HOME ALONE? the Challenges of Keeping Children Safe

The Journal of the Community Practitioners’ and Health Visitors’ Association DECEMBER 2016 VOLUME 89 / NO. 12 COMMUNITY PRACTITIONER

HOME ALONE? The challenges of keeping children safe

‘I want to listen’ Annual conference NHS no more? The new shadow The highlights from this The future of the health secretary year’s event in Telford health service YEARS OF

communitypractitioner.com | unitetheunion.org/cphva

CP_Cover_Dec16.indd 1 01/12/2016 11:11 BREASTFEEDING IS BEST FOR BABIES Science & nature hand in hand

A reduced protein infant milk from the leading experts in organic nutrition.

By reducing the protein content to less than 2g/100kcal and adding alpha-lactalbumin, we have made the protein level and quality of HiPP‘s fi rst infant milk closer to that found in breastmilk1. High protein intake in the fi rst two years of life has been linked with an increased long term risk of being overweight or obese.2

With prebiotic oligosaccharides (GOS) for healthy digestion, and Omega 3 & 6 LCPs for brain and tissue development, our formulas combine all the natural benefi ts of organic ingredients, with 50 years of breastmilk research. Discover more at hipp4hcps.co.uk

1 Contains 1.89g/100kcal of protein, including _-lactalbumin, making the protein level and quality closer to that found in breastmilk (1.7g/100kcal). Nommsen LA et al. Am J Clin Nutr 1991; 53: 457–465. 2 Koletzko B et al. Am J Clin Nutr 2009; 89(5):1502S–8S. Important Notice: Breastfeeding is best for babies. Breastmilk provides babies with the best source of nourishment. Infant formula milks and follow on milks are intended to be used when babies cannot be breastfed. The decision to discontinue breastfeeding may be diffi cult to reverse and the introduction of partial bottle feeding may reduce breastmilk supply. The fi nancial benefi ts of breastfeeding should be considered before bottle feeding is initiated. Failure to follow preparation instructions carefully may be harmful to a baby’s health. Infant formula and follow on milks should be used only on the advice of a healthcare professional.

p02.CPDEC16.indd 2 29/11/2016 15:34 COMMUNITY ContentsPRACTITIONER Volume 89 Number 12

Unite/CPHVA Existing Unite/CPHVA members with queries relating to their membership should contact 0845 850 4242 or see unitetheunion.org/contact_us.aspx for further details. To join Unite/CPHVA, see unitetheunion.org Unite/CPHVA is based at 128 Theobald’s Road London WC1X 8TN 020 3371 2006

Community Practitioner journal Unite-CPHVA members receive the journal free each month. Non-members of Unite-CPHVA and institutions may subscribe to the journal to receive it every month. Non-member subscription rates Individual (UK) £125 Individual (rest of world) £145 Institution (UK) £145 Institution (rest of world) £195 Subscription enquiries may be made to Community Practitioner subscriptions Redactive Publishing Ltd PO Box 35 Robertsbridge TN32 5WN t: 01580 883844 28 f: 01580 883849 [email protected] The journal is published on behalf of EDITORIAL FEATURES PROFESSIONAL Unite-CPHVA by Redactive Media Group 5 It’s tough out there 16 We have the highlights AND RESEARCH 17 Britton Street from this year’s annual 44 Supporting pre-registration London EC1M 5TP professional conference nurses within health visiting 020 7880 6200 NEWS 6 A look at the latest and school nursing in public health 22 As some families For editorial contacts, see the panel feel the strain COVER LAST WORD over the page. 8 The most recent research at Christmas, STORY 49 Off to pastures new for Advertising queries from the professions we take a look CPHVA executive chair Alex Edwards at safeguarding Carolyn Taylor 020 7324 2735 [email protected] 10 The truth about children over the festive childhood poverty Production season – and beyond Jane Easterman 28 Is it the end for the NHS? 12 020 7880 6248 RIGHTS AT WORK [email protected] 12 Standing up and speaking Allyson Pollock, who spoke Printed by Warners out... using the NMC code at the recent Unite-CPHVA © 2016 Community Practitioners’ and conference, explains more Health Visitors’ Association ONE-TO-ONE ISSN 1462-2815 14 Jon Ashworth MP says he 32 A new game with the The views expressed do not necessarily represent wants to listen to members power to transform the those of the editor nor of Unite/CPHVA. activity levels of communities Paid advertisements in the journal do not imply endorsement of the products or services advertised. 34 The festive period for some isn’t so festive for others

38 The last 12 months for the CPHVA executive LOOKING BACK 42 1996-2016: acts, reports 10 and white papers

December 2016 Community Practitioner 3

p3 Contents.indd 3 01/12/2016 11:11 p04.CPDEC16.indd 4 29/11/2016 15:36 THE NHS EDITORIAL

COMMUNITY PRACTITIONER It’s tough out there Editorial Advisory Board Welcome to the December issue of Community Practitioner. Obi Amadi – Lead Professional Officer Maggie Breen – Macmillan Clinical Nurse Specialist – Children and Young People, The Royal Marsden Hospital NHS Foundation Cuts, job losses, increased workloads... The reality of life on the Trust front line is hard, and it’s going to get harder. That was the general Toity Deave – Associate Professor for Family and Child Health, Centre for Child sentiment of this year’s annual professional conference in Telford last and Adolescent Health, University of the month. But, despite the sombre messages and frank discussions, the West of England, Bristol vibrancy and energy was palpable. What a lovely bunch you are too Barbara Evans – Community Nursery Nurse, Leicestershire Partnership NHS Trust – engaged, approachable and full of enthusiasm – but of course, we Gavin Fergie – Lead Professional Officer wouldn’t expect anything less! Brenda Poulton – Emerita Professor of Public Health Nursing, University of Ulster Given the fraught and incredibly stressful times you are facing, we Janet Taylor – Specialist Health Visitor Public Health, South Eastern Health and were expecting a few more downtrodden souls to be attending the Social Care Trust, Belfast event, but the reality was quite di erent. You came together, discussed with your peers, debated Surrinder Bains – Health Visitor and with speakers and challenged the shadow minister, even earning yourselves an invitation to the National Solihull Approach Trainer Louise Rowlinson – School Nurse, Houses of Parliament. You told it how it is and it felt to us that you found a true solidarity in doing Cambridgeshire Community Services so. The working environment for so many does seem exceptionally tough and yet the concurrent NHS Trust sessions, the posters and the masterclasses seemed to reect a workforce that is, despite Elaine Haycock-Stuart – Senior Lecturer, everything, still innovative and inspiring, while retaining children and families at the heart of School of Health in Social Science, University of Edinburgh everything. There is so much good work going on out there. If you have done something you’d Lucretia Baptiste – Independent School like to shout about, please get in touch – it would be great to let your colleagues know in the Nurse pages of the journal, so drop me a line today if you can at [email protected], Louise Condon – Associate Professor, College of Human and Health Services, even if it’s just to express an interest. Maybe you could inspire others to try a new approach? Swansea University Talking of journal content, this issue attempts to capture the avour of conference, with a Editorial Team round-up of just some of the highlights, including a few shots from the conference party – lead Emma Godfrey-Edwards Managing Editor professional ocers Gavin Fergie and Dave Munday’s spectacular ‘lift’ demonstrating the true [email protected] meaning of trust and teamworking (sadly not captured on lm) – and speakers, Jon Ashworth Helen Bird MP (page 14) and Allyson Pollock from the University of London (page 28). We also feature an Editor interview with CPHVA executive chair Carolyn Taylor, who is due to step down from her post and [email protected] 020 7324 2757 head o for a new chapter in her life (page 49). Keep an eye out in future issues for more projects Professor Jane Appleton and guidance from other inspirational conference speakers. Professional Editor Nicola Skowronek And of course we can’t forget what time of year it is, so the festive period gets a mention too, a Designer couple of times in fact! It wouldn’t be a December issue if we didn’t mention it – even if it is to reect the stark reality of this time of year for some. Unite/CPHVA Honorary Officers Polly Toynbee – President Elizabeth Anionwu – Vice President It’s an ideal opportunity too to take a moment away from the turkey and tinsel and drop me a Chris Cloke – Vice President line to let me know what you would like to read about in the forthcoming issues.

Unite Health Sector Officers I hope you all have a lovely break and enjoy the festivities and we’ll return in the New Year to Sarah Carpenter – National Officer tackle the issues a ecting you all in 2017. Colenzo Jarrett-Thorpe – National Officer Obi Amadi – Lead Professional Officer Gavin Fergie – Lead Professional Officer Rosalind Godson – Lead Professional Officer Dave Munday – Lead Professional Officer Jane Beach – Lead Professional Officer Ethel Rodrigues – Lead Professional Officer

Helen Bird Editor

December 2016 Community Practitioner 5

p5 eds letter.indd 5 01/12/2016 12:39 NEWS ROUND-UP

NEWS ROUND-UP A look at the latest in public health

Patchy support for breastfeeding

A report on breastfeeding in the UK has found access to support is inconsistent and under threat. The fi rst World Breastfeeding Trends Initiative UK report on policies and programmes in infant feeding found examples of good support scattered across the UK. But, in England particularly, leadership was missing, support services have ‘Health literacy’ toolkit declined in recent years, and more are under threat. for school nurses While Scotland and Northern Ireland scored 10 out of 10 for A new toolkit of ideas and resources to Produced by the Association for Young their leadership and national help school nurses improve young people’s People’s Health with support from Public strategies, the UK still has among health literacy has been launched. Health England, the toolkit also off ers guidance the lowest breastfeeding rates Comprising a wide range of tools, from on how school nursing teams can infl uence in the world. Around 80% of academic publications to examples of commissioning priorities of local authorities mothers begin to breastfeed, interesting practice, it will help school nurses and schools, and so improve health literacy for but rates plummet within weeks support children and young people in making young people across the wider community. due to lack of support and an good decisions about their own health, and to ● To access the toolkit, go to unhelpful culture. access health services. bit.ly/school_nurse_toolkit The report calls for ‘national leadership’ and recommends protection for breastfeeding mothers at work, a high standard Domestic violence most common DfE children in need census, of training for staff , and joined-up show that 394,000 are support in the community. factor for ‘in need’ children deemed ‘in need’ across Gavin Fergie, lead professional England, up slightly on the offi cer at Unite-CPHVA, said: ‘This Domestic violence and children assessed by local previous year. Of these, 50,310 is another report highlighting poor mental health are authorities in the year to were the subject of a child why we are at the bottom the biggest issues facing March 2015. Mental health protection plan (up 1.2% on of the table. This essential children known to social issues, for the child or family 2015), refl ecting a rise from less element of public health needs services in England. members, were identifi ed in than 40,000 in 2010. real investment to make the Domestic violence was more than a third of cases. ● For more, visit bit.ly/DfE_ recommendations a reality.’ a factor for almost half of The fi gures, from November’s children_in_need_2015-16 ● Go to bit.ly/WBTiUK2016

6 Community Practitioner December 2016

P6-7 News.indd 6 01/12/2016 13:32 NEWS ROUND-UP

Integrated model Online bullying is the top bullying concern for for Healthy Child Programme 16- to 18-year-olds

Bullying is the most A model for can make the biggest common reason for school nursing and diff erence to the health and children aged health visiting priorities wellbeing of children and 9% of all Childline young people. for 0 to 19-year-olds has counselling sessions 11 been published. Priorities for health visitors are about bullying and under to contact Public Health England’s include maternal mental Childline (Source: NSPCC, 2016) integrated 4-5-6 model health, breastfeeding and sets out the approach to getting ready for school. For Online bullying up by 88% delivering the Healthy Child school nurses they include The number of children reporting cyberbullying has risen by Programme – with a new resilience, keeping safe and 88% over the past fi ve years, with some as young as seven infographic illustrating the healthy lifestyles. being tormented online. role of health visitors and The 4-5-6 model can help The fi gures released by the NSPCC show that Childline, the school nurses in providing practitioners, commissioners charity’s national helpline, counselled 4541 children about seamless support. and other stakeholders cyberbullying in 2015-16, a substantial increase on the fi gure of It also refreshes the ‘high- to focus their eff orts and 2410 in 2011-12. impact areas’ for early and resources eff ectively. In a quarter of counselling sessions, support was also off ered for school-aged years, making ● For more, go to a mental health and wellbeing issue, including low self-esteem, clear where practitioners bit.ly/PHE_4-5-6_model self-harm, suicidal thoughts and depression. Online bullying is rapidly becoming a main concern for children and teenagers contacting Childline. The charity’s new report What children are telling us about bullying reveals comments posted on social media profi les, blogs and online pictures ranged from Obesity rates bullying about looks to death threats. Almost a third of counselling sessions were with children in England and young people experiencing bullying on a gaming or social highest ever networking site. In the most extreme cases, children and young people were told to ‘go and kill yourself’. The proportion of Peter Wanless, chief executive of the NSPCC, said online bullying overweight and obese was ‘one of the biggest child protection challenges of this children leaving primary generation,’ adding: ‘The 24/7 nature of the internet means that school in England is now a child can be targeted around the clock.’ the highest on record. ● To read the report, visit bit.ly/NSPCC_bullying_2016 Data from the National Child Measurement this year at the time of Programme shows that over publication), with 21.8% of NHS mileage rates remain a third (34.2%) of year six children in their fi rst year of children were overweight or primary school overweight unaltered after latest review obese in 2015-16, up from or obese in Scotland, and 31.6% in 2006-07. And more 26.2% of reception children Rates of reimbursement for the costs incurred by staff subject to Agenda than one in fi ve reception in Wales according to 2014- for Change terms who use their cars on NHS business will remain the age children were either 1 5 fi g u r e .s same, according to the November review. overweight or obese. In Northern Ireland, the The review has confi rmed that the change in fuel prices over the past The Obesity Health 2015-16 Health Survey 12 months has not increased or decreased by 5% or more, which is the Alliance called the results published in November threshold for altering mileage rates. ‘another bleak picture’ of an found 25% of all children This means the current 56p per mile up to an annual mileage of 3500 ‘increasingly worrying trend’. aged from two to 15 were and 20p per mile over this fi gure, as stated in section 17.12 of the NHS The picture is similar in classed as either overweight terms and conditions of service handbook, will remain. Wales and Scotland (neither or obese, which is down While the November review looks at the costs of fuel alone, the June

SHUTTERSTOCK/ISTOCK had published data for slightly on last year. edition focuses on the total cost of motoring, including fuel.

December 2016 Community Practitioner 7

P6-7 News.indd 7 01/12/2016 12:40 RESEARCH NEWS

Their work, published in JAMA Pediatrics, Media is a review of 20 existing studies from four continents, involving more than 125,000 children aged from six to 19. Gestational diabetes devices The researchers found that using a media risk is greater in device within 90 minutes of going to sleep linked to was associated with an increased likelihood mums who conceive of not getting enough sleep, poor sleep during winter quality, and excessive daytime sleepiness. poor sleep Even when it wasn’t used, the presence of a Women whose babies are media device in the bedroom was associated conceived in winter are more in children with an increased likelihood of poor sleep. likely to develop gestational Dr Ben Carter from King’s College London diabetes, research led by the Children who use devices such said: ‘Sleep is an often undervalued, but University of Adelaide has found. smartphones, tablets and computers important, part of children’s development, The study – investigating more at bedtime have more than double the with a regular lack of sleep causing a variety than 60,000 births in South Australia risk of a bad night’s sleep, according of health problems.’ over a fi ve-year period – is the fi rst to a new study led by researchers from ● To access the study, visit population-based study of its kind King’s College London. bit.ly/JAMA_carter_sleep to confi rm a seasonal variation in gestational diabetes. Published in the journal BMJ Diabetes Research & Care, the study found that Doctors warn of alternative 6.6% of pregnancies from winter conceptions were aff ected, compared therapy dangers with 5.4% of those in summer. Complications of gestational Doctors have warned of the potential The diabetes for children include excessive dangers of complementary therapies boy was birthweight, preterm birth, low blood after a four-year-old boy with autism was treated sugar, which can lead to seizures in the admitted to accident and emergency. for the baby, and developing type 2 diabetes The case, reported in the journal BMJ Case condition later in life. Reports, saw the young boy admitted with and had Lead author Dr Petra Verburg, from symptoms including vomiting, constipation, made a full the University of Groningen, said the weight loss and loss of appetite. recovery two factors that lead to gestational diabetes Tests revealed hypercalcaemia – a high weeks later. were still not fully understood but level of calcium in the blood – as well as a ‘Many families view previous studies have suggested that high level of vitamin D. these therapies as safer ‘natural’ options,’ the meteorological factors, physical activity, His mother revealed she had consulted a authors write. ‘But as this case demonstrates, diet and vitamin D are risk factors, ‘all naturopath who recommended 12 holistic there can be signifi cant adverse eff ects of which are impacted by the winter supplements for her son, including calcium, which may go unrecognised due to lack season’, she added. vitamin D, cod liver oil, camel milk, silver, of monitoring, recognition and experience ● To read more, visit zinc and Epsom bath salts. They were with these therapies.’ bit.ly/BMJ_verburg_diabetes thought to be the most likely explanation ● For further details, go to for his symptoms. bit.ly/BMJ_boyd_supplements

8 Community Practitioner December 2016

p8-9 PP Research News.indd 8 01/12/2016 09:53 RESEARCH NEWS

Parents missing PTSD in young children

Young children may experience post- They were assessed for PTSD between two from UEA’s Norwich Medical School, said: traumatic stress disorder (PTSD) for years and four weeks after the incident, then again ‘We found that children may experience without it being recognised by their at six months, and fi nally after three years. PTSD for years without it being recognised parents, according to new research from The study, published in the Journal of Clinical by their parents. We also found a strong link the University of East Anglia (UEA). Psychiatry, found children showing signs of between parents suff ering PTSD and their Researchers followed more than 100 stress soon after a trauma will not necessarily children suff ering as well – even years after children aged between two and 10 who had go on to suff er PTSD after three years, but a the traumatic event.’ been involved in a road accident – either in minority develop PTSD that persists for years. The fi ndings strengthen the case for more a car crash, hit as a pedestrian, or knocked Symptoms can include traumatic memories support for parents and children after trauma, off their bike. All had been taken to A&E with and nightmares, avoiding reminders of the he added. varying injuries, including bruising, fracture or trauma, and feeling like the world is unsafe. ● To read more, visit loss of consciousness. Lead researcher Dr Richard Meiser-Stedman, bit.ly/JCP_meiser-stedman_PTSD

