATIONS vital to achieving component of the public Vaccination schedules are informed by a health offer for all children. number of key determinants, including risk full vaccine It is important that they of disease and severity of disease by age. I receive the vaccinations they Th e greatest risk for a number of vaccine- coverage among are eligible for in a timely manner; this will preventable diseases, in the absence of children, say provide them with optimal protection against vaccination, is in infancy. vaccine-preventable disease that can be a In England, responsibility for Michelle Falconer, signifi cant cause of morbidity and mortality. commissioning public health services for Laura Craig, Although there is regional variation in vaccine children was transferred to local authorities coverage across the country, data reported during 2015. Health visitors provide targeted Helen Campbell for 2015-16 indicated that vaccine coverage in and universal services for the 0 to fi ve and David Green England fell for the third consecutive year and years element of the national Healthy Child also fell below that of the other UK countries for Programme. Th is aims to give every child the of Public most routine childhood vaccinations at one and good start they need to lay the foundations Health England. two years old (NHS Digital, 2016). of a healthy life (Public Health England Healthcare professionals have a key (PHE), 2016a), ensuring a healthy productive role supporting parents in making decisions adulthood is reached (PHE, 2014). about vaccinations. Health visitors, who Commissioning guides describe health specialise in providing a public health visitors’ contribution to this programme (PHE, service to preschool children and their 2016a; 2016b; 2016c). Th e transformed service families are vital in achieving parental trust model includes four levels of intervention, fi ve and high vaccine coverage, and have a mandated health reviews and six high-impact signifi cant role in supporting the childhood areas that are critical to improving the health immunisation programme. and wellbeing of children. ISTOCK
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2 2 ni ti n.indd 2 30/01/2018 18:33 PRACTICE
USING HEALTH REVIEWS TO SUPPORT Th e fi ve mandated health reviews CHILDHOOD IMMUNISATION DECISION-MAKING provide a unique opportunity for the health visitor to discuss immunisation and refer children and pregnant women VISIT ACTIONS TO SUPPORT CHILDHOOD IMMUNISATION for outstanding vaccines, which highlights their role as a key source of Introduce the benefits of vaccination (for mother and unborn baby) immunisation information and support Confirm whether pertussis vaccination has been given and support for expecting and new parents. Th e table Antenatal with decision-making if not yet given (left) includes suggested actions for health-promoting Discuss flu vaccination if flu season and support with health visitors during each health review. visits from 28 weeks decision-making of pregnancy Discuss with mother whether it has been advised for baby to SOURCE OF TRUST be offered hepatitis B vaccine at birth (if mother has an acute Health professionals are generally highly hepatitis B infection during pregnancy or is chronically infected) trusted by parents and are important in communicating immunisation information (Campbell et al, 2015). Th is Confirm whether baby was born to a hepatitis B positive mother. trust has increased in recent years, and If so remind mother of importance of hepatitis B vaccine and advice from healthcare professionals check baby has received dose one (at birth) and is scheduled for appears to be a key factor infl uencing dose two (at four weeks) parental decisions on vaccination. Most Remind parents of the benefits of all routine childhood New baby review: immunisations and the importance of vaccination at the parents have access to the internet, but ideally within 10 to recommended ages, starting with the first routine appointment those who trust the information given 14 days of birth date at eight weeks by health professionals are most likely Remind mother of the need for her to check her own MMR to have their child vaccinated at the immunisation status (for example, with GP) and encourage two scheduled age (Campbell et al, 2017). doses of MMR vaccine to protect future pregnancies if not Parental attitude tracking surveys documented in her medical notes commissioned by PHE have identifi ed health visitors as an important source of information for parents. Th e authors Confirm whether the first scheduled vaccines have been given identifi ed that between 2002 and 2010 or an appointment has been scheduled as appropriate these surveys indicated that around half Remind parents that there is no requirement for the six- to eight- Six- to eight-week of parents of children up to the age of two week baby check to be completed before the vaccines scheduled assessment recalled discussing immunisation with a at eight weeks of age are given health visitor before their children were Confirm that postnatal MMR vaccine for mum has been arranged due to be immunised. if required (two doses, one month apart) Although this dropped to just a third of parents having those discussions with their health visitor between 2015 and Confirm with parents that baby is up to date with all 2016, a PHE offi cial confi rmed there has scheduled vaccines been a steady increase since and, in March Discuss the importance of booster doses to ensure duration of protection 2017, 41% of parents of children up to two If baby was previously identified as being born to a hepatitis B years recalled discussing immunisation One-year assessment positive mother, remind mother that baby should have a booster with a health visitor. dose of hepatitis B vaccine at 12 months of age and a blood test Th e role of the health visitor as an to check for infection (hepatitis B surface antigen) at the same expert in communicating with parents time. If the infant has developed hepatitis B, they will need to be about immunisation has been described referred to a specialist (Redsell et al, 2010). Some believed their role included the entire process – from the provision of pre-vaccination information Review immunisation status, and support with planning an to vaccine administration – while others appropriate schedule if incomplete felt their role ended after supplying Two-year to two-and- Remind parents that the next scheduled vaccination appointment relevant information, leaving practice- a-half-year review will be when their child reaches three years and four months of age, based staff to complete the process. for booster doses to extend the duration of protection throughout Th e knowledge of vaccinations in their school years (for example, second dose of MMR vaccine) pregnancy and the perceived roles of PHE, 2017 nurses, midwives and health visitors ISTOCK
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in England have GROUPS AT RISK OFF NOT recently been BEING FULLY IMMUNISEDNISED explored using an online questionnaire. ● Those who have missed previousus vaccinations Th is found a high (whether as a result of parental choicechoice or otherwise)otherwise) level of knowledge ● Those with physical or learning disabilitiessabilities around vaccination ● Those not registered with a GP in pregnancy in all ● Children who are hospitalised or haveave a professional groups. chronic illness However, Vishram et ● Those from ethnic minority groups al (2017) reported that ● Vulnerable children such as those whosese families ‘practice nurses were are travellers, asylum-seekers or homelessess signifi cantly more ● Looked-aft er children likely to recommend ● Children of teenage or lone parents the pertussis and ● Younger children from large families infl uenza vaccines ● Those from non-English speaking families. to pregnant women NICE, 2009 than midwives and health visitors’. outbreak of a vaccine-preventable VACCINE COVERAGE disease. It is essential that vaccines Monitoring vaccine coverage is are administered at the recommended an important part of the ongoing ages, helping to maintain population surveillance of national vaccine protection by reducing overall programmes. Since 2014, there has transmission and enabling infants to been a gradual decline in uptake. develop their own direct protection Th is includes a fall in coverage for before entering nursery or school the primary vaccines, the fi rst dose where there is increased potential of MMR vaccine and the DTaP/IPV for exposure. STAYTAY UP TO DATDATEE booster given at three years four Every contact with a health months of age (NHS Digital, 2017). professional is an opportunity to For thethe latest developments in vvaccines,acci Th e number of children in England ensure that a child is up to date with vaccinationination policies and procedurespro in getting their fi rst dose of the MMR their vaccinations. England,nd, subscrisubscribebe ttoo the free monthly vaccine by their fi fth birthday reached Th e NICE guideline (2009) on vaccinationation nenewslett er Vaccine update at the 95% WHO target for the fi rst increasing immunisation uptake in bit.ly/ENG_vaccine and access the ‘green time during 2016-17 (NHS Digital, children and young people identifi es book’ (PHE, 2013) which contains national 2017). But a recent study looking at factors that may infl uence whether vaccination programme recommendations. vaccination records of children born a child is vaccinated or not. Th ose at Visit bit.ly/SCT_vaccine to access regular between 1995 and 2012 in Liverpool risk of not being vaccinated include Scott ish vaccine updates from Health revealed a high proportion of children children living in a more affl uent area, Protection Scotland. Updates for Wales with no MMR recorded, despite an those of highly educated parents, and and Northern Ireland can be found on intensive catch-up campaign at the the groups in the panel above. the Public Health Wales and Public Health time of a previous measles outbreak Agency websites. (Keenan et al, 2017). CONCLUSION Ensuring children are immunised Th e health visitor is in a unique on time and those with missing doses position to assess a child’s status and Michelle Falconer is an immunisation nurse are identifi ed and caught up with support parents with immunisation, specialist, Laura Craig is lead immunisation plays an important role in continued for example by signposting them nurse specialist, Helen Campbell is a senior population-level control of vaccine- to their practice nurse. clinical scientist and David Green is nurse preventable diseases such as measles. By proactively and positively consultant for immunisations, all at Vaccination provides individual promoting immunisation, health Public Health England. and population protection (herd visitors can continue to make a vital immunity), so high coverage is contribution in the delivery of a key required. When coverage drops, public health intervention that For full references, visit numbers of susceptible children prevents disease, prolongs life and bit.ly/CP_P_features accumulate and can sustain an promotes health.
