The Journal of the Community Practitioners’ and Health Visitors’ Association MARCH 2017 VOLUME 90 / NO. 3

CHILD MENTAL HEALTH SERVICES Food for thought

Practical guidance Seeing the unseen Hygiene matters Making a business case Modern slavery and Beating bugs with for your service how you can help a new scheme

communitypractitioner.com | unitetheunion.org/cphva

1 COVER FINAL.indd 1 01/03/2017 15:13 GROW Electronic Paediatric Growth Chart Solution

iGrow was put in place and links very neatly to the electronic records. When iGrow came on line, I was initially sceptical as to how easy it would be to use. From “WKHÀUVWWLPH,WULHGLWKRZHYHU,IRXQGLW extremely easy to navigate and really very intuitive. Entering data is painless and quick and it is impressive to see the new plots appearing almost instantly on the relevant chart. I’d say that it is as quick as plotting measurements on the paper charts, but with the very real bonus that there is less margin for error than with the paper charts, where there is always a ULVNWKDWDVHWRIPHDVXUHPHQWVZLOOEHSORWWHGLQFRUUHFWO\ Because my special interest is in neurodisability, it is DOVRZRQGHUIXOWKDWP\FRKRUWRIFKLOGUHQZKRKDYH 7KHXQDQLPRXVIHHGEDFNIURPP\ Down Syndrome is catered for, with an electronic colleagues re the iGrow system is that it has YHUVLRQRIWKHVSHFLÀFFKDUWIRUFKLOGUHQZLWKWKHV\QGURPH GHÀQLWHO\EHHQDSRVLWLYHPRYH The product is extremely satisfying to use. “ IRU iGrow operates well linked to our EDM and it Many thanks to you and all the team at Harlow SRSXODWHVWKHGHPRJUDSKLFGDWDIURP('0ZHOO having developed it. We value the way in which the corrected age LVFDOFXODWHGDQGSORWWHGIRUSUHWHUPLQIDQWV« Marian McGowan much easier and reliable than the manual ” Consultant Paediatrician method. St. George’s Hospital

Dr Yogi Thakker Consultant” Paediatrician Milton Keynes Community Health Services

A try before you buy version is available online. Although fully functional, the demonstration site is not NHS secure so please dod not use real patient data during your assessment. Free Trial SimplyS go to www.igrow-software.com CreateC your user name and password for a full and free 30 day access. If you wish to discuss the application please contact one of our specialist iGrow team on: 0191 4554286

p02.CPMARCH16.indd 2 24/02/2017 16:32 Contents Volume 90 Number 3

EDITORIAL 5 Keeping health in mind NEWS 6 A look at the latest stories in public health 28 10 The most recent research from the professions

12 A sign of the times? OPINION 14 Head of health Sarah Carpenter sets out NHS plans to tackle bullying in the workplace

15 A mother describes her experiences with loneliness

16 To save our public health services, we must provide the evidence that they’re needed, says QNI chief executive Crystal Oldman

18 Meet the health sector candidates for Unite’s executive council election COVER STORY 20 We asked, you told – a summary of results from 28 When rhetoric 48 A selection of useful dates our reader survey meets reality: for your professional diary why are mental health FEATURES services for children and LAST WORD 22 Rima Evans looks at the adolescents so lacking? 49 Sue Ashmore, director of ways in which practitioners Phil Harris asks why the Baby Friendly Initiative can present a business case our youngest and most at Unicef UK, discusses for their service vulnerable are having to why we need to start ask for more changing the conversation around breastfeeding 34 With nine out of 10 women now smoke-free 42 when their baby is born, the figures are going the 37 Modern slavery continues right way but there’s still to be a real and more work to do, as the widespread problem, but Smoking in Pregnancy public health nurses can Challenge Group explains help to identify victims and combat the crime, as 14 Helen Bird discovers 49 42 Public Health England is piloting an educational 22 course to increase awareness around hygiene, self-care and antibiotic use in the community. We find 26 Join the fight at this special out more

lobbying event in parliament CRISFORD CHLOE COVER:

March 2017 Community Practitioner 3

3 S.indd 3 01/03/2017 15:16 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. Wp04.CPMARCH16.indd 2 24/02/2017 16:24 EDITORIAL

Keeping health in mind Unite/CPHVA Existing Unite/CPHVA members with queries Welcome to the March issue of Community Practitioner. relating to their membership should contact 0845 850 4242 or see unitetheunion.org/ contact_us.aspx for further details. To join Unite/CPHVA, see I’ll always remember when my brother Chris was diagnosed with unitetheunion.org Tourette’s syndrome. Our mum had to look up the condition using Unite-CPHVA is based at 128 Theobald’s Road, London WC1X 8TN our dial-up internet connection, since neither the GP nor the 020 3371 2006 community mental health team nurse was able to give us much Community Practitioner information. And all the while my poor, 17-year-old brother was Unite-CPHVA members receive the journal free scared and bewildered by his symptoms, which included both each month. Non-members and institutions may subscribe to the journal to receive it. physical and vocal tics. He was being bullied at school as a result of Non-member subscription rates his ‘diff erent’ behaviour and had become depressed. It was 1997. Individual (UK) £125 Twenty years later and Tourette’s is far more widely known among Individual (rest of world) £145 Institution (UK) £145 the public and healthcare professionals, so I would hope that no Institution (rest of world) £195 teenager, nor their family, would have to face such a dearth of knowledge, understanding and Subscription enquiries may be made to support today. But it begs the question: what must it have been like 20 years before that? Community Practitioner subscriptions There’s no doubt that awareness of mental health issues across the board, but particularly in Redactive Publishing Ltd PO Box 35 children and young people, has improved hugely in recent years. But I fear that the support these Robertsbridge TN32 5WN vulnerable groups so badly need is still severely lacking – a concern that we outline in this issue’s t: 01580 883844 [email protected] cover feature on page 28. At the age of 37 my brother continues to need support, and despite his The journal is published on behalf of job as a support worker on a psychiatric ward, he still struggles to access it. Unite-CPHVA by Redactive Media Group, When will mental health reach the elusive ‘parity of esteem’ status that politicians often 17 Britton Street, London EC1M 5TP 020 7880 6200 promise? So many times I’ve wondered with sheer frustration, whether his condition, which Editorial Advisory Board now incorporates severe obsessive compulsive disorder and body dysmorphia, would be so Obi Amadi, Surrinder Bains, Lucretia overlooked if there were obvious physical manifestations. As our feature points out, while the Baptiste, Louise Condon, Toity Deave, Barbara Evans, Gavin Fergie, Elaine political rhetoric around mental health is there, the current reality far from matches it. Haycock-Stuart, Brenda Poulton, Onto more positive developments, you’ll see on page 20 a summary of fi ndings from our Janet Taylor readership survey. I’d like to thank all of you who took the time to participate and guide us on Editorial Team what you think about Community Practitioner. And don’t worry if you didn’t have a chance to Emma Godfrey-Edwards, Managing Editor [email protected] submit your feedback before the deadline: you can send me an email any time to Helen Bird, Editor [email protected] with your comments and I’d be glad to hear from you. [email protected] 020 7324 2757 One of the fi ndings that stood out was your thoughts and preferences around the delivery Chloe Crisford, Picture Editor of professional papers. As I mentioned in the January issue, we have held back from publishing Nicholas Daley, Designer any papers while the survey was ongoing. Now that the results are in, we’ve made a decision Unite Health Sector Officers based on the majority opinion to repackage professional papers into a shorter, more digestible National Officers: Sarah Carpenter and Colenzo Jarrett-Thorpe format for the pages of the printed journal, with a link to access the longer form version online. Lead Professional Officers: Obi Amadi; Gavin All authors who have submitted papers will be contacted in due course and we plan to start Fergie; Rosalind Godson; Dave Munday; Jane Beach; and Ethel Rodrigues publishing the newly formatted papers from the April issue onwards, so watch this space. In the meantime, a date has now been confi rmed for the ‘Love Your Health Visitor/School Advertising queries Alex Edwards Nurse’ lobbying event at the House of Commons. Turn to page 26 for further details, and make 020 7324 2735/[email protected] sure you mark 26 April in your diaries – it promises to be an historic day. Production Jane Easterman 020 7880 6248/[email protected] Printed by Warners © 2017 Community Practitioners’ and Health Visitors’ Association ISSN 1462-2815 The views expressed do not necessarily represent those of the editor nor of Unite-CPHVA. Helen Bird Paid advertisements in the journal do not imply endorsement of the products or services advertised. Editor

March 2017 Community Practitioner 5

5 EDITORIAL•HB.indd 5 02/03/2017 12:21 NEWS ROUND-UP NEWS ROUND-UP A look at the latest in public health

Calls for 18+ threshold for intimate piercings Stricter rules over intimate piercings have been recommended in a new report published in Wales. The age of consent for such piercings should be 18, according to the report by the Health, Social Care and Sport Committee of the National Assembly for Wales. It raises serious concerns about the ‘signifi cant harm an intimate piercing can do to a still developing body’, and about the potential vulnerability of some 16- and 17-year-olds. And it calls for anyone convicted of a sexual off ence to be barred from obtaining a licence to perform special procedures, such as intimate piercings and tattoos. The report was issued to approve the principles of the Welsh Government’s Public Health Bill. It agrees with almost UK air pollution ‘threatens all the provisions, except the proposal to set the age of consent for intimate human rights of children’ piercings to 16. The Public Health Bill will address a A United Nations expert has urged the obligations on air pollution, protecting the range of issues aff ecting health and will government to protect children from the rights of children, women of reproductive ban smoking in the grounds of schools, air pollution crisis that ‘plagues’ the UK. age, the elderly and those of poor health, playgrounds and hospitals if passed. Special rapporteur on hazardous who are especially vulnerable to toxic ● To view the Health, Social Care and substances and wastes Baskut Tuncak chemicals, in developing a new plan to Sport Committee’s report, go to warned that the plans for Brexit should tackle its air pollution crisis.’ bit.ly/HSCSC_report not open a ‘Pandora’s box’ of deregulation Most air quality zones in the UK breach and ‘regression from existing standards legal limits, and the government has had its of protection’. plans to tackle the issue declared illegal by Mr Tuncak’s visit to the UK at the end the courts on two occasions. of January coincided with record levels of A spokesman for the government air pollution in London, and he warned said it was committed to ‘safeguarding of the potential ‘silent pandemic’ for and improving’ environmental protection, children’s health. and that the UK would remain subject Referring to the UN Convention on the to international environmental Rights of the Child, which recognises their protection conventions, independent right to ‘the highest attainable standard of EU membership. of health’, he added: ‘I encourage the ● To fi nd out more about the UK’s air UK government to fulfi l its human rights pollution levels, go to bit.ly/Defra_uk-air

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KEY STATISTICS 3000 additional students will attend healthcare courses across Wales 13% New funding to unlock increase in nursing healthcare training in Wales training places

A £95m investment to support more training places, while midwifery education and training for healthcare places will increase by 40%, according to 40% professionals has been unveiled by the the Welsh Government. the increase in midwifery Welsh Government. An extra £500,000 will be available to support training places The money is set to help nurses, community healthcare. physiotherapists and radiographers among Practice and district nurse education, as well others to access a range of health science as audiology training places, will also increase training opportunities. within primary and community settings. And it will mean that more than 3000 The government says this will ‘provide vital additional students will be able to study funding for community services and will ensure healthcare-related courses across Wales, the many more patients can be cared for closer to government has pledged. home, rather than in hospital’. £500,000 The new package of funding is in addition to Health secretary Vaughan Gething said in a the amount that will funding already in place for nursing, and will statement that education is ‘fundamental to be available to support provide an additional 13% increase in nursing ensuring the sustainability of our workforce’. community healthcare

Public Health Wales updates Government revises CSE defi nition

pregnancy vaccines advice A new defi nition of child sexual exploitation (CSE) has been launched by Public Health Wales is now is unlikely to confer immunity. the government, along with new ‘working advising women to be The move follows the Joint together’ advice for practitioners. vaccinated for pertussis Committee on Vaccination and The revised defi nition sets out that CSE earlier in pregnancy. Immunisation’s review of new ‘occurs where an individual or group takes The latest advice is that evidence, showing that high advantage of an imbalance of power to all pregnant women should levels of maternal antibody coerce, manipulate or deceive a child or young person under the receive the whooping are transferred to the infant age of 18 into sexual activity (a) in exchange for something the cough vaccine between when vaccinated earlier victim needs or wants, and/or (b) for the fi nancial advantage or gestational weeks 16 to 32. in pregnancy. increased status of the perpetrator or facilitator’. And while women Public Health Wales It continues: ‘The victim may have been sexually exploited even if should be off ered the also advises that the fl u the sexual activity appears consensual. [It] does not always involve vaccination as soon as vaccination can be given physical contact; it can also occur through use of technology.’ possible after 16 weeks’ at any stage of pregnancy The new defi nition is included in the Department for Education’s gestation, it can be and at the same time as the guide for practitioners, along with its ‘working together’ advice. given right up to birth, pertussis vaccine. ●To download the new CSE guide, go to bit.ly/DfE_CSE_guide

GETTY/ISTOCK/ SCIENCE PHOTO LIBRARY GETTY/ISTOCK/ PHOTO SCIENCE although at that stage it ●See bit.ly/PHW_vaccine ●For an update on action, visit bit.ly/HO_CSE_progress

March 2017 Community Practitioner 7

6-9e Rund-.indd 7 02/03/2017 09:3 NEWS ROUND-UP

NHS ‘shouldn’t be Children of excluded’ from international alcoholics trade deals, says ‘call helpline government The government has responded to a for bedtime petition demanding that the NHS is not eight or so, going to my dad’s meant I was ‘used as a bargaining tool’ in Brexit trade stories’ eff ectively the carer. It was very typical deals. More than 52,000 people signed for my dad to pick me up from school and the petition to parliament. A children’s helpline has reported literally fall over because he was so drunk.’ A response from the Department receiving tens of thousands of Labour frontbencher Liam Byrne, chair for International Trade set out the contacts from children aff ected by of the all-party parliamentary group on government’s position that the NHS ‘is alcoholic parents. children of alcoholics, called the promise of and always will be protected in trade The National Association for Children of a government strategy a ‘breakthrough’. deals’, but that the ‘healthcare sector Alcoholics received 32,000 calls and emails ●Download the manifesto at benefi ts from international trade and last year, with children as young as fi ve bit.ly/APPG_manifesto should not be excluded’. asking for a story because their parents It went on to state: ‘Through trade were too intoxicated to put them to bed. agreements, the UK’s world-class The charity’s chief executive, Hilary pharmaceutical and medical care Henriques, said children like to hear KEY STATISTIC and devices sectors can benefi t from made-up stories, as well as popular Disney improved access to overseas markets to and Roald Dahl tales, to be reassured that sell products and bid for government ‘things can be diff erent from the life they procurement contracts.’ live at the moment’. But the department Meanwhile, public health minister insisted: ‘It will always Nicola Blackwood has vowed to draw up a remain for the UK strategy to help such children. government to The Conservative minister was moved to decide how public tears hearing shadow health minister Jon 32,000 services are run.’ Ashworth talk about his father’s drinking. helpline calls and emails ●Sign the He told the Commons: ‘From the age of received in 2016 petition at bit.ly/ petition_NHS_trade