Teenagers infl uenced by Mental health video games with alcohol risk for girls and smoking content with ADHD Video games featuring alcohol and tobacco Girls diagnosed with attention drinking and smoking references were twice as defi cit hyperactivity disorder may infl uence teenage likely to have tried smoking (ADHD) are at much higher players, according to or drinking themselves. risk of other mental health a new UK study. Psychologist Dr problems, according to research Experts Joanne Cranwell, by US psychologists. from the UK from the UK Researchers from the University Centre for Centre for of California, Los Angeles, analysed compared with only 0.8% of their Tobacco Tobacco and 18 studies of 1997 girls, about peers without ADHD. and Alcohol Alcohol Studies, 40% of whom had ADHD. Steve Lee, a UCLA associate Studies at said more than Their report in the journal professor of psychology and the University half of British Pediatrics found more than senior author of the study, said: of Nottingham parents were unaware 37% of girls with ADHD met ‘These conduct disorders, more analysed 32 bestselling of the harmful content criteria for an anxiety disorder, than anxiety and depression, video games, and found age-inappropriate games compared with only 13.9% of predict severe adult impairments, alcohol and tobacco expose children to. girls without ADHD. More than such as risky sexual behaviour, content in 44%. She called for the one in 10 were diagnosed with abusive relationships, drug abuse The research, Pan-European Game depression compared with 2.9% and crime.’ published in the journal Information rating without ADHD. ‘Kids with ADHD need structure Cyberpsychology, Behavior system to include alcohol In addition, 42% of girls with and consistency, more than the and Social Networking, and tobacco in their ADHD were diagnosed with average child; they need to know included a survey of 1094 content descriptors. oppositional defi ant disorder, the rules and the rules need to be 11- to 17-year-olds, which ● For more, go to compared with just 5% of girls applied consistently,’ he added. found teenagers who play bit.ly/CBSN_cranwell_ without it, and 12.8% were ● For more details, go to

SHUTTERSTOCK/ISTOCK video games featuring video_games diagnosed with conduct disorder bit.ly/Ped_lee_ADHD

December 2016 Community Practitioner 9

p8-9 PP Research News.indd 9 01/12/2016 09:54 BIG STORY

Neonatal and infant mortality rates are almost 50% higher in the poorest parts of Wales, compared to the least deprived areas. This is one of the shocking facts to emerge from the fi rst annual report of the new chief medical offi cer (CMO) for Wales. It reveals that, while infant mortality has declined in recent years as a result of improvements in health care, the rate is still highest in the poorest communities, standing at 5.6 deaths per 1000 in the most deprived areas of Wales, compared to 3.8 in the least deprived parts between 2006 and 2010. Dr Frank Atherton – who has started his tenure with a focus on health inequalities – called it an ‘unacceptable diff erence that demands further and earlier intervention’. His fi rst annual report,Rebalancing healthcare: working in partnership to reduce social inequity, written with deputy chief medical offi cer Professor Chris Jones, considers the impact of the ‘social gradient’ on health and wellbeing in Wales, and calls for consideration of how healthcare services and professionals can focus on those with greatest need fi rst. Much of the report centres on the impact poverty can have on children. As the authors put it: ‘Simply by growing up in a poor area in Wales, a child is more likely to have poorer health that will impact the rest of their lives.’ The One key indicator is childhood obesity. Tracked through the Child Measurement Programme in Wales, there is a clear correlation between levels of deprivation and obesity. For example, one in seven children (14.7%) living in Merthyr Tydfi l – a known area of deprivation TRUTH – is obese, compared with just one in 14 about childhood poverty In a classroom of 30 children, nine will be living in poverty. With statistics like this, Juliette Astrup takes a closer look at the issues.

10 Community Practitioner December 2016

p10-11 PP Big Story.indd 10 01/12/2016 09:55 BIG STORY

children (7.3%) in the largely better-off Vale of because it goes on postcode, you can fi nd and the raft of health and wellbeing issues Glamorgan. Similar gradients exist for childhood that some people will be included that don’t associated with it are a growing concern. injuries and tooth decay, the report fi nds. need to be, and others will fall outside that New fi gures published by the End Child Dr Atherton said the aim should be area but still be in need of help. Poverty coalition reveal a postcode lottery ‘providing universal support to all families ‘What the Welsh Government is doing is of deprivation, with nearly half of children during the fi rst 1000 days of life… with trying to look at the generic health visiting living in poverty in some parts of the UK tailored additional support to higher risk and school nursing services as well, and put – compared to one in 10 in others. In all, the individuals and families’. more resources into that, and looking at report estimates 3.5 million children are The Welsh Government has made tackling caseloads, for example. living in poverty in the UK. health inequalities a policy priority, with ‘But you have to put that into context: Levels are highest in large cities, targeted initiatives such as Flying Start already while it’s a priority for Wales, funding from particularly in London, Birmingham and making a diff erence in some of the most central government isn’t suffi cient for what Manchester, which between them account deprived areas. Wales wants to do. for 13 of the 20 parliamentary constituencies Part of the early years programme for ‘The new Healthy Child Wales programme with the highest levels of childhood poverty. families with children under four living in is now being rolled out, but we are concerned The coalition of charities, faith groups and disadvantaged areas, this scheme off ers free about whether there will be suffi cient unions warned that the benefi ts freeze in childcare for two- and three-year-olds, access resources to deliver the programme in its place until the end of the decade will put to parenting programmes, and speech and entirety – this will require more funding too.’ low-income families under further pressure, language support. She added: ‘The child poverty fi gures in and recent cuts to in-work support under And, central to Flying Start is enhanced Wales are going down because of the focus universal credit will push more working health visiting services, with a requirement that on it, but there are still a lot of challenges.’ families below the poverty line. there must be one full-time equivalent health Wales is not alone in dealing with these Chair of End Child Poverty Sam Royston visitor per 110 under-fours in the target areas, to challenges. Across the UK, child poverty said: ‘In every community, there are children provide intensive support where it’s needed. being denied the happy childhoods and In addition, the new Healthy Child Wales the good start in life other children take for programme has been made one of the Welsh granted. Our children are now twice as likely Government’s priorities over the next fi ve to be as poor as our pensioners.’ years. Now being rolled out across the country, 28% And Professor Russell Viner, offi cer for it sets out an all-Wales approach to early of children in the UK are health promotion for the Royal College of years interventions, delivering, again through living in poverty or nine Paediatrics and Child Health, called the report the health visiting service, a minimum set in a classroom of 30 ‘truly shocking’, pointing out that children of universal interventions to all families with born into the lowest social economic pre-school children, irrespective of need, with group are nine times more at risk of sudden additional support provided when required. unexpected death in infancy than babies Minister for social services and public born into wealthier families, and that poorer health Rebecca Evans said it would help 47% children ‘are more likely to be admitted to the government in ‘addressing health of children in some areas hospital, have mental health problems, be inequalities and adverse childhood are living in poverty obese and have parents who smoke or drink experiences… and tackle the signifi cant excessive amounts of alcohol’. challenge that child poverty has on He added: ‘Our new prime minister is delivering improved health outcomes’. absolutely right when she said we need to Jane Beach, lead professional offi cer for make Britain a country that works not for a regulation and Wales (health sector), at 64% privileged few, but for every one of us. And of children in poverty Unite-CPHVA said health inequalities and have at least one reducing these extraordinary inequalities child poverty needed to be ‘constantly on parent in work needs to be a major part of that.’ CP the agenda’. ● To read the CMO’s fi rst annual report, She praised the proactive approach in visit bit.ly/CMO_report_2015-16; for Wales, and welcomed the intervention by the more about the Child Measurement CMO – but sounded a note of caution. Programme in Wales, go to bit.ly/CMP_ ‘Identifying children in need is what health 35% Wales; for more on Flying Start, visit visitors and school nurses are trained to do of children in poverty bit.ly/fl ying_start_Wales;;for the Healthy – but it can be frustrating when there aren’t live in families with three Child Wales programme, go to bit.ly/ suffi cient resources to refer people to. or more children HCW_2016;and to access details about ‘Flying Start is an excellent programme, but (Source: End Child Poverty, 2016) the coalition, visit endchildpoverty.org.uk IMAGE SOURCE IMAGE

December 2016 Community Practitioner 11

p10-11 PP Big Story.indd 11 01/12/2016 09:55 RIGHTS AT WORK Standing up and SPEAKING OUT

In these times of re-organisations, redundancies, covering for vacant posts, ever-growing caseloads (to name but a few challenges for health visitors and school nurses), it is even more important that registrants adhere to the NMC code and raise their concerns. Examples of when this may be required include when trying to cover a vacant caseload feels unsafe and the registrant is concerned that patient care is being jeopardised. Or perhaps when a team knows that low staffi ng levels mean that some families In this issue, Sarah Carpenter, Unite’s are not getting followed up as they should be. For all head of health, encourages members to those situations when there are concerns, the registrants’ professional duty is to raise them. raise their concerns and always use their This might feel diffi cult, awkward or scary. But it is not a NMC code. choice. The only choice is fi nding the best way to raise it given the circumstances. Back when many of us were young, the Green Cross Unite-CPHVA has developed a series of model letters Code advised us that if we wanted to survive crossing to get registrants started in raising issues. We have a letter a busy road, we should always ‘stop, look and listen’. that local union reps can use to raise concerns, one for This simple message probably helped to save the lives when there is unsafe practice or workloads, another for of thousands of children and was underpinned by basic when there is a need to escalate an immediate concern, road safety rules about where to stand at the edge of and fi nally one for managers to use to support their pavements, how not to cross between parked cars and staff . These can all be found on the Unite website, and never to run blindly towards an ice-cream van. remember to consider the advice in last month’s edition If staff want their patients and themselves to survive in of Community Practitioner and contact your local Unite- the tumultuous world of today’s healthcare environment, CPHVA rep (your local equivalent of the Green Cross Code it is important for them to remember another type of man – there to remind you how to stay safe). code, the NMC code, and in particular section 16, which The NMC code is there to protect patients, and it is reminds registrants to ‘act without delay if you believe that registrants’ duty to do all they can to do that too. By using there is a risk to patient safety or public protection’. That section 16, registrants are doing something else as well – simple statement is underpinned by six key clauses that, in they are protecting themselves. By escalating concerns, a nutshell, instruct nurses, health visitors and midwives to: the responsibility for the problems that come from short ● Raise concerns promptly staffi ng, redundancies and cuts is given back to the ● Escalate concerns to authority employing organisation, and not left in the hands of the ● Not hinder others who raise issues individual practitioner. CP ● Protect those they may have management responsibility Sarah Carpenter, head of health at Unite for from any harm as a result of raising a concern. @sarahcarps It’s powerful stuff , and is the professional duty of every ● For more information on the NMC code, go to NMC registrant. Section 16 of the code is often seen as nmc.org.uk/standards/code/read-the-code-online being the part about whistleblowing, and it is, but it is and to take a read of Unite-CPHVA’s model letters, visit about much more than that. bit.ly/unite_professional_resources

12 Community Practitioner December 2016

p12 Rights at work.indd 12 01/12/2016 09:56 NEW VITAMIN D CPD MODULE HOW TO ASSESS AND TACKLE VITAMIN D DEFICIENCIES

The CPD module will:

• Introduce vitamin D: what it does in the body, where we find • Offer practical advice to identify children who may be at it in the diet and the consequences of vitamin D deficiency for risk of vitamin D deficiency, and suggest ways to improve children’ health children’s vitamin D status • Describe the latest advice on vitamin D • Provide figures on vitamin D intakes and prevalence of deficiency in UK children using the National Diet and Nutrition Visit: hub.communitypractitioner.com for Survey (NDNS), a government rolling survey of the UK population further information on the module.

Wp13.CPDEC16.indd 13 29/11/2016 15:37 ONE-TO-ONE

‘I want to listen’ The new shadow health secretary for England may not have a wealth of healthcare experience, but he says he wants to learn and vows to protect the NHS.

14 Community Practitioner December 2016

p14-15 121.indd 14 01/12/2016 09:57 ONE-TO-ONE

hen Jon Ashworth MP took to the stage at last month’s Unite-CPHVA conference, it was his Wfi rst public speech in the role of shadow health secretary for England. He had been in post just four weeks, following Jeremy Corbyn’s October shadow cabinet reshuffl e, when he addressed the delegates in Telford. As a man with no previous experience of a healthcare portfolio, his speech was one of broad brush-strokes, with few specifi cs about community practitioners and health visitors. But he spoke passionately about the NHS and appealed to those present to work in collaboration with him. Among the key messages in his speech were that the Tory government’s funding cuts have been the most severe in the NHS’s history, that the effi ciency savings are He believes that while a false economy and that the future is so grim ‘we will be acute hospital care is ALL ABOUT JON spending less per head on health care than Costa Rica’ broadly understood by the by 2020. public and politicians there ● Born in 1978 in Salford and On the fl ip side, he said a Labour government would is a lack of clarity around raised in north Manchester reverse the decision to scrap student bursaries, fi ght NHS care and services that are privatisation and ‘put an end to austerity economics’. provided in the community. ● Educated at Philips High Speaking to Community Practitioner after his keynote ‘Politicians and journalists School in Bury and Bury address, Mr Ashworth says: ‘It is Labour’s priority to make go to hospitals all the time College before studying at the NHS our big issue. We are going to be launching a and it is important that they the University of Durham big campaign on the NHS to show people what is really do,’ he says. ‘But I don’t think ● Served as the national happening and how it is getting worse. I never take that they see enough of secretary of Labour anything for granted, but we have got to work and pressure what happens on the front Students people and we can do it.’ line every day.’ ● Began working for the He continues: ‘We are working hard and the NHS Mr Ashworth has Labour Party as a political is becoming a massive issue, when you look at the organised with Unite to research offi cer in 2001 privatisation and all the targets that are being missed… and spend a day shadowing ● Elected to be MP for the fi gures are only getting worse.’ members. ‘I want to spend Leicester South in a The NHS has been a fi ercely contested battleground over a day on the ground seeing by-election in 2011 recent months after being dragged into the centre of the what happens and listening Brexit debate by the infamous banner on the side of Boris’s to people. I want to learn ● A former adviser to Gordon battle bus (see above right). But Mr Ashworth believes it will about caseloads and the Brown and head of party only ever be safe in Labour’s hands. pressures that people are relations for Ed Miliband ‘The country and world, with everything that has under,’ he says. ● Married to Emilie Oldknow, happened in America, seems more divided than ever,’ he He has also promised to the executive director of says. ‘That means we have got to celebrate the NHS as an invite a delegation of CPHVA governance, membership institution of solidarity. As shadow health secretary, I will members to the House of and party services for the utterly defend the NHS to be free at the point of use. We Commons, where he will Labour Party will fi ght all Tory attempts at privatisation and fi ght for our hold talks on what the ● Has two daughters, aged NHS, which stands as a glorious reminder of what can be profession needs. ‘It will be a three and fi ve. achieved when we unite together.’ meeting where we can talk When the discussion turns from national politics to the about the issues in depth,’ issues facing CPHVA members, Mr Ashworth is open about he says. his lack of expertise. The father of two talks about his own Before leaving the stage at the annual conference, Mr experiences of taking his daughter to a Sure Start children’s Ashworth closed his speech with a plea to delegates: ‘This centre. ‘The fact that they were there at one of the most is the fi rst speech I’ve given since I’ve been in the job and it important points in our lives was really valuable for us.’ is a massive honour to be Labour’s health secretary. He continues: ‘I want to do something that politicians ‘It is an awesome responsibility because the NHS is the don’t do much these days – I want to ask for help. I want to Labour Party’s greatest ever achievement. But you’ve got to listen to community practitioners and health visitors and I help me. I want to work with you and listen to you and then want to learn about the roles and the ways that they work hopefully we can draw up a plan for the future of health

IMAGE XXXXX together and understand their views.’ care that will guide the next Labour government.’ CP

December 2016 Community Practitioner 15

p14-15 121.indd 15 01/12/2016 09:57 ANNUALANNNUALN CONFERENCECONFEFEERENCE

IT’S CONFERENCE TIME! What happened at this year’s annual professional conference? Read on for the highlights.

undreds of community practitioners fl ocked to the International Centre in Telford last month for the Unite-CPHVA annual professional conference for what can only be described as Ha vibrant and engaging two days. The event saw members informed, challenged and even entertained by an array of speakers from practice, academia, stakeholder and government organisations and the House of Commons. The future may look bleak for some services across the country, but the unitingg of minds, experiences and a real sense of solidarity was apparent. If you missed ooutut this year, here are some of the highlights…

‘Collaborationl b is key’

Working together and in collaboration with local communities is the way forward, said the director of nursing at Public Health England. This was one of the central messages behind Professor Viv Bennett’s (pictured left) keynote address on the opening morning of the conference. ‘We need to close the health and wellbeing gap and we know that nurses have been at the very forefront of trying to improve population health,’ she said. ‘The whole is greater than the sum of its parts and if we come Marion together then we can really make a diff erence. Swaffi eld ‘We need to work with communities so that they are part of the Health visitor ‘doing’, and not part of the ‘done’.’ Searching for eff ective ways Professor Bennett went on to discuss the variety of challenges to contribute positively to that Unite-CPHVA members are facing when it comes to protect health visiting and to improving public health. keep the health and wellbeing of She said that these include reducing smoking levels, children and their families cutting childhood obesity levels and improving dental health. at the centre of everything ‘We know that some children are left behind and we need to

we do are key. ask what we can do to improve the situation,’ she said. CLAXON JULIAN

16 Community PraPractitionerractitioneneer DDecemberecember 20201616

p16-20 PP Conference.indd 16 01/12/2016 09:59 ANNUALANNUAUAAL CONFERENCECONFERRRENCE