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DOCTOR
will see you now
The rise of the internet has one are the given us all a world of health really explain it – give them the days when information so they can make an trained information at our fingertips. informed choice. professionals Journalist Juliett e Astrup ‘We don’t have any right to G were the sole bamboozle parents into taking guardians of knowledge about looks at how researching onboard our advice and support. health. Th e internet has given symptoms online impacts on Th ey need to have the balance of everyone access to a wealth evidence, and base their decision of information – summaries community practitioners. on that, provided it doesn’t breach of every condition, lists of safeguarding thresholds.’ symptoms and menus of While it has been embraced by possible treatments. the public, the use of online health resources It is no surprise that almost one in REBALANCING ACT has its potential pitfalls as well as benefi ts. two (47%) of us now use ‘Dr Google’ Th e shift in the dynamic between clients At the Royal College of General before consulting our GP, according to and healthcare professionals is happening Practitioners conference last October, chair a 2016 YouGov survey. Th e poll, of across the board, and is something health Professor Helen Stokes-Lampard said: ‘Dr more than 2000 British adults, also visitors must be prepared for in practice. Google can be a challenge for all healthcare showed that one in fi ve members of Michelle Moseley, Wales chair on professionals – but ultimately, patients the public (21%) has challenged the CPHVA Executive committee, and taking an active interest in their health is a their GP’s diagnosis, and that half programme manager for the specialist good thing. believe that their GP should always community public health nursing ‘Th e point to get across is that Dr Google give them the prescription, treatment programme at Cardiff University, says: is not a medically trained professional,’ or referral to a specialist they request ‘I’ve been challenged on weaning she added. ‘Reputable websites, such as (Bradshaw, 2016). practices, for example, and on NHS Choices, produced by clinicians, can Th e growth of NHS Choices, the offi cial vaccinations, particularly MMR. Health be incredibly useful, but people need to be website of the NHS in England, refl ects this visitors have to be well equipped, and cautious as there is also a lot of disreputable mushrooming demand for online health respond with advice and knowledge that information available online too.’ information. According to NHS Digital is evidence-based.’ fi gures, visits have skyrocketed, more than And while it is important to help parents GETTING THE ‘RIGHT ANSWER’ doubling from almost 196 million in 2012 recognise that not everything they read Asha Day, vice chair of the CPHVA to a peak of more than 583 million in 2015 online is valid, rubbishing the information Executive committee and a health visitor at (NHS Choices, 2017). they bring to you is a mistake. the Leicestershire Partnership NHS Trust, Enid Povey, clinical lead for NHS Michelle says: ‘You need to take time agrees guidance is needed. Choices, says: ‘Th e way the world is now, to build that relationship and not just ‘You can enter the symptoms of a people want to manage their own health disregard what they are saying – look into headache and come up with a brain and wellbeing. I think, more and more, it and come back to them. tumour, or the symptoms of arthritis and digital is not an add-on – it needs to be ‘Go into the details with them at come up with lupus,’ she says. embedded into care.’ whatever level is best for them and ‘Some clients have gone on a website
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and not realised it was a patient forum, Researchers involved in a recent study for example. When they ask questions, looking at cognitive behavioural therapy DR GOOGLE IS IN they are getting opinions, not a qualifi ed treatment for extreme health anxiety, medical opinion.’ fuelled in part by cyberchondria, She said the expectation of a ‘quick estimated unnecessary appointments answer’ fostered by the internet could and tests could affect one in fi ve hospital also be unhelpful: ‘Sometimes you have outpatients, and could be costing the 47% to think much more laterally than four NHS at least £420m a year (BBC, 2017). or fi ve words put into Google. It’s not always about signs and symptoms, it’s ENABLING CONVERSATIONS about the bigger picture – the social Th ere is also the risk that internet determinants of health, the family, research can provide an unhelpful the extended family, housing and distraction, says Leicestershire- everything else around keeping well. based community nursery nurse and of people research their Google is not a sophisticated tool.’ Community Practitioner editorial symptoms and/or a possible Th at lack of sophistication could advisory board member Barbara Evans. diagnosis before visiting their GP also leave people overwhelmed, she ‘It’s very easy for parents who are added, new parents in particular. ‘It’s struggling with a child to get fi xated information overload,’ she says. ‘You with a possible diagnosis which they put “crying baby” into a search engine have found online which appears to fi t and what are you going to get out of it?’ the bill, when other diagnoses, if you ‘Th ere is the danger that the more were to look at them, might also fi t. Th at information you read, the more it can sometimes distract from what’s becomes another anxiety about what really going on with that child.’ you are not achieving, At the same time, as opposed to being ‘MORE AND MORE, Barbara says parents’ positive,’ says Jackie DIGITAL IS NOT AN concerns should Swithenbank, a health ‘never be dismissed’ Th e estimated cost of visitor for 17 years ADD-ON – IT NEEDS and can result in cyberchondria to the NHS is and clinical practice TO BE EMBEDDED things getting looked teacher at Aneurin INTO CARE’ at earlier than they Bevan Local Health might otherwise £420m Board in south Wales. have done. ‘From a professional She adds: ‘If point of view, that there are things is a big concern – that clients will they are worrying perpetuate that lack of confi dence about, it enables 196 million in themselves and lose all sense and them to raise reason. We need to try to steer them it, so it’s not a away from that and get that balance. bad thing.’ ‘As professionals, we need to keep Jackie agrees: ‘You can help them reminding our clients that their skills, unpick what they are reading and it their intuition and their experience with becomes a learning process, giving them their children are an important part of the skills to unpick further information, the package. As well as information, it’s and go back to what they know about “this is what I’m seeing”, “this is what their own child as parents.’
I’m feeling”.’ She adds: ‘I don’t think our clients are 583 million Such easy access to so much under any illusions – they know there visits to NHS Choices potentially worrying information is a lot of information out there that is between 2012 and 2015 has already been linked to increased questionable. Th e important thing is health anxiety (Muse et al, 2012), they make sure they are looking at the For full references, resulting in the coining of the new reputable sites, and we empower them as visit bit.ly/CP_P_features term ‘cyberchondria’. much as we can, as early as we can.’
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COVER STORY
School nursing services across the UK are being changed, cut, expanded and integrated into other teams. With no apparent UK-wide consensus on what their role should be, do school nurses have a future in the modern NHS? Journalist Sarah Campbell investigates.