Scarlet fever cases at 50-year high Scarlet fever cases rose for the third Spread through close contact, consecutive year in England in 2016, or indirect contact with objects with November seeing the highest or surfaces that have been number recorded in a week for half contaminated, it is most common in a century. children between two and eight. Public Health England found scarlet Symptoms include a sore throat, fever was the most reported infectious headache, high temperature, fl ushed disease in the south-west region, face and swollen tongue. A pink-red, according to its weekly infectious sandpaper-like rash develops 12 to 48 diseases report for the week ending hours later. 29 January. Prompt treatment with antibiotics is While the disease is far less recommended to avoid complications. common than it used to be, there ●Public Health England’s guidance have been a number of outbreaks of on scarlet fever is available at scarlet fever in recent years. bit.ly/PHE_scarlet_fever

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Five mandated visits to 11 mandated visits, there may be areas that while in Wales it is have withdrawn or are continue in England, also fi ve under not providing this as a government decides the Healthy Child full health visitor service. Wales Programme. ‘This is important for The Department of Health has decided Ms Blackwood said: good outcomes for children to continue the current mandate of ‘Health visitors support and families, but must be part fi ve universal health visiting checks families to give children the best of the 4-5-6 model so that healthcare in England. possible start in life – that’s why we have professionals and universal services are also Public health minister Nicola Blackwood taken strong action to make these services part of the off er,’ she said. made the announcement on 1 March, mandatory across the country. Viv Bennett, chief nurse at Public Health after Unite-CPHVA called for the fi ve-visit ‘We have given local authorities £16bn England, added: ‘We are committed to requirement to be renewed. between 2016 and 2021 to spend on supporting local government to ensure The union warned in February that the public health.’ these checks are given to every young child.’ government should not ‘backslide’ on the Unite-CPHVA lead professional offi cer Obi ●Public Health England’s review number, while calling for a sixth visit when Amadi welcomed the news, saying it was of mandation for the health visiting the baby is three to four months old. ‘the right decision’ by government. service can be viewed at In Scotland, the current requirement is for ‘But it needs to be fully implemented, as bit.ly/PHE_mandate_review

Fears for vaccination programmes as GPs step up resignation plans

Babies, mothers and the elderly Dr Tom Black, chair of the Northern could be left vulnerable to diseases Ireland General Practitioners if plans for a mass resignation by GPs Committee, said general practice is in Northern Ireland go ahead. ‘on the brink’ and that GPs feel they The British Medical Association have ‘no alternative’ but to submit (BMA) is currently gathering undated resignations. The committee resignation letters from GP surgeries has set a threshold of resignations after outgoing health minister from 60% of practices before it Michelle O’Neill failed to deliver a moves forward with any action. promised rescue package to help Dr Black said it could take months struggling practices. to reach the threshold. This could threaten immunisation It is not yet known whether programmes delivered by family contingency plans are being doctors, such as measles, mumps, developed to continue the meningitis, fl u, shingles, diphtheria, immunisation programmes. tetanus and whooping cough. ● See bit.ly/BT_immunisations

“Mush is an absolute saviour for our new mums”

Jess, Midwife

Mush is a new app to connect mums with local mums with babies the same age GETTY/ISTOCK/SHUTTERSTOCK/ALAMY

March 2017 Community Practitioner 9

6-9e Rund-.indd 9 02/03/2017 12:22 RESEARCH NEWS

SOUTH KOREA AUSTRALIA Babies retain mother tongue even in Youngest children in class ‘more the fi rst few months, study fi nds likely’ to get ADHD medication Language knowledge laid down training course. An Australian study has found that the youngest children in in the earliest months is retained The international adoptees class are more likely than older classmates to be medicated even when that birth language is exceeded expectations when for attention defi cit hyperactivity disorder (ADHD). lost, a study has shown. compared with a group of adults The fi ndings, published in the Medical Journal of Australia, Dutch-speaking adults who had not been exposed to raise concerns that age-related immaturity is being mistaken adopted from South Korea were the Korean language as children. for the disorder, leading to misdiagnoses. found to exceed expectations And signifi cantly, there was The study involved a total of 311,384 children. at Korean pronunciation when no diff erence between children Researchers at Curtin University found that among the retrained after losing their who were adopted under six children aged six to 10, those born in June – the last month bibirthrth language.languagee. montmonthshs ofof age,a before they could of a recommended school-year intake – were almost twice ass In tthehee sstudy,tudy, adadultsults agedaged spsspeak,eak, andand thoset who were likely to have received ADHD medication than those born thehe abouaboutt 300 wwhohoh had adadoptedopted aafterft 17 months. previous July. been adoadoptedpted as Dr JiyounJiyou Choi of Hanyang For children aged 11 to 15, the eff ect was less marked bbabiesabies bbyy DutcDutch-h-- UniversityUnU iversity in Seoul, who led but ‘still signifi cant’. Similar diff erences were found when speakinspeakingg familiesfamilies thetthhe research,resear published in the comparing children born in the fi rst three and the last three were askedasked toto journaljjoournal RoyalRo Society Open months of the school-year intake. pronopronounceunce ScienceSciencn e, said:sa ‘Try to talk to your ‘Allowing parents to decide when KoKoreanrean babiesbabies asas much as possible their child is ready for school could cconsonantsonsonannts becausebeb cause they are absorbing prevent misdiagnosis,’ said lead afafterteer a andaand digestingdig what you researcher Martin Whitely. shshorthoorrt areaare sasaying.’y The researchers said the fi ndings ● TheThe full study is compare with those of other aavailablevail at international studies. bbit.ly/RSOS_birth_it. ● Read more at bit.ly/MJA_adhd language

ENGLAND Virtual reality room helping children with autism

An immersive virtual reality they feared and some were children able to face a situation It makes a huge diff erence to room is helping children with found to have completely that they previously found so their lives.’ autism overcome their extreme overcome their phobias, even a distressing, such as going into a ● To read more about phobias, thanks to the fi ndings year later. shop after just four sessions in the research, go to of a 2014 study. The treatment allows children the treatment room, is amazing. bit.ly/NU_blue_room Two years after Newcastle to experience scenarios University scientists published including getting on a busy their research into how ‘blue bus, crossing a bridge, going room’ technology can help shopping or talking to a shop youngsters with autism assistant, all within in a 360° spectrum disorders, the virtual environment, while treatment has been given supported by a psychologist. to the fi rst NHS patients. Dr Jeremy Parr, clinical According to the 2014 study senior lecturer specialising in published in the journal PLOS paediatric neurodisability at One, eight out of nine children Newcastle University’s Institute were able to tackle the situation of Neuroscience, said: ‘To see

10 Community Practitioner March 2017

10-11 Reear e.indd 10 01/03/2017 15:19 RESEARCH NEWS

SCOTLAND AUSTRALIA First-born children are smarter than their siblings, study fi nds First-born children outperform siblings as they receive more mental stimulation from their parents, according to research. US Children born fi rst in a family score higher in IQ tests as early as 12 months, because they receive more support with tasks that Road safety risk around develop thinking skills, a study published in the Journal of Human Resources found. parks ‘needs to be addressed’ Economists at the University of Edinburgh and the University of Sydney examined data Child pedestrian fatalities are up to children under age 18, using GPS mapping from a US longitudinal survey, which saw twice as likely around parks as they are to evaluate the quarter-mile area around 5000 children observed from pre-birth to 14, around schools, according to a study parks, and compare fatality rates there to with assessments in areas including reading based on30 years’ crash data in the US. those around schools and the city as and vocabulary every two years. The authors of the study, published in a whole. They found that parents off ered less Injury Prevention, call for safety initiatives In all six cities, fatality risk around parks mental stimulation to subsequent children, to take account of traffi c risks around parks was found to be 1.16 to 1.81 times that and took part in fewer activities such as as well as those around schools. of the city overall, and 1.04 to 2.23 times such as reading, crafts and playing musical ‘We need to stop our practice of more common compared to the vicinity instruments. Mothers also took higher risks thinking myopically by focusing just of schools. during the pregnancy of latter-born children, around schools and start thinking about Reducing speed limits, placing crossings such as increased smoking. how we make our entire cities safer,’ near parks and locating parks in quiet Researchers say the fi ndings could help said lead author Nick Ferenchak, a civil residential areas were among the authors’ to explain the birth order eff ect, which sees engineer at the University of Colorado. safety recommendations. children born earlier in a family getting The study looked at data on crashes ● For more on this research, go to better wages and education in later life. in six cities between 1982 and 2012 for bit.ly/IP_child_safety ●The research cacann bbee viviewedewed at bit.ly/JHR_birth_orderh_order

WALES US E-cigarettes more appealing Pre-schoolers suff eringng to young people in Wales eye burn injuries from liquitabs

Young people in Wales are now 16-year-olds across Wales. Parents are being urged to store liquid detergent tablets almost twice as likely to try It found that since 2013, safely after new research has shown eye injuries in young an e-cigarette than tobacco, youth experimentation with children had gone up 30-fold in the last few years. according to new research. e-cigarettes has grown rapidly In the US between 2010 and 2015, there were more than The Cardiff University study in Wales, with older students 1200 eye burn injuries related to the tablets among three- and concluded there is no evidence and boys the most likely to have four-year-olds, the study in JAMA Ophthalmology found. In that e-cigarettes make young tried it. 2015, there were 480 incidents compared to just 12 in 2012. people more likely to smoke, Tobacco, cannabis, alcohol, UK doctors have previously warned of the risks the brightly but it warns their use among mephedrone and laughing coloured tabs pose to children mistaking them for sweets, the young may become a public gas use were also strongly while the Royal Society for the Prevention of Accidents says health issue if left unmonitored. associated with experimental tablets were responsible for more childhood injuries than any The study, published in the e-cigarette use. other household product in the UK. British Medical Journal Open, ●The research can be ● For more information, go to bit.ly/JAMAO_detergent

SHUTTERSTOCK/ISTOCK involved more than 32,000 11- to accessed at bit.ly/BMJO_e-cigs

March 2017 Community Practitioner 11

10-11 Reear e.indd 11 01/03/2017 15:19 THE BIG STORY

What would the future

pplications to study nursing of healthcare look in England are down almost like without nurses? a quarter in the wake of the government’s decision to axe Juliette Astrup bursaries. According to the examines the steep Alatest UCAS fi gures, applicants from England A making at least one choice for nursing- decline in applicants related courses, including midwifery, are down 23% – amounting to almost 10,000 to nursing programmes fewer applicants. in England. It follows the government’s decision to sign start charging nursing students in England tuition fees and replace NHS bursaries with loans, which many warned would lead to a slump in interest in the profession. But the government insists that this of the is a temporary blip, and has argued that its education funding reforms will allow universities to provide an additional 10,000 student nurse, midwife and allied health professional training places by 2020. Overall, applications to higher education times? from England are down 5% across all subjects when comparing the fi gures healthcare students in order to help increase The newly created nursing associate role from 15 January – the main application application numbers where required.’ is already being piloted across 11 sites – with deadline – with those from the previous year. It is also true that students will continue a cohort of 1000 beginning their two-year, Applications from the EU are down 7%. to apply for courses beyond the January work-based training scheme in January, and Signifi cantly, the largest decreases are deadline, so these fi gures don’t refl ect the 1000 more set to start in April. among older age groups – who make up a complete picture. There are also nursing degree signifi cant proportion of nursing applicants. However, such a drop isn’t easily dismissed, apprenticeships which, according to So, while 18-year-old applicants to nursing nor can it be regarded purely through the the health secretary’s announcement in from England fell by 10%, those aged over 19 lens of the funding reforms. Applications November, could see the fi rst apprentice decreased by between 16% and 29%. to nursing-related degrees have also fallen, nurses working on wards from September. A Department of Health (DH) albeit only slightly, in Scotland, and more so spokesperson says: ‘Student contributions in Northern Ireland, despite there being no to university costs have changed on three changes there. They have also fallen in Wales, previous occasions, and every time there has where the bursary is being retained. been an immediate dip in application rates followed by a steady rise — we are confi dent STILL MAKING A DIFFERENCE? nursing courses will follow a similar trend, Ros Godson, lead professional offi cer for and are certain we will have all the student public health at Unite-CPHVA, says the image nurses the NHS needs by September. of nursing and the changing nature of the ‘At a national level, a 23% drop will still job are among the factors at work. allow the NHS to fi ll the required 20,000 ‘There has always been an unwritten social student nursing places; assuming students contract that while nursing was hard work, meet the entry requirements of their off er it was also rewarding – and that’s what’s from their course provider. Entry to nursing, breaking down. People who go into nursing midwifery and allied health professions want to be able to make a diff erence – but remains extremely competitive, with 57,000 you see nurses coming off shift exhausted applicants for around 20,000 places in 2014.’ and not feeling that they have been able to The DH has also promised extra funding do that,’ she says. to help cover additional expenses like travel But the story no longer ends with and more support for students with children, university applications, with the introduction as well as working to ‘promote the courses of new routes into the profession now set to

and packages on off er to prospective have an impact on the numbers. ISTOCK

12 Community Practitioner March 2017

12-13 The Big Story.indd 12 01/03/2017 15:20 THE BIG STORY

Once established, up to 1000 apprentice enough staff , because they have a lot nurses could join the NHS each year. of unqualifi ed apprentices to support them.’ Depending on their qualifi cations and KEY STATISTICS And the Council of Deans of Health, experience, these apprentice nurses will join which represents the UK’s university the fi ve-year course at diff erent stages, and Applicants from England making faculties engaged in education and research stay in work while learning. Similarly, nursing at least one choice for a nursing- for nurses, midwives and allied health associates will get their training paid for related course are down professionals, has already raised concern that while remaining in work. the introduction of associate roles will ‘dilute But, as Ros points out, the government’s the number of registered nurses’. promise of 10,000 more nursing places by the end of this parliament, combined with 23% FUTURE RISE the training of the new nurse associates and With so many factors at work, it is diffi cult to apprentices, could put signifi cant additional predict the true impact on the profession. pressure on qualifi ed nurses. Professor Dame Jessica Corner, chair of ‘They’ve all got to be supervised and the Council of Deans of Health, seeks to monitored; they’ve all got to have their NHS will still fi ll the required reassure. She says: ‘It is to be expected that certifi cation signed off – and that puts there would be fewer applications in the fi rst pressure on the practical and organisational year of the [funding] changes, but we would side too.’ expect this to pick up in future years. She adds that while the new burden of 20,000 ‘This also comes in the context of a debt would put many people off a nursing student nursing places reduction in applications to higher education degree – especially mature students across all subjects,’ she adds, which leads to and those from poorer backgrounds – the conclusion that postgraduate studies, ‘they might become nurses through the such as specialist community public health apprenticeship scheme – depending on nursing, will also suff er low uptake as a result. how they are supported by their employers’. Professor Steve West, chair of Universities ‘We would persuade employers to take UK’s Health Education and Research apprentices on as Band 2 and 3 so they can Policy Network, adds: ‘Though no longer have a proper living wage,’ she adds. funding these degrees, the government Ultimately, there are still a lot of unknowns. must continue to endorse and promote ‘We don’t have the measure of how the 57,000 the degree route. These courses lead into apprenticeships are going to fi t in,’ says Ros. The number of applicants for critically important roles in our future health

