Re: The Future of HV and SN

June 24, 2001

Dear Pippa,

I do entirely accept your rationale but continue to have anxieties that

health visiting will dissapear as the new public health nurses come off

line. I forsee a not too distant future when health visiting will

be substituted by a community nurse (lower grade of course) that would

undertake child surveillance child protection and check for PND.

The more complex role of the HV is being shared out between others.

I guess if after all this time our value has not been 'felt' nor appreciated

by colleagues and policy makers then perhaps a more limited role in the

future is appropriate. I know that many families would miss us but

those who will have families in the future would be unknowing of the service

that they are not having. I must say that my HV colleagues in this

area seem pretty complacent about the future. I seem to be more or

less alone in being alarmed about what is happening in the Bath area.

Regards,

Ruth Grant

P Bagnall wrote:

The

primary purpose of the variuos regulatory bodies is to protect the public.

I have a real problem with the notion of "defending health visiting".

Just exactly what is being defended? Professional status, a unique

professional group? To what gain? I still can't get to grips

with this. From the

school nursing point of view I find the separate registration for health

visitors is unhelpful. I warm to the idea of combining health visiting

and school nursing under the public health umbrella but I do believe they

have different contributions to make. I wrote an article in the NT

(about May 1999) suggesting we consider health visitors as child and family

focussed and school nurses as adolescent health specialists. I have

explored this model with a number of groups of health visitors and school

nurses and whilst HVs are concerned at the suggestion that they may have

a direct contribution to make to children beyond the age of five there

has been a genuine willingness to consider this model. Incidentally,

school nurses evolved out of the need for HVs to delegate (according to

one SENATE member). Why did this happen? Was it just too much

work, was it because children's and adolescents needs were deemed to be

less important or was it because a separate set of skills are required.

Whilst this may have not been a direct decision I would like to suggest

that the latter was perhaps a significant contributing factor. As

courses for school nurses develop they cover some very important subjects

perhaps overlooked in the past i.e. teenage pregnancies and the sexual

health requirements of young people, depression and deliberate self-harm

in adolescents, eating disorders and body image, bullying, self-confidence

and self-esteem , learning difficulties etc.etc. Whilst these may

link with HV education I think there is validity in concentrating in depth

on the unique needs of young people and adolescents. Incidentally,

I am not upset, just trying to make a contribution that extends SENATE'S

deliberations beyond health visiting. It is good to be able to explore

issues which are important in such a neutral way. Without wishing

to sound defensive it would be better if the debate could concentrate on

the value of professional contributions rather than a sort of "them and

us" approach. If SENATE

is purely about defending HV registration then I will keep quiet (I am

by no means an expert on this matter but I can't help feeling that this

"separateness" is not helpful). If, as the title suggests, it is

about shaping the future of health visiting and school nursing I will gladly

share my views. My dream would be to see robust body talking up health

visiting and school nursing and debating the future public health nursing!

June 24, 2001

Dear Pippa

surely what needs to be defended is an approach to practice that health

visiting has. I agree with Ruths comments and would like to add that

health visitors may well spend alot of their time with families of young

pre-school aged children, but this not means that there focus of care is

only about pre-school aged children. Their practice is within the whole

community, fullfilling the principles of HVing and working at a macro

level. Working to improve the life chances of yes young children but

also the adults who are responsible for them and for those whose

lifestyles impact on the life of others. Which means of course that they

shouldn't be carving up their care for age groups, but should continue to

focus on needs across a population. Doing this collaboratively with

school nurse colleagues who have particular expertise with school aged

children.

Quoting P Bagnall <p.bagnall@...>:

> The primary purpose of the variuos regulatory bodies is to protect

> the publ> ic. I have a real problem with the notion of " defending health

> visiting " . > Just exactly what is being defended? Professional

status, a

> unique profess> ional group? To what gain? I still can't get to grips

with this.

>

> From the school nursing point of view I find the separate

> registration for > health visitors is unhelpful. I warm to the idea of

combining

> health visiti> ng and school nursing under the public health umbrella

but I do

> believe the> y have different contributions to make. I wrote an

article in the

> NT (abou> t May 1999) suggesting we consider health visitors as child

and

> family focu> ssed and school nurses as adolescent health specialists.

