Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 480 - 483)



  480. Do the health visitors share that view?
  (Ms Amadi) I would tend to say if life was different and we were able to have the resources that we desired, you would find much more of a universal service. At the moment where resources are limited, prioritising has to happen and the priority for a lot of trusts, although there is a variation in different areas, would be towards children under five. There is a recognition that we need to invest in our children. They are the future politicians.


  481. Do not put it that way, please!
  (Ms Amadi) If you think about the health visiting service that may be provided in an area where there is a more elderly population, quite clearly you will see more evidence of, for example, health visitors for the elderly and the specialists will be reflected in the population because when you have the resources and you do your needs assessment, you identify what the health priorities are for that particular area and then you resource them. It would follow that you would see health visitors or a range of community nurses working in a variety of settings that you do not see now because there is this real tight resource issue.

John Austin

  482. Can I also raise a question about the school nurse which certainly in my area is a diminishing resource. We have come a long way from the old vision of the "nit nurse" and annual medical inspections to in many areas school nurses being used in a very positive, health promotion role. What do you see as the role of the school nurse in the public health agenda?
  (Ms Jackson) We have just published a strategy on school nursing within the public health agenda. We have identified four areas of practice for school nurses, healthy schools being one of those areas, child and adolescent mental health, vulnerable young people, and children with chronic and complex health needs being the fourth area of practice. Those four areas of practice are based on the needs of the school age population UK-wide and also based on the policy agenda currently. We would see school nurses as working in a more flexible way than they have done hitherto. They have been very much governed by contacts, by screening, which fortunately is now going. We would like to see school nurses working with schools undertaking health needs assessments within those schools which will then contribute to the overall health needs assessment within a given area to then identify particular needs for a school. One school does not necessarily have to receive the same service as the other schools; it should be based on need. In Huddersfield they have got the health needs assessment process for the school age population down to a T. It is multi-agency and it includes secondary care, social services and the police, and so on, and from that they are able to identify particular needs. They know, for instance, that one of their secondary schools equates to 20 per cent of the teenage pregnancy rate in Huddersfield and they are able to target their services on those schools and also support schools in their own targets in meeting the healthy schools standard. We would like to see school nurses working outside the school gates which some are developing. In Hertfordshire a school nurse is working with children who are looked after. She is not working in a school but in a residential care home providing the same service that those young people would have received in the school setting. School nurses have predominantly been term time and part-time term time. We want to see school nurse services all year around. Children and young people have lives outside of schools and that is where obviously lots of issues occur and where there is also a need for the service.


  483. Are there any quick final questions or any points that any of the witnesses want to add?
  (Dr Crowley) I would like to clarify one thing we have touched on very briefly about the links with communities in Newcastle. I would like to impress upon the Committee what we have tried to do in Newcastle about creating partnerships with communities, which has been built around the community development approach focused on equity. We have also tried to develop representation for communities that is accountable to wider networks. And my concern is we are continuing down a road whereby the interests of the public and patients are represented by isolated individuals on committees. I think the NHS Plan brings us further down that road. I would like to underline the strength that we have found in creating community networks around representatives whereby a much wider agenda is then brought to the different committees, whether it be a PCT or a PCG or a health partnership. The resources to develop that are much better off owned by the community and accountable to them, not managed by the system. Finally, and parallel to that, what we need is a situation whereby decision-making by the health structures or partnership structures is in parallel made considerably more open to outside influence than it currently is, otherwise the community links will come to nothing.
  (Professor Drinkwater) From the professional side the strength of that is that it is far more difficult to marginalise that from a professional perspective. It is relatively easy to marginalise a single main representative on a PCG but in that sort of model, where you have got a representation which is supported and where you have an annual community conference, you ignore that at your peril.

  (Dr Heath) We would support that.

  Chairman: Can I thank you for your very helpful evidence this morning. There are a number of areas we have not pursued because of lack of time and it might well be that we will write to you with further questions. If there are any points you would like to add to your evidence we would be very happy to hear from you. Thank you very much for your evidence this morning.

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