‘It might make employers feel that they have 20,000 nursing positions in 2014 Sources: UCAS, Department of Health and care services.’ CP

March 2017 Community Practitioner 13

12-13 The Big Story.indd 13 02/03/2017 12:23 RIGHTS AT WORK

Bullying in the workplace continues to be a real problem Stamping out in healthcare settings. Unite head of health Sarah Carpenter sets out the NHS plans BULLYING to tackle it.

t the beginning of 2017, a ● Support staff to respectfully challenge about what your organisation is intending document was produced by problem behaviours in the meantime to do about meeting its responsibilities to the NHS Social Partnership ● Publish their plans and progress so staff , those it employs. Forum (SPF) giving a clear patients and the public can hold them The SPF guidance has a clear goal message to employers that to account and ambition: ‘For NHS organisations they A need to take action to stop bullying. ● Achieve measurable change in NHS to provide excellent, compassionate Formed almost 20 years ago, the SPF organisations, which is refl ected in the leadership in a supportive culture where is a group that brings together NHS statistics collated at a national level staff can fl ourish and problem behaviours Employers, NHS trade unions, NHS by 2020. such as bullying disappear.’ England, Health Education England, NHS And therein lies the key. Accountability Stand up, speak out and call your leaders Improvement and the Department of for the culture lies at the heart of to account. CP Health. It takes responsibility for looking resolving any problem, and it is up to all at the implications of policy on the NHS staff and their unions to ensure that the ● To read the SPF’s call to action, go to workforce, and is fi rmly rooted in the belief organisation is held accountable for what bit.ly/SPF_tackling_bullying that partnership working can improve they do – or fail to do. patient care. This document is new, and maybe your Over the years it has produced many employer has not yet realised it exists. But important documents, and the most recent the problem it seeks to address is old, and on bullying is no exception. often embedded into an organisational With NHS staff surveys repeatedly culture. NHS organisations showing that about a quarter of have around three years employees feel bullied by their managers to make a diff erence, or colleagues, it’s clear that this serious but Unite wants to see issue needs addressing. And the fi gure them take action now. rises further still when it focuses on BAEM So, if you are a union staff . The eff ects of bullying are disastrous rep, a manager or a for the individuals aff ected, but also member of staff , start have a detrimental impact on the whole asking the questions organisation through absenteeism, and a culture of fear. Bullying is usually the symptom of wider organisational problems, and the SPF guidance asks NHS leaders to work in partnership with their trade unions to be clear on how they will: ● Achieve the overarching leadership and cultural change to tackle bullying in partnership

SHUTTERSTOCK with staff

14 Community Practitioner March 2017

1 Ri a r.indd 1 01/03/2017 15:23 FEEDBACK

Hearing from a client can allow healthcare professionals to look at their practice from another perspective and consider ways to improve it. Here, a mother shares her experiences of Your views loneliness…

A MOTHER’S VOICE two. I wasn’t sure how I should fi ll my days and those in distress. But they mustn’t I was completely fl oored by how lonely I or how we could all be happy together. Days underestimate the eff ect of loneliness during felt, not only with my fi rst baby but with my felt insurmountable and endless; I used to this huge transition in women’s lives. If they second. I had moved with my husband’s job cry when my husband left for work, knowing could tell mums about ways to meet other to America and back, and when I arrived I had 12 hours by myself until he returned. mums nearby, this would be a huge help, back at 34 weeks pregnant to a new area of I know I am one of 80% of mums who and take a lot of the pressure off the health London, I gave birth to a beautiful baby girl. admit to feeling lonely when they have small visitor to rely on unsupported mums coming I had a wonderful visit from a health visitor children. I also know that 50% of mums back to the clinics for help. If I found support the week after, and the baby was fi ne. admit to going to the supermarket just for and friendship with a like-minded mum in But I wasn’t fi ne: I didn’t know how I was the adult interaction! The fact is, there isn’t my area, others can too. CP meant to handle having two children under much you can do when they are that small, and those days feel very long. I would take ●Katie Massie-Taylor, mother, long walks outside with no real purpose, South London MENTORSHIP INFORMATION feeling very alone. I am a registered health visitor, Then I met another mum in a playground HEALTH PROMOTION HELP working in a practice placement in a chance encounter. It was clear she was We’re keen to hear about innovative facilitator role. We provide in exactly the same position as me, with kids ways of promoting the school successful pre-registration nursing, the same age, and we could share these nursing service and immunisations, adult and child fi eld placements experiences together. We bonded over how and off ering public health messages/ in public health. We are reviewing sleep deprived we felt. We soon met up further advice and support to mentorship models and would every day, and my mental state completely hard-to-reach groups. Our areas of welcome any information from transformed. It all suddenly felt manageable interest include those not accessing others about the models they use in and normal; I was able to laugh with her their education provision, NEET public health or other community about things that I had wanted to cry and home-educated adolescents. If services. Please contact me at about before. you are able to help, please contact [email protected] Health visitors do a great job of checking [email protected] ●Gill Franklin, practice placement the physical health of new mums and ●Beverley Wheeler, school nurse facilitator, south of Tyne and Wear babies. They are also trained to see worrying manager, Reading

GETTY patterns of behaviour, over-anxious mums,

March 2017 Community Practitioner 15

15 eeda.indd 15 01/03/2017 15:25 ONE-TO-ONE Making the or 130 years, the Queen’s Nursing Institute (QNI) has supported, promoted and represented the interests of community nurses. case for As it celebrates its anniversary Fyear, chief executive Dr Crystal Oldman is refl ective of the changes the profession has undergone. At the charity’s helm since 2012 and herself an experienced community prevention nurse, Crystal has witnessed the changes fi rsthand, and admits the resources ‘are not In times of professional their data – the decisions they’re making quite where they need to be’ in 2017. in the community, the individuals they’re ‘Simon Stevens [chief executive, NHS turmoil it can be diffi cult working with.’ England] spoke at our conference last year to think objectively. This evidence is particularly crucial in and said quite explicitly that the focus has view of the unseen nature of the work, been very much on the hospital sector. That But to save our public Crystal notes. ‘The services are hidden: it’s is important, but it has meant that it’s taken health services we not about patients waiting for an operation, our attention away from the community,’ or queuing up at A&E to be seen. So much she explains. ‘When I fi rst qualifi ed, there must provide evidence of the work happens in patients’ homes, was far more emphasis on the community, that they’re needed, in clinics and GPs’ surgeries – you can’t and on the role of the health visitor. see it, touch it, feel it like you can with a ‘The service was for families and young says Crystal Oldman. hospital – it’s far more diffi cult to describe. children up to school age, but a number The Queen’s Nursing That’s why I say data and evidence of the of us also used to go into schools to off er impact that you have as a nurse working health promotion, sexual health advice and Institute chief executive in your community is really important to immunisations, and we also used to see talks to Helen Bird. demonstrate the diff erence you make.’ older people who were frail and at home. It But proving the benefi ts of early was much more like the Queen’s Nurses of interventions can present a challenge, 130 years ago: serving the community from importantly, the evidence to justify these purely because of the nature of the work, cradle to grave.’ services must be provided, says Crystal. Crystal acknowledges. ‘Prevention can There have also been a number of ‘I would say look at the Five year forward sometimes be a very long process in terms positive changes in nursing, Crystal asserts, view, which shows an emphasis on of measuring outcomes,’ she says, ‘so including nurse prescribing. ‘That has been prevention and promotion of health in the the impact you have as a health visitor or a fantastic development for nursing, and a community,’ she says. ‘I would also ask for school nurse to a child or family may only real recognition of the skills they have. the evidence and the risk assessment of the be seen in three, four, fi ve years’ time. ‘And I think the one constant thing basis on which the cuts are being made. ‘And that’s not very palatable for an that’s remained is the importance of the ‘The decisions are being made because organisation that’s making decisions about relationships you have with your clients, there is no money, but have those making funding, because they can’t see a tangible families and your community,’ she adds. the decisions undertaken a risk assessment? outcome within a year of that funding.’ And have the nurses seen it, to know that Nonetheless, collect and build that A CONSISTENT MESSAGE it has been an informed decision? Because evidence we must, Crystal adds. And the But with so many public health services nurses do have the evidence – they have QNI has seen fi rsthand that it works – its in England under threat of cuts, or the evidence of the outcomes of their campaign to save the district nursing having already undergone them, the interventions, so they need to be in a programme in universities has paid staff who have dedicated their careers to position to present this evidence as part dividends, with a year-on-year increase in delivering high-quality care to children of that decision-making process.’ those undertaking the programme, plus a and families in the community are now She adds: ‘We know it doesn’t happen number of additional universities opening feeling powerless and vulnerable. While overnight: there is a consultation process, the programme. this is a hugely emotional time for many, and staff need to get involved in that with ‘So we know it can be done, and it has to the right questions need to be asked and, the evidence of what they do. This is about be a really consistent message,’ she says.

16 Community Practitioner March 2017

16-17 ne--ne rya dan.indd 16 01/03/2017 15:26 ONE-TO-ONE

The services are hidden: it’s not about patients waiting for an operation, or queuing up at A&E… You can’t see it, touch it, feel it like you can with a hospital – it’s far more diffi cult to describe

‘This isn’t about widgets: it’s about nurses who have the values we hold so dear in our profession, and it’s about having the right people with the right commitment, attributes and knowledge.’ The new nursing associate role, alongside the nurse apprenticeship scheme set to start in September, is sure to have a further impact on education. Crystal doesn’t ‘fully understand’ the apprenticeship route – a view that is surely held by many – while her concerns over nursing associates involve substitution and standards. ‘We’ve got new standards for pre-registration nursing coming up, but we’ve already determined what nursing associate standards are. I’m struggling to understand why that is.’ As the profession forges ahead with ‘The direction of travel is the community, and THE NEXT GENERATION an already challenging year, Crystal, who if we want more people in the community, Of course, nurse training is another area of sits on the governing body of a clinical we’ve got to have nurses who are qualifi ed the profession that’s changing, and Crystal commissioning group, warns of tighter to manage the nursing care and the teams admits she’s ‘deeply concerned’ by the 23% fi nancial squeezes to come and emphasises of staff nurses and healthcare assistants to drop in nursing programme applications the importance of gathering and presenting deliver high-quality care to people in their after the end of student nursing bursaries evidence to justify the retention of public homes to prevent unplanned admissions. was announced in England (see page 12). health services sooner rather than later. ‘How do you do that? You have an ‘The impact will be felt in three years’ time ‘The main challenges are going to be up-to-date programme that supports the if we don’t have suffi cient numbers of nurse fi nancial, particularly into 2018,’ she says. ‘If development of a modern-day district nurse.’ students of the right calibre,’ she argues. we have evidence of the diff erence a service can make, then there is an argument there to ALL ABOUT CRYSTAL retain that service because what we’re doing is saving on services later.’ ● Qualifi ed as a health visitor in 1983 and worked for the NHS for 18 years, before Learning from and sharing with other spending another 18 years in the academic fi eld countries is also an important factor. ‘Wales ● Joined the QNI in 2012 as chief executive has been well ahead of England with its ● Cites ‘relationships with patients’ as what she misses most about nursing support for the graduate registrant,’ Crystal ● Is inspired by her sister, who is battling leukaemia – ‘She’s the most amazing notes. And another aspect is remaining a woman’ – and a close friend who she met on her fi rst day of nurse training champion for your profession and keeping ● Current hobby is ‘clearing my house’ in preparation to move in mind why you joined it. ● Plans to one day open her new garden to the National Garden Scheme, which ‘That’s the key: remaining positive,’ she provides funding to the QNI and other nursing charities (see qni.org.uk). concludes. ‘Who’d want to work anywhere else after working in the community?’ CP

March 2017 Community Practitioner 17

16-17 ne--ne rya dan.indd 17 02/03/2017 12:23 UNION NEWS

MEET THE CANDIDATES With the voting period for Unite’s executive council elections set to start on 27 March, we hear from the health sector constituency candidates about why they should get your vote.