I have

> explored t> his model with a number of groups of health visitors and

school

> nurses and > whilst HVs are concerned at the suggestion that they may

have a

> direct cont> ribution to make to children beyond the age of five there

has been

> a genuin> e willingness to consider this model.

>

> Incidentally, school nurses evolved out of the need for HVs to

> delegate (ac> cording to one SENATE member). Why did this happen? Was

it just

> too much > work, was it because children's and adolescents needs were

deemed

> to be les> s important or was it because a separate set of skills are

> required. Whils> t this may have not been a direct decision I would

like to suggest

> that the> latter was perhaps a significant contributing factor. As

courses

> for scho> ol nurses develop they cover some very important subjects

perhaps

> overlooke> d in the past i.e. teenage pregnancies and the sexual health

> requirements o> f young people, depression and deliberate self-harm in

> adolescents, eating > disorders and body image, bullying, self-

confidence and

> self-esteem , learn> ing difficulties etc.etc. Whilst these may link

with HV education

> I think > there is validity in concentrating in depth on the unique

needs of

> young pe> ople and adolescents.

>

> Incidentally, I am not upset, just trying to make a contribution

> that exten> ds SENATE'S deliberations beyond health visiting. It is

good to be

> able to > explore issues which are important in such a neutral way.

Without

> wishing > to sound defensive it would be better if the debate could

> concentrate on th> e value of professional contributions rather than a

sort of " them

> and us " a> pproach.

>

> If SENATE is purely about defending HV registration then I will

> keep quiet > (I am by no means an expert on this matter but I can't help

> feeling that th> is " separateness " is not helpful). If, as the title

suggests, it

> is about > shaping the future of health visiting and school nursing I

will

> gladly shar> e my views. My dream would be to see robust body talking

up health

> visiting> and school nursing and debating the future public health

nursing!

>

Whittaker

Senior Lecturer

Dept of Nursing

University of Central Lancashire

Preston

This message was sent by Easymail - http://www.easynet.co.uk/

June 25, 2001

Pippa, thank you for suggesting that what is being defended is a unique

professional group. That is exactly how I see it. In common with school

nursing the health visitor is dealing with the well population. I like to

think that alongside school nurses we have this strong focus on prevention.

Do you know, it is hard to explain this holistic approach so how about an

example from my own practice. A mother has a substance abuse problem that

impacts on the behaviour of her three year old and it also means that her

six year old doesn't get to school, her partner has just been made redundant

is depressed and the family are now in rent arrears. Her very supportive

neighbour often in the house tells the HV during a home visit that a money

lender is about to get heavy-handed. I dont know of any other bit of

'nursing' where the social model of health is such a driver. In this case

based on a true story the HV worked on the behaviour of the three year old,

liaised strongly with the school nurse for the needs of the six year old.

Worked with the husband encouraging recognition of his own needs with an

eventual referral to the CPN. There was ongoing intermittant help from the

social worker, the health visitor was the bridge to that service, liaison

from the health visitor to the housing department meant they were supportive

over the arrears. The police intelligence officer was already on the case

over the money lender and also the drug situation on the estate. The mother

eventually re-engaged with the substance misuse team. And so the long term

work of health visiting went on. The health visitor was the channel through

which it all flowed. I guess this case was about demonstrating holism and

prevention and dealing with the needs of the whole family and what that

really means. No wonder HV's are aghast when they get pigeon-holed into the

0-5's. That was never my experience of the job. SO back to where I came in

the job of health visiting is unique and thank you once again for reminding

us of that fact and of the importance of the current debate and your

perspective and contribution to it.

Houston

>From: " P Bagnall " <p.bagnall@...>

>Reply-

>< >

>Subject: The Future of HV and SN

>Date: Sun, 24 Jun 2001 19:49:43 -0700

>

>The primary purpose of the variuos regulatory bodies is to protect the

>public. I have a real problem with the notion of " defending health

>visiting " . Just exactly what is being defended? Professional status, a

>unique professional group? To what gain? I still can't get to grips with

>this.