Debate on Congratulations to the commissioning winners of the poster awards. There were What are the opportunities and risks ‘Building capacity and capability in three categories from commissioning of services by local communities is important. You are there on – practice authorities? A panel debate on the issues the ground meeting people day in and day development, was held on the morning of the fi rst day. out and you have a lot of infl uence.’ research and the The take-home messages from the three Andrea Westlake, head of public panel members were: health, children’s wellbeing, people’s choice Herefordshire Council ‘There are unprecedented fi nancial cuts WINNER: in local authorities and it is a ‘The opportunity you have to make Practice development concern that we’ve all got to a difference every day is huge Lynda Mutter, practice development acknowledge… If there are Aleksandra and we need to look at nurse, and Ivana Oracova, trainee any issues, then have a Dackiewicz how we can secure that health psychologist from NHS Greater conversation with your Community nursery nurse in tough times… We Glasgow and Clyde for their poster public health team, My biggest worry is growing have a lot of evidence entitled ‘Communicating with parents so we can minimise caseloads and responsibilities that if you invest in about change using a strengths- some of the fi nancial expanding. We are doing more the early years, you based approach: development of a challenges.’ and more, but we don’t have save money later.’ pilot training day’. Becky Pollard, the staffi ng levels to facilitate Professor Viv Bennett, director of public it. There is a lack of director of nursing, WINNER: health, Bristol resources. Public Health England Research PhD student from Oxford Brookes University Georgia Cook for her ‘Parents, children and slumber: UK parents help-seeking behaviours Does alcohol improve mental health? relating to infant and toddler sleep’ poster. Increased consumption of social status, work, income, affl uent areas said they alcohol is linked to better smoking, drinking, exercise, consume alcohol, but it WINNER: mental health, according loneliness, happiness and job was more likely to be social People’s choice to the results of a large- satisfaction, among others. drinking with friends than Gaynor Roberts, health visitor and scale study. ‘We really want to know heavy drinking alone. practice teacher from Hateley Heath The evidence was which combination of factors Life expectancy in two Family Education Training Centre presented in a discussion explains what’s going on areas just over two miles and Sandwell and West Birmingham looking at the impact of here,’ said Dr Warren. apart in the study diff ers NHS Hospitals Trust for her poster austerity on healthcare needs. There was one result that by more than 15 years, the on ‘Strategic level working between It was being presented he said was unexpected research shows. commissioners, health visitors and by Dr Jon Warren, a senior – increased alcohol In the deprived centre partner agencies to achieve positive research associate from consumption was linked to of Stockton-on-Tees, life outcomes from pregnancy’. Durham University, who is one improved mental health. expectancy is 17.3 years lower of the authors of the study. ‘The results show that than the upmarket village of Look out for future issues of the journal The research was a mixed- people will have better Hatburn. The diff erence for for more details about their work. method, qualitative and mental health if they drink, women is 11.3 years. quantitative study. but smoking doesn’t seem The results also reveal It included a large-scale to make a diff erence,’ he told that in the more deprived survey completed by those the conference. areas, smoking was higher, living in the 20 most deprived However, he went on to access to transport was and the 20 most affl uent in stress that it was not a simple lower, education level was and around Stockton-on-Tees case that drinking more lower and professional status in County Durham. improves mental health. was lower. The residents were asked He said that a higher ● To read more, go to dur. questions on topics including percentage of those in ac.uk/health.inequalities

DecemberDeceDmbe br 2016 CoCCommunityommunitom ityittyt PPractitioner titi 17

p16-20 PP Conference.indd 17 01/12/2016 10:00 ANANNUALNNUALN CONFERENCECONFEFEERENCEE

money, the long-term eff ects of austerity and NHS cuts the future impact of Brexit. ‘Let’s all make sure that that the public knows who is to blame for local cuts and Jo Turner @Turner23Jo ‘are worst in losses,’ she said. @pollytoynbee worried ‘It’s not the local council who have these that there r so few SNs supporting history’ cuts thrust upon them – it’s Whitehall. 9 million 5-19yr old. Equates to 2-3 She went on to say that unless something minutes of care per year #CPHVA16 NHS funding is the worst that it has ever changes, by 2020, ‘there will be no care other Victoria Button @Vicky1104 been as the NHS spirals deeper into crisis, than the most basic statutory care’. Austerity does have an impact! said the CPHVA’s honorary president. At the end of the hard-hitting speech, Qualitative research matters! Polly Toynbee painted a grim which also covered a lack of new jobs, #CPHVA16 #LoveYourHealthVisitor picture of the state of the health the cutting of vital services and #LoveYourSchoolNurse service in her fi nal president’s attacks by the media, she ended by Anwen Evans @Anwenevans5 address before standing down. paying tribute to the profession. HVs are well placed to infl uence She said: ‘In the last fi ve years, She concluded: ‘You are the change in their communities, the NHS has had the harshest quiet, often unseen backbone of #letstalktoourcommissioners funding cuts since it came into the NHS and you deserve recognition #CPHVA16 existence, no wonder there is a crisis.’ from everyone and I’m proud to have Joanne McEwan @joanne_mcewan Alongside slashed budgets she discussed represented you. #CPHVA16 Carolyn Taylor says that services being tendered to private companies, ● Go to page 14 for shadow health secretary #cphva members are feeling the the acute sector swallowing community sector Jon Ashworth’s take on the issues. cost of LA commissioning – we have the evidence!

Jo Smith @jojow27 Domestic abuse in The Archers #CPHVA16 Health visitors have a responsibility to infl uence policies A quaint rural radio soap opera originally coercive behaviour that slowly builds up over let’s not forget this billed as ‘an everyday story of country folk’, months that people just don’t normally see. is responsible for a change in attitudes to ‘It has been such a powerful thing and Anna Leggett @AnnaMaryLeggett domestic violence, it was claimed. the storyline has really changed the game Thank you @Unite_CPHVA Polly Neate, chief executive of the charity in terms of making people understand that for a wonderful few Women’s Aid, has been working with domestic abuse is about control.’ days. Now to go Jayne Ley, the team behind Radio 4’s The Ms Neate was giving the annual Nick back and inspire Nurse Archers for the last two years. Robbin Lecture – a keynote speech at the the workforce. I’ve been surprised by the Ms Neate and colleagues conference that focuses on social justice. #CPHVA16 negativity. Why is everyone have been advising on the She said that a shift in models for support so disheartened when there’s controversial domestic around domestic abuse is required, from a so much to celebrate? People violence storyline. risk-led model, to a need-based model. are giving up and that worries She said: ‘It has had more ‘There’s pretty much no intervention in me – I think we need a more of an impact than I ever early domestic abuse and that just doesn’t positive attitude or we will could have dreamt. exist and we need to change that,’ she said. have a demoralised ‘We wanted to cover this ● For more, visit womensaid.org.uk workforce.

First speech in role Commons for a meeting to discuss the issues vehemently facing the profession. oppose any In his fi rst public speech, the new shadow ‘I wanted to come here today not just to speak outsourcing health secretary for England vowed to to you, but to listen and to learn from you,’ he said. to the private work closely with health visitors. ‘You touch lives and represent the best of sector. Just four weeks after being appointed to the NHS and I want to ask for your help – I He also said the post, Jon Ashworth MP took to the stage. want you to tell me about your work day in that a Labour He said that he had made an agreement day out, so I can understand your views and government with Unite to shadow members for a day. fi ght for you.’ would reverse the decision to scrap the He also invited a delegation of Unite- Mr Ashworth promised that he would fi ght bursaries for students. CPHVA members to come to the House of the under-resourcing of the NHS and would ● See page 14 for a feature on Jon Ashworth.

1188 Community PraPractitionerractitionera er DDecemberecember 2016

p16-20 PP Conference.indd 18 01/12/2016 10:00 ANNUALANNUAUAAL CONFERENCECONFERRENCER

Identifying radicalisation In a session covering the role of the practitioner when it comes to radicalisation, there were a range of fi gures and statistics about Isis revealed. Simplifi ed skills Diane Horsley Included in the facts divulged School nurse were that the group has at least I see the greatest 46,000 Twitter accounts; it posts challenge being the over 200,000 tweets a day; it and knowledge pressures being posed produces more than 50 videos to fulfi ll the local a week; it mainly targets 18- to authority KPIs. 25-year-olds; and it has started framework targeting eight- to 10-year-olds. Susan Warburton, national lead The Public Health Skills and Knowledge Claire Cotter, programme manager for NHS England’s National Prevent Framework has been modernised and for Public Health England, talked the Sub Group, gave the presentation revised, due to the shifting nature of the delegates through the changes. following her session on safeguarding healthcare landscape. She said: ‘We were fortunate to have against child sexual exploitation. It was launched at an event in London on some clear messages of what people Prevent is a group of nursing, 15 November and a presentation was given wanted to work with. safeguarding, security, emergency the following day at the conference. ‘The main ones were that people and management specialists that The framework has been in existence wanted it to be function-based and aims to protect vulnerable individuals since 2008 and is a tool for individuals they also wanted it to be based around from being groomed in to terrorist working in public health. Its purpose is to simplifi ed language.’ activity or supporting terrorism. help identify individuals’ skill and knowledge There was extensive research carried Ms Warburton said: ‘You are working development needs. out before the work was undertaken. with these vulnerable people. Previously there were 703 descriptors in the This included workshops around the UK, ‘It’s not easy to identify them, but framework, but this has been reduced to 70. an online survey and digital interaction was keep your eyes and ears open and The language has also been simplifi ed to tested with 100 public health workers. use your professional curiosity.’ make it more accessible and user-friendly and ● To take a read of the revised framework, ● To read more, go to bit.ly/ it now includes a digital ‘skills passport’. visit bit.ly/PHE_PHSKF2016 NHSEngland_prevent

Sexual exploitation of children Overcoming

Delegates at the conference were children to share concerns, support treatment challenges encouraged to spot the warning signs and recovery and share information with of child sexual exploitation. other agencies. The conference’s closing Susan Warburton, deputy safeguarding Other potential signs that there is a speaker was Simon lead for NHS England, talked through the problem may be children going missing Weston OBE. potential indicators. for long periods of time, returning home He talked about the ‘Children who are involved in sexual abuse late, changing groups of fi ends, mood challenges he faced after or exploitation will often have bruises or cuts swings or age-inappropriate sexual his ship was bombed in and may be abusing alcohol or drugs.’ behaviour and clothing. the Falkland’s War. She continued: ‘They may have unwanted Ms Warburton encouraged people Mr Weston overcame 46% burns, pregnancies or STDs and you may hear to sign up to the ‘Seen and Heard’ redefi ned his role in life and delivered a about children who are having nightmares or campaign, which looks at the role of message of hope to those at the event. fl ashbacks, also they could become violent healthcare professionals in relation to He also praised delegates who he towards themselves or others.’ child sexual exploitations. described as ‘an inspiration’. She said it is the role of healthcare ● For more information on the campaign, ● See the previous issue’s Last Word professionals to spot the signs, encourage visit seenandheard.org.uk for an interview with Simon Weston.

Community Practitioner 19

p16-20 PP Conference.indd 19 01/12/2016 10:00 ANNUAL CONFERENCE IT’S TIME TO PARTY! Delegates put on their glad rags for an eveningng of dining, drinking and dazzling dancing.

For more highlights from the event, go to #CPHVA16.

20 Community PracPractitioneractctitionerr December 20201616

p16-20 PP Conference.indd 20 01/12/2016 10:01 BREASTFEEDING IS BEST FOR BABIES FOR HEALTHCARE PROFESSIONALS ONLY

Which First Infant Milk is most in line with expert opinion on growth?

The Department of Health SMA PRO First Infant Milk is the only first infant milk clinically recommends exclusive proven to achieve a growth rate comparable with a breastfed 10 breastfeeding for the first baby as defined by WHO growth standards six months of life.1 SMA PRO First Infant Milk versus WHO growth standard z-scores at 4 months WHO growth standard Protein and the importance Retarded Accelerated of slower growth rates growth growth

Because the protein in breast Weight-for-age milk is adapted to a baby’s needs,2 a breastfed baby tends Length-for-age to grow more slowly than a formula fed baby.3 This slower Head circumference growth rate has shown to have BMI significant long-term health Z-scores benefits, including a lower risk -3 -2.5 -2 -1.5 -1 -0.5 0 0.5 1 1.5 2 2.5 3 of obesity, cardiovascular Green dots represent average growth measurements in infants fed SMA PRO First Infant Milk compared to disease and diabetes.4 WHO growth standards. Growth within -/+ 0.5 standard deviation of WHO growth standards is desirable.

We’ve responded to expert opinion about proteins in SMA® PRO First Infant Milk

“ Protein intakes of infants are generally SMA PRO First Infant Milk is the well above the requirements, so protein lowest protein formula available at content of Infant Formula and Follow-on ›› 1.25 g*/100 ml (1.87 g*/100 kcal)6 Formula could be reduced” European Food Safety Authority 20145 *Powder only, liquids will vary

“ The breast milk content of amino acids SMA PRO First Infant Milk has an is the best estimate of infant amino acid essential amino acid profile similar requirements” ›› to that of breast milk8 WHO/FAO/UNU 20147 Visit us: smahcp.co.uk

Of the essential amino acids, four have or smahcp.ie been shown, when supplied in excess, to be SMA PRO First Infant Milk has lower associated with increased release of insulin. levels of insulinogenic amino acids This may trigger a cascade of reactions in ›› compared with other first infant milks8 the body which may result in faster growth.9 European Childhood Obesity Trial Study Group 20159

Getting the right quantity and quality of protein in infant and toddler diets has lifelong health benefits. Supporting you to support parents

References: 1. UNICEF. The Health benefits of IMPORTANT NOTICE: Breast milk is best for babies and breastfeeding breastfeeding. 2. Lönnerdal B. Am J Clin Nutrition should continue for as long as possible. Good maternal nutrition is 2003; 77: 1537–43. 3. WHO UK Growth Charts. important for the preparation and maintenance of breastfeeding. http://www.rcpch.ac.uk/improving-child-health/ public-health/uk-who-growth-charts/faqs/uk- Introducing partial bottle-feeding may have a negative effect on who-growth-chart-faqs. 4. Singhal A & Lucas A. breastfeeding and reversing a decision not to breastfeed is difficult. Lancet 2004; 363: 1642–1645. 5. EFSA. Scientific A caregiver should always seek the advice of a doctor, midwife, health Opinion on the essential composition of infant and follow-on formulae. EFSA Journal 2014; 12(7): visitor, public health nurse, dietitian or pharmacist on the need for and 3760. 6. SMA® PRO First Infant Milk Datacard. proper method of use of infant formulae and on all matters of infant 7. Protein and Amino Acid Requirements in feeding. Social and financial implications should be considered when Human Nutrition. Report of a Joint WHO/FAO/ selecting a method of infant feeding. Infant formulae should always be UNU Expert Consensus 2007. 8. Nestlé data on file, 2014. 9. Kirchberg FF et al. J Clin Endocrinol prepared and used as directed. Inappropriate foods or feeding methods, Metab 2015; 100(1): 149–58. 10. Grathwohl DJ et al. or improper use of infant formula, may present a health hazard. Abstract at EAPS Congress, 2010. ®Registered trademark ZTC1238a/07/16

p21.CPDEC16.indd 21 29/11/2016 15:38 COVER FEATURE

As some families feel the strain at Christmas, Juliette Astrup takes a look at safeguarding children over the festive season – and beyond. HOME ALONE?

he statistics around safeguarding make for these ‘digital natives’ racing ahead of the concerning reading. adults around them into new and potentially There has been a 24% dangerous territories online. increase in the number of Many of these deeply concerning issues will children becoming subject to be magnifi ed over the coming weeks, as with Ta child protection plan or added to the child 24% the festive season come additional fi nancial The increase in the number of children protection register in the UK between 2010-11 strains, family tensions and excess alcohol, becoming subject to a child protection and 2014-15, NSPCC statistics show. Over the which ramp up pressures at home, while the plan/added to the child protection same period, there has been a 76% rise in annual ‘shutdown’ means children’s needs register over the UK between police-recorded child sexual off ences against become less visible. 2010-11 and 2014-15 under-18s. Not a year goes by without police forces The wider picture of safeguarding across the UK recording a spike in domestic children across the UK appears fraught with violence, with incidents reported to go up by challenges, according to the NSPCC report, off ences against children. as much as a third on Christmas Day. Many How safe are our children? 2016. It also states And children’s lives are changing forces launch annual awareness campaigns to that child abuse and neglect are on the rise, dramatically, with new technologies and address the issue at this time of year.

GETTY as is the number of recorded online abuse applications moving at a pace that can leave And while many children are spoiled with

22 Community Practitioner December 2016

p22-27 CP Cover feature.indd 22 01/12/2016 12:19 COVER FEATURE

gifts and days of feasting, there are far too many families who struggle simply to put food well a parent can look after their child. Parents on the table. Foodbank use remains at record with a low income are more likely to feel levels in the UK, and Christmas is one of the chronically stressed, and children living in the busiest times, according to the Trussell Trust, most deprived neighbourhoods have a greater which operates 424 foodbanks across the UK, 25 chance of being on a child protection plan or helping more than 130,000 people with three- This Christmas, a child will contact Childline being taken into care than those in the least day food supplies in December alone. every 25 seconds, according to the NSPCC deprived areas, the NSPCC has found.

THE ‘PRESSURE COOKER EFFECT’ THE CHRISTMAS ‘CLOSE-DOWN’ Chris Cloke, NSPCC head of safeguarding in There is also the impact of the general ‘close- communities, says a number of factors can down’ over Christmas, Chris adds, whereby increase stress for families around Christmas, social services, courts and GP practices off er a including fi nancial pressures – heating bills reduced or duty service, and children are not in particular – which leave some facing under the watch of teachers and school nurses. a choice between ‘heating and ‘I think that all services would say that they eating’. There is also the ‘pressure do make arrangements to cover Christmas, cooker eff ect’ of spending time but, nevertheless, a lot of people together, ‘particularly if there may make assumptions are already tensions within the about them being family,’ he adds. closed. ‘We know alcohol can also be a factor in the way parents treat their children, and we know parents are going out to parties at this time of year and making decisions about leaving their children at home alone or not,’ says Chris. ‘Certainly we hear of cases when parents leave children for inappropriate amounts of time.’ Clearly, growing up in poverty doesn’t necessarily mean a child will suff er from neglect or abuse, but research has shown that increased or continued stress can seriously aff ect how

December 2016 Community Practitioner 23

p22-27 CP Cover feature.indd 23 01/12/2016 13:32 COVER FEATURE

ENGLAND NORTHERN IRELAND WALES The key legislation: Children Acts of 1989 The key legislation: Children (Northern The key legislation: Children Acts of and 2004 Ireland) Order 1995 and Safeguarding 1989 and 2004; The Social Services and Board for Northern Ireland Act 2011 Wellbeing (Wales) Act 2014 Organisation: 148 Local Safeguarding Children Boards (LSCBs) which produce Organisation: Child protection is fully Organisation: The key guidance in Wales their own procedures that should be devolved to the Northern Ireland Executive is Safeguarding children: working together followed by practitioners and professionals and Northern Ireland Government under the Children Act 2004. The All Wales who come into contact with children and departments. The Safeguarding Board Child Protection Procedures provide their families in their local authority area. for Northern Ireland co-ordinates, and processes that all professionals in Wales The latest guidance is Working together to Department of Health Social Services must follow. Six safeguarding children safeguard children, published March 2015. and Public Safety guidance Co-operating boards, replacing the 22 LSCBs, and a to safeguard children and young people national independent safeguarding board in Northern Ireland (2016) provides the are being set up. overarching policy framework.