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chool nursing is at best a mixed picture do a lot of safeguarding in our area so we go to a lot of child at the moment. On one hand, the protection meetings,’ she says. ‘However, a lot of the time school nursing workforce in England we’re asked to attend as a healthcare professional to make the – including nurse consultants and meeting quorate when in fact we might not know the child or school nurses without a school nurse be best placed to help make decisions about him or her.’ qualifi cation – has shrunk from a high For Paula, these meetings take up so much of her time she of 3026 in January 2010 to 2396 in doesn’t feel she has the chance to do the early intervention August 2017 (NHS Workforce Statistics, work she believes children really need. ‘Ideally, I’d love to be 2017) – a decrease of 21%. On the other, based in school and be seen more by the children,’ she says. the number of nurses with the specialist ‘And while I have a diploma in CAMHS, I think that all school community public health nursing (SCPHN) school nurse nurses should be upskilled in mental health issues.’ Squalifi cation on the NMC register – which covers all of the UK – increased by 17% from 3032 to 3556 between 2012 and 2017 CAUTIOUS OPTIMISM (NMC, 2017). Note that these NMC fi gures don’t mean all Paula’s health trust is undertaking a consultation on changes these people are working as school nurses, just that they to the service. ‘It’s exciting: I think we’ll have more control hold the qualifi cation. over what the service will look like in the future,’ she says. Certainly, if you read the newspapers, a shortage of school Paula’s cautious optimism is shared with other school nurses nurses is putting children’s lives at risk (Connett, 2017). But around the UK – but not necessarily around the rest of England. speak to school nurses around the UK, and you’ll discover At the Aneurin Bevan University Health Board (ABUHB) in functioning, effi cient services – as well as areas where school south Wales, Angela Phillips, a senior nurse in the looked-after nursing services no longer exist. children and school health nursing service, says: ‘Politically, there’s been a lot of support for school nursing in Wales.’ WHAT’S GOING ON? Th e new school nursing framework, published by the Th ere are many reasons for this uneven picture: local Welsh Government and NHS Wales in May 2017, sets out a authorities, mainly in England, make decisions about comprehensive view of what school nursing should look like school nursing services based on local needs, with resulting across the country, incorporating the Healthy Child Wales differences in local school nursing business models. School Programme. Th at the government is behind it is good, says nurses can be highly involved in local commissioning – or Angela, although the framework has brought new challenges not, depending on local commissioning models, budgets and and responsibilities, including a new school entry review (a levels of skill and confi dence among school nurse leaders questionnaire for parents) – ‘with no additional resource, themselves. So it’s largely in England where the biggest shall we say. Although some health boards in Wales (including discrepancies in models occur; the devolved nations tend to ABUHB) have employed immunisation teams and this has take a national approach – but more of that later. been benefi cial.’ Besides all this, the role of the school nurse is changing ‘I suppose it’s a question of how you make a very small signifi cantly, for the most part expanding. Th e fi rst school service go a long way,’ Angela says. ‘In our health board, nurses appeared around the turn of the 20th century, and for instance, every year group is about 6500 children. So at their role was cemented in 1907 when a law was passed reception age, we’re seeing 6500 children a year to measure that obliged schools to provide all children with medical them, test their vision and do the entry review on them. inspections. Nowadays, health assessments are still a part And we immunise around 42,000 children a year. On top of of the school nurse’s job – but only a part. On top of this, that, if you’re trying to get public health messages through they carry out home visits to families in diffi culty, run to the population… it’s a big ask for such a small service to do immunisation clinics, are heavily involved in safeguarding, that. So I think it’s about school nurses supporting schools lead public health programmes such as healthy eating and to get those messages through and using services more smoking cessation, and signpost children and parents to other effi ciently. With the surveillance screening-type tasks and services and information. immunisation, we need an effective skill mix so we’re not Paula Fletcher, a school nurse in Liverpool, relishes this using specialist practitioners in those sorts of roles. We are changing role but doesn’t feel the balance is right yet. ‘We moving towards that in Wales.’ ISTOCK
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‘MY PASSION’S BASICALLY SCHOOL NURSING. I LOVE recruited at Band 5 – staff nurses – programme. ‘It is a very positive AN UNDERDOG AND to deliver for school-age children,’ move because the role of the school says Annie. ‘A lot of their role was nurse is changing in Scotland in line SCHOOL NURSING IS taken up with immunisation and with current need,’ she says. ‘Much DEFINITELY THAT’ child protection. Th ere had been a more emphasis is laid on supporting veer away from health promotion the most vulnerable of our children and drop-ins in schools.’ and young people and their families, In 2013, the Scottish Government particularly with their mental health issued a chief executive letter and emotional wellbeing. Our new Th is sentiment is echoed by advising NHS boards that the school programme is preparing the current Margaret Bunting, a lead nurse nurse role should be reintroduced and future workforce.’ for school nursing at the Southern as a SCPHN qualifi cation in school Health and Social Care Trust in nursing, that health visitor roles A DIFFERENT PICTURE Northern Ireland. ‘Currently the should be enhanced and refocused, Despite some fl aws, a cautiously Public Health Agency is writing a and a programme of training – the optimistic and relatively cohesive paper on the development of school reintroduction of the SCPHN-SN picture is being drawn by school nursing services. It’s looking to course – developed. ‘We were quite nurses in Scotland, Northern Ireland streamline the services across the excited about that because it put and Wales. Head south of the border fi ve health trusts,’ she says. school nursing back in recognition,’ to England, however, and that She adds that a similar review says Annie. ‘Various national groups picture fades. For example, just was carried out recently for health were set up to plan the future under two years ago in Cumbria, visiting, which had positive effects services and research the evidence the children and families services on funding. ‘We are looking at base for school nursing practice.’ were targeted to make year-on- trying to develop the services and One of the three Scottish year savings of £750,000. In May maybe be more defi ned about what universities given the task of re- 2017, school nursing was cut school nursing is,’ she says. establishing the SCPHN school altogether. No school nurses were In Scotland, meanwhile, there’s nursing course is the University made redundant, but they were a feeling that school nursing is of the West of Scotland. Dr Ruth redeployed in other teams. at a turning point for the better. Astbury is the programme lead for ‘Th e model we deliver was ‘Historically in Scotland, school its PG Dip SCPHN school nursing changed,’ explains Jane, a member nursing was a diminishing service,’ says Annie Hair, a senior nurse and chair of the CPHVA’s occupational professional group for health CASE STUDY: VITAL HELP visiting in the UK. ‘School nurses had ceased to be recognised as A PARENT REVEALS THE ‘ADDED VALUE’ OF SCHOOL NURSES specialist community practitioners, and the SCPHN course was no Peter* and his husband adopted two brothers aged three and five in 2014. longer offered in Scotland.’ In some ‘The boys came from a chaotic home and we didn’t have accurate health areas, the job titles ‘school nurse’ records for them,’ Peter remembers. and ‘health visitor’ had been largely When the boys started school and nursery in south London, they met their superseded by ‘public health nurse’. school nurse. ‘She was so impressive: she knew all the kids’ names,’ Peter Th is led to recruitment problems says, who was concerned there was no record of the boys’ immunisations. as the number of Band 6 qualifi ed ‘The nurse said “leave it with me”,’ he says. ‘She checked with the boys’ school nurses dwindled. ‘Th ere previous GPs and got accurate immunisation records. Now they’re fully hadn’t been a course for a number up to date with their jabs. It’s really comforting to know there’s a health of years, so school nurses were professional att ached to their school who knows their background well.’
ISTOCK *Name has been changed to protect the children’s identity
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SCHOOL NURSING: WHAT THE GOVERNMENTS SAY
SCOTLAND NORTHERN IRELAND ‘School nurses are an integral part of the NHS Charlott e McArdle, Northern Ireland’s workforce, playing a vital role in supporting chief nursing officer, says: ‘Our children, young people and their families, school nursing workforce has a vitally especially those who are vulnerable,’ says a important role in contributing to the Scott ish Government spokesperson. health and wellbeing of our children ‘That is why we are refocusing their role to and young people. Therefore I see work especially with those who most need the school nursing specialist practice their support. programme [commissioned by the ‘We have recommended that NHS Department of Health and delivered boards and integrated joint boards develop by Ulster University] as a very teams that enable school nurses, health important and valuable programme visitors, community children’s nurses and allied for the implementation of Health and health professionals to work together aiming wellbeing 2026: delivering together. to improve outcomes and services for our School nurses are well placed to lead young people.’ the changes needed.’
ENGLAND ‘Local areas are determining how many school nurses they need and what the skill mix should be,’ says Wendy WALES Nicholson, national lead nurse ‘There is an ongoing need to ensure that we for children, young people commission enough school nursing places,’ and families at Public says Rhiannon Beaumont-Wood, executive Health England. director of quality, nursing and allied health ‘That’s down to local professionals at Public Health Wales. discretion. In addition, ‘In May last year, the new school nursing we’ve now got school framework expanded the role of secondary nurses employed by social school nurses to include partner primary enterprises and local schools. This means that all schools in Wales authorities, and those now have a dedicated nurse. numbers won’t be captured in ‘School nurses need to keep abreast of the electronic NHS staff record. new and emerging communicable and ‘We know that there are challenges due non-communicable threats to health, to austerity. But that has presented us with and ensure they keep their knowledge opportunities to reformulate what the school and skills up to date to respond appropriately. nurse offer is, to work very closely with ‘School nurses are well placed to provide commissioners in local authorities and design accurate information and advice on a range exciting service models that are innovative, of health and wellbeing issues to both pupils creative and adaptable. School nurses have and teaching professionals.’ been able to shape their roles.’
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of the health visiting team (and by the local school nurse or health Elwell, a school nurse in Sunderland whose name we have changed for visitor – this is a large rural area. and CPHVA Executive member for anonymity). ‘Now there are two GPs are struggling a bit to know the North East, says: ‘In my area services: the Universal Service, where to refer people to because they certainly want the school which targets under-fi ves but they used to be able to refer to the nurses out there because it’s a good doesn’t include child protection school nurse. Th ere is now an online value service when you consider work; and the Strengthening counselling service but obviously how they’re able to network and in Families Team, a 5 to 19 service if you’re a fi ve-year-old you’re not the schools. What we can deliver that still delivers immunisations going to be accessing that.’ with little staff is pretty good.’ but which also covers all children Does she feel that young people who are on a safeguarding plan, have suffered from this change THE KEY TO SUCCESS? including under-fi ves.’ to the service? ‘It’s an unknown Several of the school nurses spoken Jane says that both teams now quantity at the moment,’ Jane says. to agree that measuring outcomes have higher caseloads. ‘And the ‘We haven’t had time to measure is going to be key to the future people in Strengthening Families any outcomes. Th e jury’s out.’ of school nursing. Part of Ruth’s are pretty stretched because they’re Some local authorities in England work at the University of the West covering wide geographic patches clearly appreciate the value of of Scotland will be to develop that would have been covered before school nursing services. Claire an evidence base to prove the effectiveness of their work. ‘We need to develop a clear research programme that shows the clear added value of having a school nurse for children and young SCHOOL NURSING IN NUMBERS people,’ Ruth says. A DECLINING WORKFORCE IN ENGLAND ‘School nurses are generalists,’ adds Claire. ‘A bit like a GP, only we’re generalists in public health and early intervention. We work 3026 with parents as well; if there are issues with them we take it up via 3000 2 1% safeguarding. We open many a can of worms.’ 2396 Claire recently left school nursing to work in looked-after children’s 630 nursing, but says: ‘My passion’s 2000 nurses basically school nursing. I love an underdog and school nursing is defi nitely that.’ Th e challenge for the profession, then, in a budget- 1000 restricted NHS, is to shake off that status – and prove its worth.