Suzanne Abachor are becoming progressively more aggressive Stephen Thompson I work as a porter at my towards us. I know how they use the threat I have been a member of hospital, where I am also chair of privatisation as an excuse to implement Unite for approximately 34 of a large, diverse and active punitive cuts to the service. years. I’m a paramedic and I’m branch including all grades of staff . I fi ght I have a track record on campaigning passionate about caring for our members every day to defend fellow workers, support and fi ghting on a number of issues and will within the workplace, their education and the branch representatives and to build continue to do so. their health and wellbeing. the union. The pressure placed upon you in the NHS I passionately believe that we need to is increasing day by day and those pressures extend unionisation throughout the NHS Jasmin Suraya impact on your daily working life. With the and I played a key role in mobilising support Our union has witnessed uncertainty of funding health services in for last year’s pay strikes and for the junior continued health sector post-Brexit Britain and the spectre of NHS doctors at my hospital. membership increase – with sustainability and transformation plans, I sit on the Unite health sector national fi gures currently over 100,000. We are the there has never been a more important time committee and am UK delegate on the largest sector in Unite because we have to defend the health of the nation and the Compass European Works Council. I would built a reputation for fi ghting to better your services the NHS provide. CP bring signifi cant experience of national terms and conditions. More than ever, our bargaining and campaigning to the role. members need a stronger union. As an executive council member, I’ve ● To read the executive council health fought for progressive policies to save the candidates’ full statements, go to Ian Evans NHS from further cuts and have experience bit.ly/Unite_EC_candidates Why should you support me? as a workplace rep and in public health. I I have been a workplace rep support all aspects of our health service and for over 16 years, working have led on a campaign tackling issues of ELECTION TIMETABLE principally in pathology. I have also worked institutional racism and will continue to in pharmacy and as a porter. I understand do so. ● Voting papers posted to eligible the issues we go through every day because, As the only BAEM woman on the members: w/c 27 March like you, I have to face them. 62-member Unite executive, I have a ● Count and scrutiny of ballot I have been fortunate to meet colleagues reputation for sticking up for equality for papers: 20-28 April from all corners of the UK and listen to what underrepresented groups. I’m asking for ● New executive council takes you have to say. I understand the issues with your vote to continue the fi ght. offi ce: 1 May

ISTOCK downbanding. I recognise that employers

18 Community Practitioner March 2017

1 ninee 2.indd 1 01/03/2017 15:27 Cleanse and protect newborn skin from day 1

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p19.CPMARCH16.indd 19 24/02/2017 16:17 READER SURVEY Hearing your voices In January we launched a readership survey in order to get a better idea of what you’d like from your journal. Here’s a summary of the results…

THE RESPONDENTS THE JOURNAL 72% spend 30 minutes or more reading each issue %

From all parts of the UK, but a majority from London and eastern 90% think the average 74% 14.5% length of each Unite-CPHVA and north west issue is about right members for over fi ve years 14.1% regions of England 83% ranked Community Practitioner as their fi rst or second Unite- CPHVA member benefi t

Majority work full time health visitors

51% and for the NHS 74%74% working with 81% infants/pre-school 59% children would like the option to read the journal online

81% Band 6 or higher

20 Community Practitioner March 2017

20-21 Reader Survey .indd 20 01/03/2017 15:28 READER SURVEY

THE CONTENT THE DESIGN

81% think Community Practitioner fi nd the design contains valuable information of Community % to help them do their job Practitioner attractive

are happy with the number 88% of Unite-CPHVA updates 91% fi nd the articles clearly written and easy to understand 84% believe the number of images is about right say the journal has improved their practice knowledge and understanding 77% would like to see 58% % professional papers say the front cover and CPD articles makes them want to presented in a open the journal 81 shorter, digestible would like to access format in the the full professional printed journal papers online 68% are satisfi ed with the balance between content 79% and adverts deem practice-related content the most 84%84% important like the amount of text

CONGRATULATIONS… ADD YOUR VOICE If you didn’t complete the The two winners of a Community Practitioner reader £50 M&S voucher in the survey but would like to give prize draw were Susan your feedback on the journal, Cooke and Anne Lynch. send an email to helen@ Congratulations! communitypractitioner.com

March 2017 Community Practitioner 21

20-21 Reader Survey .indd 21 01/03/2017 16:59 FIGHTING BACK

          

   HOW TO...

The looming shadow here’s been no escaping equivalent school nurses will be replaced the barrage of press reports by a team of six, centrally based ‘health of cuts to public health over the last year about the and wellbeing coordinators’. Proposals threatened cuts to health are on the table too to reduce the health services is causing visitor and school nursing visitor workforce. servicesT as a result of pressure on public Nottinghamshire Healthcare NHS widespread feelings health budgets in England. Foundation Trust has also made of despondency Humber NHS Foundation Trust, for signifi cant changes to the way public and anxiety. But example, is currently consulting on plans health services are delivered for parents to reduce the number of health visitors and young people. A total of 20 new, practitioners can working in East Riding by a quarter after locally based ‘healthy families teams’ have fi ght back, as Rima its budget was cut by £500,000. been created bringing health visiting, According to Unite, the number of school nursing, family nurse partnership, Evans discovers. full-time equivalent health visitors will the national child measurement fall from 51 to 38 and there will be a programme and breastfeeding support fall in school nurses to just six full-time services together under one contract. equivalent staff . Although no redundancies were made, Cumbria receives one of the smallest the number of health visitors was cut by public health allocations per head of 38 full-time equivalent staff . population at £38, according to its county Such service redesigns and changes are council. Its public health budget has been being implemented across many areas as sliding by £925,000 a year for the last local authorities struggle to deliver more two years and will again in the coming with less. While redundancies have been fi nancial year. minimised in some areas, with deep cuts It wants to redesign services to help imminent elsewhere there are widespread realise savings by decommissioning the feelings of uncertainty, despondency and traditional school nursing service from concern over jobs, and for the quality of this April. Its plans mean 11 full-time future services.

22 Community Practitioner March 2017

22-24 How to... V2.indd 22 01/03/2017 16:15 FIGHTING BACK

PRESENT A BUSINESS CASE offi cer for strategy, policy and equalities, together a case for ‘selling’ what you do? Practitioners can fi ght against cuts to says: ‘Time and time again the value of Leanne McHugh is a health visitor and services by supporting the campaigning having health visitor and school nursing 0 to 19 practice educator covering the activities of Unite. services has been proven. It seems like a Lincolnshire area. Her role is to meet the However, other positive action includes nonsense these cuts have been imposed on education needs of both student and fully taking steps to make the ‘business case’ for local authorities. qualifi ed health visitor and school nursing your services, promoting their value to local ‘So it’s important to make your case by teams and ensure there is a good skill mix, decision-makers in an eff ort to help them spelling out the successes and outlining all while also looking for new opportunities to understand why they are so essential and the elements you cover such as safeguarding promote the eff ectiveness of their services infl uence the fi nal outcome. or accident prevention.’ delivered to families and communities. Obi Amadi, Unite-CPHVA lead professional But where do you start when putting First and foremost, says Leanne, is to stay positive and focused. ‘No matter what cuts we may face, the families and children we A COUNCIL’S VIEW care for are the priority. It’s vital we remain What factors might local government decision-makers consider when making positive with them and continue to deliver decisions about health visiting services in the light of squeezed public health the best service for them. If all we talk about budgets and scare resources? is impending cuts, it’s going to disillusion A document published in February by the Local Government Association gives people. Our job is to empower people and some clues as to their priorities, which might help give a steer to health visitors teach them whatever skills they need so they pulling together a case for retaining their service. can see the value of the service we provide.’ Improving outcomes for children and families in the early years: a key role for health visiting services emphasises the vital part they play in improving health ALL ABOUT EVIDENCE and wellbeing of children and families. Its recommendations to councils include: Taking an evidence-based approach is also ● Explore opportunities for integrated working between health visiting crucial to making commissioners listen. and other council teams ‘Historically, health visitors haven’t been ● Look at how health visitors can do more to promote healthy lifestyles very good about gathering evidence,’ admits ● Invest in specialist health visitor roles to working with vulnerable, groups such Leanne. ‘It’s about putting pen to paper to as the homeless demonstrate and off er evidence on what ● Consider how digital technologies can extend the reach of health visiting. makes us the best person to off er these services. To save money, a council might SHUTTERSTOCK

March 2017 Community Practitioner 23

22-24 How to... V2.indd 23 01/03/2017 16:16 FIGHTING BACK

assume a Band 2 could step in to do a with local drama students on making video primary birth visit. We need to be able to clips that act out scenarios school nurses explain why not, and outline the unique skill and health visitors face in practice was set we bring to the job.’ education-based, the project ended up She adds: ‘List what you might generating a lot of interest, not least for the do during a visit that makes such a drama students themselves. diff erence to families. For example, ‘The videos are designed to be screened empowering them to do certain to groups of health visitors and school tasks for themselves that saves nurses to stimulate discussion about money in the long run, or off ering a how to handle particular situations,’ holistic assessment that lower band says Leanne. ‘However, the drama practitioners wouldn’t be able to do. Details students bought into it so much, they like this need to be captured in a working put scripts together themselves and document that proves our worth.’ the NHS project, as it’s been called, has While so far Leanne’s area has escaped been written into their curriculum. the looming threat of cuts, she explains that ‘Now we plan to make a two-minute staff within the 0 to 19 service are being clip for parents showing what transferred from Lincolnshire Community two-year reviews are about. This Health Services NHS Trust to Lincolnshire will help raise awareness of our County Council. essential service and what we do. Leanne reports that the value of the Projects like this reinforce our value service is enhanced by a robust evidence and need.’ base that underpins the knowledge health Cuts to services are so widespread it’s visitors and school nurses have; a document vital to stay as solution-focused and forward that tells people what a qualifi ed health thinking as you can, Leanne stresses. visitor or school nurse does and that ‘sells’ ‘We have to stay upbeat and look at the value of their off ering. whatever resources or people are out ‘We devised a 0 to 19 portfolio that there we can tap into, to help highlight takes you through all of the core off ers the eff ectiveness and strengths of what and allows a practitioner to document we do.’ CP where they got their knowledge and ● Tell us about your best practice and understanding from, and how they cost-saving projects by writing to transferred that into practice,’ she says. helen@community practitioner.com ‘So, if someone isn’t quite clear on why a health visitor needs to carry out a six-week STAND UP, GET INVOLVED review in addition to the one carried out by a GP, this document clearly shows the ‘Members need to stand up and be local council reasons, what a health visitor is looking counted in the campaign to maintain ● Getting in touch with health and out for and the ways in which they help services for families and children,’ says wellbeing boards parents. It highlights all the fantastic things Obi Amadi. ● Contacting your local MP only we can do and proves our worth to ‘We need to speak out on their behalf ● Speaking to children’s groups to commissioners at a time when there is so and put pressure on to make sure our raise awareness among parents of much turmoil. children and young people are given potential changes or cuts ‘Educationally, it’s also very important the best services that will optimise ● Signing the Love Your Health Visitor/ for practitioners since it provides evidence their health for the future.’ Love Your School Nurse petition at towards revalidation.’ However, Obi warns: ‘Members bit.ly/LYHV_petition should get together with colleagues to ● Attending the lobbying event at THINK CREATIVELY work on this – if you work in isolation it parliament on 26 April (see page 26 Leanne also advises fellow practitioners to can become too stressful.’ for details) think creatively and innovatively about ways To make your views count, Obi ● Informing Unite about any proposed to generate excitement and enthusiasm suggests the following actions: cuts and changes happening in your for the services you provide. Though the ● Making presentations to your area or trust.

primary motivation behind an idea to work SHUTTERSTOCK

24 Community Practitioner March 2017

22-24 How to... V2.indd 24 02/03/2017 14:44 Unite-CPHVA Annual Professional Conference 2017

Save the date 17th-18th October 2017 Motorpoint Arena Cardiff

The last year has been full of challenges for community practitioners. More than ever, it is important to feel the support of your colleagues and keep ahead of the ever-changing political and professional landscape.

We will shortly be opening registration for 2017 – so stay tuned!

And if you just can’t wait, later in this issue you’ll find information about the 2017 Call for Papers and how you can get involved!

I enjoyed listening to colleagues’ shared passion and commitment to making a difference within the many areas of public health.” Health Visitor, 2016 attendee

cphvaconference.co.uk

p25.CPMARCH16.indd 25 24/02/2017 16:19 LOBBY EVENT

A unique opportunity is Join calling: join the ‘Love Your Health Visitor/Love Your the School Nurse’ lobby of parliament on 26 April and fight make your voice heard…

hen shadow steps, followed by a group photo health secretary ● Travel expenses will be covered for for England Jon those wishing to attend Ashworth spoke ● While the event is England- at the Unite- focused, UK-wide members who WCPHVA conference in November, are passionate about lobbying for he extended a unique invitation to the future of public health nursing delegates, off ering CPHVA members are encouraged to join. the opportunity to visit the House of Commons and speak directly to MPs There’s no limit on numbers, about what is happening to public so if you can attend, show the health services in your local area. government the strength of the A date has now been confi rmed – profession in the face of adversity 26 April – and further details are set and make your voice heard. CP out as follows… ●Express your interest in ● Members are advised to arrive at attending to your regional the House of Commons at 12pm offi cer, details of which (but expect security to be busy, can be found at bit.ly/ due to Prime Minister’s Questions) Unite_health_regional ● A dedicated room in the Commons ● To sign the ‘Love will be the base for discussions Your Health Visitor’ from 12pm petition, go ● A meeting will take place at 1pm to bit.ly/ for an hour, which will include Jon LYHV_ Ashworth and other members of petition the shadow health team ● Unite-CPHVA will issue lobby packs in advance, and for those people without an MP to lobby, will run mini-briefi ng sessions with accompanying documents ● Everyone who attends the event will leave with a campaign pack containing all of the relevant documents ● The day will end at 4pm, with a short fi nal meeting about the next ISTOCK

26 Community Practitioner March 2017

26 y.indd 26 01/03/2017 15:7 Get to know us better when it comes to safety

Here at JOHNSON’S®, we’re mums and dads too, and like you, we want what’s best and safest for our little ones. That’s why, for over 125 years, we’ve utilised the latest science to create safe, mild and HıHFWLYHEDE\SURGXFWV We have a 5-step safety assurance process which ensures our products are safe: e are choos Every supplier must meet our rigorous quality and safety standards ver ingredient is assessed for safet (YHU\LQJUHGLHQWLVULJRURXVO\UHYLHZHGE\VFLHQWLIJFH[SHUWVWRHQVXUHLWPHHWVRUH[FHHGVWKH requirements for safe use e go above and beond ith or ingredients and prodcts Depending on the product, we work with dermatologists, ophthalmologists, paediatricians, midwives, and other specialists to help ensure clinical safety e carefll assess ho real cstomers se or prodcts Hundreds of families test our products before they are ever placed on a shelf hen it comes to safet, e never rest We speak to thousands of parents, scientists, and regulators to remain vigilant and ensure every product meets our safety standards throughout its lifetime Because we care about every little baby.

For more information about our Safety and Care Commitment, please visit: www.safetyandcarecommitment.com We welcome any feedback, please email us at [email protected]

© Johnson & Johnson Ltd 2016 UK/JOB/16-8099

p27.CPMARCH16.indd 27 24/02/2017 16:21 COVER FEATURE

The prime minister has said child mental healthcare is a priority, but the reality is not matching the rhetoric, reports Phil Harris.

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ew in the public sector may disagree that inadequate mental healthcare is a ‘burning injustice’, and that services have been ‘dangerously disregarded’, but it was still a surprise to hear those words come from the mouth of a serving prime minister. In January Theresa May used her fi rst major speech on health and society to demand improvements in mental health, and child mental healthcare in particular, devoting more than 2000 words to the subject and calling for parity of esteem between mental and physical healthcare. Her speech called for action and early interventions to be based in schools and communities, and announced a range of measures, including a plan to give every secondary school mental health fi rst aid training so that staff can identify symptoms and help children who may be developing a mental health issue; trials on strengthening links between schools and NHS specialist staff , including a review of children and adolescent mental health services (CAMHS) across the country. She also pledged that by 2021, no child would be sent away from their local area to receive treatment for mental health problems. The speech followed comments made late last year by health secretary Jeremy Hunt, in which he called child mental health services the NHS’s biggest weakness, and said: ‘I think we are letting down too many families and not intervening early enough when there is a curable mental health condition, which we can do something about when a child is eight or nine, but if you leave it until they are 15 or 16, it’s too late. There are too many tragedies because children develop eating disorders or psychosis or chronic depression, which is then very diffi cult to put right as they get older.’