‘Child abuse, neglect and maltreatment of year meant some children ‘could be left in of year, or go to family or friends, so children happens throughout the year – it doesn’t stop dangerous situations’. who are vulnerable may not be as visible.’ at Christmas,’ he adds. Adds Chris: ‘I think people can push their Ros Godson, lead professional offi cer There is also a drop off in reporting, with concerns to one side at this time of year. for public health at Unite-CPHVA, says fewer calls coming to the NSPCC helpline They may also be infl uenced by the view that safeguarding is ‘integral’ to the job of health over Christmas, says Chris. In 2010, the charity comes through the media that Christmas is for visitors and school nurses throughout the year: ran a campaign warning that reluctance to families, and all families are having a good time. ‘Even at Christmas time there will be a duty report cases of abuse and neglect at this time ‘And people tend to stay indoors at this time social worker – you have to refer in the same way, not taking account of social services’ ability to deal with it or not – you have to stick TOP TIPS ON SAFEGUARDING to the agreed protocol,’ she adds. ‘There are children you worry about over ‘Recommend that parents make time to be with their children, listen to their Christmas. You might make sure that a school- 1children, play with their children, and have a good time together. That is a really aged child has the Childline number, or if you important message for parents at this time of year.’ know there is domestic abuse in a family, you Chris Cloke, NSPCC might make sure the abused parent has the emergency numbers. ‘With any safeguarding issue, you must refer upwards to social services straight ‘But we are not emergency services – we are away. Social services might not take the referral – but it is up to them to decide 2 a public health service, a prevention service, whether it reaches the threshold. You have to know your local policy, and the and hopefully the things we have done during common assessment framework agreed by the local safeguarding children board the year can help families from falling into or its equivalent. The better the referral, the better than likelihood of social services problems over Christmas. taking it up.’ ‘The challenge is the lack of money and Ros Godson, Unite-CPHVA resources. We used to be able to refer to ‘Whereas before the focus of child protection was more likely to be familial charities or services, but as well as social services 3 in terms of abuse, it is now much broader. We have to consider issues of child raising their threshold, charities and other exploitation and traffi cking across the UK and online abuse is potentially a resources have also raised their thresholds due global issue.’ to a lack of money. That does make it harder.’ Wendy Mitchell, nurse consultant at the child protection unit in NHS Greater Glasgow and Clyde CHANGE IS HAPPENING With the safeguarding challenges mounting, ‘One of the biggest challenges in the lives of young people is negotiating the there is legislative change in the pipeline and 4 boundaries between what is private and what is public, and how to handle underway. Across the four nations, policies themselves in the much more open environment of social media, which off ers the and guidelines are being updated to refl ect opportunity for bullying, social exclusion and abuse.’ the evolving world and the priorities of the David Jones, outgoing chairman of the Association of Independent Local Safeguarding devolved governments. Children Board Chairs The Welsh Government has recently passed

ALAMY several pieces of legislation with safeguarding

24 Community Practitioner December 2016

p22-27 CP Cover feature.indd 24 01/12/2016 13:33 COVER FEATURE

SCOTLAND The key legislation: Children (Scotland) Act 1995, The Children and Young People (Scotland) Act 2014

Organisation: The 2014 Act places a range of duties on public authorities to promote and safeguard children’s wellbeing, including a named person for every child. Local child protection committees are responsible for the strategic planning of local interagency child protection work. In February, the Scottish Government announced a review of child protection. This is due to report by the end of the year.

at their core. These are the Social services and In Northern Ireland, the new guidelines Co- the next four years. Well-being (Wales) Act 2014; the Well-being of operating to safeguard children and young people Wendy Mitchell, head of nursing Future Generations (Wales) Act 2014 and the in Northern Ireland were adopted this year. This performance and strategic management, Violence against Women, Domestic Abuse and overarching framework will be supplemented child protection at NHS Greater Glasgow and Sexual Violence Act 2015. by regional policies and procedures now being Clyde, says while she welcomes the Scottish Rhiannon Beaumont-Wood, executive consulted on by the Safeguarding Board for Government’s focus, the extent and pace of director of quality, nursing and allied health Northern Ireland. legislative change is likely to have an impact professionals, Public Health Wales, says ‘all And in Scotland a raft of changes are on health visitors and other community Welsh policy and legislation has to take into feeding through, including the updated practitioners in Scotland. account children’s rights’ after Wales became National Action Plan to Prevent and Tackle ‘I think one of the challenges just now is the fi rst UK country to incorporate the United Child Exploitation, and the Children and Young the number of changes underway within Nations Convention on the Rights of the Child People (Scotland) Act 2014, which came into children and family services,’ she says. ‘We into its domestic law. force this year. need to be able to measure improvement from And the new Social Services and Well-being This Act embeds in law the existing Getting change and ensure there are no unintended (Wales) Act 2014 is ‘encouraging a renewed it right for every child agenda, and includes a consequences for children and young people. focus on prevention and early intervention’, requirement for a named person for every child England too is facing a potential shake-up, she adds. – one person for the child or parents to contact depending on the outcome of the Children ‘The Welsh Government is strongly if they want support. and Social Workers’ Bill, which is currently committed to improving all aspects of the The Scottish Government is also rolling progressing through parliament. lives of the population with an emphasis on out the universal health visiting pathway’s This controversial bill included a proposal safeguarding. Health visitors and school nurses programme of home visits and has promised to allow local authorities to apply to opt out play a key role in making this happen.’ 500 health visitors will join the workforce over of statutory child protection duties in order to introduce more innovative practices – although the government suff ered a defeat in the Lords on this. It would also abolish local safeguarding children boards, which currently coordinate the child protection work of organisations in their area.

SAFEGUARDING UNDER PRESSURE 292% David Jones, outgoing chair of the Association The increase in recorded offences related to ‘obscene publications’, of Independent Local Safeguarding Children including the production, distribution and viewing of child abuse images Board Chairs, says beneath such high-level – over the past fi ve years in Northern Ireland. It was 134% in England, debates, the safeguarding of children is facing a 184% in Wales, and 168% in Scotland signifi cant pressures. ‘We have seen a huge increase in the number of cases being referred to children’s

December 2016 Community Practitioner 25

p22-27 CP Cover feature.indd 25 01/12/2016 13:33 COVER FEATURE

10,136

The number of police-recorded cruelty and neglect offences against children aged under 16 in the UK in 2014-15

60% The rise in police-recorded offences of cruelty and neglect in Northern Ireland between 2010-11 and 2014-15. The increase is 48% in Wales and 46% in England. In Scotland, the fi gure has dropped by almost half in that time

The number of ‘invisible’ children suffering from abuse or neglect for every child on a child protection register, or subject to a 8 child protection plan

26 Community Practitioner December 2016

p22-27 CP Cover feature.indd 26 01/12/2016 13:33 COVER FEATURE

do they manage child protection alongside SOPHIE’S STORY the other demands on their time? Evidence suggests from the literature review and the ‘My experiences of being neglected as a child are with me every day. No one was children’s commissioner report that there is a there most of the time and, even when they were there, they weren’t properly there real strain, since child protection paperwork as they were out of it. It was just hell. takes up so much time.’ ‘My parents both used drugs and when I was growing up there was no one there to She adds: ‘There’s also the importance of do the basic things that a child needs, like cooking meals. Mum wouldn’t even notice children building trust through regular contact whether I had or hadn’t gone to school as she was always upstairs smashed out of her with school nurses, and how that is being face. I wanted to go to school as I didn’t want a life like my parents. I could pretend managed from a safeguarding point of view in that while I was there that everything was fi ne at home. No-one there knew what was the current climate. happening at home until the house was raided. ‘And the balance between preventative and ‘When I was younger I constantly had to go and answer the door to let strangers reactive work, and how much child protection in and out. I was really scared of them. At fi rst I didn’t know what was actually going work is impacting on the public health remit.’ on upstairs. For a few months, I don’t remember seeing her apart from when I was getting told off or told that I wasn’t letting enough people in. NAVIGATING THE CHALLENGES ‘I was often left by myself and I felt so lonely. I even felt lonely when mum and dad Safeguarding children is at the heart of health were in the house because mentally they were completely out of it.’ visiting, school and nursery nursing throughout (Courtesy of the NSPCC) the year. But practitioners are performing that role upon shifting seas. Children’s lives are changing rapidly as new services – something like 40% over the last fi ve particular practitioner back again.’ She says that technologies alter how they live – and the or six years, and that is within a context of local can leave a child ‘in a far worse situation’. dangers they might face. At the same time, authorities losing around 40% to 50% of their She adds: ‘The budget for the health visiting issues like radicalisation and female genital funding, and a growing crisis of funding within area I work in is being cut by 25% next year mutilation are coming to the fore, while neglect the health service too. and a further 25% the following year. You and online abuse are on the rise. ‘School structures are changing, health have to wonder what is going to happen to As the devolved governments begin to steer services are fragmenting – all those things those children. It is unethical and unsafe.’ their own courses in this area, new policies aff ect relationships Referrals are and practices are evolving in all four nations. and the ability to also a concern And underlying it is the intense pressure on hold things together for school nurses, resources across the NHS and local authorities, – that is all likely to according to a report which some fear is already aff ecting safety. have an impact from the offi ce Navigating a course across such turbulent on safeguarding.’ of the children’s waters is the challenge that must be faced in What is the impact of commissioner order to keep children safe, now and always. CP such intense pressure on 76% for England. resources on how health the rise in police-recorded child The Lightning FOR MORE INFORMATION All Wales child protection procedures visitors, school nurses sexual offences against under-18s in review of school bit.ly/Wales_child_protection and other community the UK between 2010-11 and 2014-15 nurses, published in All Wales National action plan to tackle child sexual exploitation bit.ly/Wales_sexual_exploitation practitioners carry out September, found Children’s Commissioner Lightning review of school nurses their safeguarding roles? they were fi nding it bit.ly/lightning_review_2016 Policies and procedure committee of the Safeguarding Board One experienced harder to successfully for Northern Ireland health visitor from the Midlands, who asked to refer children at risk to because of some bit.ly/SBNI_policies_committee Helping school nurses to tackle child sexual exploitation in remain anonymous, expresses grave concerns. councils’ increasingly high thresholds for child England She says thresholds for referrals to social protection intervention, leaving them doing bit.ly/PHE_school_nurses early stage child protection work, which used National action plan to prevent and tackle child sexual services had ‘risen tremendously’, especially exploitation – update from the Scottish Government for child neglect or emotional abuse. to be carried out by social workers. bit.ly/Scotland_sexual_exploitation ‘For low-lying abuse, continuing abuse, That is among the issues that could be NSPCC’s How safe are our children? 2016 and 2014 version bit.ly/NSPCC_how_safe_2016 abuse that goes on into adulthood, I don’t brought to light by school nurse Lauren bit.ly/NSPCC_how_safe_2014 think the thresholds are low enough,’ she adds. Harding, a PhD student at Oxford Brookes Tackling child sexual exploitation in Northern Ireland – action plan bit.ly/NI_sexual_exploitation ‘As a health visitor, when you make the referral University, who is undertaking a four-year study The rise in domestic abuse at Christmas to fi rst response you are hoping the family will into the role of school nurses in safeguarding bit.ly/NHS_choices_christmas Universal health visiting pathway in Scotland get the help they need, but in doing that, and children and young people – helping to bit.ly/Scotland_health_visiting not having it reach the threshold, you can and address the paucity of information in this area. Updates on the Child Protection Improvement Plan in Scotland do frequently undermine any work you have ‘We know the number of nurses is small and bit.ly/Scotland_child_protection Working together to safeguard children in England done with that family as they don’t want that that they have large, complex caseloads – how bit.ly/England_safeguard_children

December 2016 Community Practitioner 27

p22-27 CP Cover feature.indd 27 01/12/2016 12:50 THE NHS

NHS NO MORE? Changes to the NHS in England could mean the end of a health service that is free at the point of delivery. Allyson Pollock, professor of public health research and policy, who presented her thoughts at the recent Unite-CPHVA annual conference in Telford, explains more on what can be done to reverse it.

or more than 60 years, the NHS The politicising of the NHS continues today: has provided freedom from fear the current Westminster government seems to of healthcare bills and it has been believe that we can aff ord to dispense with an there when we need it. It has been NHS. On 31 March 2012, the coalition government the most loved of all the welfare passed the Health and Social Care Act, which institutions that were set up after dismantles the NHS in England and makes a move FWorld War II ended. towards private funding, with user charges and But, since its creation on 5 July 1948, it has also insurance and the marketisation of health care. been subject to a great deal of political buff eting. It New models of care based on the American has survived decades of politician interference that healthcare system are being put in place, where has changed the NHS in many ways. For example, risks and costs are passed to patients and care in 1990, prime minister (PM) Margaret Thatcher and is provided through the market. It is a far cry health secretary Kenneth Clarke paved the way for from the ethos of the NHS, but the act makes it the private fi nance initiative and foundation trusts possible by removing the 64-year-old duty on the with their introduction of the internal market and secretary of state to provide services throughout purchaser/provider split. Then, in 2000, PM Tony England. With the abdication of governmental Blair and health secretary Alan Milburn ushered in responsibility for the NHS, services can wither the NHS privatisation plan. and close. Increasingly, there will be areas of the

28 Community Practitioner December 2016

p28-30 CP The NHS.indd 28 01/12/2016 13:34 THE NHS

country that will have little or no easy access services and foundation trusts can now to public health care. charge patients. Since the act, foundation The act has also made commercial trusts are now only 51% public, which contracting virtually compulsory. Today, means they can raise up to half their income armies of lawyers, consultants and managers from private patients. For example, the are joined by clinicians who, rather than Royal Marsden NHS Foundation Trust now providing patient care, spend their days 20% generates over 27% of its income from preparing multiple bids and tenders, and of NHS beds private patients and private cancer care awarding contracts. Every year, thousands of (Royal Marsden, 2016). Others, such as the contracts are put out to tender, many of them have closed in East London Foundation Trust, based in an going to the private sector and multinational impoverished area of London, have no private corporations (NHS Support Federation, 2016). the last decade income (East London, 2016). A foundation trust hospital can now CHANGED LANDSCAPE franchise out its wards and services to Contracting is bad news for the NHS. It the private sector like a department store, leeches money and scarce resources from the leasing out beds and clinical space to private system, fragments and disrupts continuity of healthcare companies such as the Hospital care, and undermines training and staffi ng. (Pollock and Roderick, 2016). Corporation of America, BMI, Care UK or And it doesn’t save money either, because As the money leaks out of the healthcare SERCO. All this at a time when NHS capacity market contracting is expensive. Although the system, our public hospitals and services is shrinking: the health service has the lowest Westminster government does not collect go into a deadly spiral of debt accelerated number of beds in Europe and almost 20% data on the contracts or the cost of market by sustained reductions in NHS funding, of beds have closed in the last decade (NHS contracting, we know from the US that resulting in vital services being axed England, 2016). contracting accounts for around 30% to 40% and closed. At the same time, CCGs are drawing of healthcare expenditure, compared with NHS commissioners in clinical up increasingly restrictive criteria and the 5% in the non-marketised NHS prior to 1990 commissioning groups (CCGs) can reduce boundary between paid NHS and private care

December 2016 Community Practitioner 29 ISTOCK

p28-30 CP The NHS.indd 29 01/12/2016 13:58 THE NHS

is being blurred. Access to services is being curtailed as CCGs decommission them to pave the way for top-up policies or out-of- pocket payments.

REVERSING THE FRAGMENTATION The perfect storm is completed by the trend towards devolution of services out of the health service. NHS services that have already been devolved to local authorities since 2012 – including public health, sexual health services, children’s services, health visiting and school nursing – have already been decimated (Merrifi eld, 2015). Public Greenwood, and it has cross-party support health has been carved out of the NHS and it in the House of Commons (NHS Bill, 2015), as is up to local authorities whether or not they well as support from the unions. commission those services. Unsurprisingly, at You can do your bit too. Oppose the STPs a time of austerity, councils are voting with by campaigning locally and nationally to stop their budgets. Across the country, I have the cuts and closures and privatisation. Write heard reports that up to a third of school £2.5bn to your MPs and demand that the break-up nurses and health visitors are being cut – this and destruction of our NHS is reversed. Ask needs to be tracked systematically by the The combined them to back the bill to bring back our NHS, nursing profession. It is likely that this will get because our NHS will only be there while we worse with the introduction of sustainability defi cit of are prepared to fi ght for it. CP and transformation plans (STPs). These 44 ● Allyson Pollock is professor of public geographic footprints are the non-legal NHS trusts in health research and policy at Barts and The structures via which NHS England is using England today London School of Medicine and Dentistry, to push the agenda of service closure, by Queen Mary University of London

detaching decisions from local communities. References The Local Government and Cities Bill, which Age UK. (2014) Care in crisis 2014. See: ageuk.org.uk/ Documents/EN-GB/Campaigns/CIC/Care_in_Crisis_ received royal assent on 28 January 2016, Treasury, 2015) confi rmed that the last decade report_2014.pdf?epslanguage=en-GB?dtrk%3Dtrue (accessed allows all health functions to be devolved to was the most austere ever faced by the 23 November 2016). local authorities. NHS and social care funding, NHS and the largest sustained decrease in East London NHS Foundation Trust. (2016) Annual reports and accounts 2015/16. See: gov.uk/government/uploads/system/ to the tune of £6bn, has been devolved to funding as a percentage of GDP since 1950. uploads/attachment_data/fi le/541905/EASTLONDON_ Annual_Report_and_Accounts_2015-16.pdf (accessed 29 Greater Manchester in the name of integration NHS spending is falling as a proportion of November 2016). and community care. It is not simply a case GDP and is projected to fall further by 2020, HM Treasury. (2015) Spending review and autumn statement of transferring work from one public body well below the European average (The King’s 2015. See: gov.uk/government/uploads/system/uploads/ attachment_data/fi le/479749/52229_Blue_Book_PU1865_ to another – the diff erent systems, approach Fund, 2016). As a consequence, today the Web_Accessible.pdf (accessed 29 November 2016). and remit make for worrying clashes that combined defi cits of NHS trusts are £2.5bn The King’s Fund. (2016) How does NHS spending compare with health spending internationally? See: kingsfund.org.uk/ suggest our healthcare services will not come and rising, with 75% of foundation trusts in blog/2016/01/how-does-nhs-spending-compare-health- out well. There are question marks over the defi cit. Social care funding for older people spending-internationally (accessed 23 November 2016). Merrifi eld N. (2015) Public health nursing faces despair of new arrangements that cause deep concern. has also been reduced drastically, by 10% council budget cuts. See: nursingtimes.net/clinical-archive/ For example, how can services be integrated in real terms between 2010-11 and 2013-14 public-health/public-health-nursing-faces-despair-of-council- budget-cuts/7000036.fullarticle (accessed 23 November 2016). when social care is means tested and the NHS (Age UK, 2014). NHS Bill. (2015) Margaret Greenwood MP – press release. See: is free at the point of use? How will care in the But there is an alternative to the privateers’ nhsbill2015.org/margaret-greenwood-mp-press-release community work when local authorities are model and the insurance-based health care (accessed 23 November 2016). NHS England. (2016) Bed availability and occupancy data – in crisis, having faced unprecedented cuts in of the US. The NHS is no experiment – it’s overnight. See: england.nhs.uk/statistics/statistical-work-areas/ expenditure? Nationally, the number of adults been tried and tested, and succeeded. It’s bed-availability-and-occupancy/bed-data-overnight (accessed 29 November 2016). receiving community services has fallen by a not too late to bring back the NHS of old, NHS Support Federation. (2016) Problems with outsourcing NHS third from 1.5 million to one million in under and there are attempts to do so. care: decline in quality. See: nhsforsale.info/database/what-s- the-impact.html (accessed 23 November 2016). fi ve years as entitlement criteria become more The NHS Reinstatement Bill has been Pollock AM, Roderick P. (2016) The abolition of the NHS in and more restrictive (Age UK, 2014). brought to parliament fi ve times. It will have England. See: allysonpollock.com/?tag=nhs-reinstatement-bill its second reading on 24 February 2017. (accessed 29 November 2016). The Royal Marsden NHS Foundation Trust. (2016) Annual REINSTATE THE OLD NHS Only a law can repair the fragmentation reports and accounts 2015/16. See: gov.uk/government/ There have been some brutal cuts to health and break-up of the NHS. The NHS Bill uploads/system/uploads/attachment_data/fi le/542000/ ROYALMARSDEN_Annual_Report_and_Accounts_2015-16.pdf

and social care. The spending review (HM 2016 is sponsored by Labour MP Margaret (accessed 29 November 2016). SHUTTERSTOCK