For full 0 references, visit bit.ly/CP_features ISTOCK
NHS Workforce Statistics, 2017 January 2010 August 2017
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30 34 r t r h r in .indd 34 30/01/2018 18:3 GUIDELINES FOR AUTHORS What would you like to write for the journal? A research paper? An article? Do you know how to go about it? We will be publishing our author guidelines for all potential content in the next issue, so keep an eye out and get in touch. If you have any ideas in the interim, then email [email protected]
AUTHORSHIP
REFEREES AND REVIEW COPYRIGHT
PUBLICATION STYLE AND FORMAT
AIM AND REFERENCES FOCUS
35 GuidelinesforAuthors.indd 1 30/01/2018 18:38 FEATURES
hen I fi rst said I wanted to become a health visitor, ‘W my colleagues just laughed at me.’ Ross Mawhinny was working in A FEW intensive care nursing – a fi eld that has traditionally appealed more to male nursing staff. ‘I’d been like a lot of other men in nursing, and had been attracted into roles like A&E and ITU. Th ey seemed technical, with a bit of drama, and GOOD meant a chance to affect people’s lives and give a sense of achievement. ‘I hadn’t thought about health visiting or community roles. But when I did my placement I was really struck by what they did and how they had to cope with the social challenges MEN and the nature of the interventions.’ Ross decided to make the switch In some areas of nursing, men are to health visiting after feeling his ITU commonplace, but community roles career was stagnating, and is now one of only two practising male HVs in the seem to remain largely off-limits. whole of Northern Ireland, he reveals. Journalist Phil Harris investigates. Th is picture of rarity is repeated
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across the UK. NMC fi gures show that for Media coverage of child abuse, and paranoia MALE CPs nursing as a whole there were 654,521 nurses about being considered an abuser, is also likely on the register in September 2017, of which to act as a deterrent to many men. IN NUMBERS 73,902 (11.29%) were men. ‘I think it’s hard enough for men to But the proportion of men on the specialist overcome stigma about going into nursing,’ In England alone, community public health nursing part of the Mark says, ‘but if they also say they want to register is much lower. Th ere are just 653 work with children and vulnerable families, men out of a total of 28,996 (2.25%), and the then people may wonder what their motives percentage has been declining slowly yet are, and maybe even think they could be some steadily over the past few years (NMC, 2017). sort of sexual deviant. And men are obviously What’s clear is that for many years, men very concerned about this.’ in nursing have disproportionately gone into Ross adds: ‘I am very cognisant about abuse 4.9% areas such as A&E, intensive care and mental and am very careful about how I go about health, and it is uncommon to fi nd men my role. Th e safety of the child has to be working in community roles (for instance, see paramount. Th ere are safeguards in place, and ‘Male CPs in numbers’, opposite). these are for me as well as the children and Th e data on the future workforce shows families I work with. I think this could put of staff working in the situation isn’t set to change dramatically. some men off. It has never felt like a barrier to community nursing Figures from the Higher Education Statistics me but I am careful.’ roles are men Agency (HESA) for 2015-16 show there are Ross also says that men may also take the 153,795 people studying view that community jobs nursing across the UK, of FOR MANY YEARS, are less appealing because which 17,820 were male the skills involved are not Th e figures drop lower (11.6%) (HESA, 2017). MEN IN NURSING HAVE as portable as they are in for health visiting: Overall the proportion DISPROPORTIONATELY other roles. of males studying nursing GONE INTO AREAS ‘I think men are more has been declining likely to think strategically since 2011-12. SUCH AS A&E, in terms of their careers, Th e HESA guresfi INTENSIVE CARE AND and to plan for the future. also show there were MENTAL HEALTH Men often go into areas 2340 people specifi cally such as intensive care 1% studying community because they consider nursing, of which just 130 them to be passports (5.5%) across the entire to anywhere, such as UK were male. Again, this working on cruise ships, proportion has been declining in prisons or on virtually any type of ward, of staff are men – from a high of 10.4% in 2008-9. and moving to these situations wouldn’t be (107/9929) a problem. BARRIER GRIEF ‘But there is a perception that health visiting So what is stopping more men from taking on is more specialised and not as useful if nursing roles generally, and community roles you want to be fl exible and move around And for school nursing, in particular? in your career.’ Mark Lees, lecturer in nursing at Edinburgh Pay may also be a factor: equal pay for men Napier University and a former HV, thinks and women is an ongoing and topical issue. there are several reasons, with old-fashioned Offi ce for National Statistics fi gures show the views of male and female roles still being very median earnings of full-time male employees powerful and signifi cant. in the UK across all industries is £592 per week ‘Th ere is certainly still stigma in society and compared with £494 for women (ONS, 2017). % there is an expectation that men and women Mark adds: ‘With all this in mind it’s 1.4 should have certain types of jobs,’ he says. probably not surprising that the numbers of ‘Th is means men are less likely to go into men in community roles have not improved.’ nursing as a whole. And then people just don’t think of jobs like health visiting being male SOCIETY REFLECTION are men roles. Th is can be hard to overcome, as some Of course, community nursing is not alone (42/3089 staff) healthcare staff have the same expectations in showing a dramatic gender imbalance. NHS Digital, 2017 NEIL WEBB and views as wider society.’ Teaching is also overwhelmingly a female
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profession – just 15% of primary school female-dominated professions too. teachers are male, while the fi gure rises ‘And it wasn’t too long ago that people to 38% for secondary school teachers thought of medicine as a career for men (Department for Education, 2016). only, and that has completely changed. Th ere are even fewer men in roles such So society can change the way it views as teaching assistants (8% male) and these things.’ support staff (18% male). Overall, just 20% of all school staff are male, and the BOYS BRING BENEFITS ‘DADS HAVE ALWAYS proportion of male teachers and staff has Dave says it is a pity there are not RESPONDED WELL been falling steadily over recent years. more men in community roles as they TO ME. THEY DON’T Yet men make up 51.2% of the British can bring a different mindset and population (World Bank, 2013) so is it approach, and help families in slightly LEAVE THE ROOM right that some professions do not refl ect different ways. AND THEY FEEL wider society in terms of gender balance? For instance, Mark says that he ABLE TO TALK TO ME Dave Munday, a Unite in Health lead worked with many deprived families professional offi cer and health visitor says: in Glasgow, many of whom had a ABOUT... THEIR FEARS ‘Clearly there should be more male staff man as the primary caregiver because AND CONCERNS’ in health visiting and school nursing, and they were unemployed or unable to perhaps there is a vicious circle whereby work, while their wives or girlfriends having hardly any men means there are had full-time jobs. He revealed it few role models and then this means was important for them to be able to ask men are put off because they can’t see practical questions in a matter-of-fact themselves doing the work. way without the embarrassment they may ‘But if we had some more positive male have felt with female staff. role models, this would help to blow away He also said that mothers often some of the stereotypes and show what complimented him on his matter-of-fact a great career it can be for both men and and practical approach. ‘I had to have a women. I’m sure this applies to other different perspective,’ he says.
WHAT COLLEAGUES THINK…
The number of male CPs a conversation but then Men tend to be encouragedged may reflect society views at everything was fine.’ to move away from large, for now, but what of It tended to be older frontline care into fellow colleagues? And do female staff, perhaps with management or academicmic their views have an impact? more traditional views, roles, found HV in Northernern who were more likely to Ireland Ross Mawhinny: The vast majority of female keep their distance. colleagues were highly ‘I oft en got the feeling ‘People have oft en saidd supportive of nursing they felt health visiting to me: “You’re a man lecturer and former HV wasn’t a suitable role for so you’ll go far,” and Mark Lees, treating him a man and they didn’t there has always been a equally. But some were approve. But it’s maybe perception I will end up inn a more suspicious: not that surprising, management job,’ he says.ys. given the strong society ‘I just want to be on the ‘I’ve had situations being conventions about shop floor, although I amm the only man in the room gender roles. also att racted to the ideaa ofof on training courses with ‘Lots of male and helping to teach, developp other health visitors, when female staff don’t think and inspire others. no one would sit next to community roles are for ‘I’ve always thought me,’ he says. ‘But I think men. It was up to me to promotions should be onn it’s probably just a natural show them I could be as merit, and that gender suspicion of something skilled and professional shouldn’t matt er. But yes,s, different. I’d have to start as any woman.’ I’m very motivated.’