A NEW FOCUS So what has caused this sudden governmental focus on improving child mental health? And will it really lead to a revolution in how services are funded, commissioned and provided? The fi rst question is easier to answer. The steady trickle of negative news stories about the mental wellbeing of children has turned into an alarming and damaging fl ood. Some of the recently published statistics about child mental health services are simply staggering. Last year the Lightning review by children’s commissioner Anne Longfi eld examined Freedom of Information Act data from 48 out of

60 England trusts for 2015, and the results were disturbing. Of the one CRISFORD CHLOE

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in 250 children who had been referred for CAMHS services, 28% had been turned away.ay. Waiting times were also extremely long: in one area, the average wait was 200 days. And almost inconceivably, of the 3000 children and young people who had been referred to CAMHS with a life-threatening condition such as attempted suicide, self- harm, psychosis or severe anorexia, 14% were turned away and 51% had to go on a waiting list – with some going 112 days before being seen. NHS Digital fi gures released in December showed that the number of under-18s attending A&E due to mental health crises has risen by more than half in the last fi ve years. In the same month, the National Society for the Prevention of Cruelty to across the country have been cut under Children published data showing the her government. number of children receiving hospital There is a crisis in ‘There is a crisis in young people’s mental treatment for self-harm in 2015 was 19,000 health that can only be tackled by a long- – a 14% rise over the previous three years. young people’s mental term investment in school and community- Meanwhile, a report from the Royal health that can only be based prevention services, which Theresa College of Paediatrics and Child Health May should urgently address.’ showed that suicide was the second most tackled by a long-term common cause of death in young people investment in services FUNDING AND REALITY aged 15 to 19, and accounts for more than a Yet the government says extra money has quarter of all deaths among this age group. been given for children’s mental healthcare. Rates had been in decline since 2000, but who served as care minister in the coalition So what’s going wrong? have started to rise again since 2010. government, called the prime minister’s The ministerial Children and Young And in Children’s Mental Health Week words a ‘puny response’ and ‘an attempt to People’s Mental Health and Wellbeing in February, Childline revealed that calls cover up’ for years of Conservative failure in Taskforce published its Future in mind report about mental health have soared, with child mental healthcare. in 2015, which argued the need for change children now seeking the charity’s help for And Luciana Berger MP, the former across the whole system to improve children psychological issues every 11 minutes. shadow mental health minister, was similarly and young people’s mental health, and Given this reality, and with the unimpressed. ‘Unfortunately, there have the government backed this with £1.4bn of government showing no signs of rowing been warm words from Tory prime ministers extra funding. back on its austerity agenda, it is perhaps before that have not been backed up by But research by the child mental health unsurprising that Mrs May’s words did not action,’ she tells Community Practitioner. charity YoungMinds showed that only half inspire much confi dence. ‘Children’s centres, school nurses, health of clinical commissioning groups increased Liberal Democrat Norman Lamb MP, visitors, youth clubs and CAMHS services their spending on children’s mental health

KEY STATISTICS Of the £1.4bn of extra government funding was put towards 1 in 250 children’s mental health services in 2015 children who had been 200 referred for the average number of CAMHS in 28% days spent waiting for England had been turned away CAMHS in one area

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closely monitored, CELEBRATING GOOD so is eff ectively COMMUNITY PRACTICE meaningless. This leads to cuts Although the overall picture is in the provision of extremely challenging, there are community services many examples of innovative and staff such as school practice in child mental health nurses, who are of course that give reasons for optimism. among the professionals most ideally One is the work of Off the Record placed to identify emotional problems in (OTR), a mental health charity in children, intervene early and link children Bristol, which provides a range of and families to other services. counselling and therapy services for those aged 11 to 25. Young INCREASING NEEDS people self-refer via email, text Mandy Bancroft, senior lecturer in mental or phone, and get a ‘choice’ health nursing at the University of the West appointment within two weeks. of England and former CAMHS worker, says They can then choose from using the extra money. The other half children have more need for mental health options including single and was using it to backfi ll cuts or to spend care and services than ever before. group counselling, resilience on other priorities. ‘Children are under greater pressure than labs, creative writing and art and Sarah Brennan, the charity’s chief ever,’ she says. ‘They are continually being drama therapy. executive, says the lack of funding means assessed and tested, and teachers and Laura Brain, participation that children’s mental health services have parents expect them to do well at all times. and rights worker at OTR, says been in crisis for years. Schools have to perform well in league the work is strongly focused on ‘The sad reality is that services have been tables and that pressure gets transferred to prevention, and is not about severely underfunded, and our research the children. being a crisis service, although shows that not all of the new money the ‘Meanwhile, the internet and social media OTR works with local CAMHS government has committed is going where play a huge role in most children’s lives. Years staff to provide an A&E service. it’s intended. ago bullying was restricted to school hours, ‘We provide a safe and ‘If the government’s aspirations are to be but now it can and does go on 24/7. We’re confi dential place for children achieved, we need to make sure that the also seeing a big rise in eating disorders in and young people to talk, and extra money reaches the front line and the girls and boys because of constant media don’t provide family therapy,’ vulnerable children who so desperately coverage of body issues.’ she says. ‘The children shape need support.’ Austerity has also meant that children what we do and we have young And as Community Practitioner has been are more likely to suff er emotional stress people on our board of trustees. reporting, local authorities have been when they’re at home because of parental ‘We work closely with local raiding their public health nursing money unemployment, health problems and schools and CAMHS services, to fund other council services as they alcohol abuse, Mandy adds. and one of our staff is present at reel from swingeing budget cuts. Even ‘It’s a great national shame that such a CAMHS intake meetings, which is though this cash is theoretically ringfenced, small amount of funding goes to CAMHS quite unusual.’ the protection is not tightly defi ned or and to help with early intervention in schools From its formation in 1965 OTR has grown to have around 50 staff and 130 youth and adult volunteers, and works around the clock to support over 3000 young people a year. Andy, who self-referred to OTR, says: ‘The staff here have 14,917 been incredible, making me feel comfortable and at ease. I think the number of under- they’ve probably saved my life 18s attending A&E with 3000 psychiatric conditions such and I can’t thank OTR enough. young people per year as psychosis in 2014-15 I’m not entirely better but I’m are supported by the Off – up from 6950 in 2010-11 getting there.’

the Record scheme (Source: NHS Digital) ISTOCK

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WHAT STAFF CAN DO School budgets are Ros Godson, Unite- themselves to look for professionals to play CPHVA lead professional early signs of mental their part.’ being cut by £3bn so it offi cer for public health, health problems, and And, of course, Ros will become increasingly says that resources know how to get the advises making the most are stretched beyond appropriate help and of your union. Speak diffi cult to fund in- breaking point, and information to the to your Unite-CPHVA school care unless these there is a ‘yawning people who need it.’ rep and get active in cuts are reversed chasm’ between the School nurses in your workplace to make rhetoric of politicians particular need to your voice heard. It’s and the reality. push for whole school important to provide because such a high percentage of problems Community approaches, using the evidence on why services start in childhood or adolescence, and by practitioners don’t ideas from the Healthy are needed and to adulthood they are completely entrenched.’ usually have enough Schools project, which raise awareness with A 2017 poll carried out by the National time to address mental provides lots of practical management, the Association of Head Teachers (NAHT) and health as thoroughly advice on its website. local community and children’s mental health charity Place2Be as they would like but, ‘You can follow the the media. found that 93% of heads believed pupils she adds, there are still NICE guidelines on Finally, you can bring more worries into school than they things staff can do wellbeing, and read the keep up to date via did fi ve years ago, and that 96% thought to help. Public Health England Community Practitioner children’s ability to learn is aff ected by She says: ‘It’s vital briefi ngs on child mental and Unite-CPHVA’s social emotional problems. for staff working with health. There are lots media channels. See Other NAHT research has found that 31% families and young of ways to help build facebook.com/CPHVA of head teachers are planning to reduce people to stay up to date resilience in children, and twitter.com/ mental health support for children over the with training, educate and encourage other Unite_CPHVA next year. NAHT general secretary Russell Hobby says that the timing of cuts is tough. ‘Just as we are becoming aware of children’s mental health issues, the resources are being taken away,’ he says. ‘School budgets are being cut by £3bn so it will become increasingly diffi cult to fund in-school care for children unless these cuts are reversed immediately. ‘The problem is exacerbated when the school seeks to access help itself, because of the chaos in the health and social care system,’ he adds. None of this comes as a surprise to Jess, a school nurse in London. Jess says we have gradually been losing the whole preventative layer, and so it is no wonder that we now have an acute crisis across the country. ‘When I last did an informal audit of my school nurse referrals, I found that 90% to 95% of them were due to mental health issues, and even with the physical issues there are mental health aspects. ‘Specialist community public health nurses, particularly school nurses, are the people on the front line, and are the fundamental bridge between health and education. We are best placed to make a

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real diff erence. ‘We need to be visible, accessible and RESOURCES confi dential – and we can’t do that if we are There is a wealth of support available KEY STATISTICS not around or just doing brief visits every for community practitioners, parents Suicide was the couple of weeks. Most school nurses I know and children, including: end up being spread too thinly and have to try to get around several secondary schools ● TIME TO CHANGE: guidance and lots of primary schools in their patch.’ for professionals working with 2nd Jess says there are lots of ways school children, including session plans, most common cause of death in nurses can make a diff erence if they are blogs and videos, details of mental young people aged 15 to 19 and accounts for more that a quarter of able to be in schools. For example, they can health services and free materials all deaths among this age group work to build resilience among children time-to-change.org.uk/get- and young people, and to reduce the risk of involved/resources-youth- mental illness. professionals Ultimately, she thinks child mental health is a simple binary choice for society. If we as ● HEADMEDS: advice and a nation think it’s important, then we have information for young people to pay for it. But despite the big words from on mental health medication, politicians, the opposite seems to be true. developed by YoungMinds, young ‘We have been cut, cut and cut so now as a people and pharmacologists profession we can do less, less and less,’ Jess headmeds.org.uk Childline receives calls regarding says. ‘As a result, morale in the service has mental health issues every never been lower. ● PLACE2BE: the national charity ‘As the old saying goes, we are now providing emotional support 11 minutes picking up the bodies from the bottom to children in schools of the river rather than trying to stop the place2be.org.uk people falling in.’ CP ● NO HARM DONE: a video and advice pack from YoungMinds for professionals on spotting and responding to self-harm youngminds.org.uk/noharmdone

● MINDFULL: self-help advice and resources written by young people and professionals mindfull.org 19,000 the number of children ● INNOVATION LABS: a range of needing hospital treatment apps to improve young people’s for self-harm in 2015 mental health innovationlabs.org.uk

● PROMOTING CHILDREN AND YOUNG PEOPLE’S EMOTIONAL HEALTH AND WELLBEING: whole- school and college approach guide from Public Health England bit.ly/PHE_emotional_health

● Kidstime Foundation: for children aff ected by a parent or sibling’s 96% mental illness of school heads believe that kidstimefoundation.org children’s ability to learn is

aff ected by emotional problems CRISFORD CHLOE

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Kicking

the Although nine in 10 women are now smoke- free when their baby is born, the Smoking in habit Pregnancy Challenge he Smoking in Pregnancy Alcohol Studies, have the privilege of co- Group is determined to Challenge Group was chairing the challenge group. established in 2012 in response The group fi rst presented its report and improve on that fi gure to a request from the former key recommendations to the public health and make it more than public health minister to minister in June 2013. Since then, it has produceT recommendations on how the continued to meet and monitor progress just a pregnant pause. reducing smoking in pregnancy ambition on reducing smoking in pregnancy rates. contained in the government’s tobacco Working with Public Health England, the Four of the group’s strategy could be realised. group has worked together to produce a members explain how. The group is coordinated by Action range of materials, aimed at both pregnant on Smoking and Health (ASH) and is an women and the health professionals alliance of baby charities, professional who work with them. These include free organisations (including Unite-CPHVA), resources on carbon monoxide monitoring stop smoking services and academics who and the latest information on e-cigarettes. have developed a programme of local and It’s clear that maintaining a strong national action to support women to give and coordinated focus on smoking in up smoking while pregnant. The Lullaby pregnancy has had an impact. We have Trust chief executive Francine Bates and seen a welcome reduction in the number Professor Linda Bauld, who is deputy of women who smoke in pregnancy director at the UK Centre for Tobacco and across the country. However, with one in

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KEY STATISTICS

2.8 million The risk of SIDS was about e-cigarette users in Britain 2½ - 4 times higher in mothers who smoked one to 9 out of 10 10 cigerattes per day of women who quit smoking women are now smoke-free when will relapse their baby is born 80%-90% Source: Notley, 2015

10 pregnant women still smoking at the annual Safer Sleep Week from 13 March known risks to bystanders time their baby is born, there is still much (see page 48) and hopes practitioners ● E-cigarettes do not contain carbon to be done, and the group continues to will use this opportunity to promote safer monoxide (CO) or many of the other work together on this important issue. It sleep to families, including the risks of harmful chemicals found in cigarettes is currently awaiting the publication of smoking in pregnancy. ● While licensed nicotine replacement the new Department of Health tobacco products are the recommended option, control plan, which it is hoped will set out E-CIGARETTES IN PREGNANCY if a pregnant woman chooses to use a new ambition to reduce the levels of E-cigarettes are now the most popular an e-cigarette and if that helps her to smoking in pregnancy in the population form of support to stop smoking, and stay smoke-free, she should not be to below 6%. ASH estimates there are 2.8 million discouraged from doing so. users in Britain. Research on e-cigarettes in pregnancy SIDS AND SMOKING Many smokers report fi nding the is underway in the UK, including two Working with the Smoking in Pregnancy devices helpful for stopping smoking. studies funded by Cancer Research UK Challenge Group is a key feature at the Some women are now using e-cigarettes that involve interviews with pregnant Lullaby Trust. There is strong, consistent as a replacement for smoking in women who have used them and a evidence from studies worldwide that pregnancy, although there are no current national survey on prevalence of use smoking during and after pregnancy fi gures in the UK for how many. However, in pregnancy. Results from these initial increases the risk of SIDS. health professionals are increasingly studies should be available soon. And During pregnancy, the number of likely to be asked by pregnant women for later in 2017, a randomised controlled cigarettes smoked is highly associated advice about these products. trial of e-cigarettes for smoking cessation with risk. For example, two studies In response, the Smoking in Pregnancy in pregnancy will begin, funded by the showed that the risk of SIDS was about Challenge Group has produced a short National Institute for Health Research. two-and-a-half to four times higher in briefi ng to assist health professionals The Smoking in Pregnancy mothers who smoked one to 10 cigarettes in responding to some of the most Challenge Group briefi ng is per day than in non-smokers. For mothers frequently asked questions. It also supplemented by a one-page who smoked more than 20 cigarettes a provides a summary of the current infographic, designed for health day, the risk was about seven to eight- research evidence in this area. Key professionals to use in face-to-face and-a-half times higher. Passive smoking messages include: consultations with women who also signifi cantly increases the risk of SIDS, ● Stopping smoking is one of the have expressed an interest in using and the risk increases further where both best things a woman and her e-cigarettes to quit smoking. parents smoke. partner can do to protect the In January 2017, in partnership The Lullaby Trust is proud to have health of their baby through with the Royal College of Midwives, played its part in helping to reduce the pregnancy and beyond the group presented a webinar on numbers of babies who have died from ● Although not completely risk-free, e-cigarette use in pregnancy. With SIDS over the last 25 years. The number e-cigarettes carry a fraction of the more than 60 health professionals of unexplained infant deaths is now at a risk of smoking for users, with no taking part, it was a productive and record low: 230 across the UK in 2014. The charity is confi dent it can drive this down further by encouraging all new parents to follow its safer sleep guidelines. Community practitioners play a vital role in helping to communicate these