30 Community Practitioner December 2016

p28-30 CP The NHS.indd 30 01/12/2016 13:35 BREASTFEEDING a STAR: AN EVIDENCE-BASED APPROACH TO THE IS BEST FOR BABIES MANAGEMENT OF INFANT REGURGITATION

Functional gastrointestinal disorders PRESENT IN (FGIDs) are an under-recognised and poorly managed group of digestive >50% OF 1 symptoms and feeding problems1 INFANTS

WHAT IS INFANT REGURGITATION?2 A normal physiological process INFANT REGURGITATION Regurgitation is the that occurs in a passage of stomach developing infant gut content up the oesophagus PLACES A SIGNIFICANT Mouth and into the mouth BURDEN ON FAMILIES,

5HƮX[LVWKHSDVVDJH THE NHS AND THE of stomach content Weak action of into the oesophagus ECONOMY ALIKE: lower oesophageal sphincter for

Stomach The distressing levels of crying and disrupted 1 Duodenum feeding can cause serious anxiety for parents Stomach contents leak back 'HVSLWHHYLGHQFHWRVXSSRUWƬUVWOLQH up into the without the presence nutritional management in bottle fed babies, oesophagus 4,6 of other symptoms*3 use of infant alginate therapies remains high Pyloric sphincter NHS England spent

INFANT REGURGITATION IS IN INFANTS WITH VOMITING OR REGURGITATION, FREQUENTLY CONFUSED WITH LOOK OUT FOR ‘RED FLAGS’ SYMPTOMS WHICH MAY £5.2m 4 GASTRO-OESOPHAGEAL SUGGEST DISORDERS OTHER THAN GOR, FOR EXAMPLE: in 2015 on infant alginate REFLUX DISEASE (GORD) WHICH O PROJECTILE VOMITING IS LESS PREVALENT, MORE O BILE OR BLOOD STAINED VOMIT SUHVFULSWLRQVDQGWKLVƬJXUHLV SERIOUS AND MAY REQUIRE O FEEDING DIFFICULTIES OR FALTERING GROWTH increasing by 10% year on year 6,7,8 SPECIALIST REFERRAL.4,5 O APPEARING UNWELL

A trained professional carries out FOR BREASTFED BABIES a breastfeeding assessment NATIONAL GUIDELINES 4 With persistent regurgitation, consider RECOMMEND: trialling alginate therapy for 1-2 weeks

FOR FORMULA FED INFANTS

Assess feeding history and a STAR APPROACH reduce feed volume if excessive TO TREATING for infant’s weight4 INFANT Trial smaller, more frequent feeds (while maintaining an appropriate REGURGITATION total volume of daily feed)4

To assist Trial a thickened formula (for example, healthcare containing rice starch, cornstarch, professionals with locust bean gum or carob bean gum)4 correct evidence-based management of frequent UHƮX[DQGUHJXUJLWDWLRQ If the stepped-care approach is in formula-fed infants unsuccessful, stop the thickened formula 4 the acronym a STAR and trial alginates for 1-2 weeks can help to convey the NICE-recommended, stepped-care If alginates are successful approach4 continue use but stopping it at intervals to assess recovery4

$VGHƬQHGE\WKH5RPH,9GLDJQRVWLFFULWHULDIRUIXQFWLRQDOJDVWURLQWHVWLQDOGLVRUGHUV REFERENCES ,DFRQR*et al. Dig Liver Dis  s/LJKWGDOH-et al. Pediatr  HsH%HQQLQJD0$et al. Gastroenterologys1,&(Gastro-oesophageal UHƮX[GLVHDVHUHFRJQLWLRQGLDJQRVLVDQGPDQDJHPHQWLQFKLOGUHQDQG\RXQJSHRSOH$YDLODEOHDWZZZQLFHRUJXNJXLGDQFH1*>$FFHVVHG$SULO@0DUWLJQH/HWDO(XU-3HGLDWU   +HDOWK6RFLDO&DUH,QIRUPDWLRQ&HQWUH3UHVFULSWLRQFRVWDQDO\VLV(QJODQGs$SULO$YDLODEOHDWKWWSZZZKVFLFJRYXNFDWDORJXH38%>$FFHVVHG $SULO@+HDOWK6RFLDO&DUH,QIRUPDWLRQ&HQWUH3UHVFULSWLRQFRVWDQDO\VLV(QJODQGs$SULO$YDLODEOHDWKWWSZZZKVFLFJRYXNFDWDORJXH38%>$FFHVVHG$SULO@ +HDOWK6RFLDO&DUH,QIRUPDWLRQ&HQWUH3UHVFULSWLRQFRVWDQDO\VLV(QJODQGs$SULO$YDLODEOHDWKWWSZZZKVFLFJRYXNFDWDORJXH38%>$FFHVVHG$SULO@

p31.CPDEC16.indd 31 29/11/2016 15:39 PHYSICAL ACTIVITY

Beat the STREET A new game has the power to transform the activity levels of communities. Dr William Bird explains how community practitioners can harness Beat the Street to improve public health.

nactivity is one of the biggest issues facing young people in the UK. The Department of Health (DH) recommends that children do at least 60 minutes of vigorous physical activity each day, but over half of fi ve- to 15-year-olds in the UK do not meet these basic recommendations. The benefi ts of promoting physical activity in schools go Ibeyond improving health. Not only does increased activity reduce a child’s risk of illness and disease, but it leads to better exam results, greater progress through school and better behaviour. In the past, it has been challenging for community practitioners, such as school nurses and health visitors, to create lasting change to the physical activity levels of children. Traditional interventions have had limited success, as it can prove diffi cult to sustain activity after the completion of a programme or engage hard-to-reach children. Children who are raised in a physically active environment are more likely to achieve higher academic success and less likely to develop mental health problems than those who are less active. Community practitioners are able to engage with individual children, but it can be hard to engage with the child’s friends, family and teachers to create an environment that will see them continue to be active into adult life. Increased In 2014, Intelligent Health developed a whole- activity reduces a community approach to increasing physical activity child’s risk of illness and called Beat the Street. It’s a high-profi le intervention disease, and also leads to designed to make a step change in activity levels better exam results, greater across a community. The person-centred approach progress through school, enables activity to be incorporated into daily routines better behaviour and by making it easy, timely, attractive and social. The attainment long-term goal is to embed active habits, leading to lasting health improvements. Initially launched in Reading, the programme has since been delivered across the UK – in locations including London, Birmingham, Manchester, Liverpool,

Rhondda Cynon Taff and Northern Ireland – with dramatic results. HEALTH INTELLIGENT

32 Community Practitioner December 2016

p32-33 Beat the street.indd 32 01/12/2016 12:42 PHYSICAL ACTIVITY

people in contrast to the struggles of traditional health campaigns: in 2016 so far, 303,000 people, including 130,000 children, have joined in. In 2015, 39% of residents in Annan and Dalbeattie in Scotland walked, ran and cycled for Beat the Street. Over two years of Beat the Street, Reading has seen a 20% increase in the number of people reaching the DH’s recommended activity levels of 150 minutes a week for adults. A total of 865 schools have played and curriculum material has now been created to follow on from Beat the Street to show why moving is so important, which may bring about permanent change. On an individual level, there have been many transformative stories thanks to making activity fun. In Tendring, a mother was able to get her son with ADHD excited about exercise for the fi rst time, while in Hertfordshire, a head teacher with type 2 diabetes was able to stay off his medicine thanks to walking for Beat the Street.

One of the POSITIVE EXPERIENCE fundamental reasons There are many reasons why the game has Beat the Street is able been so successful at inspiring communities to to engage across ages and become more active. Schools are at the heart physical activity levels is of a community and children ‘own’ the game, through a ‘health-by- encouraging parents, teachers, friends and family stealth’ approach to join their school team and increase their chances of coming at the top of the leader boards. Prizes may encourage initial engagement, but, by the end, everyone enjoys spending time together and discovering their town or city. One of the fundamental reasons Beat the Street is able to engage across ages and physical activity levels is through a ‘health-by-stealth’ approach. Messages in the lead-up to the game don’t use public health language but emphasise the fun and how people can take part with friends and family. Players discover for themselves the health benefi ts as they take part. As the game progresses, positive behaviour is encouraged with information on the benefi ts that individuals will see from their increased activity levels. Beat the Street creates a positive environment around physical activity. During the six-week game, children walk to school rather than being driven and teachers create opportunities to be active, as well as taking the game into the classroom to help with literacy or maths lessons. Meanwhile, at home, families take their kids on walks to help ACCESSIBLE increase the number of points for their school. All of this builds positive The game transforms entire communities into playable towns with attitudes towards being active, as well as forming new habits, which residents competing to see who can walk, run or cycle the furthest. will last long after the game has fi nished. Special sensors called ‘beat boxes’ appear on lampposts across the Community practitioners are in a powerful position to work in local area, which players can tap with cards or fobs to track their partnership with pupils, parents and teachers to rebuild the link journey and receive points – the further they travel, the more points between physical activity and childhood. Through initiatives like they get. Schools, community groups and businesses are spurred into Beat the Street, community practitioners can engage with a child’s physical activity by the opportunity to win substantial prizes if their entire social circle and creative a positive, lasting environment around team travels the furthest during the six-week period. The gamifi cation physical activity. CP of the town makes this particularly attractive to children – as witnessed ● For more information about Intelligent Health and Beat by Pokémon Go – but the Beat the Street game is accessible to the Street, email [email protected]; to read about everyone, young and old. Teachers, pupils, parents and community children’s activity levels, go to bit.ly/BMJ_griffi ths_cohort; for practitioners all join the same team and support each other in the further details about the benefi ts of physical activity, visit bit.ly/ game to earn as many points as they can. PHE_pupil_health; for more about the results achieved by Beat Since its launch, Beat the Street has engaged with huge numbers of the Street, go to bit.ly/IH_evidence

December 2016 Community Practitioner 33

p32-33 Beat the street.indd 33 01/12/2016 12:42 FESTIVE SEASON LET NOTHING YOU DISMAY The festive season is almost upon us, and though it might not be a time of universal goodwill, it’s not quite a commercial sell-out either…

34 Community Practitioner December 2016

p34-37 CP Christmas.indd 34 01/12/2016 13:35 FESTIVE SEASON

ishing you a peaceful Christmas. We wish you a Merry Christmas. Have a jolly Christmas. Have a Happy Christmas. WThis selection of typical messages from The cold weather is a seasonal greeting cards leave us in no doubt factor, but the accident how we are all supposed to feel at this time of year. To be fair, most of us will experience at rate also goes up, least a small twinge of comfort and joy over the holiday period, but beneath all the cheer, possibly because the tinsel and twinkling lights, Christmas has people are out of their its dark side. It is a time of accidents, injury, those questioned said they would have to stress, anxiety, violence and death. usual routines borrow to pay for presents. Extrapolated to Some of these bad elements are even by- the entire population, that’s an estimated products of the good ones. Take for example 17.3 million people. Many also said they would what most of us consider an overwhelmingly have to use credit to pay for food (23% – an positive aspect of Christmas: family. In an age recently lost loved ones or for other reasons estimated 11.5 million people). when families tend be spread geographically fi nd themselves alone. For these people, the far and wide, Christmas is a time for parents, festive season only reinforces the loneliness THE BLEAK MIDWINTER grandparents, children, siblings, cousins and and isolation they feel. In 2013, a study by Age While the family arguments, loneliness, everyone else to come together, share a UK estimated that as many as 450,000 over 65s stress and debt might feel bad enough, it meal, exchange presents, and celebrate what would spend Christmas Day on their own. gets worse. According to ONS data collected unites us. Trouble is, it can descend into a Stress and anxiety are ever present. A recent between 2000 and 2010, the winter death rate painful reminder of what disunites us, causing study by the National Accident Helpline found peaks between 21 December and 19 January. squabbles, disputes and resentment. that over one in four people (27%) feel more On average, an additional 2481 people die The family angle can also take on a negative stressed during the festive season, though it’s each day in England and Wales during this and painful perspective for those who have worse for women, with nearly a third (32%) period. It hits a high around New Year’s Day. feeling the pressure. Small wonder, as women The general eff ect of winter and the cold have traditionally taken up most of the strain weather is a factor, but the accident rate also at Christmas. They tend to plan, organise, goes up, possibly because people are out prepare and execute the entire operation, of their usual routines. ONS data from 1995 often starting as early as October. to 2005 shows that fatal traffi c accidents Related to this are money worries. A study increased by 30% for women and 9% for by the charity the Money Advice Trust last men during December, as did deaths from December found that more than a third of falls (16% for women, 21% for men) and fi res (40% for women, 27% for men). Alcohol and drugs also take a toll. Again according to the

December 2016 Community Practitioner 35 GETTY

p34-37 CP Christmas.indd 35 01/12/2016 10:06 FESTIVE SEASON

happy and peaceful time, which has been A REVEREND’S VIEW the case since the early 1900s. One man who knows more about this than most is The Reverend Richard Dormandy, vicar of Holy Trinity Church in Tulse Hill, the historian Dr Martin Johnes at Swansea south London, shares his thoughts on the relationship between commerce and University, whose book, Christmas and the Christianity at Christmas: British, provides an in-depth analysis of the festive season over the past century or so. ● ‘For many people, whether they regularly come to church or not, Christmas has a He is quick to dispel the idea that Christmas strong ethical purpose: it’s not just a party. I think there’s a greater awareness today isn’t what it used to be. ‘It’s mostly middle- than in the 70s and 80s of the meaning of Christmas beyond the tinsel and glitter.’ aged men who complain that Christmas is ● ‘We have to accept there are diff erent ways of celebrating and showing love. For one intrusive and over-commercialised,’ he says. family that might be the food and drink, for another it might be a more sober and ‘In reality they are complaining that they are religious approach. Why harp on about commercialisation? Shops sell stuff ! It’s their getting older and Christmas doesn’t have job. But I do believe it’s important that as individuals we take control. It’s tragic when the same magic as when they were seven or people go into debt to pay for Christmas.’ eight, which of course it wouldn’t.’ He adds that it was often the time of year when men ● ‘As part of local fi lm festival, we are showing Miracle on 34th Street. I’ve never seen it lost control of the household: ‘Women always and thought I ought to watch it fi rst. It’s all about the commercialisation of Christmas took the lead, men just paid for it.’ and how it gets subverted, even in 1947.’ Johnes reveals that if we went back to ● ‘We reach out to people in the community throughout the year. This Christmas we 1914, we would recognise the middle class are working with a local school to provide lunch for elderly and isolated people, and Christmas. ‘The family would come together, with the Prison Fellowship to help people in prison provide gifts to their children.’ they would have a tree, decorations, presents and plenty to eat and drink.’ The working ● ‘Overall I look forward to Christmas. It’s a lot of work, for example, organising and class Christmas is a diff erent matter. ‘They preparing the carol service, but it’s a great celebration.’ would eat a better meal, but not much so, and most would have been saving for half the year to aff ord it.’ For the unskilled classes, ONS, in December we drink 41% above the bigger spike: calls to the police on Christmas it was grim. ‘Weekly savings were impossible monthly average, and the related deaths Day itself go up by as much as a third. for them,’ says Johnes, ‘so they didn’t do during the 21 December to 19 January One cause of death that doesn’t spike too well. Even the very poorest, those in the window are 13% above the daily average for during the festive season, possibly against workhouses, were better off . It was a time of December and January. NHS fi gures show expectations given all the other pressures, charity and they would usually get a decent that A&E departments get hit by a wave of is suicide. In fact, the ONS fi gures show that meal and even some beer.’ admissions for acute intoxication. New Year’s December is below average, particularly for The tension between commerce and Day is the worst, followed by the Saturday women. Sadly it doesn’t last long, as January Christianity has been a long-running theme, before Christmas. has one of the highest rates. with the religious element giving way to Violence and murder go up, too. Home the commercial, argues Johnes. ‘Society has Offi ce data shows that the murder average for JOYFUL AND TRIUMPHANT become less religious overall. That said, more most days of the year is 1.6, but this goes up If this sounds like a compelling argument for people got to church at Christmas than any to just over two a day between Christmas Eve cancelling Christmas, we should remember other time of the year. And it’s the one time and 6 January. Domestic violence has an even that the vast majority of people will have a of year when people are guaranteed to hear

Overall we will spend around £76bn That’s £835 for every household, with around £161 on food and drink, and To deliver all his presents around the £634 world on time, on presentsan Santa 10mthe approximate number of would have to travel at a speed of 650 turkeys UK families will miles per second (the speed of sound is

serve up this Christmas 340 metres per second) SHUTTERSTOCK/THENOUNPROJECT

36 Community Practitioner December 2016

p34-37 CP Christmas.indd 36 01/12/2016 10:06 FESTIVE SEASON

the Christian message. Christianity has played out from normal life. Also, the vast majority of fi nding yourself sat next to Martin Johnes at along with the commerciality to an extent. It people in the country are doing more or less Christmas lunch. CP knows it can’t fi ght people’s desire to eat, drink the same thing, so in that sense it’s a force for ● For more on the the Age UK study, go and be merry. So it has adopted and adapted.’ social integration.’ to bit.ly/AgeUK_christmas; to read more Overall, he doesn’t doubt the value of It has a personal downside, though. ‘My on the National Accident Helpline study, Christmas. ‘I believe it is a force for good. It work has changed Christmas for me,’ he says. go to bit.ly/NAH_festive_fear; for more brings families together. Okay, it doesn’t always ‘I’m always thinking about it, commenting festive stats and traditions, visit bit.ly/ work out perfectly, but it makes us think of on it. In fact, I’ve become a bit of a Christmas BritTurkey_christmas; and to read more on each other. It’s good for the economy, with a bore.’ He needn’t worry too much. As we have the science behind the Santa Claus theory, less selfi sh impulse behind it. It gives us time seen, far worse things could happen than go to bit.ly/Harden_physics_of_santa Nearly 1 in 50 people have fallen out 1 in 5 of the loft while getting people have cut themselves preparing decorations down vegetables on Christmas dayn

Badly wired Christmas lights have given more than 1 in 40 an electric shock

p34-37 CP Christmas.indd 37 01/12/2016 10:06 ANNUAL REPORT The last MONTHS The members of the CPHVA executive provide a round-up of their activities on behalf of members during 2016. 121 We fi nd out what they’ve been up to.