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‘I had no experience of giving birth more in society now than they ever so I would focus more on the immediate could before. problems and the future – asking the ‘Th ere is an expectation that men PUTTING THE women where do we go from here and are more involved in childcare now, how we can we realistically make things and many are becoming stay-at-home WORD OUT better now. I would set targets and dads. Th is means we could be raising a encourage the mothers to look forward.’ generation of male children who have Ross says that being a man has always good role models and who are happy and felt benefi cial in his role. ‘Dads have comfortable being affectionate and caring. always responded well to me. Th ey don’t Th is might in turn lead to society being leave the room and they feel able to talk more accepting of men in caring roles.’ to me about practical things like paternity While Ross thinks that if men can get While views of gender roles allowances, and their fears and concerns.’ beyond the barriers they would fi nd the may not change overnight, Ross says that the mothers on his health visiting role very rewarding. ‘Roles more can certainly be done to caseload never have a problem with his like intensive care are technical and att ract men to the profession. gender, and once they get beyond their involve a full system approach and action, For example, the initial curiosity, they always welcome his and many fi nd that appealing,’ he says. government could promote help and perspective. ‘But health visiting is more like it to men. Mark Lees says: ‘Th ey often ask early on if I have detective work. You’re independent, ‘There’s not a lot of activity children myself, and at fi rst I joke that and out there on your own. You’ve got going on to change things. I have hundreds in my caseload. But I to think on your feet, move quickly and Certainly health visiting is not then add that my partner and I have been solve problems. promoted that way. You don’t trying but so far haven’t been able to ‘It should be a lot more appealing to see men in any advertising have children. men than many people think.’ or promotion about health ‘Th is establishes that although I am a Ross also highlights that it’s a specialty visiting – it’s always young, man doing an unusual role, I am just a that is about long-term relationships, white women.’ normal person with feelings and issues communication and the ability to build Ross Mawhinny believes the like anyone else, and it also means that rapport, something that many men, like profession could learn from they are likely to be equally honest with many women, are good at. the police and their efforts to me about their situation.’ Ultimately though, Ross believes that drive up recruitment from all Dave warns though against treating all the gender of staff is not important: parts of society – black, white, male health visitors as ‘a homogenous ‘Th e situation is challenging in terms of old, young, male, female. blob’. He says: ‘We are all different, just numbers of staff generally, and resources Educational establishments as all female health visitors are different, are few. So we need the best, whoever can also make a difference, and we all have our own personal they are. Whether it’s men or women and some are stepping up circumstances and motivations. doesn’t matter. Ultimately people don’t their efforts. Edinburgh ‘Personally I never had any doubt that care who’s looking after them, as long as Napier University is actively I would end up working as a health they do their job well.’ promoting nursing to men visitor. When working as a nurse on a at its recruitment events, ward I always thought it would be much HAVE YOUR SAY and working with student better to keep people well for as long and qualified male nurses to as possible so they didn’t need to be in Why do you think there aren’t research how to make the hospital. Health visiting was a route to more men working in CP profession more att ractive to do this with its focus on prevention and professions? What value do men, and how barriers can be helping people to be healthy and well you think men could add? overcome. Findings so far on right from the start.’ What can be done to att ract what appeals to men about more of the male workforce a nursing career include CHANGING TIMES to community health? that it’s seen as rewarding Mark is confi dent that the future will Whatever your view on the (Pollock, 2017). bring a better mix of male and female topic, let us know. Tweet us on Suggestions to get the right staff in community roles. @CommPrac and use #menCP message out there also include ‘I defi nitely think times are changing. to read other member’s views. hosting school pupil visits, In the past, men were expected to be and speaking to advisers who standoffi sh about children and not For full references, visit influence their career choices. be involved in childcare. Now they bit.ly/CP_features
NEIL WEBB are able to show emotions and affection
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As a new sexual orientation monitoring standard is published, journalist Anna Scott asks if gathering this data is overreaching, ailored, more or an important step in inclusive approaches promoting LGBT equality to recovery are ‘T critical, and a civil in healthcare outcomes. and human right.’ Th ese are the words of a gay man who attended an NHS rehab programme for alcoholism in which he felt the service did not meet his needs in considering the links between his addiction and sexuality (Prest, 2017). INTRUSION OR Th is is the kind of situation in which the confi dential monitoring of patients’ sexual orientation could lead to patients and service users who are lesbian, gay, bisexual or transgender INCLUSION? (LGBT) receiving better, more ISTOCK
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bespoke services from the NHS, and (NHS England, 2017). one of the reasons that NHS England Th e LGBT Foundation recommends that service users’ and NHS Digital have published a new sexual orientation is monitored at the point of registration standard to improve the recording of or service delivery, service user engagement, evaluating sexual orientation data. satisfaction or logging complaints. Th e Sexual Orientation Monitoring ‘It’s important to fi nd the right time to monitor and to Information Standard aims to provide monitor on several occasions: someone may not disclose at a consistent approach for recording fi rst but may feel comfortable enough to do so later on; and data of all patients and service users an individual’s sexual orientation can change over time,’ over the age of 16 across England (NHS its Good practice guide to monitoring sexual orientation states England, 2017). (LGBT Foundation, 2017). It will also cover local authorities ‘A service user might not disclose when registering with responsibilities for adult social for a service, but later appreciates this could be useful care in all service areas where it may information for service planning and provision.’ be relevant to record this data in a standardised way, and it can be used SETTING THE STANDARD more widely by local authorities (NHS Twelve sites were chosen across England to pilot the England, 2017). standard, focusing on four key areas: leadership, IT ‘All bodies are required under the systems, workforce training and development and Equality Act 2010 to ensure that no communication with patients. Th ey have been tasked patient is discriminated against,’ an with working out the best way to implement the standard, NHS England spokesperson says. ‘Th is making sure that the question is asked in an appropriate information standard is designed to way and in a relevant context, so that the NHS has the help NHS bodies be compliant with information to improve care and help reduce health the law by consistently collecting, inequalities, according to NHS England. only where relevant, personal details One pilot site – Oxleas NHS Foundation Trust, which of patients such as race, sex and provides health and social care services in south London and sexual orientation. Th ey do not have Kent – launched a communication campaign for service users. to do it in every area, people do not Th e trust had already increased its monitoring of sexual have to answer the questions and it OPEN TO orientation in service users over the past few years, and has will have no impact on the care they subsequently been encouraging people using their services receive’ (see panel, right). QUESTION? to tell relevant staff about their sexual orientation (LGBT Monitoring this data will enable Foundation, 2017). health and social organisations to The standard sets out It produced a leafl et for all patients and aimed at LGBT demonstrate that they provide equal the format for the people and their carers, outlining what to expect when access to services for LGBT individuals questions for healthcare accessing Oxleas’ services, including a discussion of and contribute to the improvement professionals to ask ‘why should I tell my health professional I’m gay?’ (LGBT of care providers’ understanding patients, where relevant: Foundation, 2017). of inequalities in health and care A number of ways of implementing the information outcomes for different populations Sexual orientation: standard are suggested, based on what organisations (LGBT Foundation, 2017). Which of the following already monitoring the information have done, including Th e standard recommends that options best describes taking a phased approach (see panel overleaf). ‘In this way, ‘sexual orientation monitoring occurs how you think of yourself? the costs of implementation [have been] absorbed into at every face-to-face contact with 1. Heterosexual or straight other costs and have not brought any additional fi nancial the patient, where no record of this 2. Gay or lesbian burden,’ the standard guidance reads (NHS England, 2017). data already exists.’ It continues: 3. Bisexual ‘Demographic data will be periodically 4. Other sexual IN PRACTICE reviewed by the organisation collecting orientation not listed In a commonly given example, when a patient registers it [and] entries will need to be verifi ed U. Person asked and does with a GP and answers questions about their age, gender with the patient (similar to periodic not know or is not sure and ethnicity, there would also be a question about sexual reviews of data such as address)’ (NHS Z. Not stated (person orientation. Th e decision to answer the question would England, 2017). asked but declined to lie with the patient and the information recorded would If the patient does not want to provide a response) be confi dential. disclose their sexual orientation, this 9. Not known (not ‘It means you can build up meaningful data, which response will become part of the record, recorded). then allows you to get a snapshot,’ says John Walding, as it is with ethnicity data recording NHS England, 2017 marketing, campaigns and communications manager at
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the LGBT Foundation, which developed the standard with NHS Digital on behalf of NHS England. ‘Th e more information we have, depending on where it’s relevant, the more we would be able to inform decisions on the best forms of support that could be given to those particular patients. Having that knowledge completes the picture and means that the services that are offered are much more geared towards providing the best support possible. Th at’s the rationale behind [the standard],’ he adds.