>

>From the school nursing point of view I find the separate registration for

>health visitors is unhelpful. I warm to the idea of combining health

>visiting and school nursing under the public health umbrella but I do

>believe they have different contributions to make. I wrote an article in

>the NT (about May 1999) suggesting we consider health visitors as child and

>family focussed and school nurses as adolescent health specialists. I have

>explored this model with a number of groups of health visitors and school

>nurses and whilst HVs are concerned at the suggestion that they may have a

>direct contribution to make to children beyond the age of five there has

>been a genuine willingness to consider this model.

>

>Incidentally, school nurses evolved out of the need for HVs to delegate

>(according to one SENATE member). Why did this happen? Was it just too

>much work, was it because children's and adolescents needs were deemed to

>be less important or was it because a separate set of skills are required.

>Whilst this may have not been a direct decision I would like to suggest

>that the latter was perhaps a significant contributing factor. As courses

>for school nurses develop they cover some very important subjects perhaps

>overlooked in the past i.e. teenage pregnancies and the sexual health

>requirements of young people, depression and deliberate self-harm in

>adolescents, eating disorders and body image, bullying, self-confidence and

>self-esteem , learning difficulties etc.etc. Whilst these may link with HV

>education I think there is validity in concentrating in depth on the unique

>needs of young people and adolescents.

>

>Incidentally, I am not upset, just trying to make a contribution that

>extends SENATE'S deliberations beyond health visiting. It is good to be

>able to explore issues which are important in such a neutral way. Without

>wishing to sound defensive it would be better if the debate could

>concentrate on the value of professional contributions rather than a sort

>of " them and us " approach.

>

>If SENATE is purely about defending HV registration then I will keep quiet

>(I am by no means an expert on this matter but I can't help feeling that

>this " separateness " is not helpful). If, as the title suggests, it is

>about shaping the future of health visiting and school nursing I will

>gladly share my views. My dream would be to see robust body talking up

>health visiting and school nursing and debating the future public health

>nursing!

>

_________________________________________________________________________

Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com.

June 25, 2001

Dear Ruth

I echo some of your concerns but I feel taht a lot fo the complacency is due to

lack of awareness/knowledge of what is uner discussion/threat. Many

practitioners are so bogged down at the moment that when they have come up for

air

the issues that have been discussed and the implications of them are unknown to

them. Am I the only one who feel this?

Toity

On Sun, 24 Jun 2001 21:37:06 +0100

ruthngrant <ruthngrant@...> wrote:

> Dear Pippa,

>

> I do entirely accept your rationale but continue to have anxieties that

> health visiting will dissapear as the new public health nurses come off

> line. I forsee a not too distant future when health visiting will be

> substituted by a community nurse (lower grade of course) that would

> undertake child surveillance child protection and check for PND. The

> more complex role of the HV is being shared out between others. I guess

> if after all this time our value has not been 'felt' nor appreciated by

> colleagues and policy makers then perhaps a more limited role in the

> future is appropriate. I know that many families would miss us but

> those who will have families in the future would be unknowing of the

> service that they are not having. I must say that my HV colleagues in

> this area seem pretty complacent about the future. I seem to be more or

> less alone in being alarmed about what is happening in the Bath area.

>

> Regards,

>

> Ruth Grant

>

> P Bagnall wrote:

>

> > The primary purpose of the variuos regulatory bodies is to protect the

> > public. I have a real problem with the notion of " defending health

> > visiting " . Just exactly what is being defended? Professional status,

> > a unique professional group? To what gain? I still can't get to

> > grips with this. From the school nursing point of view I find the

> > separate registration for health visitors is unhelpful. I warm to the

> > idea of combining health visiting and school nursing under the public

> > health umbrella but I do believe they have different contributions to

> > make. I wrote an article in the NT (about May 1999) suggesting we

> > consider health visitors as child and family focussed and school

> > nurses as adolescent health specialists. I have explored this model

> > with a number of groups of health visitors and school nurses and

> > whilst HVs are concerned at the suggestion that they may have a direct

> > contribution to make to children beyond the age of five there has been

> > a genuine willingness to consider this model. Incidentally, school

> > nurses evolved out of the need for HVs to delegate (according to one

> > SENATE member). Why did this happen? Was it just too much work, was

> > it because children's and adolescents needs were deemed to be less

> > important or was it because a separate set of skills are required.