CAROLYN executive. I ensure briefi ngs and publications Jarrett-Thorpe, but we also said goodbye TAYLOR go out and the day-to-day issues for practice to a very dear friend, Barrie Brown, who CHAIR AND are addressed. had worked with us since the HVA days. His NORTH EAST It has been the year of revalidation – after retirement gave us a new head of health, YORKS & our professional team were a pilot for the Sarah Carpenter, who will be working closely HUMBER NMC, they developed a workshop that with the executive over the coming year. What a year to fi nish has been delivered across the The CPHVA awards were a my term as your chair. It is, of course, the UK. After that followed the What fantastic demonstration of 120-year anniversary of the CPHVA but, aside duty of candour and, about the what the membership from that, 2016 has seen huge changes in again, workshops are future? There are still can achieve – please the political landscape. I don’t think any of us being delivered, many more challenges continue to nominate could have anticipated the speed in which supported by your colleagues. ahead... Who are the important local authority commissioning would change local members. There is a group people? They are the children and the status of health visiting and school The journal has of members whose nursing services. continued to be families whom we serve; any loss work often goes There is no doubt that it’s a challenge. produced and of our services is a loss to the unrecognised – Your regional chairs are keeping abreast our commercial community and will adversely your workplace of what is happening in all areas and and ethical policy aff ect their health and representatives. As responding with campaigns as appropriate. is updated when wellbeing. well as your branch For our colleagues in the devolved countries, concerns are raised by the Carolyn offi cers, these members are these issues are not so relevant, but they membership. We are hoping volunteers who give support have their own challenges. that, within the next 18 months, and care to other members as My role as chair is to be an ambassador we will have no formula milk advertising. individual situations arise. They help those for CPHVA, both at home and abroad, but This year, we also celebrated Rachael going through sickness, disciplinary and mainly to determine our strategic work Maskell’s entry into parliament and performance management, unbeknownst to with the professional offi cers and the welcomed our new national offi cer, Colenzo you. They also fi ght for your service to remain

38 Community Practitioner December 2016

p38-41 Annual report.indd 38 01/12/2016 13:36 ANNUAL REPORT

This year, I worked with colleagues to look at safeguarding issues and the concerns that members have, unchanged and particularly in a time of change. This year, I have nurse at Public Health England, in May to against proposed Janet worked with discuss issues relating to the transfer of reductions to Some areas have clinics without colleagues on the health visiting services to local authorities. your terms and timely access to senior executive to look at I also wrote to Ann Longfi eld, children’s conditions. All of practitioners, which can be safeguarding issues commissioner, to raise issues about this this they do silently and the concerns together with the school nursing services’ a cause for concern. and often to their own that members have transfer to local authorities. Our concern was Elaine detriment. Celebrate this highlighted, particularly acknowledged but, to date, no further action work, seek them out and give at a time of change. We are has been taken. them the ‘thank you’ they deserve. supporting some research that is being Using my area as an example for what is Nominate them for an award or join them undertaken by Oxford Brookes University, happening in many areas of London, the because the more there are, the stronger we which is exploring health visitor and school transfer of services has meant that £1m has can be. nursing issues. been removed from the health visiting budget. What about the future? There are still I was also involved with the conference This will result in a lack of transparency, as many more challenges ahead. The annual planning committee in 2016, helping to shape well as increased safeguarding risk due to the professional forum and conference will the content of our professional conference. reduced number of health visitors and high challenge you to continue where the Northern Ireland has had a busy and ratio of novice-to-expert practitioners. Some suff ragettes left off . Who are the important productive 2016 too. areas have clinics without timely access to people? They are the children and families In May, Belfast City Council granted the senior practitioners for support or guidance, whom we serve; any loss of our services is freedom of the city to Belfast nurses. There which can be a cause for concern when it a loss to the community and will adversely was a ceremony in the City Hall to give a comes to safeguarding, as well as meaning aff ect their health and wellbeing. formal expression of thanks to those who there is potential for high-risk practice. I have been so proud to call myself a health had made such a positive contribution over In April, I held a meeting with health visitors visitor and even more proud to represent the years to the people of Belfast. Our Lord in the London and Eastern region. It was you all for a signifi cant number of years at Mayor talked about how this was especially well attended and we were pleased to have national level, holding the chair’s position appreciated during the diffi cult times of the Obi and Carolyn in attendance. I continue to three times. I want to take this opportunity to Troubles. Unite provided a delegation of support regional members, responding to thank all those members and offi cers for the retired and current practitioners and, along questions and queries across London and signifi cant work they do on your behalf and with Bernie McCrea, I accepted the honour the Essex region as services are transferred, the support they have given me. on behalf of our nurses. outsourced or members are downbanded. Now, I will take my passion to another We had a successful Northern Ireland In May, I was honoured to attend the country to support the development of the Unite-CPHVA conference on 29 September Garden Party at Buckingham Palace, after Uganda Nurses’ and Midwives’ Union and – a fi rst for the country – as part of our being nominated by the CPHVA committee a new nursing and midwifery school, but I celebration of #HVweek. More than to represent the organisation. will continue to support the CPHVA in some 70 delegates attended the event, with capacity. Good luck to our new executive inspirational speakers throughout the day. MARGARET and new offi cers – they will need all of Ethel Rodrigues replaced Gavin Fergie WARNER our support as we move into 2017 and the as the lead professional offi cer who SOUTH EAST challenges it brings. supports Northern Ireland, after a change Our region was ● For an interview with Carolyn, turn to in the professional offi cers’ portfolios. We the fi rst in the UK page 49. welcome her and look forward to working to hold a 120-year closely together. celebration. This JANET TAYLOR was a very positive event, held at Esher Place, VICE CHAIR AND ELAINE in June. More than 20 attended and it was NORTHERN BAPTISTE encouraging to have several student health IRELAND LONDON AND visitors and many new faces. Our key speaker The CPHVA national EASTERN was Lorin LaFave from the Breck Foundation, award ceremony on I have been raising who gave a heart-wrenching talk of the online 8 April was a great concerns regarding grooming that led to the murder of her son. success and was made even more special the changes to We also had a workshop on the duty of for me as I was privileged and proud to be health visiting services across London. Obi candour given by Ethel Rodrigues, lead awarded public health nurse of the year. Amadi and I met with Nicky Brown, senior professional offi cer for education and Ireland

December 2016 Community Practitioner 39

p38-41 Annual report.indd 39 01/12/2016 11:14 ANNUAL REPORT

An ongoing part of my executive responsibility is agile/mobile working... Asha and I produced at Unite. Jenni FoFormby, the newly appointed their preferred form a leafl et on this. hope to get an artist southth east regionalregion secretary also addressed of communication Susan to map the journey the meetinmeeting.g. and they chose I have been representing of health visiting I hbhave been the executive link with regards email. I continue the association nationally over the past 120 to revalidation. There have been several to build links on the perinatal mental years. It is hoped that workshops and training sessions across the and support my health agenda. we will raise funds for country. Although there was a lot of anxiety colleagues, and I Asha a local charity during prior to its launch, there have been no propose to meet with reps this evening. reports of any major concerns from any of the over the next few months. I have been representing the regions. It appears to be working well! We held our 120-years celebration association nationally on the perinatal Having served the maximum of two event at the end of September during mental health agenda. This includes working terms on the executive committee, I will #HVweek. We had a talk by Lord Alf Dubs in towards a nationally driven education be standing down from this role at the North Cumbria. programme, based on competencies for all end of the year. I will off er my predecessor An ongoing part of my executive staff working across the perinatal mental any help I can, particularly with regard to responsibility is agile/mobile working and, health pathway. re-establishing regional meetings. to meet this obligation, Asha Day from the I have had the opportunity to participate East Midlands region and I produced a in Twitter chats. For example, the last Twitter SARAH leafl et entitled 10 top tips for agile working chat on perinatal mental health saw more REDDINGTON- in the community. than 80 participants, 1163 tweets and 2.5 BOWES million impressions. It’s very positive for SOUTH WEST SU LOWE members and I’d encourage you all to get In my region, it is WEST involved in 2017. hoped the education MIDLANDS Both Leicester and Derby were pleased to reference group chair, In our region, we be able to support members with tickets to Maggie Coates, will be conducting a health experienced the attend the recent CPHVA annual conference visiting outcomes measurement framework. same problems in Telford. The aim is to scope any evidence-based that are familiar to models already available, as well as devise a many of you across England. This led me MANDY new model for HV/SCPHN over the next year. to resign as the executive member so that BRIMBLE Due to the amount of work this entails, it will I could concentrate my eff orts in the Love WALES be carried over to next year’s plan. Your Health Visitor campaign. If you have I took over the I have been working hard to establish better not already done so, please sign in support executive role in regional communication – emails have been at bit.ly/love_your_health_visitor September 2015. sent to all of the south west membership Before I stepped down, I had begun a Through liaison about the 120 years’ celebrations. There were piece of work on the health visitor mandated with the lead professional offi cer for Wales two events in our area, both in July. The fi rst contacts and this will now be completed by Jane Beach and lead regional offi cer for was held at the English Riviera Centre and the executive committee. health in Wales Richard Munn, there has 35 members attended and the second at I remain an active local accredited been a regeneration of CPHVA activities Durweston Village Hall in Blandford, Dorset, representative and will do all I can to in Wales. which had 33 attendees. support the association. This year, two health visiting forums have This year, I’ve undertaken two joint taken place, with 10 to 15 members at each pieces of work with colleagues. One is a ASHA DAY event. We have gone on to liaise with the professional practice chapter in a textbook EAST MIDLANDS all-Wales health visiting forum chair and for community practice for pre-registration I am a recent members and established the CPHVA students and the other a piece of work on addition to the (Wales) Facebook page, which currently maintaining prescribing competencies. executive and I has 28 members. have been working Our 120-years celebration event took SUSAN BLACK hard to get our place in July and was well received. NORTH WEST regional branch more active. Our North Wales members have requested In 2016, I aimed In Derbyshire, they held their 120 years’ a meeting – this will be addressed by the to improve links celebration event during #HVweek, themed new executive member once in position. with members and as health visiting through the decades. In the meantime, we had our #HVweek I achieved it. All In Leicester, we plan to have a meal where conference in Swalec Stadium on 26 members were asked we will document clinical narratives and we September, which was a great success.

40 Community Practitioner December 2016

p38-41 Annual report.indd 40 01/12/2016 13:36 ANNUAL REPORT

ANNIE HAIR for conference, but will be available in the and Northern Ireland. SCOTLAND new year. In 2015, the annual professional meeting I have continued In addition to this, Carolyn and I were identifi ed a need for the CNN expert to attend the successful in preventing the downbanding reference group to produce various CPHVA executive, of our school nurses. This was after a long, factsheets for members. Documents we have representing the but determined, fi ght. We need to use all produced this year include: the role of the whole of Scotland. opportunities to get news of our success out CNN in the universal/universal plus service; This has been an exciting time for health there and I encourage all members to tell us best practice when carrying out a 24-month visiting with signifi cant investment in what you did that worked. review and a 27-month review; a factsheet to training and additional SCPHN health compare the roles of a CNN/family outreach visitors across Scotland to reach the 500 STELLA MANN worker and children’s centre worker; and a new posts promised. COMMUNITY CNN job profi le. My professional areas of activity have NURSERY Three members of the CNN expert included work around the Children and NURSES reference group represented Unite-CPHVA at Young People’s Act, National Practice The community a Public Health England meeting to discuss Model and Named Person Service. We had nursery nurses the future role of the CNN, school nurse the fi rst Scottish conference in nine years on (CNN) have and nursery nurse. There was discussion 27 September in Glasgow. Members signed established an expert reference group. We about ways to raise the profi le of the CNN up for an exciting day. We hope this will met three times this year and we now have with commissioners and to promote the prove a springboard for professional activity representation from all regions in England. uniqueness of the CNN. These meetings are across Scotland. We still have vacancies for Scotland, Wales going to continue over the next year. CP I have tried to reach out to members in other areas of Scotland but, largely, activity has centred on the West of Scotland. OBI AMADI In addition, I have been working with universities in Scotland, meeting with Lead professional offi cer for strategy, policy and equalities new students and graduates. As you can see from the reports of your regional and country We need to attract a new active chairs they have been involved in a lot of activity on behalf nomination to the CPHVA from Scotland. The of the CPHVA. I hope you have been able to join them at the journal has recently advertised for this and various meetings, workshops and study days described, share your knowledge and give we do need to have Scotland represented. support to all they do on your behalf. Interested connected members should consider this opportunity and apply. As has been said, this was another anniversary for us – our association turned 120 years old. We have come a long way from a few Salford women coming together to discuss how CLAIRE ELLWELL they could make an impact on the sanitation issues of the day, among other things. SCHOOL At the same time that I mention our anniversary, I have to acknowledge that many NURSING services in England may feel there is little to celebrate as our members face cuts to I am a new co- services, downbanding and decommissioning. Some are campaigning against these optee to the cuts and identifying the risks to services and safeguarding in particular. executive this year, We have the Love Your Health Visitor campaign, started in the West Midlands, and previously being a I hope you have signed their petition and are planning to launch your own. Visit representative on the school nurse organising bit.ly/love_your_health_visitor for more information. professional committee. We have now As a team, we will continue to support our members on professional issues. In order to established the school nurse expert reference do this eff ectively, we need you to keep in touch with us – your voices are important to group and have been working our way our work and we need to know what is going, as soon as it happens. Support your local through the issues members have identifi ed reps who will contact your regional offi cer for support when they need to, or get as your concerns. in touch with us through your professional regional chair – you know who and where We have also been working on updating they are. They have volunteered to represent you on professional matters. Also, don’t our skill mix document – this will focus forget to share what is going with the Community Practitioner – it is your professional mainly on the school nurse and staff journal so use it, inform it, share it. nurse roles, but may incorporate others. In addition, I have been looking to reproduce We need to ensure we have a strong profession in another 120 years’ time. We need the vacant caseload documents. Although to ensure we remain ‘radical, professional and caring’. close to completion, they were not ready

December 2016 Community Practitioner 41

p38-41 Annual report.indd 41 01/12/2016 13:36 LOOKING BACK

organisation to formally assess the such as smoking, obesity, diet and performance of NHS hospitals. nutrition, exercise and sexual health. It supports individual ACTS choice, personalised services and 2002 coordinated working between the Another NHS reorganisation public and private sectors. REPORTS sees district health authorities replaced by strategic health The fi rst 10 foundation trusts authorities (SHAs) and primary are established, with more control care trusts (PCTs). The concept of over their budgets and services. AND WHITE foundation trusts is investigated. The government announces Sir Derek Wanless publishes plans to devolve responsibility for PAPERS… his review into the long-term commissioning services from funding needs of the NHS, which PCTs to local GPs with practice- Julie Griffi ths takes a look at the 20 years to suggests that future funding based commissioning. 2016 in the last of our ‘Looking back’ series. needs will depend on the extent to which future demand for health care is reduced by good public 2005 health policies and disease The document commissioning 1996 1999 prevention. The report justifi es a patient-led NHS outlines plans The National Institute for Health what is to be a 50% real-terms to better engage local clinicians and Clinical Excellence (NICE) is increase in NHS spending in the in the design of services and established to standardise the fi ve years after its publication. roll-out practice-based quality of care across the NHS. commissioning faster.