IMPLICATIONS FOR PRACTITIONERS But what about health visitors, community nursery nurses and school nurses dealing with clients who are often under the age of 16, to whom the standard doesn’t apply? Th e standard will have a ‘positive’ impact on the work of community practitioners, says one health visitor. ‘It enables public health nurses (school nursing) and Healthy Child Programme nurses to meet the holistic needs of a child or young person,’ says Louise Lester, public health nurse at Leicestershire Partnership NHS Trust. ‘It enables us to use terminology in a manner that respects the needs of the child or young person and which makes them feel comfortable and accepted, thus maximising the positive outcomes of our interventions for the child or young person that we are providing an intervention for,’ she adds. Currently, school nurses operating within Leicestershire Partnership NHS Trust address sexual orientation with age- appropriate children and young people as part of their full and holistic baseline health assessments, Louise says. Th e child or young person is reassured that any contact with the nurse is confi dential and ‘safe’, and they are free to talk about any of their NEED TO KNOW: SEXUAL DATA HANDLING needs or problems, or just to share ● Data should be collected using the same recording and reporting method for any information that they choose other equalities data, such as age and gender regarding sexual orientation or gender. ● Implementation should be phased in and any necessary changes to IT systems ‘We are professionals who are made as part of broader system updates skilled at asking questions that enable ● Training costs should be incorporated into the routine costs of updating the young person to share information monitoring and performance systems at a pace that is comfortable for ● Role-based access arrangements should be reviewed because professionals are them,’ Louise says. ‘Quite often we collecting personally identifiable sensitive data are the fi rst adults or professionals ● Information about sexual orientation is sensitive personal data for the purposes that a child or young person has of the Data Protection Act 1998, and therefore providers must have consent or an shared their sexual orientation with.’ alternative legal basis for processing such data ● Privacy impact assessments should be updated to take account of the sensitive IN THE HOME COUNTRIES data being collected But this isn’t the same for all ● Organisations should review how they process this data ahead of the community practitioners. Another implementation of the General Data Protection Regulation coming into force on NHS trust in England says that while it 25 May 2018 – the European Parliament regulation which seeks to strengthen data ‘routinely collects the required data’, protection for all EU citizens – to ensure compliance sexual orientation seems to be ‘an ● A ‘cross-system task and finish’ group consisting of 19 organisations including NHS area of practice that will need better trusts, local authorities and campaign organisations has been set up to support strengthening across the services’. the implementation of the standard across IT systems, workforce development In the devolved nations, the picture and communication to the health service and the wider public.
is even more complicated. ‘Th ere NHS England, 2017 ISTOCK
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are currently no plans to introduce a similar approach in Wales,’ says a spokesperson for the Welsh Government. Even if the government did introduce such a standard, it’s not clear how it would apply to community practitioners. ‘GPs in Wales would want to know their patients and will ask about their sexuality if it is relevant to their medical condition,’ the spokesman adds. It’s a similar situation in Scotland, with one health board saying its community practitioners would not ask the question of any patients. In Northern Ireland, the Public Health Agency is not involved in any standard for sexual orientation monitoring, a spokesperson says. Developing the information standard has very much been focused on England. ‘We are unable to infl uence other devolved governments,’ says Mike Cullen, sexual orientation monitoring coordinator at the LGBT Foundation. ‘We would be very happy if they were to follow suit, as we believe sexual orientation monitoring is key for reducing health inequalities faced by lesbian, gay and bisexual people.’
MAKING A DIFFERENCE Despite the English focus, there is an understanding elsewhere that greater information about sexual HEALTH orientation can make a difference to the care patients As a result, it’s vital that training receive. As long ago as 2006, a report for NHS Education and peer support help upskill new INEQUALITIES Scotland noted that monitoring patients’ sexual orientation starters into the public health role to FOR LGBT PEOPLE is useful, helping with the appropriate provision of services enable them to develop skills around in a health board. asking questions, listening, reacting ‘Patients should be able to “be themselves” when they and understanding the terminology receive care from the health sector,’ it states. ‘Sometimes that must be used, Louise says. patients might have unique healthcare needs because of At her trust, a care pathway is being % their sexual orientation, or may have developed to be 88 particular circumstances that are affected included in its local by their sexual orientation. Or, very GREATER standard operating simply, patients might just want to be INFORMATION guidance, including of trans people have had able to refer to their partner informally’ appropriate mental health problems (Stonewall, 2006). ABOUT SEXUAL questions to ask, But the report also acknowledges ORIENTATION CAN hyperlinks to LGB people are that not all patients will understand MAKE A DIFFERENCE relevant legislation, or identify with labels given for sexual national and local TO THE CARE orientation. And monitoring becomes standards and 7x even more complex for community PATIENTS RECEIVE organisations, and a more likely practitioners dealing with children aged referral pathway to to use drugs under 16 and their parents and carers. LGBT services and a ‘It’s not compulsory to gather sexual orientation data for young transgender specialist worker. any patients or their carers, but we would always encourage ‘I do not feel that it is an intrusive practitioners to do so where appropriate,’ Mike says. question – it is necessary to enable 2x needs to be met and optimum more likely to HELP FOR COMMUNITY PRACTITIONERS outcomes,’ Louise says. ‘Th e binge-drink ‘I feel it is vital for community practitioners to gather skills of the public health nurses this information in an open and honest way,’ Louise support this.’ LGBT Foundation, 2017; McNeil et al, 2012 Lester says. ‘Th e child or young person needs to know that the questions are asked to enable us to meet their needs so that they have the best outcomes and receive the For full references, visit bit.ly/CP_features support required.’
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ABRIDGED VERSION SUPPORTING ASYLUM-SEEKERS Robert Dransfield and Liz Clark explore what health visitors need to know in dealing with asylum-seeker families, who are among the most vulnerable in our society.
RESEARCH IN NEED OF SPECIAL CARE health issue that health visitors can help to SUMMARY It will come as little surprise that many address. As children who have been exposed Asylum-seekers can suffer from asylum-seekers have poor mental health. to constant levels of anxiety and stress may poor mental health as a result Women and child asylum-seekers are continue to have long-term psychological of trauma, sexual exploitation, particularly vulnerable as they are more damage into adulthood (Shonkoff and rape, trafficking, domestic abuse likely to have mental health problems Fisher, 2013), it is vitally important that the and neglect. due to sexual exploitation, rape, health visitor has a clear understanding of traffi cking, domestic abuse and neglect, potential issues when undertaking health Health visitors can assess, all of which impacts on their physical and assessments so there is no delay in getting signpost and plan care for this mental wellbeing. timely and correct support in place. client group. They should have Many health-visiting services in the So what do health visitors need a good understanding of their UK have asylum-seeking families on their to know? A good starting point is an complex needs to take a leading caseload who have fl ed war and persecution understanding of the complexities of this role in early intervention. in their home countries (Cowley et al, client group, including an awareness of 2013) and may have cultural differences Trauma from war or persecution experienced trauma and particular has the heaviest impact on and abuse that impacts ASYLUM-SEEKERS diffi culties they may children and can lead to toxic on their mental health OFTEN MISS CONTACT be experiencing. stress syndrome and long-term (Freeman, 2007). Th e main mental psychological damage. Women Depression, anxiety WITH HEALTH VISITORS health problems are also at high risk as they are and post-traumatic DUE TO FREQUENT of asylum-seekers oft en ‘invisible’ to health services. stress disorder are AND RAPID CHANGES are reported to be common, and poor depression, anxiety Health visitors can use their mental health can then OF ADDRESS disorders and post- advanced communication skills to further deteriorate traumatic stress help asylum-seekers take control because of diffi culties disorders (Keyes, of their lives, remembering in accessing healthcare 2000). Other risk asylum-seekers can be suspicious through, for example, lack of understanding factors that affect and exacerbate the of authority figures. of the UK health and social systems. symptoms of these mental health issues Health visitors are in an ideal position to include poverty, poor education, low self- They can identify mental health help: they take leading roles in the delivery esteem and poor physical health (Woodward problems early and signpost to and development of early intervention, et al, 2016). Th ere are also a number of key services. In addition, they can and can provide a link between families behavioural consequences that may relate help asylum-seekers understand and other agencies (Department of Health, to immigrant poor mental health, including welfare systems and ensure 2011). Sara and Lappin (2017) suggest domestic violence and fear of engaging with continuity of healthcare. that childhood trauma is a major public services (Woodward et al, 2016).