> > Whilst this may have not been a direct decision I would like to

> > suggest that the latter was perhaps a significant contributing

> > factor. As courses for school nurses develop they cover some very

> > important subjects perhaps overlooked in the past i.e. teenage

> > pregnancies and the sexual health requirements of young people,

> > depression and deliberate self-harm in adolescents, eating disorders

> > and body image, bullying, self-confidence and self-esteem , learning

> > difficulties etc.etc. Whilst these may link with HV education I think

> > there is validity in concentrating in depth on the unique needs of

> > young people and adolescents. Incidentally, I am not upset, just

> > trying to make a contribution that extends SENATE'S deliberations

> > beyond health visiting. It is good to be able to explore issues which

> > are important in such a neutral way. Without wishing to sound

> > defensive it would be better if the debate could concentrate on the

> > value of professional contributions rather than a sort of " them and

> > us " approach. If SENATE is purely about defending HV registration then

> > I will keep quiet (I am by no means an expert on this matter but I

> > can't help feeling that this " separateness " is not helpful). If, as

> > the title suggests, it is about shaping the future of health visiting

> > and school nursing I will gladly share my views. My dream would be to

> > see robust body talking up health visiting and school nursing and

> > debating the future public health nursing!

> >

June 25, 2001

I agree Toity, anyone in practice that I have mentioned these issues to has

been galvanised by the potential implications, but they had not previously

had an opportunity to think about it as there is so much else with the

change to PCTs etc, etc going on.

Best wishes

Re: The Future of HV and SN

> Dear Ruth

>

> I echo some of your concerns but I feel taht a lot fo the complacency is

due to

> lack of awareness/knowledge of what is uner discussion/threat. Many

> practitioners are so bogged down at the moment that when they have come up

for air

> the issues that have been discussed and the implications of them are

unknown to

> them. Am I the only one who feel this?

>

> Toity

>

> On Sun, 24 Jun 2001 21:37:06 +0100

> ruthngrant <ruthngrant@...> wrote:

>

> > Dear Pippa,

> >

> > I do entirely accept your rationale but continue to have anxieties that

> > health visiting will dissapear as the new public health nurses come off

> > line. I forsee a not too distant future when health visiting will be

> > substituted by a community nurse (lower grade of course) that would

> > undertake child surveillance child protection and check for PND. The

> > more complex role of the HV is being shared out between others. I guess

> > if after all this time our value has not been 'felt' nor appreciated by

> > colleagues and policy makers then perhaps a more limited role in the

> > future is appropriate. I know that many families would miss us but

> > those who will have families in the future would be unknowing of the

> > service that they are not having. I must say that my HV colleagues in

> > this area seem pretty complacent about the future. I seem to be more or

> > less alone in being alarmed about what is happening in the Bath area.

> >

> > Regards,

> >

> > Ruth Grant

> >

> > P Bagnall wrote:

> >

> > > The primary purpose of the variuos regulatory bodies is to protect the

> > > public. I have a real problem with the notion of " defending health

> > > visiting " . Just exactly what is being defended? Professional status,

> > > a unique professional group? To what gain? I still can't get to

> > > grips with this. From the school nursing point of view I find the

> > > separate registration for health visitors is unhelpful. I warm to the

> > > idea of combining health visiting and school nursing under the public

> > > health umbrella but I do believe they have different contributions to

> > > make. I wrote an article in the NT (about May 1999) suggesting we

> > > consider health visitors as child and family focussed and school

> > > nurses as adolescent health specialists. I have explored this model

> > > with a number of groups of health visitors and school nurses and

> > > whilst HVs are concerned at the suggestion that they may have a direct

> > > contribution to make to children beyond the age of five there has been

> > > a genuine willingness to consider this model. Incidentally, school

> > > nurses evolved out of the need for HVs to delegate (according to one

> > > SENATE member). Why did this happen? Was it just too much work, was

> > > it because children's and adolescents needs were deemed to be less

> > > important or was it because a separate set of skills are required.