An NHS reorganisation sees GP 2003 fundholding abolished and new In exchange for pay increases, 2006 Under John Major, three white primary care groups (PCGs) set up. NHS staff vote in favour of new The white paper, Our health, papers are released: Choice and framework Agenda for Change. our care, our say, is published. It opportunity; The NHS: a service with The hope is the new system will encourages patient choice and ambitions; and Primary care: 2000 help to increase the recruitment the movement of services out of delivering the future. The latter is on Prime minister Tony Blair and retention of staff in the NHS. hospitals into community services. partnerships in primary care, and commits to large and progressive between primary and secondary increases in NHS funding. The A new contract for GPs is The smoking ban is introduced care and local authorities. NHS publishes a 10-year negotiated, giving greater in Scotland. modernisation programme of autonomy on the range of services investment and reform. they provide. The new contract 1997 increases wages and pensions. 2007 The NHS Primary Care Act A smoking ban in England, enables possibilities for delivering 2001 Wales and Northern Ireland primary care. GPs are encouraged The Health and Social Care Act 2004 comes into eff ect. to increase fl exibility and choice. 2001 formalises The NHS plan. As The public health white paper, directed by the Health Act 1999, Choosing Health, reiterates the Labour comes to power and the Commission for Healthcare agenda to promote individual 2008 publishes a white paper: The new Improvement is created – the fi rst responsibility with a focus on issues NHS: modern, dependable, which says access to the NHS ‘will be based on need and need alone’. 1998 The Acheson inquiry into Professor Sir (soon to become health inequalities is published Lord) Darzi joins the government and NHS Direct is set up with the as a health minister and is tasked promise it will make a diff erence with leading a major review of to the lives of people 24 hours a the NHS to outline a 10-year vision

day, 365 days a year. 1997 for its future. His vision includes

42 Community Practitioner December 2016

p42-43 CP Looking back_v2.indd 42 01/12/2016 12:14 LOOKING BACK

increase competition and abolish takes on responsibility for SHAs and PCTs. It envisages a education, training and bottom-up, clinically owned workforce development. network of GP commissioning groups with budgets to buy care Public health responsibilities on behalf of their local are transferred to local authorities. communities. Public Health Public Health England is set up to England is to the lead on public improve the nation’s health and health at the national level, with wellbeing and reduce inequalities. local authorities taking the lead locally. The voice of patients is to New health and wellbeing be empowered through the boards are established. establishment of a new national 2007 body, Healthwatch. 2014 centralising specialist services and savings of £15bn to £20bn from NHS England publishes its Five polyclinics are proposed. 2011 to 2014. 2012 year forward view, outlining how the NHS needs to reduce health Health minister Lord Darzi inequalities, improve quality of care leads the ‘NHS next stage review’ 2010 and meet an estimated £30bn gap and outlines his 10-year vision for A general election results in a in funding by 2020-21. the NHS in the report, High coalition government between quality care for all. the Conservatives and Liberal Democrats. Among many pledges 2015 on health, the coalition agreement After nearly 18 months and The Conservatives come into 2009 promises ‘no more top-down thousands of amendments, the power. One of their manifesto The NHS constitution is reorganisations of the NHS’. Health and Social Care Bill is passed. pledges is to spend an extra £8bn published, with revised rights and on the NHS over the next fi ve years. responsibilities for patients and The white paper, Equity and The NHS Commissioning Board £600m of this is funded through staff . It proposes seven principles excellence: liberating the NHS, is (now NHS England) is established cuts to public health. on how the NHS should act and published and includes reforms as an independent statutory body. make decisions, six core values and such as scrapping performance It initially performs limited pledges to patients and staff , as targets, including waiting times, functions. A primary role is to 2016 well as a list of rights and giving groups of GP practices establish and authorise clinical The EU referendum results in a responsibilities. These include ‘real’ budgets to buy care, commissioning groups (CCGs) vote to leave, despite health unions treating patients with dignity and abolishing all PCTs and SHAs, ahead of 1 April 2013. At the same backing the remain campaign. CP enabling informed choice. and creating a new NHS time, Monitor starts to take on its Commissioning Board. new regulatory A new health and social care functions. regulator in England, the Care The government’s vision for Quality Commission (CQC), is public health in England is created following the merger of published in Healthy lives, healthy 2013 three regulators: the Healthcare people. It proposes a new Robert Francis QC, Commission, the Commission for organisation – Public Health chair of the Mid Social Care Inspection and the England – whose sole Staff ordshire NHS Mental Health Act Commission. responsibility would be to Foundation Trust public provide advice on and infl uence inquiry into poor care The CQC takes on responsibility public health issues. Crucially, it and high mortality rates, for regulating and inspecting also entails the return of public presents his fi nal report. health and social care services in health back to local authorities, England, including services after more than two decades as PCTs are abolished as provided by the NHS, local a subset of the NHS. part of the Health and authorities, private companies Social Care Act, their and voluntary organisations. functions passing to 2011 NHS England and 211 NHS chief executive Sir David The Health and Social Care Bill CCGs. SHAs are also Nicholson warns the NHS to prepare proposes reforms to increase the abolished. Health for unprecedented effi ciency infl uence of GPs on commissioning, Education England 2016

December 2016 Community Practitioner 43

p42-43 CP Looking back_v2.indd 43 01/12/2016 12:14 PROFESSIONAL AND RESEARCH

Supporting pre-registration nurses within health visiting and school nursing

Queries have primarily focused on how to interpret the standards to support learning and assessment in practice (SLAiP) (NMC, Adelle Shaw-Flach, Research Project Consultant, Anglia Ruskin University 2008) and how to meet students’ learning Georgina Hoy, Senior Lecturer, Anglia Ruskin University needs with regards to assessing practice and supporting learning within SCPHN Abstract settings. For the purposes of this article, During the Health Visitor Implementation Plan (DH, 2011), health visiting teams we will be referring to nursing students were fl ooded with high numbers of health visitor students and, as a result, pre- who are undertaking a pre-registration registration student nurse placements for both health visitor and school nurse nursing programme at a higher education placements were reduced or temporarily suspended until its conclusion in 2015. institution (HEI). Since then, pre-registration placements within health visiting and school nursing have been reactivated, and pre-registration students are once again able to join WHAT ARE SLAiP AND the clinical learning environment of specialist community public health nursing WHAT DOES THIS MEAN (SCPHN). The reintroduction of student nurses to some clinical areas and fi rst- FOR PRACTICE LEARNING? time introduction in others has generated questions from health visitors and SLAiP (NMC, 2008) are the professional body school nurses about pre-registration nurses and their learning needs. This article standards governing the support, mentoring aims to answer some of the queries we have encountered about developing the and assessment of students within their quality of the practice learning environment, so that student nurses’ development practice placements. SLAiP (NMC, 2008) is supported in accordance with the NMC Standards for pre-registration nursing determines that mentors and practice education (NMC, 2010). This article may provide the opportunity for professional teachers have to remain on the live mentor development, refl ection and learning that can contribute towards revalidation. register, and stipulate that at least 40% of a student’s time in practice is under the direct Key words or indirect supervision of a mentor/practice Mentor, learning, pre-registration student nurses, SCPHN, SLAiP teacher (NMC, 2008 section 3.2.3). Named mentors retain ultimate accountability for the assessment of students, even if the student spends time with other practitioners during INTRODUCTION supporting mentors and students in practice, their placement, within a coaching capacity. Following a gap during the completion of we have sought to resolve and answer queries So communication between staff supervising the Health Visitor Implementation Plan (DH, that have arisen as practitioners seek to (re) students is crucial. 2011) in 2015, most health visiting and school acquaint themselves with the requirements nursing services will now be experiencing for supporting pre-registration students on WHAT ARE THE BENEFITS OF the reintroduction of pre-registration placements in SCPHN practice settings. This HOSTING STUDENT NURSE nursing students to the clinical environment. article seeks to share issues raised about the PLACEMENTS IN HV AND SN TEAMS? Pre-registration students diff er in their reintroduction of pre-registration student ● The primary reason for hosting student regulatory and learning requirements from nurses by mentors, managers and students, nurses is to support the next generation of those of specialist community public health during mentor forums and updates, student nurses by enabling them to meet their NMC nursing (SCPHN) students. Within our role of forums and from placement evaluations. requirements of 2300 hours in practice

44 Community Practitioner December 2016

p44-48 PPI.indd 44 01/12/2016 14:31 PROFESSIONAL AND RESEARCH

during their programme (NMC, 2010; NMC, We have a collective with nursing students. So education and 2008 section 3.4). The NMC stipulates that responsibility for the learning of the next pre-registration programmes should be responsibility to share generation of nurses is not just for mentors divided between acute and community skills, knowledge and those with education in their role – it settings. A community placement enables is everyone’s business. We are all involved nursing students to learn about the world and experience with in shaping and infl uencing their learning. outside acute care. nursing students. These future nurses may or may not take ● Health visiting and school nursing services an SCPHN career path, but they will qualify are aligned with the government’s vision So education and with an understanding of these services and for integrated care, which aims to improve how they fi t into the overall jigsaw of health ‘outcomes and experiences for individuals responsibility for the service provision. and communities’ through public health learning of the next ● Students placed within health visiting and (DH, 2013: 13). Embedding the ethos and school nursing services benefi t from the skills required to practise early in students’ generation of nurses opportunity to see how the staff uphold the professional journeys is key to move towards is not just for NHS Constitution principles and values (DH, integrating care within public health practice 2015), and to role model this within their (DH, 2013), and to upholding the NHS mentors and those own practice. Constitution values (DH, 2015). ● Good quality placements within school ● SCPHNs and the wider team work to with education in nursing and health visiting services are a fi nite infl uence the health and wellbeing of both their role – it is resource. As such, each and every placement, individuals and communities. The vision for and the commitment of the staff who provide health services of the future pivots around everyone’s business students with quality learning opportunities, public health and primary care, and nurses is highly valued by both students and HEIs. increasingly need to have an understanding of population-based preventative and early PLACEMENTS AND ASSESSMENTS intervention approaches to public health There are a variety of types of placements (NHS England, 2014; DH, 2013). The recent opportunity to observe and learn from those that student nurses require, which may be Shape of caring review (Willis, 2015: 44) at the forefront of public health delivery (NHS organised diff erently from one area to the emphasises how ‘public health needs to be England, 2014). next. Formative and summative assessments embedded within pre-registration education ● The NMC code (2015) states that we, as are characteristic of ‘core’ or ‘hub’ placements from the outset’ and is integral to the future nurses, have a collective responsibility to and so require a live mentor, which is an of health care. Nursing students need the share skills, knowledge and experience NMC requirement (NMC, 2008, section 3.2.2). Others are ‘insight’, ‘short’ or ‘spoke’ placements, during which students may not BOX 1: CASE STUDY be formally assessed. However, professional behaviours, skills and competencies form part of a continual assessment process throughout Q: Ali Mohammed is a school nurse and a qualifi ed mentor, who hasn’t students’ practice placements. mentored a student for four years and hasn’t attended any mentor updates within this time period. He has been asked to mentor a student for a second WHAT IS A LIVE MENTOR? year placement, and, whilst very keen, isn’t sure whether he can or not. It is mandatory that a mentor will have A: Ali will need to contact the education and learning team within his trust for successfully completed a recognised support to re-enter the live mentor register. The mentorship qualifi cation that he mentorship qualifi cation that will prepare undertook originally will need to be reviewed to ensure currency. He will need to be them to practice in accordance with the SLAiP updated/attend an update, and ensure that he is familiar with the current curriculum (NMC, 2008). In order to be recognised as and assessment requirements of the HEI(s) that his healthcare organisation works ‘live’ on the mentor register, SLAiP requires with. He will also need support from his line manager around starting the process mentors to participate in yearly updates, plus of working towards a triennial review. Mentors need to support and work with two successfully complete the criteria for the students within a three- year period in order to fulfi ll requirements for triennial triennial review (NMC, 2008). review. One way of updating could be to co-mentor a student and so, in addition to The responsibility for both holding and fulfi lling the other requirements, build confi dence and skills while practising. ongoing maintenance of the live register lies locally with placement providers (NMC, 2008). Responsibility and provision of the annual

December 2016 Community Practitioner 45

p44-48 PPI.indd 45 01/12/2016 14:31 PROFESSIONAL AND RESEARCH

updates is delivered in partnership between placement providers and the HEI (NMC, 2008). BOX 2: WHO CAN ASSESS STUDENTS’ LEARNING? Locally, mentors may have the opportunity to choose diff erent formats for updating – in some areas, for example, the option of using First-year students Any ‘mentor who is a nurse registered in any of the four Progression point fi elds of practice’ (NMC, 2010; sections R8.2.2b and online updates may be available. Some G8.2.2b: 85) mentors may achieve additional criteria to become sign-off mentors (SOMs). This Second-year students Any ‘mentor who is a nurse registered in any of the four qualifi es the mentor to sign off a student Progression point fi elds of practice’ (NMC, 2010; sections R8.2.2c and G8.2.2b: to join (or rejoin as in the case of return-to- 85) practice students) the NMC register at the end of their programme (NMC, 2010). All practice Registered nurse (and a live SOM) registered on the same part of the register as that which the student is intending teachers and midwives are SOMs. The NMC Third-year students to enter. The registered nurse must also be currently (2010) specifi es that, in order to fulfi ll the role, practising in the same fi eld of practice as that which the Final placement only student is intending to enter (SLAiP (NMC, 2008) section SOMs should be allocated the equivalent of 2.1.3; NMC, 2010 section R8.2.2d). NB: Students may also one hour per student per week. be supported by a SOM in training who is themselves being supported by a live SOM. TRIENNIAL REVIEW All live mentors, including SOMs, are required to complete a triennial review to stay on the SLAiP requirements (NMC, 2008). If someone Other practitioners who are not mentors live mentor register. Triennial review is a three- who has lapsed from the register mentors can work with students, as long as the yearly process of refl ection mapped against a student, it has serious implications for the mentor coordinates this in advance and the eight NMC domains in SLAiP (NMC, 2008). student whose placement may be nullifi ed – formally communicates with and follows up Meeting the below requirements for triennial see box 1 on page 45. afterwards for feedback from their colleagues. review contributes to the evidence required The mentor retains overall accountability for for revalidation: WHAT DOES THE 40% SUPERVISION the student and for the protection of service ● Current registration with the NMC REQUIREMENT MEAN? users and the public. This also means that ● Staying up to date with students’ curricula SLAiP (NMC, 2008, section 3.2.3: 39) states it mentors who are part time do not need to be ● Mentored a minimum of two students over a is mandatory that ‘whilst giving direct care in working with students all the time, but they three-year period the practice setting at least 40% of a student’s do need to set goals with the student when ● Supervise students directly or indirectly for a time must be spent being supervised (directly they are working with other staff . This model minimum of 40% of their placement or indirectly) by a mentor/practice teacher’. also means that qualifi ed staff who are not ● Meet the standards of the eight domains in So mentors must spend enough time with currently mentors have the opportunity to the SLAiP (NMC, 2008) standards students to make an informed assessment of become involved with supporting students’ ● Engage in continuing professional the student’s achievement and progression in learning in practice, and they may then development relation to their practice outcomes. decide to train as a mentor. ● Since SLAiP (NMC, 2008) was published, a new requirement is to comply with revalidation (NMC, 2016a). BOX 3: CASE STUDY WHAT IF I HAVEN’T MENTORED A STUDENT FOR SOME TIME? If you wish to mentor students and have a Q: Abigail Brown is a child fi eld student in her third year fi nal placement and has mentoring qualifi cation, but have not had requested a placement with a health visiting team. She has been allocated to a yearly updates or triennial reviews that relate HV who is a child trained nurse and a live SOM. Can this mentor assess Abigail to pre-registration nursing programmes, and sign her off as a registered child nurse at the end of her placement? then it is likely that you are not currently live A: Close inspection of SLAiP (NMC, 2008, section 2.1.3) indicates that the SOM, in on the register. In order to reactivate your addition to due regard, must currently work within the same fi eld of practice as the mentorship, become live and assess students, fi eld that the student is intending to enter. Our interpretation of this is that because, in you will need to make contact with your this scenario, the mentor is working as a HV and not clinically as a children’s nurse, the trust’s education and learning team. Every student’s clinical learning opportunities may be compromised, which has implications year, large numbers of nurses lapse from the for the due regard of the fi nal assessment for this student. live register because they have not fulfi lled

46 Community Practitioner December 2016

p44-48 PPI.indd 46 01/12/2016 14:32 PROFESSIONAL AND RESEARCH

WHAT DO STUDENTS NEED BOX 4: ADDRESSING CLUSTER TO ACHIEVE DURING THEIR KEY POINTS SKILLS PLACEMENT? According to the NMC (2010), there are four 1. Care, compassion and areas of competency that pre-registration ● The benefi ts for pre-registration communication – consultation styles student nurses need to achieve before they nursing students having placements used for sensitive issues are able to apply to be registered as nurses with health visiting and school 2. Organisational aspects of care with the NMC. These are: nursing teams – Healthy Child Programme (DH, 2009) 1. Professional values ● Revisits regulatory requirements 3. Infection prevention and control 2. Communication and interpersonal skills for learning and assessing pre- – childhood illnesses and diseases 3. Nursing practice and decision-making registration nursing students 4. Nutrition and fl uid management 4. Leadership, management and team-working. ● Assessing practice and supporting – healthy nutrition During core placements, students are learning for student nurses 5. Medicines management – required to work towards and achieve ● Developing the quality of the non-medical prescribing specifi c competencies within their practice learning environment for assessment documents that will be assessed student nurses by a live mentor, or SOM. The NMC (2010) ● The professional and personal HOW DOES THE WIDER TEAM FIT also stipulates that student nurses must benefi ts in hosting student nurses. INTO THIS? address fi ve essential cluster skills during Students benefi t from spending time with their assessed placements. These are: and learning from members of the wider 1. Care, compassion and communication Given these potentially signifi cant team – for example, someone with an in-depth 2. Organisational aspects of care diff erences in how HEIs assess practice, it knowledge of child development, play, or child 3. Infection prevention and control is important that mentors have a robust and adolescent behaviour. An example of this 4. Nutrition and fl uid management understanding of the requirements for could be the nursery nurse, whose specialist 5. Medicines management. assessing practice within the locality in knowledge and skills are a fundamental part During non-core placements, students are which they are working and mentoring of health visitor (HV) and school nurse (SN) also required to demonstrate that they are students. In addition to the requirement for teams. Despite the nursery nurse not being an achieving requisite competencies. students’ to pass their practice placements, NMC registrant, they can still support students’ In some areas, pre-registration nursing there are two progression points within learning, providing the mentor oversees this. practice is also graded, as opposed to being the degree, which students are required to This applies to other professionals too. given a pass or fail. This is not an NMC pass in order to move from one part of their requirement. HEIs have the option of how training to the next (NMC, 2010). WHAT IS ‘DUE REGARD’? they interpret this so mentors may encounter Interpretation of the NMC’s cluster skills There are diff erent regulations attached to who a variety of assessment documentation if requires some creativity for those in a can assess students in diff erent years and their working with students from diff erent HEIs. community setting, as they can initially fi elds of practice – see box 2. In some situations Midwifery education diff ers from nursing appear to have an acute care focus. interpreting ‘due regard’ and ensuring learning in that the NMC (2009) has stipulated that When looking at the fi ve cluster skills, needs are met can be challenging – see box 3. practice should be fi ne graded. many community practitioners perceive barriers to fulfi lling these within SN or HV practice. However, there are a breadth of BOX 5: DEVELOPING ACTION PLANS opportunities for supporting pre-registration nursing students to achieve cluster skills. Perrin and Scott (2016) give a range of Learning need: Student X needs to gain experience in professional communication examples in their informative article. We using the telephone in practice have used some to illustrate how they can Learning actions: be linked to meet the essential cluster skills 1. Student X to telephone fi ve clients to arrange developmental reviews – see box 4. 2. Student X to contact another healthcare professional to refer a client to them 3. Student X to telephone a school to make arrangements to visit WHAT ABOUT ACTION PLANS? 4. Date for review of action plan. Some mentors tell us that they are These specifi c goals make it easier to see if the outcomes have been met. apprehensive about writing action plans with students, and deciding when they are needed. Both students and mentors should