ISTOCK/SUPERSTOCK messages. The trust will be holding its

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useful discussion, and both a summary Q&A CASE STUDY: HACKNEY HEALTH VISITING SERVICE document and the full video of the webinar are available to view (see link below). In Hackney, midwives CHALLENGE GROUP RESOURCES have been trained As part of this work, the Smoking in to identify and refer Pregnancy Challenge Group has produced a women who are range of free resources to support midwives smoking at the time and other healthcare professionals in having of booking. Women conversations with pregnant women about are routinely screened quitting smoking. for CO and those These include: identifi ed as a smoker ● An online training module around are referred to the delivering very brief advice on smoking stop smoking service, to pregnant women, including using an opt-out CO screening. referral pathway (NICE, ● Resources for both midwives and pregnant 2010). Women who women to help explain the dangers have recently stopped associated with CO. smoking and/or are ● An information guide on the use of using e-cigarettes are electronic cigarettes in pregnancy, also off ered support aimed at midwives and other healthcare to enable them to stay professionals, and an infographic for smoke-free. pregnant women considering using Hackney Council electronic cigarettes. commissions a range ● A live document detailing initiatives within of providers of stop The health visiting partners. As a result, England that support smoking cessation smoking services, with and midwifery the new health visiting in pregnancy. some of those advisors services are part of the contract identifi es the having received Homerton University role of health visitors in ● All resources mentioned in this article additional training Hospital Foundation supporting women to are available at bit.ly/SIPCG_smokefree to help them support Trust. They are also quit or to stay smoke- pregnant women. both members of the free and to protect ABOUT THE AUTHORS However, it has been Smoking in Pregnancy their children from the ● Hilary Wareing is director of Improving estimated that by 12 and After Childbirth long-term impacts of Performance in Practice (iPiP) months postpartum, Task and Finish Group. second-hand smoke. ● Linda Bauld is professor of health policy 80% to 90% of women This group includes Hackney’s health and director of the Institute for Social who quit will have representation from visitors have recently Marketing at the University of Stirling relapsed (Notley, the area’s clinical received training to ● Jennifer Ruddick is senior policy and 2015). Continued commissioning group, enable them to identify campaigns offi cer at Action on Smoking abstinence is important Hackney Council public women who smoke and Health for women’s health health team, the family using CO screening ● Francine Bates is chief executive of The and to protect babies, nurse partnership at the new birth visit. Lullaby Trust infants and children and stop smoking Again, they refer those from the harmful service providers. who smoke to the stop REFERENCES eff ects of second- The task and fi nish smoking service. National Institute for Health and Care Excellence. (2010) hand and third-hand group recognised It is early days, Smoking: stopping in pregnancy and after childbirth. See: nice. org.uk/guidance/pH26 (accessed 28 February 2017). smoke (Royal College the need not only but the impact of Caitlin Notley AB. (2015) Postpartum smoking relapse – a of Physicians, 2010). In to implement this intervention is thematic synthesis of qualitative studies. Addiction 110(11): addition, children are interventions that will being monitored and 1712-23. signifi cantly more likely reduce the prevalence evaluated and the Royal College of Physicians. (2010) Passive smoking and children. See: https://cdn.shopify.com/s/fi les/1/0924/4392/fi les/passive- to become smokers of smoking during results will be shared smoking-and-children.pdf?15599436013786148553 (accessed themselves if their pregnancies but to in what will hopefully 28 February 2017). Hill KG, Hawkins JD, Catalano RF, Abbott RD, Guo J. (2005) parents smoke continue to support be an increasingly Family infl uences on the risk of daily smoking initiation.Journal (Hill, 2005). women and their smoke-free future. of Adolescent Health 37(3): 202-10.

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Out of the While we may associate modern slavery with an overseas practice, e just says: “Come and meet labour, or facilitating their travel with my mum for a cup of tea,” the intention of exploiting them soon in reality it’s rife in and I didn’t think anything after’. While the crime is often associated the UK. Helen Bird of it – I just got in the car with poorer countries, and the ‘slaves’ and went to his house…’ themselves as people being locked up and explores how public ‘HWhen ‘Anna’ described her experience of in shackles, in reality there are some 13,000 health nurses can being subsequently held captive, raped and victims of modern slavery on UK soil, often sexually abused over a period of 13 years by hidden away doing long hours of labour help to identify and ‘Malik’ and several other men to BBC Radio under terrible conditions, or being held in 4’s Today programme at the end of last year, domestic servitude situations. support victims in it struck a chord with many of us. According to a study by researchers at the community. And the fact that it was a health visitor King’s College London, as many as one who eventually managed to help Anna to in eight NHS professionals report having freedom brought home just how important been in contact with a patient they knew or a role healthcare professionals in the suspected had been exploited in modern community could play in identifying and slavery. And detective sergeant Helen supporting people just like her, who have Gordos, tactical advisor for the National become victims of modern slavery. Crime Agency’s (NCA) modern slavery The Modern Slavery Act 2015 defi nes the human traffi cking unit, says that healthcare off ences that fall under this broad term to practitioners working in the community

CK include ‘holding a person in a position of play a highly important role in assisting

ISTOCK ISTO slavery, servitude, forced or compulsory the police in their investigations. ‘We need

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to reach the people that are seeing it, like instinct is a valuable sense for practitioners health visitors – people that are engaging – to have. ‘The message I like to put across is because we [the police] often come in after that if it doesn’t feel right, it probably isn’t, the event,’ she says. KEY STATISTICS which means you need to seek support ‘They are undoubtedly going to come and get somebody there straight away,’ across individuals that they may have she stresses. concerns about. They will see those Similarly, Hilary Garratt urges public health indicators in the homes they’re going to nurses to embrace their ‘sixth sense’ while and school nurses will potentially see those practising. The deputy chief nursing offi cer indicators with the children they’ve got in for England and director of nursing at NHS front of them.’ England has done much work to help raise awareness of modern slavery and highlight DOES IT FEEL RIGHT? 13,000 the importance of taking action across the While in Anna’s case, the opportunity to pass NHS. She places the crime in the same vein a note discreetly to the health visitor, who victims of modern slavery in the UK as child sexual abuse and female genital had come to carry out a new birth check mutilation (FGM), describing it as ‘a public on her fourth child, meant there could be health and social issue’. no doubt as to the situation she was in, the ‘I think curiosity is a really good skill and indicators are often far more subtle. Helen its power is underrated,’ she explains. ‘If you describes some of the potential signs to be 1 in 8 raise awareness then people do become aware of in the community (see box for a professionals report having curious. You might go into people’s homes been in contact with a patient more detailed list): ‘The exploiters might take and see odd behaviour, people with fear in they knew or suspected had been control of the conversation and not allow exploited in modern slavery their eyes, people who can’t be left alone in [the victim] to talk, there might be people a room with professionals… Curiosity just trying to infl uence you or distract you from leads you to look further, [because] it’s often your enquiries,’ she says. ‘A multi-occupancy ‘We see the child being brought across to the small things,’ she adds. property in poor condition is often a strong the UK in order to allow the adult to claim indicator – very often they’re managed by benefi ts. Sometimes children are passed TAKING ACTION the exploiters, and conditions might be around to diff erent families, while some If a practitioner does have reason to suspect unsanitary, degraded or overcrowded. are used in domestic servitude situations,’ modern slavery is in operation, it’s important ‘We’ve had a lot of scenarios in relation to she explains. And among the indicators for to act on those suspicions rather than private fostering arrangements recently,’ she potential child victims are whether they are ignore them, as something that may seem adds, ‘mainly from west African countries, at school, registered with a GP and whether insignifi cant could prove very signifi cant, where children are willingly handed over to the adult presenting as their carer can prove Helen asserts. ‘Sometimes we don’t know an adult, because they’ve been told they can their relationship with the child. what we’ve got in front of us, but if you get give the child a better life in the UK. But more often than not, Helen adds, signs that someone is vulnerable, then it’s important to take positive and safe action and get the right people there to assist you in doing that,’ she says. She goes on to describe a case known as ‘Operation Portsmouth’, a multi-agency investigation involving Greater Manchester Police, immigration enforcement, the NCA, the Red Cross and social services, in which health visitors raised concerns about a number of Eastern European women and their children and the way in which they were presenting. All of the women were married to Pakistani men and traffi cking was suspected. ‘We took them to a safe location to speak to them and see whether they were victims of a crime,’ Helen explains. ‘I think it’s a really good example to highlight that the investigation came about as a result

of observations and information sharing SHUTTERSTOCK

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MODERN SLAVERY INDICATORS: There are many signs that could inform you a person is a victim of modern slavery

GENERAL SIGNS ● Cardiovascular symptoms vaginal infections, pelvic SITUATIONAL/ ● Reluctance to come ● Musculoskeletal symptoms infl ammation or pain or ENVIRONMENTAL SIGNS forward with information ● Tattoos or other marks irregular bleeding. ● Distrust of authorities ● Not recognising themselves indicating ownership ● Acting as if instructed as having been traffi cked by exploiters. PSYCHOLOGICAL SIGNS by another or enslaved ● Expression of fear ● Lack of knowledge about ● Telling their stories with SEXUAL HEALTH SIGNS or anxiety the area they live in the UK obvious errors. ● Pregnancy as a result ● Depression ● Fear of saying what their of their modern slavery ● Isolation immigration status is PHYSICAL SIGNS situation or they may have ● Suff ering from post- ● Fearful and emotional ● Injuries apparently as recently been forced to traumatic stress about their family a result of assault or terminate a pregnancy ● Drug use or dependents controlling measures ● Sexually transmitted ● Alcohol use ● Limited English, for ● Neurological symptoms, diseases ● Self-harm example only seeming headaches, dizzy spells, ● Injuries of a sexual nature ● Suicidal feelings to have vocabulary memory loss ● Gynaecological symptoms, ● An attitude of self-blame, that relates to their ● Gastrointestinal symptoms such as urinary or shame and loss of control. exploitative situation.

Source: Summarised from the Antislavery Commissioner report, Home Offi ce, 2016

from health visitors.’ clear about the facts,’ she says, reiterating Fortunately, Anna’s story is one that The police investigations resulted in the Helen’s encouragement to ‘escalate it using most public health nurses are unlikely to arrests of 12 men for immigration off ences, the correct safeguarding processes’. encounter in practice. But her words after and so despite the women choosing not the event are enough to encourage us all to disclose at that time it was nonetheless COLLECTIVE APPROACH to be that bit more vigilant from day to a successful operation. ‘We were able to Of course, as well as these individual day: ‘He’s taken everything from me – he’s safeguard and support them,’ Helen adds. measures for identifying and referring damaged my insides and I feel horrible, dirty. Since you need to be what’s known as victims, we need to work to combat modern I do hope one day for justice for all that he a ‘fi rst responder’ – which currently does slavery on a more collective basis. Hilary did to me.’ not extend to healthcare professionals stresses the need to keep the conversation And, as Hilary concludes, ‘it may – to report a suspected case of modern going and ‘talk about it’ as a profession. She never arise but it needs to be part of slavery through the national referral also says access to training is important. the conversation’. CP mechanism, the correct action to take for ‘We’ve got lots of training in place now,’ community practitioners is to follow your she explains. ‘It’s a real modern-day problem USEFUL RESOURCES normal safeguarding referral route, Helen now and part of our safeguarding role, along explains, whether it be a multi-agency with domestic abuse and FGM – it goes ● National Crime Agency modern safeguarding hub or social services. Or, she along in equal measure.’ slavery human traffi cking unit: adds, if the situation requires more urgency Hilary confi rms that NHS England is bit.ly/NCA_MSHTU – for example, if it’s feared the victim will working with the police and social services ● Home Offi ce modern slavery disappear if immediate action is not taken to develop a multi-agency, level one training documents and materials: – then the professional should treat it as programme, which is currently being piloted bit.ly/HO_modern_slavery an emergency. in London with a view to rolling it out later ● Unseen: unseen.org ‘We need to get them out of that situation,’ this year. ‘We’re also developing more ● Antislavery Commissioner report: she says. ‘If the health visitor is on their own, specialist training at levels two and three bit.ly/ASC_report_2016 we would suggest they call the police and for staff who are likely to come into contact ● Modern Slavery Helpline: get them to the address straight away so [the with modern slaves – people working in 0800 0121 700 victim] can be debriefed in an environment safeguarding and in A&E and people in ● Salvation Army modern slavery that’s conducive to them disclosing.’ primary care,’ she adds. helpline: 0300 3038 151 Hilary off ers some additional advice: ‘You And a safeguarding toolkit and awareness ● NHS England modern slavery need to talk to another trusted professional campaign are also in development with awareness video: bit.ly/NHSE_ or manager about it. Document it – keep an healthcare associations for distribution modern_slavery accurate record of concerns – and be really across all four UK nations, Hilary says.

March 2017 Community Practitioner 39

37-39 Modern Slavery.indd 39 02/03/2017 12:25 Unite-CPHVA Annual Professional Conference 2017 17th - 18th October 2017 Motorpoint Arena Cardiff

This is your chance to showcase outstanding achievements from your area! Have you or your team done something worth sharing? Could other practitioners learn from innovation or research that you have taken part in? If the answer is yes, submit your work and join us at conference this autumn. Deadline 31st March 2017

cphvaconference.co.uk

p40-41.CPMARCH16.indd 40 24/02/2017 16:23 I thought the poster presentations were inspirational and highlighted some great areas of practice.” Community Nurse, 2016 attendee

The Unite-CPHVA Conference Call for Papers process is now open

We want to hear from community practitioners, academics and students from across the UK to showcase their research, innovation and best practice.

Successful candidates will have the opportunity to present their work at the 2017 Unite-CPHVA Annual Professional Conference as either a seminar or a poster.