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As the early years (0 to 3) are the most important in a child’s mindful of their traumatic previous experiences (Bennett-Levy development, children exposed to traumatic events at this age et al, 2004) and supporting them to communicate their own can face psychological and emotional problems in adult life needs, so that they can take back some control of their life. Th is (Boyd and Bee, 2009). Traumatic recurring events in a child’s can mean so much to someone who has lost everything (Martin life are known as toxic stress syndrome. Toxic stress can result and Carey, 2009). in severe consequences for the child, such as delinquency, Health visitors can also play an important role in the early reduced intelligence, increased aggression, depression and identifi cation of low mood and mental health problems, and affectionless psychopathy (Gronski et al, 2013). Asylum- getting the support the family needs in a timely manner. Th is seeking children with no parents face an even greater risk of is done by undertaking a holistic health needs assessment and developing mental health illness and disorders (Sanchez-Cao making appropriate referrals to other services. Th ese might et al, 2012). include stay-and-play sessions at a local children’s centre, Asylum-seeking women are at high risk of suffering from English classes, nursery provision, mental health services perinatal illness due to pre-existing poor mental health as a and charitable services within the community. Effective result of traumatic experiences (Edge, 2007). Th e impact of this signposting and referrals to key services can help reduce can be evidenced in cases of poor attachment between a mother social isolation, build community capacity and improve the and her children when the mother is suffering from depression wellbeing, health and education of this client group (Cabrera (Boyd and Bee, 2009). and Leyendecker, 2017). In addition, asylum-seeking women and their children can face social isolation as they fi nd themselves in an unfamiliar country, which can hinder their integration into the local community. Th ey risk becoming invisible, with their mental health needs going unaddressed (McKeary and Newbold, 2010). Another risk of invisibility comes from the dearth of research conducted into black minority ethnic (BME) women’s mental health. As Edge (2007) notes, most UK research on mental illness of BME groups is based on severe and In the 12 months to June 2017 enduring cases, such as schizophrenia, and the focus is on men not women. If these women are invisible to health-visiting services, they are unable to access and receive the appropriate healthcare interventions to support them and their children. Refugee Council, 2017 HOW HEALTH VISITORS CAN HELP Communication is, of course, critical. Language and communication barriers appear to be key factors in poor new arrivals to the UK sought asylum healthcare interventions with asylum-seekers. According to Briscoe and Lavender (2009), there is a human need for mutual understanding and meaningful communication. Health visitors will often require the services of an interpreter, and it can be effective to meet up prior to visiting the client. Th e interpreter may be an invaluable source of information about the culture Th e top three countries of origin were: and country of the asylum-seeker. At the end of the visit, the health visitor could also have a debriefi ng session with the interpreter (Tribe, 2007). It is important to recognise that the solution is not simply to have an interpreter that speaks the language (Katan, 2004); Iran Pakistan Iraq adept nonverbal communication is instrumental in the success of effective communication. Silverman et al (2013) and Norfolk et al (2007) discuss the importance of the role of empathy in establishing a rapport in consultation with a patient. Th e health visitor can show nonverbal communication with empathic responses, such as smiling and nodding appropriately as 25% they listen. of applications Health visitors can also use their advanced communication are from women skills to uncover the hidden emotional and psychological life of their clients using a person-centred approach. Th ey need to listen and understand the families’ needs while also being
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RAISING RESILIENCE experiences. Asylum-seekers may fi nd it diffi cult to Another way that can impact talk openly and honestly about their experiences on successful outcomes is with a stranger, such as the health visitor, if they recognising the strength and have been forced to fl ee their country of origin resilience of these individuals. as a result of speaking out about their views and Luthar (1993) describes experiences (Tribe, 2007). resilience as being a person’s It can also be diffi cult for asylum-seekers to capacity to overcome understand welfare and health systems within problems in their lives, the UK. Th e challenge for health visitors is despite the apparently high explaining how they function when people have risks of becoming emotionally nothing to compare it with from their own countries and psychologically damaged (Perreira et al, 2012). It helps to keep it simple, by those diffi culties. Evidence focusing on practicalities such as the process of shows that asylum-seeking registering with a GP and dentist. children can experience positive In addition, ensuring a continuity of mental health outcomes and PRINCIPAL health-visiting services for asylum-seeking resilience, despite their diffi cult MENTAL families can be diffi cult (Robertshaw et al, 2017). experiences (Measham et al, 2014). Th ese families can without warning move from Asylum-seekers who have high HEALTH ISSUES house to house (Drennan and Joseph, 2005) and resilience may be able to cope more IN ASYLUM- may often miss health- effectively with their previous SEEKERS visiting contacts due experiences and move forward with to frequent and rapid RELIGION CAN BE their lives, especially if they have changes of address. Depression AN IMPORTANT the support of the wider family Obviously, this can be (Panter-Brick et al, 2014). Anxiety disorders very time-consuming SOURCE OF Recognising the importance Post-traumatic for the health visitor PROTECTING of religion can also help. Religion stress disorder when attempting to CHILDREN FROM has been highlighted as an Psychosis ensure continuity of important source of protecting care and can also have MENTAL HEALTH children from mental health safeguarding implications. PROBLEMS problems and being more resilient. It can severely hinder AND BEING Fernando (2011) found that PRINCIPAL the development of children who followed Buddhist RISK FACTORS sustaining, consistent and MORE RESILIENT and Christian practices were therapeutic relationships able to cope more effectively between the health visitor in diffi cult circumstances. In Poverty and asylum-seeking families. addition to a child’s personal Poor education Increased caseload pressures may also mean that characteristics, environmental Low self-esteem the health visitor struggles to fi nd the time and factors such as supportive adults resources required to fully meet the needs of such Poor physical health and good community networks, vulnerable people. which may include religious Language barrier Nevertheless, health visitors have such an groups and religious communities, Fear and uncertainty important part to play in helping these families. were important in promoting and Health visitors’ unique and crucial role can bring sustaining resilience (Gorman- Woodward et al, 2016; enormous value to asylum-seekers – assessing, Keyes, 2000 Smith and Tolan, 2003). signposting and planning care for these most Of course, none of this is without vulnerable of families. challenges and it can be helpful for health visitors to be aware and Robert Dransfield, health visitor at Bradford prepared for them. One diffi culty District Care NHS Foundation Trust, and might be that families are wary and Liz Clark, principal lecturer, School of Health may mistrust perceived authority and Community Studies, Leeds fi gures as a result of their previous Beckett University.
To view references and the full version of this paper, entitled Mental health needs of asylum-seeking women and children: implications for health-visiting practice, go to bit.ly/CP_research_dransfield
46 COMMUNITY PRACTITIONER | FEBRUARY 2018
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Argyll & Bute Hscp
Mid Argyll, Kintyre & Islay Locality Team Lead Children’s Services Department – Mid Argyll or Campbeltown 37.5 hours, permanent – Band 7 – £32,103 - £42,205 We are seeking a dynamic and experienced team player to fi ll the role of Team Leader in Mid Argyll, Kintyre and Islay (MAKI). The area has a wide rural geography and the Team operates as one Team with two main bases across this Area Mid Argyll and Campbeltown. The base for the post will be negotiable between Mid Argyll and Campbeltown. The Team Leader will be instrumental in facilitating, leading, supervising and supporting change and Health Visiting agendas around the universal Health Visiting pathway and the Named Person role. The team is an integrated children’s’ team with Health Visitors, School Nurses, Staff Nurses (Schools), Primary Mental Health Nurses and Nursery Nurses. It is a requirement of the post to have active Health Visiting experience, previous managerial experience and evidence of continuing professional development relevant to the post. The role involves a part managerial and part clinical role there a supervisory position working with and managing and supporting colleagues across the team through active supervision and management. The post holder will have overall responsibility for all caseloads in MAKI and contribute to the quality and performance management agendas within the HSCP. You will be expected to travel effi ciently and effectively between various work locations within Argyll & Bute to meet the operational requirements of the Service. Further information can be obtained from Patricia Renfrew, Consultant Nurse, Children and Families – Argyll and Bute HSCP Tel: 01700 501544/07771 937403, Email: [email protected] Application forms are available from HR Department, NHS Highland, Argyll & Bute, Aros, Lochgilphead, Argyll, PA31 8LB – Tel: 01546 606788 (24 hour answering machine service) or e-mail – [email protected] Shortlisted applicants will be contacted by e-mail. Please check your e-mails regularly, including your junk/spam folder. Please quote job reference number 17ab/196 in the subject line of your e-mail or enquiry. The closing date is 2nd March 2018.