December 2016 Community Practitioner 47

p44-48 PPI.indd 47 01/12/2016 14:32 PROFESSIONAL AND RESEARCH

routinely work together to devise action Student nurses benefi t greatly from learning plans at both the beginning and formative Mentors need to about the skills and expertise of HVs and SNs, stages of placements. The content of these ensure that action and the exposure to observing public health will diff er depending upon the placement practice. Some examples have been given area and the student’s needs, fi eld and year plans are specifi c and showing how practice can be linked to the of study. can be understood essential cluster skills. The process of working together for the We have discussed the SLAiP (NMC, 2008) students’ learning goals is fundamental by all who read them standards that relate to the learning and to the assessment of students’ progress assessment of students in SCPHN settings, through their placement. It is required for using practice examples and a question and all students regardless of ability, since even answer format. students who are surpassing expectations This article can be used as a guide to help need to be extended. WHAT’S IN IT FOR YOU? busy practitioners review the key points Additional action plans may be required ● You have the opportunity to be a relating to learning and assessment of student for students who need extra support, such signifi cant role model in a student’s journey nurses. The wider personal and professional as those who are experiencing diffi culties. ● Facilitating student learning can keep you benefi ts of supporting students’ learning in This process should be the fi rst step to be up to date practice have been highlighted, particularly in taken if the mentor has concerns about the ● Students can be given projects about current relation to revalidation. CP student’s practice, and would also need to or new areas of practice or research, and then

be undertaken in partnership with the HEI. might update the team by developing a display References Mentors need to ensure that action plans are board or a short presentation Department of Health. (2009) Healthy child programme. HMSO: London. specifi c and can be understood by all who ● Potential for recruitment in the future Department of Health. (2011) Health visitor implementation need to read them so avoid abbreviations that when the students qualify plan 2011-2015: a call to action. HMSO: London. Department of Health. (2013) Integrated care: our shared may be misinterpreted. For an example, see ● The preparation and coordination commitment. See: gov.uk/government/publications/ box 5 on page 47. of students’ placements demonstrates integrated-care (accessed 6 November 2016). Department of Health. (2015) The NHS constitution for England. leadership skills See: gov.uk/government/publications/the-nhs-constitution- HOW ARE STUDENT NUMBERS ● Supporting students can be used as for-england (accessed 6 November 2016). NHS England. (2014) Five year forward view. See: england.nhs. DETERMINED FOR A PLACEMENT? evidence that can be submitted as part uk/wp-content/uploads/2014/10/5yfv-web.pdf (accessed 6 Each placement is required to have a current of revalidation November 2016). NHS Improvement. (2016) Evidence from NHS Improvement education audit (NMC, 2016b). The education ● It could lead to further professional on clinical staff shortages: a workforce analysis. See: gov.uk/ audit process diff ers between HEIs but is, development/new roles/promotion government/uploads/system/uploads/attachment_data/ fi le/500288/Clinical_workforce_report.pdf (accessed 6 in essence, a quality assurance process ● Working with students can be rewarding November 2016). stipulated by the NMC. Audits capture on a personal level NMC. (2016a) Revalidation. See: revalidation.nmc.org.uk (accessed 6 November 2016). ● information about the learning opportunities There is the potential to shape a new NMC. (2016b) Quality assurance framework: for nursing and available to students, staffi ng levels and workforce generation midwifery education and local supervising authorities. See: nmc. org.uk/globalassets/sitedocuments/edandqa/nmc-quality- numbers of live mentors. Audited capacity, ● You are part of a wider network of mentors assurance-framework.pdf (accessed 6 November 2016). which is the number of students who can and educators, including representatives from NMC. (2015) The code. See: nmc.org.uk/standards/code/read- the-code-online (accessed 6 November 2016). be taken on placement at any given time, is the HEI as well as from the trust NMC. (2010) Standards for pre-registration nursing education. driven by SLAiP guidance (NMC, 2008) and is ● You are sharing your skills and knowledge See: nmc.org.uk/globalassets/sitedocuments/standards/ nmc-standards-for-pre-registration-nursing-education.pdf agreed between the education lead for the with students and hence leaving a legacy for (accessed 6 healthcare organisation and the HEI. Audits future generations November 2016). NMC. (2009) Standards for pre-registration midwifery education. review the learning resources available to ● Standards of care may be raised as you See: nmc.org.uk/globalassets/sitedocuments/standards/ nmc-standards-for-preregistration-midwifery-education.pdf students, previous student evaluations, become more critical and refl ective of your (accessed 6 November 2016). particular learning opportunities within own practice when working with a student. NMC. (2008) Standards to support learning and assessment in practice. See: nmc.org.uk/globalassets/sitedocuments/ that area of practice, and the outcomes standards/nmc-standards-to-support-learning-assessment. of external reviews such as Care Quality CONCLUSION pdf (accessed 6 November 2016). Perrin L, Scott S. (2016) Health visitors have much to off er Commission inspections. Audits are This article has focused on answering pre-registration child branch student nurses. Community required to be revised every two years as queries raised by the reintroduction of Practitioner 89(5): 44-7. Willis L. (2015) Raising the bar. Shape of caring: a review a minimum requirement, although they pre-registration student nurses into SCPHN of the future education and training of registered nurses may need to be revised more frequently settings following the completion of the and care assistants. See: hee.nhs.uk/sites/default/fi les/ documents/2348-Shape-of-caring-review-FINAL_0.pdf to retain currency. Health Visitor Implementation Plan (DH, 2011). (accessed 6 November 2016).

48 Community Practitioner December 2016

p44-48 PPI.indd 48 01/12/2016 14:32 LAST WORD

Off to pastures new After playing an integral role in the recent Unite-CPHVA conference proceedings, Carolyn Taylor is ready to embark on a new chapter in her life. Juliette Astrup catches up with her to fi nd out more.

he end of 2016 brings with it the end of an era as, after four decades in T health visiting and 20 years of union work, Carolyn Taylor steps down as national chair of the CPHVA. Having taken up the role three times during the course of her career, it is not the fi rst time she has done so – but it will be the last. Carolyn is not only leaving her position as chair of the executive committee, and her job as a health visitor for South Tyneside NHS Foundation Trust – she is leaving the country altogether. In January, she will move to Uganda to continue her work training and supporting nurses and midwives there. ‘I have very mixed emotions about leaving,’ she says. ‘I know my colleagues need my support and knowledge and everything else, however the time has come where I feel I need to give back somewhere else.

December 2016 Community Practitioner 49

p49-50 Last word.indd 49 01/12/2016 10:13 LAST WORD

‘But the association has been challenging and fi ghting for 120 years and that’s not going to change. Members and the offi cers who serve them will continue to challenge whichever government is in power to deliver the services we know our families deserve and require. Because, as always, it will be the most vulnerable who will be disenfranchised and disadvantaged by any reduction in public health services.’ Carolyn has dedicated her working life to health visiting after a day spent alongside a health visitor as a 17-year-old Ranger Guide. now they’re back in. Who knows what’s going She fell for the combination of ‘helping other FACT FILE to happen now? people, working with babies and young ‘These are the things I worry about for the children, and teaching’, she says. ● Has six grandchildren and another future, for my colleagues, and how that will But it was a career break to raise her four on the way aff ect their work. children, during which she worked as a ● Is a member of a musical society and ‘I don’t think that local authorities don’t childminder, that fi rst introduced her to union once played Robin Hood want to deliver the service – it’s purely work, through the National Childminding ● Is the holder of the Silver Acorn down to the money. Some local authorities Association, as it was then known. award for services to scouting are already recommissioning health visiting After returning to health visiting in 1986, services at the levels required because ● Travelled overland to Turkey she became a union rep and has represented they have the money in the pot. Others do through then communist Bulgaria members at local, regional and national levels. not. There’s going to be huge inequality She has seen the profession go through a ● Once drove down Mount Vesuvius across the country as to what services are myriad of changes, from being under local in a bus with its wheels alight. being delivered.’ authority control up until 1974, through all the Though the new chair has yet to be elected, various NHS organisational incarnations Carolyn says the members will be ‘in safe – primary care groups, primary care trusts and ‘All the previous organisations have been hands’ as she refocuses her considerable foundation trusts. Now, as Carolyn prepares to top-down, with processes to follow – this dedication and energy on helping colleagues leave, things have gone full circle, with many time it’s everybody for themselves, and it in Uganda, working through the Mityana health visiting services going back under local makes it more confusing. Community Development Foundation, which authority control. ‘I used to work with all age groups – with she founded in 2007, the Nurses and Midwives ‘That’s something we are going to have elderly people, with disabled people, I taught Union and the Nursing and Midwifery School. to come to terms with in 2017,’ she adds. in schools – I did the whole range when I She leaves behind a legacy of decades ‘Services will change – but we have no idea started. Then it went down to 0 to fi ve. I used of service, spearheading countless campaigns what’s going on at this moment in time. to do antenatal visits – then they were out – that include the rebanding of school nurses, implementing changes to the mileage system, bringing information technology into the CAROLYN’S CV professional, and retaining the third part of the NMC’s register. ● She gained a diploma in hospital and community nursing in 1975; a triple She adds: ‘In terms of the union, I hope I qualifi cation in nursing, district nursing and health visiting, which earned her the will be remembered as someone who was aff ectionate title ‘dippie nurse’ hardworking and promoted the profession, ● At just 21 she began working as a health visitor at Monkseaton in North Tyneside and helped with the integration of the unions, which has not always been an easy journey. ● She has worked on both the professional side and the industrial side of the CPHVA, having also chaired the occupational advisory committee ‘When I think about the future of health visiting, I think we must maintain a universal ● Currently a staff governor of the South Tyneside NHS Foundation Trust, she was service, and I would prefer to see health also an elected primary care group nurse, an elected board nurse and member of visitors continue to be employed by the the professional executive committee under previous NHS structures health service. The preventative role must be ● She was awarded the MacQueen travel bursary by the CPHVA, as well as the maintained and we must retain home visits – Heyman travelling scholarship from South Tyneside NHS Foundation Trust that is the heart of health visiting. ● She was also presented with the Angela Reed Memorial for professional services to ‘While there have been huge changes in the CPHVA at the recent Unite-CPHVA conference. the organisational structure, the job is still the same. It is still so important.’ CP

50 Community Practitioner December 2016

p49-50 Last word.indd 50 01/12/2016 10:14 Courses & Recruitment COMMUNITY TO ADVERTISE PRACTITIONER www.communitypractitioner.com | www.unitetheunion.org/cphva CONTACT: Alex Edwards dl 020 7324 2735 e [email protected]

WWW.BABYMASSAGETEACHERTRAINING.COM For Flying Start Children’s Centre Staff and Family Health Professionals Here’s Wishing You All A VERY ‘MERRY CHRISTMAS’ Touch-Learn International’s

Two Day Teacher Training in Developmental Baby Massage Teacher Training Baby Massage with Peter Walker Venues across the UK, plus in-house OAll mechanisms identifi ed in current UK and International Accredited Teaching Certifi cates Federation of Prenatal option. A fi ve-day, comprehensive research to support parent-infant Education and Independent Professional Therapists International baby massage teacher course for relationships A unique course with Peter Walker a teacher’s trainer, physical therapist, author health professionals and parenting OUnderpinning theory based on and yoga teacher with over 40 years experience in the delivery of baby massage practitioners provided by Touch-Learn current research training as well as providing group and one-to-one sessions to parents with International, the exemplary training O Practical teaching in the fi eld children with special needs. A background in physical therapy and yoga company. This highly acclaimed  underpins the high quality of his training programme, with techniques based programme is accredited by The Royal ORelevant anatomy and physiology on the stages of baby’s physical and emotional development, supported by College of Midwives and the University OQuality supporting materials and neuroscience research on baby’s brain development. Peter Walker is credited with the of Wolverhampton. text books free teaching of baby massage in NHS centres throughout the UK. This quality training programme OSummative assessment includes simple massage techniques, OFree, informative biannual 1. The importance of Emotional • Improving circulation, respiration, coupled with an in-depth knowledge newsletter Intelligence and a Loving Touch. back strength, joint fl exibility and to practise safely, ethically and OTutorial and on-going support Bonding and Attachment - birth overall muscle tone. professionally so practitioners feel to eight weeks (can also be taught • Relief of common infant ailments. confi dent to teach parents in a variety antenatal) • Consideration of babies with of settings. Trainers are all experienced Other courses from Touch-Learn O Massage for Babies with Special • Emotional Intelligence and additional needs and practitioners with professional/HE  Needs Attachment. developmental delay. teaching qualifi cations. O Baby Yoga Teacher • Introducing overall good reciprocity • Includes contra-indications, safety, Included within the course: O Baby Signing Teacher to facilitate mother-infant relaxation correct baby massage oils and OStrategies to empower parents OBaby Wearing Advisor and ‘bonding’. usage. • Relieve intra-uterine and diffi cult birth experience. 3. Primary Preparation for Infant For further details of in-house training and UK dates please ring or • Relieve physiological fl exion and Balance and Good Posture visit www.touchlearn.co.uk abdominal tension. Touch-Learn International Ltd 4. High quality resource. Copy of • Release the diaphragm and Tel: 01889 566222 [email protected] improve respiration. Developmental Baby Massage book www.touchlearn.co.uk with DVD and course notes for 2. Developmental Baby Massage – 8 teachers and parents/carers weeks to Standing • Baby-led sessions. Developmental Baby Massage Teacher • Quality time for parents to get Training Available ‘In-House’ to know their baby through a loving throughout the UK also. touch, learning about baby’s cue’s and communication. Email: [email protected] • Benefi ts of safe tummy time. Tel: 01752 939767 • Baby observation for a foundation Post course support given Free bi-monthly of secure attachment. quality News Letter • Infant development, relevant Also available Skype clinic for Developmental Learn Baby Massage with the International anatomy and physiology. Delay Email [email protected] Association of Infant Massage

Train to become a Certified Infant Membership of the IAIM UK Massage Instructor with the Chapter includes: Read by more International Association of Infant OA local, national and international support network COMMUNITY health visitors Massage (IAIM), the largest and longest standing worldwide association solely OContinued professional development than any other dedicated to baby massage. Our including study days with expert PRACTITIONER magazine curriculum is taught in more than 45 speakers, trainer-led massage stroke countries and has been developed and refresher sessions and a biennial refined over 30 years through research, international conference From a 21,000 circulation the magazine reaches: reflective practice and practical OAccess to relevant articles, · 80% of the UK’s health visitors experience. This has resulted in a widely information and the latest research endorsed and implemented parenting on our website · 75% of all UK school nurses programme. OA regular newsletter.

Community Practitioner is an ideal platform Our highly acclaimed comprehensive Our training courses are run regularly at training comprises: centres nationwide and are facilitated to promote your product, service or by experienced IAIM Trainers. OA four-day training course including vacancy as it reaches highly skilled supervised practical teaching of a Find us on Facebook - IAIM UK Chapter professionals who constantly refer to parent/baby massage class the title for information and advice. OA take home written assignment For further details please visit OFurther practical teaching and reading. www.iaim.org.uk. In-house trainings are available on request. CONTACT By training with our highly respected organisation you will join a worldwide IAIM (UK) Chapter If you want to reach this valuable audience, please contact: network of instructors offering a 0208 989 9597 [email protected] [email protected] or call 020 7324 2735 supportive environment to teach life-long parenting and relaxation skills. www.iaim.org.uk

Class_Rec.indd 51 29/11/2016 15:32 Diprobase® A clinical cornerstone emollient therapy 1,2 ® Q Diprobase is the most prescribed emollient cream brand in primary care1 ® Q Diprobase is the most used emollient cream brand in hospitals2 ® Q Diprobase has been soothing and protecting eczematous skin for over 30 years

Formularies should include ‘an appropriate range’ of emollients3 Patient choice is important in helping to find the correct emollient for each child3

Diprobase® – mums’ preferred emollient cream* *Market Research, 308 mums were asked which products they preferred out of brands that they had used for their children’s eczema and dry skin.

Q Why not recommend mums buy 50g bag-sized, add-ons to moisturise, protect, relieve and soothe when they collect their prescription?

Q No other emollients have the same formulation as Diprobase®; a formulation that is reassuringly free-from common irritants

DIPROBASE® PRESCRIBING INFORMATION Uses: Diprobase Cream and Ointment are emollients, with moisturising and protective Cream: 50g tube = £1.28; 500g pump = £6.32. Ointment: 50g tube = £1.28; 500g tub = £5.99. properties, indicated for follow-up treatment with topical steroids or in spacing such treatments. Legal Category: GSL. Marketing Authorisation Numbers: Cream: PL 00010/0658; Ointment: They may also be used as diluents for topical steroids. Diprobase products are recommended PL 00010/0659. Marketing Authorisation Holder: Bayer plc, Consumer Care Division, for the symptomatic relief of red, inflamed, damaged, dry or chapped skin, the protection Bayer House, Strawberry Hill, Newbury, Berkshire, RG14 1JA, U.K. Date of Revision of Text: of raw skin areas and as a pre-bathing emollient for dry/eczematous skin to alleviate drying December 2014. Please refer to the full SPC text before prescribing this product. effects. Dosage: The cream or ointment should be thinly applied to cover the affected area completely, massaging gently and thoroughly into the skin. Frequency of application should be Adverse events should be reported. Reporting forms and information can be found at established by the physician. Generally, Diprobase Cream and Ointment can be used as often www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Bayer Plc, as required. Contra-indications: Hypersensitivity to any of the ingredients. Side-effects: Skin Consumer Care Division. reactions including pruritus, rash, erythema, skin exfoliation, burning sensation, hypersensitivity, pain, dry skin and bullous dermatitis have been reported with product use. Package Quantities: Cream: 50g tubes, 500g pump dispensers; Ointment: 50g tubes, 500g tubs. Basic NHS Costs: Date of preparation September 2016 Job code: UKDIP09160017

1. IMS Health, Xponent BPI, August 2015 – July 2016, Prescriptions, NFC: Topical External Creams. 2. IMS Health, IMS HPAI Trawling Dataset, August 2015 – July 2016, Units (Number of packs), NFC: Topical External Creams. 3. NICE guidance for Commissioners. Support for commissioning for atopic eczema in children. September 2013. Available at: https://www.nice.org.uk/guidance/qs44/ resources/support-for-commissioning-for-atopic-eczema-in-children-253673821. Accessed September 2016.

p52.CPDEC16.indd 52 29/11/2016 15:35