> > > Whilst this may have not been a direct decision I would like to

> > > suggest that the latter was perhaps a significant contributing

> > > factor. As courses for school nurses develop they cover some very

> > > important subjects perhaps overlooked in the past i.e. teenage

> > > pregnancies and the sexual health requirements of young people,

> > > depression and deliberate self-harm in adolescents, eating disorders

> > > and body image, bullying, self-confidence and self-esteem , learning

> > > difficulties etc.etc. Whilst these may link with HV education I think

> > > there is validity in concentrating in depth on the unique needs of

> > > young people and adolescents. Incidentally, I am not upset, just

> > > trying to make a contribution that extends SENATE'S deliberations

> > > beyond health visiting. It is good to be able to explore issues which

> > > are important in such a neutral way. Without wishing to sound

> > > defensive it would be better if the debate could concentrate on the

> > > value of professional contributions rather than a sort of " them and

> > > us " approach. If SENATE is purely about defending HV registration then

> > > I will keep quiet (I am by no means an expert on this matter but I

> > > can't help feeling that this " separateness " is not helpful). If, as

> > > the title suggests, it is about shaping the future of health visiting

> > > and school nursing I will gladly share my views. My dream would be to

> > > see robust body talking up health visiting and school nursing and

> > > debating the future public health nursing!

> > >

June 25, 2001

As one of the areas where your input was so vital, I applaud this perspective. In my role as professional head of nursing, I am acutely aware of the need for a specialist group of nurses to focus on the grossly unmet needs of adolescents. In Croydon, we continue to develop this model as resources allow. Our recent public health training and reconfiguration into HV and SN teams has refocused the thinking of the needs of families in communities and the school as a community.

However, I fully support the continuation of a seperate HV register and would encourage school nurse colleagues to make their opinions heard. If we are to ever recruit to the levels required to address inequalities in health, we must have multiple access routes, not just nursing. The successful wide introduction of NNEBs into HV/SN teams only strengthens this arguement. Many of these staff could make excellent HVs given the opportunity and not faced with the need to undertake a nursing course first. Do shool nurses need their own register? Is this the way to make this workforce more visible?

Maggie Ioannou

The Future of HV and SN

The primary purpose of the variuos regulatory bodies is to protect the public. I have a real problem with the notion of "defending health visiting". Just exactly what is being defended? Professional status, a unique professional group? To what gain? I still can't get to grips with this.

From the school nursing point of view I find the separate registration for health visitors is unhelpful. I warm to the idea of combining health visiting and school nursing under the public health umbrella but I do believe they have different contributions to make. I wrote an article in the NT (about May 1999) suggesting we consider health visitors as child and family focussed and school nurses as adolescent health specialists. I have explored this model with a number of groups of health visitors and school nurses and whilst HVs are concerned at the suggestion that they may have a direct contribution to make to children beyond the age of five there has been a genuine willingness to consider this model.

Incidentally, school nurses evolved out of the need for HVs to delegate (according to one SENATE member). Why did this happen? Was it just too much work, was it because children's and adolescents needs were deemed to be less important or was it because a separate set of skills are required. Whilst this may have not been a direct decision I would like to suggest that the latter was perhaps a significant contributing factor. As courses for school nurses develop they cover some very important subjects perhaps overlooked in the past i.e. teenage pregnancies and the sexual health requirements of young people, depression and deliberate self-harm in adolescents, eating disorders and body image, bullying, self-confidence and self-esteem , learning difficulties etc.etc. Whilst these may link with HV education I think there is validity in concentrating in depth on the unique needs of young people and adolescents.

Incidentally, I am not upset, just trying to make a contribution that extends SENATE'S deliberations beyond health visiting. It is good to be able to explore issues which are important in such a neutral way. Without wishing to sound defensive it would be better if the debate could concentrate on the value of professional contributions rather than a sort of "them and us" approach.

If SENATE is purely about defending HV registration then I will keep quiet (I am by no means an expert on this matter but I can't help feeling that this "separateness" is not helpful). If, as the title suggests, it is about shaping the future of health visiting and school nursing I will gladly share my views. My dream would be to see robust body talking up health visiting and school nursing and debating the future public health nursing!