Categories

We are looking for entries from the full scope of practice including:

• Mental Health and Wellbeing • Communication • Parenting • Commissioning and Integration • Equalities • Education and Research • Leadership • Public Health • Safeguarding • Practitioner Wellbeing • Other

For submission guidelines and entry form, please visit: cphvaconference.co.uk/call-for-papers

p40-41.CPMARCH16.indd 41 24/02/2017 16:24 FAMILY HYGIENE

ne of Public Health England’s (PHE) seven priorities in protecting and improving the nation’s health is to tackle antimicrobial resistance O(PHE, 2014). The UK fi ve-year antimicrobial resistance strategy from the Department of Health (2013) outlines seven key areas for future action, one of which includes improving the knowledge and understanding of antimicrobial resistance by educating the public. A new scheme sets out to support these priorities by off ering education on these topics. Led by PHE, e-Bug is an international health education resource for children on hygiene, infection and antibiotics. The overall aim of the tool is to reduce the incidence of antibiotic resistance across Europe by increasing understanding about microbes, hygiene, infection prevention and antibiotic use in young people, who represent our future prescribers and antibiotic users. It has been found that 70% of all antibiotics are prescribed in the community (PHE, 2016), while 50% of these are thought to be unnecessary or inappropriate (Davey et al, 2005; Wise et al, 1998). Furthermore, there is public misunderstanding about how long infections usually last and how to use antibiotics correctly (McNulty et al, 2007). So educating the public and the community on hygiene and self-care is important to discourage inappropriate use of antibiotics. To that end, e-Bug has recently expanded its educational resources into the community with a specially developed hygiene and self-care course. Beating bugs DEVELOPING THE SCHEME In collaboration with the Kingfi sher Treasure Seekers community group, e-Bug has developed the six-week community hygiene and self-care course, called Beat the Bugs. The course aims to increase awareness and change behaviour around hygiene, TOGETHER self-care and antibiotic use in an interactive and fun way. It’s designed to be delivered Public Health England’s Charlotte Eley, by professionals working in the community, Vicki Young and Cliodna McNulty describe an such as school nurses, public health nurses and health visitors, to a range of groups, educational course to increase awareness and including hard-to-reach adults. The course change behaviour around hygiene, self-care and is freely available to download and can

ISTOCK be delivered as a six-week course or as antibiotic use in the community.

42 Community Practitioner March 2017

2- ea e u .indd 2 02/03/2017 09: FAMILY HYGIENE

independent sessions. achieved through the creation of posters respectively. These sessions had the highest Beat the Bugs builds on existing e-Bug for each session, the provision of additional improvement in knowledge, with average activities and includes six sessions: an information for the course leader and the improvements of 53% and 39% respectively. introduction to microbes; hand and development of a pictorial Managing your The highest baseline knowledge was respiratory hygiene; food hygiene; oral infection leafl et. reported in the food hygiene session and hygiene; antibiotics; and a fi nal session on A second pilot was then carried out, the fi nal session on self-care, with an average self-care and action planning for the future. involving eight adults with learning correct score of 64% and 70% respectively. At the end of each session, participants and physical diffi culties and/or mental In the microbes session, participant complete an ‘action plan’ for the week and impairment, and enabled the collection of knowledge improved the most on the pledge to make a behavioural change, for quantitative and qualitative data. Before and statements: ‘Bacteria, viruses and fungi are example: ‘After this session, I will use soap after questionnaires, referred to as ‘quizzes’ the three main types of microbes’ and ‘It is to wash my hands.’ At the following session, to participants, were completed at the start important to protect our useful microbes’, the course leader will revisit the pledges to and end of each session. The questionnaires while in the antibiotics session, knowledge see how successful participants were with had knowledge-based statements, and improved the most around: ‘You should only implementing them and to reinforce the participants circled whether the statements take antibiotics if your doctor has prescribed learning objectives. were ‘right’, ‘wrong’ or ‘not sure’. Each them to you’ and ‘You must not use other session was observed by an e-Bug researcher people’s antibiotics’. PILOT FINDINGS to increase validity and monitor fi delity. Qualitative results revealed that Two pilots of Beat the Bugs have been A follow-up participant focus group and participants had retained knowledge, conducted: one involving adults with course leader interview was conducted six particularly about self-care. They reported learning diffi culties and one with parents at weeks later to explore in depth their views positive behaviour changes, including an a children’s centre, which is ongoing. These on the course and to establish retention increase in appropriate hand-washing and fi ndings provide an insight into the benefi ts, of knowledge. tooth-brushing. learning outcomes and transferability of the course across diff erent community groups. POSITIVE RESULTS Why do we brush our teeth? A preliminary pilot was conducted with Quantitative results from the before ‘It’s important to brush your teeth so you don’t seven adults with a variety of learning, and after questionnaires showed an get any cavities in them and also you won’t physical and/or mental health diffi culties, improvement in participant knowledge in get any holes so you won’t get your teeth and was used to make improvements to the each session. The lowest baseline knowledge damaged.’ (Participant, six-week follow-up) draft course. Feedback from this was reported in the microbes fi rst pilot called for certain and antibiotics sessions, We also learned about coughs and colds adjustments to be made, with an average correct and what we should do to make ourselves such as the number of score of 36% and 44% feel better. What do you remember? visual components being increased Left to right: and a reduction HORRID HANDS: Participants learn in the amount how far microbes of reading for can spread from our hands to the participants. This was things we touch using UV gel and a UV torch. They learn that the best way to stop harmful microbes spreading is by washing their hands thoroughly.

THE SNOT GUN: Participants recreate a giant sneeze and see how far a sneeze travels. They learn that the best way to stop your colds spreading is by catching coughs and sneezes in a tissue and washing their hands.

March 2017 Community Practitioner 43

2- ea e u .indd 3 01/03/2017 15: Mary Seacole Awards 2017-18 For nurses, midwives and health visitors

Applications are invited from individual nurses, midwives and health visitors in England to participate in the prestigious Mary Seacole Awards for 2017-18.

These awards, funded by Health Education England, provide the RSSRUWXQLW\WRXQGHUWDNHDVSHFL¿F KHDOWKFDUHSURMHFWWKDWEHQH¿WVDQG improves the health outcomes of people from black and minority ethnic communities and contributes to your personal development.

To apply and for more information: Email [email protected] or visit www.nhsemployers.org/ maryseacole

Closing date 5 May 2017

Publication code 004 808

p44.CPMARCH16.indd 44 24/02/2017 16:41 FAMILY HYGIENE

‘Always drink plenty of water, always get a FUTURE PLANS good rest, and always wash your hands and Beat the Bugs can be used as a tool for the use a clean tissue and use paracetamols if you public and community groups to increase need them.’ (Participant, six-week follow-up) KEY STATISTICS awareness and change behaviour around hygiene, self-care and antibiotic use. The Participants understood that they should course aims to increase the participant’s only take antibiotics if they really need confi dence and knowledge on managing to, that they should not share antibiotics 70% their own infections, in order to reduce with friends or family and should only inappropriate antibiotic use. of all antibiotics are prescribed in take antibiotics as the doctor or nurse the community, while The Beat the Bugs community resource has prescribed: supports the implementation of NICE of these are guidance on improving public knowledge What should you do if your doctor gives thought to be and behaviour around hygiene, self-care you antibiotics? 50% unnecessary and antibiotic use (NICE, 2017). CP ‘I would take them like they told me to, and if you have any left take them to the pharmacy.’ ● The authors would like to undertake (Participant, six-week follow-up) further evaluations in a range of community groups. If you’re interested, However, they found it diffi cult to describe email [email protected] exactly what an antibiotic is – and when it 36% ● Download the Beat the Bugs course is needed: The lowest baseline knowledge and view training dates at ‘I think there is still loads of work we need to score was reported in the microbes e-Bug.eu/Beat-The-Bugs and antibiotics sessions. do with antibiotics… It’s just a really diffi cult concept to teach in a literal way.’ REFERENCES (Course leader, six-week follow-up) Davey P, Brown E, Fenelon L et al. (2005) Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Systematic Review 4: CD003543. There will be a review of the antibiotics Department of Health. (2013) UK fi ve year antimicrobial session in order to investigate how the resistance strategy 2013 to 2018. See: https://www.gov.uk/ government/uploads/system/uploads/attachment_data/ diffi cult messages around antibiotics can be fi le/244058/20130902_UK_5_year_AMR_strategy.pdf (accessed translated to community groups in a way 24 February 2017). that they will fully understand. McNulty CA, Boyle P, Nichols T, Clappison P, Davey P. (2007) The public’s attitudes to and compliance with antibiotics. Journal of A third pilot is being conducted at a Antimicrobial Chemotherapy 60(1): 63-8. children’s centre with parents who have NICE. (2017) Antimicrobial stewardship: changing risk-related varying levels of English. This will enable 2 pints behaviours in the general population. See: https://www.nice.org. uk/guidance/ng63 (accessed 24 February 2017). the e-Bug team to determine the course’s the amount of snot you produce Public Health England. (2016) English surveillance programme transferability to other community groups every day, which is mostly swallowed for antimicrobial utilisation and resistance (ESPAUR). See: https://www.gov.uk/government/uploads/system/uploads/ and whether any further modifi cations and attachment_data/fi le/570276/ESPAUR_executive_summary_ adaptations are required to roll the course and_recommendations.pdf (accessed 24 February 2017). out on a wider scale. Public Health England. (2014) From evidence into action: opportunities to protect and improve the nation’s health. See: https://www.gov.uk/government/uploads/system/uploads/ ‘TRAIN THE TRAINER’ attachment_data/fi le/366852/PHE_Priorities.pdf (accessed 24 February 2017). In response to feedback from the pilot 64% Wise R, Hart T, Cars O et al. (1998) Antimicrobial resistance is a courses, and after discussions with other The highest baseline knowledge major threat to public health. British Medical Journal 317(7159): score was reported in the food community groups, a ‘train the trainer’ 609-10. hygiene and self-care sessions workshop was developed for community leaders to learn about Beat the Bugs and provide them with the knowledge, confi dence and skills to deliver the course in their community groups. A variety of community workers have completed the workshops, including 7 areas teachers, school nurses and community for action outlined by support workers. The e-Bug team aims to the UK fi ve-year antimicrobial deliver the workshops on a termly basis to resistance strategy further promote the course.

MarchM 20177 Community Practitioner 45

2- ea e u .indd 5 01/03/2017 15:9 BREASTFEEDING IS BEST FOR BABIES FOR HEALTHCARE PROFESSIONALS ONLY

What is responsive feeding and how can it help to shape a baby’s future?

The first 1000 days of a baby’s life, from conception to the age of two, are crucial1

Making the right decisions So why does breastfeeding The importance of during this period can help promote self-regulation? responsive feeding deliver lifelong benefits2 Breastfeeding is a naturally is recognised by: It’s well known that breastfeeding responsive way of feeding. is an unparallelled way to feed Responsive feeding refers to UNICEF9 an infant, delivering numerous a reciprocal relationship benefits to both mum and baby, between infant and caregiver WHO10 in the short- and long-term. to communicate feelings of hunger and satiety through 11 But it is less known that behavioural cues, followed by a NHS breastfeeding actually heightens correct interpretation of those infants’ ability to self-regulate cues and a response from the RCN12 their energy intake.3 There’s caregiver.7 Breastfeeding naturally two parts to this; the act of If you want to find out more about lends itself well to the activity of the ‘UNICEF Baby Friendly Initiative’, breastfeeding and the breast responsive feeding as there is no you can find their top tips for responsive milk itself. set limit of preplanned milk and bottle-feeding on our website Research has shown that infants the mother and baby are in such close proximity.8 fed breast milk from a bottle, How else can we rather than directly from the When breastfeeding is not help to support infants breast, were 67% less likely to possible, feeding responsively respond to their internal satiety may still be possible from a grow at a healthy rate? cues.4 What’s more, babies fed bottle. To help parents and Whilst we have discussed the breast milk from a bottle, rather caregivers SMA® Nutrition importance of the behavioural than from the breast, gained has developed a leaflet full of aspects of infant feeding, it’s significantly more weight, which practical tips which is available recognised that the nutritional could be linked to an increased to download from our website. risk of obesity in later life.5,6 profile of food given to an infant in early life is significant too. The act of breastfeeding, rather than just breast milk, With that in mind, over the past ® is therefore associated with 50 years, SMA Nutrition has better appetite regulation. invested in protein research to develop a low quantity, high quality protein formula following evidence that this supports slower growth rates comparable to that of a breastfed baby.13

What to remember to tell parents when responsively feeding

Hungry Full • Sucks on fists • Is distracted • Smiles and gazes at caregiver • Turns head away • Opens mouth while feeding • Spits out the nipple or falls asleep • Cries or fusses • Slows or stops sucking • Wakes or tosses • Seals lips

p46-47.CPMARCH16.indd 46 24/02/2017 16:33 BREASTFEEDING IS BEST FOR BABIES FOR HEALTHCARE PROFESSIONALS ONLY

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Using a formula that has a protein profile closer to breast milk supports healthy growth13

Percentage difference of essential amino acids compared to breast milk15

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References: 1. United Nations System (2006). The double 16 burden of Malnutrition- a challenge for cities worldwide. Third By combining the practical elements of responsive parenting World Urban Forum SCN Statement, Vancouver 19–23 June with a formula clinically proven to show growth comparable http://www.unsystem.org/scn. 2. Singhal A and Lucas A. 13 2004. Early origins of cardiovascular disease: is there a to a breast fed baby , we can help give formula-fed infants unifying hypothesis? The Lancet 363, 1642–1645. 3. Schwartz the best chance for healthy growth and the associated C, Scholtens PAMJ, Lalanne A et al. 2011. Development of healthy eating habits early in life. Review of recent evidence lifelong benefits. and selected guidelines. Appetite. 57 (3), 796–807. 4. DiSantis KI, Collins BN, Fisher JO, Davey A. 2011. Do infants fed directly from the breast have improved appetite regulation and slower growth during early childhood compared with infants fed from the bottle? Int J Behav Nutr Phys Act. 8 (89). 5. Li R, Magadia J, Fein S, Grummer-Shaw LM. 2012. Risk of IMPORTANT NOTICE: The World Health Organisation (WHO) has recommended Bottlefeeding for Rapid Weight Gain During the First Year of Life. Arch Pediatr Adolesc Med. 166 (5), 431–436. 6. Harder T, that pregnant women and new mothers be informed on the benefits and Bergmann R, Kallischnigg G, Plagermann A. 2005. Duration of superiority of breastfeeding – in particular the fact that it provides the best breastfeeding and risk of overweight: a meta-analysis. Am J Epidemiol. 162 (5), 397–403. 7. Black M and Aboud FE. 2011. nutrition and protection from illness for babies. Mothers should be given guidance Responsive Feeding Is Embedded in a Theoretical Framework of Responsive Parenting. J Nutr. 141, 490–494. 8. Harbron J, on the preparation for, and maintenance of, lactation, with special emphasis on Booley S, Najaar B, Day CE. 2013. Responsive feeding: establishing healthy eating behaviour early on in life. S Afr J the importance of a well-balanced diet both during pregnancy and after delivery. Clin Nutr. 26 (3), 141–149. 9. UNICEF Guidelines for Bottle- Unnecessary introduction of partial bottle-feeding or other foods and drinks feeding. Available at http://www.unicef.org.uk/unicef-assets/ pdfs/Baby%20Friendly%20responsive%20bottle%20feeding should be discouraged since it will have a negative effect on breastfeeding. %20tips%20red%20book%20p4.pdf (accessed August 2016). 10. WHO, nutrition, complementary feeding. Available at Similarly, mothers should be warned of the difficulty of reversing a decision not http://www.who.int/nutrition/topics/complementary_ feeding/en/ (accessed August 2016). 11. NHS Choices – to breastfeed. Before advising a mother to use an infant formula, she should be your breastfeeding questions answered. Available at advised of the social and financial implications of her decision: for example, if a http://www.nhs.uk/Conditions/pregnancy-and-baby/ Pages/your-breastfeeding-questions.aspx (accessed August baby is exclusively bottle-fed, more than one can (400 g) per week will be 2016). 12. Royal College of Nursing, formula feeds, 2016. 13. Grathwohl DJ et al. 2010 Abstract at EAPS Congress needed, so the family circumstances and costs should be kept in mind. Mothers 2010. 14. Kirchberg FF, Harder U, Weber et al. Dietary Protein Intake Affects Amino Acid and Acylcarnitine Metabolism in should be reminded that breast milk is not only the best, but also the most Infants Aged 6 Months. J Clin Endocrinol Metab. 100 (1), 149– 58. 15. Nestle Data on File, 2014. 16. Savage JS, Birch LL, economical food for babies. If a decision to use an infant formula is taken, it is Marini M, Anzman-Frasca S and Paul IM., 2016. Effect of the important to give instructions on correct preparation methods, emphasising that INSIGHT Responsive Parenting Intervention on Rapid Infant Weight Gain and Overweight Status at Age 1 Year A unboiled water, unsterilised bottles or incorrect dilution can all lead to illness. Randomized Clinical Trial. JAMA Pediatr. 170 (8), 742–749.

