Memorandum by Community Practitioners
and Health Visitors Association (PH 61)
1. The CPHVA welcomes the opportunity to
submit evidence to the Health Select Committee on the review of
the public health function. The CPHVA is the UK professional body
that represents registered nurses and health visitors who work
in a primary or community health setting. The CPHVA is an autonomous
section of the MSF trade union. With 18,000 members, it is the
third largest professional nursing union and is the only union,
which has public health at its heart. To this end within its small
professional team the CPHVA appointed in February of this year
a professional officer with a dedicated lead on public health.
1.1 The core functions of the CPHVA include:
provision of specialist professional
support and professional advice to
provision of education and training
advocacy on behalf of its members.
1. HEALTH ACTION
2.1 The CPHVA fully supports these initiatives
of working with local communities. However, there has been slow
establishment of many of the initiatives with the focus on systems
as much as content at present. We also feel strongly that these
initiatives should not sit in isolation of each other but should
fit into a collective plan for the local community. This becomes
more evident as the life of these initiatives draws to a close.
The CPHVA seeks reassurance that detailed exit strategies are
put into place. There is also a need to ensure that there is a
community voice in developing these strategies.
2.2 The CPHVA views the HimPs as the public
health vehicle and we strongly believe that there should be coterminosity
between Local Authority and PCT boundaries to facilitate inter-agency
2.3 The CPHVA would like to see recognition
of the contribution that health visitors and community nurses
can bring to local health needs assessment through for instance
community, school and caseload profiling.
2.4 The CPHVA have concerns regarding the
omission of health improvement targets for children and young
people in the first year of HimPs. The CPHVA has concerns about
child and adolescent mental health services in terms of does it
really fit with adult mental health services? Are we doing children
an injustice by this link? Also, there is the need to ensure that
"transitional care" services (between 16 to 18) are
being developed sensitively.
2.5 The CPHVA would stress the need for
the development of long term outcomes as well as short term outcomes,
which is of particular relevance in relation to public health.
Qualitative measures as well as quantitative measures should also
be developed and equally valued.
3. THE HEALTH
3.1 The CPHVA is seeking to work closely
with the HAD particularly in relation to building an evidence
base for public health practice. The Chair of the CPHVA has just
been appointed as a Non Executive Board Member of the HAD, which
will certainly strengthen our working relationships.
3.2 The CPHVA feels that the strategic direction
of the HAD looks promising but feel that it is important to ensure
effective health promotion is not lost between HAD and NICE.
4. PCGS AND
4.1 The development of a primary care lead
NHS has provided opportunities for a more public health focused
service. However, the CPHVA being committed to the professional
development of its members as public health practitioners, feels
the structures being established to support these developments
often do not allow practitioners to develop their new roles to
the full potential.
4.2 The CPHVA has strong concerns regarding
the demographic profile of the current health visitor and community-nursing
workforce. Disinvestment in services in recent years, reduced
training places and the fact that a large percentage of this workforce
will reach retirement age within the next five years. The CPHVA
is also aware of diversities in workforce planning regionally.
These issues are particularly acute within health visiting and
school nursing where these two groups have been identified as
public health practitioners with key roles in delivering the public
health agenda. The CPHVA wishes to see re-investment in health
visiting and community nursing with training being mandatory requirement
for all nurses working at specialist practitioner level.
4.3 The potentially pivotal role that PCTs/PCGs
have in public health is recognised but there needs to be an acknowledgement
that there are skills gaps and leadership issues that must be
addressed. There is also the need to develop more socially based
models of service delivery.
4.4 As advocates for the clients they serve
health visitors and community nurses need to have close working
relationships with public health departments. Therefore public
health departments should not be divorced from PCTs.
4.5 Current structures may not facilitate
joint working in some instances, eg differing "employers"
some school nurses acute based, some education, most primary based.
The CPHVA has concerns that the public health function of school
nurses is not lost and to this end would see the service best
placed within PCTs.
5. THE ROLE
5.1 The CPHVA applauded the Governments
move to introduce a new ministerial post responsible for public
health and the fact that this post has been maintained. The CPHVA
does consider that this should be a senior ministerial post given
that public health is such a key policy area and we would question
the rationale for the "downgrading" of the post.
5.2 The CPHVA supports the Governments commitment
to cross-departmental working which is so crucial to the implementation
and sustainability of public health policy. The CPHVA sees the
Minister's post as being pivotal to ensuring that this happens.
There have been consultation documents published from one department
where clearly the link to other departments has not happened.
Eg the proposed Personal Advisor Scheme within the Connexions
6.1 The CPHVA feels that there is a need
for some debate around where this role should sit within the new
emerging structures in order to effect most credibility and hold
6.2 The CPHVA feels strongly that the post
of Director of Public Health should not be confined to doctors
but open to any public health practitioner. There needs to be
investment in public health education with career structures for
all professionals involved in public health. The multi-disciplinary
Specialist Practice Pathway in Public Health, which is being developed,
could provide an avenue for this shift, the CPHVA is contributing
to this development.
7. REDUCING HEALTH
7.1 The CPHVA have concerns that some of
the initiatives set out to reduce health inequalities may in fact
produce inequalities in some areas. Health visitors and community
nurses report a difficulty in accessing funding streams and therefore
we would support a move away from funding of special projects
to more mainstream funding.
7.2 The CPHVA feels that only through "joined
up policy" eg "Sure Start" can we hope to achieve
a reduction in health inequalities. What is needed is clear markers;
agreed by stakeholders and with long enough timescale.