June 25, 2001

Pippa, I have followed this debate with interest and would like to

make a contribution re needs of adolescents. I trained as a HV 20

years ago and like many of those taking part in the discussion was

actively working as HV / SN for 15 of those years. My experience was

that because I was particularly interested in school work I was very

involved with that population. However what I found was that the

service delivered to school populations depended on the level of

interest and caseload pressures of the attached HV. As a service this

was clearly not equitable. Some colleagues were not providing any

more than a basic screening service (with the assistance of (then)

clinic nurses. However having separated the two services the " school

nurses " currently in post have not had the benefit of training in

order to do the job. This is being addressed by part time secondment

on to BSc courses, but means that for the majority they are working

in situations for which they have not beeen prepared. At least the HV

preparation undertaken previously meant that there was a good

knowledge base and understanding of the underpinning theories

relating to adolescence, behaviour, etc. as well as assessed skills

for working with this age group. In my opinion this knowledge base

was not part of nurse training and as far as I a can determine is

still not included in current nursing preparation. Child branch seems

to concentrate on ill children and adult branch doesn't address the

needs of adolescents. Therefore I conclude that nurse training does

not adequately prepare practitioners for the role of the school

nurse. This being the case why is there such a strong attachment to

the family of nursing? Shouldn't we be saying that all school nurses -

or at least team leaders- need to be appropriately trained and

registered in the care of the adolescent in the preventive / public

health role? Wouldn't this be protecting adolescents?

> The primary purpose of the variuos regulatory bodies is to protect

the public. I have a real problem with the notion of " defending

health visiting " . Just exactly what is being defended? Professional

status, a unique professional group? To what gain? I still can't

get to grips with this.

>

> From the school nursing point of view I find the separate

registration for health visitors is unhelpful. I warm to the idea of

combining health visiting and school nursing under the public health

umbrella but I do believe they have different contributions to make.

I wrote an article in the NT (about May 1999) suggesting we consider

health visitors as child and family focussed and school nurses as

adolescent health specialists. I have explored this model with a

number of groups of health visitors and school nurses and whilst HVs

are concerned at the suggestion that they may have a direct

contribution to make to children beyond the age of five there has

been a genuine willingness to consider this model.

>

> Incidentally, school nurses evolved out of the need for HVs to

delegate (according to one SENATE member). Why did this happen? Was

it just too much work, was it because children's and adolescents

needs were deemed to be less important or was it because a separate

set of skills are required. Whilst this may have not been a direct

decision I would like to suggest that the latter was perhaps a

significant contributing factor. As courses for school nurses

develop they cover some very important subjects perhaps overlooked in

the past i.e. teenage pregnancies and the sexual health requirements

of young people, depression and deliberate self-harm in adolescents,

eating disorders and body image, bullying, self-confidence and self-

esteem , learning difficulties etc.etc. Whilst these may link with

HV education I think there is validity in concentrating in depth on

the unique needs of young people and adolescents.

>

> Incidentally, I am not upset, just trying to make a contribution

that extends SENATE'S deliberations beyond health visiting. It is

good to be able to explore issues which are important in such a

neutral way. Without wishing to sound defensive it would be better

if the debate could concentrate on the value of professional

contributions rather than a sort of " them and us " approach.

>

> If SENATE is purely about defending HV registration then I will

keep quiet (I am by no means an expert on this matter but I can't

help feeling that this " separateness " is not helpful). If, as the

title suggests, it is about shaping the future of health visiting and

school nursing I will gladly share my views. My dream would be to see

robust body talking up health visiting and school nursing and

debating the future public health nursing!

June 26, 2001

Dear Toity,

I agree about the work pressures and especially the volume of reading, material

on

structural changes and general info. I also think that many colleagues are

trusting

and simply do not believe that they could be written out of the plot. At a

CPHVA

meeting last night we agreed that HVs will mutate but that existing staff will

remain

employed but that their role may be much altered to become team leaders of a

targetted

service and the breadth and depth of the sort of work Houston describes

will be

lost. It was our opinion that we would be expected to send all such work to

others.

Regards

Ruth

Toity Deave wrote:

> Dear Ruth

>

> I echo some of your concerns but I feel taht a lot fo the complacency is due

to

> lack of awareness/knowledge of what is uner discussion/threat. Many

> practitioners are so bogged down at the moment that when they have come up for

air

> the issues that have been discussed and the implications of them are unknown