www.nhshighland.scot.nhs.uk
COMMUNITY The Journal of the Community Practitioners’ and Health Visitors’ Association NOVEMBER 2017 VOLUME 90 / PRACTITIONER NO. 11 O. 12 OLUME 90 / NNO. 12 n DEC/JANDEC/JAN 2018 VOLUMEV 90 /
f the Community Practitioners’ and Health Visitors’ Associatio The Journal ofo the Community Practitioners’ and Health Visitors’ Association Read by more health visitors than any other journal From a 16,500 circulation the journal Exploring the eff ect of parental confl ict on children
Call to action 201720 reaches: TheTThhee hhighighlights of ghlights of Sepsis warning thistthhhiiss year’syeyea conference ar’s confere Raising awareness Cutting violence and helping carers communitypractitioner.co.ukcommunitypract John Carnochan on early intervention 80 | unitetheunion.org/cphva · % of the UK’s health visitors 01 .indd 1 ALL BY 75 MYSELF · % of all UK school nurses Has loneliness become an epidemic? · 50% of all UK community nursery nurses Period poverty Staying strong Tackling the social The health divide Why resilience and fi nancial taboo Life expectancy remains is important a postcode lottery | unitetheunion.org/cphva Community Practitioner is an ideal communitypractitioner.co.uk 21/12/201 08: platform to promote your product, service or vacancy as it reaches highly CONTACT skilled professionals who constantly refer to the title for information and If you want to reach this valuable audience, please contact: advice. [email protected] or call 020 7880 7621
CONTACT: KRISTIINA KRUUSMA | TEL: 020 7880 7621 | EMAIL: [email protected]
2018 r it nt.indd 4 30/01/2018 10:03 PROFESSIONAL PA SE
LEADING EDITORIAL Th is new THE issue took our talented An award-winning team of art team journalists is at the helm of your around VALUE journal. Th ey have an average of 500 15 years + hours OF CP experience to design This new ‘pause’ series each, most of which has been in the vast area that is health. So they have is all about taking a their eyes fi rmly on the health and wider news agenda, know how to moment to digest and secure top professionals to share reflect on information their expertise and insight, produce the highest quality features, news and ideas. This month, as and opinion pieces, and we have redesigned and execute the journal with the utmost accuracy. refreshed your Community On the topic of accuracy, professional editor Jillian Practitioner, the CP team Taylor checks all articles present all the reasons with a clinical element as well as the research why your professional More than papers. She also lends her journal is leading the way 70% of you expertise to the journal overall to help ensure in coverage of the issues read every CP remains the only that matt er most. We also issue of the professional journal for journal last your professional needs. highlight how you can keep Th e CP editorial advisory it there by contributing year, while board also regularly more than 75% of you contribute their ideas your expertise. and expertise to help have used tips and advice ensure the journal content from the journal at work continually hits the spot.
FURTHERING KNOWLEDGE – THE UNITE-CPHVA ANNUAL PROFESSIONAL CONFERENCE
Th e conference provides the chance to share and acquire knowledge, as key opinion formers come together to offer their expertise on the most pressing issues for community 40+ 80+ practitioners. Speakers include members from practice, exhibitors Speakers academia, and government. Th is year, conference will be 2 held on 17 to 18 October at the Bournemouth International days 450+ Centre. Visit cphvaconference.co.uk for details. delegates
48 COMMUNITY PRACTITIONER | FEBRUARY 2018
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INFORMATION ON THE GO REGULAR UPDATES
You’ll fi nd all features, Communitypractitioner.co.uk is a news and opinion pieces fully responsive website so you can from the journal at the catch up on the latest CP insight CP website. PLUS, you’ll 47% wherever you are. 47% of the visits fi nd extra news stories; to the website come from mobiles a professional resources or tablets, so lots of you are already section; jobs; and content enjoying content in this way. Bookmark us today! from the past 14 years at communitypractitioner. co.uk/archive Over the past year, the professional resources section, In addition to the journal which includes the journal’s and website, the editorial peer-reviewed research papers 20% team produce a fortnightly in full, has accounted for about e-newsletter delivered 20% of all page views. So if you straight into your email successfully submit research to inbox. Newsletters provide the journal, thousands of your the latest public health and professional colleagues will read it. If you want to share professional news, detail your work, it makes sense to contact CP fi rst. events or surveys and highlight features in the latest issue. If you’ve contributed articles or comments, peers will be paying attention, with more than 70,000+ e-newsletters being read in A total of a year On social media, 9594 minutes the CP team are spent reading communitypractitioner.co.uk each month. With busy regularly highlight lives that’s some feat. Not only does this show that the content is being well received, but if you successfully submit an article idea or contribute the content in the quotes, it means you’re also raising your professional profi le. current journal, and reveal what’s coming up and how to contribute. TAKING A STAND Follow us, join in: Community Practitioner is the only journal in the sector that no longer accepts breastmilk substitute facebook.com/ product advertising. Unite-CPHVA and the CommPrac journal continue to create a supportive, enabling environment for women who choose to initiate twitt er.com/ breastfeeding and the prolonged use of breastmilk. commprac
49 COMMUNITY PRACTITIONER | FEBRUARY 2018
48-49 Professional Pause.indd 49 31/01/2018 12:54 PETER WALKER’S TEACHER TRAINING IN DEVELOPMENTAL BABY MASSAGE
24-25 February – London COURSES 23-24 June – London 3-4 November – London
Th is two-day certifi ed course is a personal teacher-training programme with Peter Walker, who has over 40 years’ TOUCH-LEARN INTERNATIONAL BABY MASSAGE experience with 25,000 teachers in over 22 countries. Peter is TEACHER TRAINING COURSE credited with the free teaching of developmental baby massage in NHS centres across the UK. Inexpensive, high-quality and A comprehensive baby massage teacher course for health originally university-accredited, the course includes key professionals and parenting practitioners with long- principles of neuroscience and child development. established company Touch-Learn. Th is highly acclaimed Th e course is for family health professionals, health fi ve-day programme is accredited by the Royal College of visitors, children’s centre staff and anyone involved in Midwives, the University of Wolverhampton and Independent supporting and nurturing new parents and their babies, Professional Th erapists International. Th e curriculum includes including those concerned with limiting developmental simple massage techniques, underpinned by research and delay and disabilities from birth. Fully accredited by FEDANT, practical knowledge to enable practitioners to feel confi dent the course resources include Peter’s international bestseller in supporting parents sensitively, safely and professionally in Developmental baby massage, course notes, session notes for a variety of settings. Experienced trainers with professional/ parents, a bi-monthly newsletter and post-course support. HE teaching qualifi cations. Touch-Learn teachers are provided with free handouts to support classes. Location: Th e Active Birth Centre,London. London. Peter is also available for Location: Scheduled and in-house courses across the UK. in-house teaching in the Call for dates. UK and abroad.
T: 01889 566222 T: 01752 218392 M: 07814 624681 E: [email protected] E: [email protected] W: thebabieswebsite.com W: touchlearn.co.uk
TRAINING IN NEONATAL BEHAVIOUR LEARN BABY MASSAGE WITH THE Newborn Behavioural Observations (NBO) INTERNATIONAL ASSOCIATION OF 26-27 April – London INFANT MASSAGE (IAIM) Neonatal Behavioural Assessment Scale (NBAS) 2-3 May – Cambridge Train to become a certifi ed infant massage instructor with the IAIM, the largest and longest-standing NBO is a relationship-building tool between parent and baby worldwide association dedicated solely to baby and parent and practitioner suitable for babies from birth to massage. Our curriculum is taught in more than 60 three months old. countries and has been developed and refi ned over NBAS is an assessment of newborn babies and is suitable for 30 years through research, refl ective practice and those practitioners or researchers who want a detailed look practical experience. Th is has resulted in a widely at baby behaviour. Th e NBAS is recommended in the Healthy endorsed and implemented parenting programme. Child Programme (Department of Health). Th e NBAS and By training with our highly respected organisation, NBO are recommended in the National Health Visiting Service you will join a worldwide network of instructors Specifi cation (NHS England) and the Specialist Health Visitors offering a supportive environment to teach lifelong in Perinatal and Infant Mental Health (NHS Health Education parenting and relaxation skills. England). Book your place via the website. T: 020 8989 9597 T: 01223 314429 E: [email protected] E: [email protected] W: iaim.org.uk W: brazelton.co.uk/courses Facebook: IAIM UK Chapter
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0 r .indd 0 30/01/2018 18:43 1. 2018.indd 1 30/01/2018 10:02 Cleanse and protect newborn skin from day 1
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2. 2018.indd 2 2 /01/2018 13:33