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p46-47.CPMARCH16.indd 47 24/02/2017 16:33 DIARY

Upcoming courses, training and events relevant to practice… 24 March CHIEF NURSING OFFICER SAFER SLEEP WEEK British Library, London FOR WALES CONFERENCE 13-19 March W: bit.ly/register_BL 10 May The Lullaby Trust’s national 29 March Annual showcase conference, awareness campaign invites Library of Birmingham enabling nurses and midwives healthcare professionals to W: bit.ly/register_ to share good practice, new promote safer sleep to parents Birmingham ideas and celebrate successes. of young babies. See online for Topics include leadership, details and free resources. MATERNAL AND quality, workforce development W: bit.ly/safer_sleep_week CHILDHOOD OBESITY and patient/public involvement. #safersleepweek SYMPOSIUM Location: Cardiff City Stadium 29 March W: bit.ly/CNO_Wales_2017 SUPPORTING CHILDREN An opportunity for nurses, AND FAMILIES AFFECTED teachers, practice nurses and CHILD SAFETY WEEK BY A FAMILY MEMBER’S commissioners to hear from 5-11 June OFFENDING – A leading experts, also service The Child Accident Prevention PRACTITIONER’S GUIDE user experiences and an Trust is asking professionals 20 March opportunity to network. to share their experience and Join i-HOP as it launches its Location: Central London knowledge – not just about practitioner’s guide about the horrors of accidents, but the impact of a loved one’s EUROPEAN DAY OF practical steps to prevent them. off ending on the whole family, ACTION AGAINST W: bit.ly/CAPT_CSW2017 and eff ective interventions. COMMERCIALISATION Location: Birmingham OF HEALTHCARE SCHOOL NURSES W: bit.ly/i-HOP_guide_launch 7 April INTERNATIONAL 2017 E: charlotte.caldwell@ A day of action across Europe CONFERENCE barnardos.org.uk to denounce current austerity 24-28 July measures, their consequences The theme for this year’s BOOKSTART EVENTS and free trade. conference is ‘School nurses BookTrust is holding some W: bit.ly/Europe_health_ interacting within the public events throughout March to network health model to promote the encourage a multi-agency health of children – globally’. approach to delivering the LOVEOVE YOUR HEALTH Location: San Francisco, US Bookstart programme. VISITOR/SCHOOL NURSESE W: bit.ly/SNI_2017 20 March LOBBY OFOF PARLIAMENT PARLIAMENT Nottingham Waterstones ADVERTISE WITH US 26 April W: bit.ly/register_Nottingham Join Unite-CPHVA in this unique If you would like to 21 March opportunity to present the advertise here, contact Manchester Central Library case for public health services senior sales executive Alex W: bit.ly/register_Manchester directly to MPs in the House of Edwards on 020 7324 2735 23 March Commons.C See page 26 of thiss or email alex.edwards@ Middlesbrough Library issuesue for details. redactive.co.uk W: bit.ly/register_ Location:atiiono : Londonon Middlesbrough

48 Community Practitioner March 2017

iary ae.indd 01/03/2017 15:2 LAST WORD

have spent my entire working life trying Sue Ashmore, to improve care for women who want director of the Baby to breastfeed, and yet I still hesitate to write openly about it. This is because Friendly Initiative breastfeeding is such a fraught subject in Ithe UK – often viewed as diffi cult to achieve, at Unicef UK, and sometimes seen as unnecessary, discusses why we because of a mistaken perception that need to change the formula milk is a close second best. Each time I write about breastfeeding, conversation around I face a dilemma. On one hand, there is more evidence than ever before that breastfeeding. breastfeeding has long-lasting and profound benefi ts for both mother and baby. On the other hand, simply stating this fact causes pain and anger for the many families who tried very hard to breastfeed but were not able to. I really do understand that pain, because those people are also my own friends and family. But does that pain and anger mean we ought to keep quiet about breastfeeding? Or should we do everything we can to remove those barriers that prevented women from successfully breastfeeding in order that more babies can be breastfed

in future? ISTOCK

March 2017 Community Practitioner 49

9-50 a rd.indd 9 01/03/2017 15: LAST WORD

NEW EVIDENCE At the start of this year, the Royal In our ‘Change the College of Paediatrics and Child conversation’ campaign, we’re Health’s State of child health calling on health departments report highlighted the vast child across England, Northern Ireland, health inequalities between Scotland and Wales to lead the socio-economic groups in the UK, way in removing the barriers to and the UK’s poor child health breastfeeding. These are many record compared with the rest and varied, and include: of Europe. With the UK ranking ●Insuffi cient professional support 15 out of 19 European countries to get breastfeeding off to a on infant mortality, it called good start for urgent steps to be taken to ●Not enough community improve child health, including support to deal with problems a increasing our worryingly low bit further down the line breastfeeding rates. ●A lack of understanding about This followed the publication how important breastfeeding of new evidence in The Lancet is for health and brain that delivered a resounding development. verdict: breastfeeding saves lives and There are also ways that those of us who improves health in every country in the are not politicians can help. We can call on world. It helps to reduce obesity, cancer, FEEDING FACTS shops and restaurants to be breastfeeding- diabetes and leads to higher IQ. But friendly, ensure that our workplace has the report also found that women are breastfeeding-friendly policies, be non- constantly failed by the societies in which 8 out of 10 judgemental about how an individual they live, because without a supportive women stop breastfeeding woman is feeding her baby (an outsider environment around you, breastfeeding before they want to can never know the diff erent pressures can become almost impossible. she may have come under), and, of course, In the UK, we have excelled at placing gently speak up on behalf of a breastfeeding barriers in the way of women who want to woman if she is being given a hard time in a breastfeed, while at the same time insisting public place. that ‘breast is best’ – a lethal combination What we really need to address is the that sets women up to fail and then makes fact that the UK’s low breastfeeding rates them feel really guilty about it. The result are a public health issue – and addressing is that the UK has some of the lowest this issue cannot be the responsibility of breastfeeding rates in the world. an individual mother living in a society In the past, well-meaning breastfeeding that normalises bottle-feeding and paints promotion has sometimes been insensitive breastfeeding as controversial, diffi cult and and over-zealous. This is changing, with Babies receiving any breastmilk unnecessary. That is the conversation we maternity units and health visiting services by six months need to change. Instead, let’s talk about working hard to ensure that care is mother- removing the barriers that stop women centred and free from judgement. UK 34% breastfeeding, and then allow mothers to But we have a far bigger mountain to carry out their own informed decisions with climb in terms of removing the barriers dignity and respect. Let’s insist that our – social, cultural, practical and economic – US 49% governments show leadership and respond that prevent successful breastfeeding. to the overwhelming evidence around the NORWAY benefi ts of breastfeeding. CP SUPPORTING WOMEN 71% Last year, we launched a campaign ●To take part in Unicef’s call to UK to ‘Change the conversation’ around of health visiting governments to take urgent action to breastfeeding. We wanted to stop the services are remove the barriers to breastfeeding, pressure piled onto individual women 85% engaged with go to unicef.uk/gemzcq to breastfeed, and instead build an Baby Friendly (62% ●The State of child health report can be environment that is supportive of women, fully accredited) viewed at bit.ly/RCPCH_soch2017 by removing the barriers that block ●To read more about The Lancet studies, Source: Unicef Baby Friendly Initiative Call to action, 2016 successful breastfeeding. go to bit.ly/Unicef_lancet_breastfeeding

50 Community Practitioner March 2017

9-50 a rd.indd 50 02/03/2017 12:25 Courses 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 Available ‘In House’ throughout the UK Learn Baby Massage with the International Two Day Teacher Training in Developmental Association of Infant Massage Baby Massage with Peter Walker Train to become a Certified Infant Membership of the IAIM UK UK and International Accredited Teaching Certifi cates Federation of Prenatal Chapter includes: Education and Independent Professional Therapists International Massage Instructor with the International Association of Infant OA local, national and international A unique course with Peter Walker a teacher’s trainer, physical therapist, author and Massage (IAIM), the largest and longest support network yoga teacher with over 40 years experience in the delivery of baby massage training standing worldwide association solely OContinued professional development as well as providing group and one-to-one sessions to parents with children with dedicated to baby massage. Our including study days with expert special needs. A background in physical therapy and yoga underpins the high quality curriculum is taught in more than 45 speakers, trainer-led massage stroke of his training programme, with techniques based on the stages of baby’s physical countries and has been developed and refresher sessions and a biennial and emotional development, supported by neuroscience research on baby’s brain refined over 30 years through research, international conference development. Peter Walker is credited with the free teaching of baby massage in NHS reflective practice and practical OAccess to relevant articles, centres throughout the UK. experience. This has resulted in a widely information and the latest research 1. The importance of Emotional • Relief of common infant ailments. endorsed and implemented parenting on our website Intelligence and a Loving Touch. • Consideration of babies with programme. OA regular newsletter. Bonding and Attachment - birth additional needs and Our training courses are run regularly at to eight weeks (can also be taught developmental delay. Our highly acclaimed comprehensive centres nationwide and are facilitated antenatal) • Includes contra-indications, safety, training comprises: by experienced IAIM Trainers. • Emotional Intelligence and correct baby massage oils and OA four-day training course including Attachment. usage. supervised practical teaching of a Find us on Facebook - IAIM UK Chapter • Introducing overall good reciprocity parent/baby massage class 3. Primary Preparation for Infant to facilitate mother-infant relaxation OA take home written assignment For further details please visit Balance and Good Posture and ‘bonding’. OFurther practical teaching and reading. www.iaim.org.uk. In-house • Relieve intra-uterine and diffi cult 4. High quality resource. Copy of trainings are available on request. birth experience. Developmental Baby Massage book By training with our highly respected • Relieve physiological fl exion and with DVD and course notes for organisation you will join a worldwide IAIM (UK) Chapter abdominal tension. teachers and parents/carers network of instructors offering a 0208 989 9597 supportive environment to teach [email protected] • Release the diaphragm and Developmental Baby Massage Courses life-long parenting and relaxation skills. www.iaim.org.uk improve respiration. Available ‘In House’ throughout the UK. Next open courses for 2017 at 2. Developmental Baby Massage – 8 THE ACTIVE BIRTH CENTRE, 25 BICKERTON weeks to Standing • Baby-led sessions. ROAD, LONDON N19 5JT • Quality time for parents to get 22nd and 23rd April 2017 to know their baby through a loving touch, learning about baby’s cue’s 30th September and 1st October 2017 and communication. Also see • Benefi ts of safe tummy time. www.babymassageteachertraining.com • Baby observation for a foundation www.thebabieswebsite.com of secure attachment. Email: [email protected] Touch-Learn International’s • Infant development, relevant Tel: 01752 939767 anatomy and physiology. Post course support given. Free bi-monthly Baby Massage Teacher Training quality newsletter • Improving circulation, respiration, Clinic For Mothers with Babies with Venues across the UK, plus in-house back strength, joint fl exibility and Developmental Delay using Skype/FaceTime OAll mechanisms identifi ed in current overall muscle tone. Email [email protected] option. A fi ve-day, comprehensive research to support parent-infant baby massage teacher course for relationships health professionals and parenting OUnderpinning theory based on practitioners provided by Touch-Learn current research Millpond Children’s Sleep Workshop – Training NHS professionals since 2007 International, the exemplary training O Practical teaching in the fi eld 100% of delegates would recommend to a colleague company. This highly acclaimed  programme is accredited by The Royal ORelevant anatomy and physiology TUESDAY 25th APRIL 2017 CENTRAL LONDON College of Midwives and the University OQuality supporting materials and of Wolverhampton. text books Our popular one-day interactive workshop, designed for professionals This quality training programme OSummative assessment working with families with babies through to school age children. includes simple massage techniques, OFree, informative biannual • Explore sleep cycles/needs coupled with an in-depth knowledge newsletter • Understand child sleep problems to practise safely, ethically and O Tutorial and on-going support • Interpret sleep information professionally so practitioners feel  questionnaires and diary • Plan a range of sleep techniques confi dent to teach parents in a variety • Lunch & book included of settings. Trainers are all experienced Other courses from Touch-Learn practitioners with professional/HE OMassage for Babies with Special NEW teaching qualifi cations. Needs PRICE O Baby Yoga Teacher Included within the course: O Baby Signing Teacher £110 OStrategies to empower parents OBaby Wearing Advisor

For further details of in-house training and UK dates please ring or visit www.touchlearn.co.uk Touch-Learn International Ltd T : 020 8444 0040 Tel: 01889 566222 [email protected] E: [email protected] www.touchlearn.co.uk W: www.millpondsleepclinic.com

aRe.indd 51 2/02/2017 16:15 ® Naturally Beautiful Babies

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