Select Committee on Health Minutes of Evidence

Memorandum by Community Practitioners and Health Visitors' Association

CPHVA Evidence to the Health Select Committee Inquiry into the relationship between Health and Social Services from a primary health care perspective (HSS 79)

BACKGROUND

  Many of the health and social issues which form the work of community practitioners and health visitors overlap with that of social services. There is a great importance that, in order to avoid duplication and public confusion, the role of each agency is well understood. As trusts employ community nurses and health visitors and social services are employed by local authorities this understanding is not always evidence. However there are areas where jointly funded specific posts have been created to very good effect.

  Where both agencies are based at the same centre, communication is easier, however where the bases are distant from each other commitment must be made to facilitate dialogue.

  Health visitors often approach social services as an advocate for the client.

AREAS OF WORK WHERE JOINT WORKING IS BENEFICIAL

  Older people Social needs are identified by district nurse practice nurse or health visitor—referral to social services. Areas of poor practice is when assessment on discharge from hospital is done by social services who will not identify the health care needs. Good practice is when this is done by district nurses and referred on for the social needs. Difficulties arise when neither agencies wants to use their resources, eg health or social bath.

CHILDREN WITH SPECIAL NEEDS

  There is an urgent need to examine the health and social needs of these children and their families.

  Carers Respite care arrangements. Community nurses often identify carers who may need additional care and support.

  Child protection Joint working under the Children Act 1989. This defines the boundaries regarding what constitutes health or social care. There are clear definitions of the services offered by different agencies. However health workers are often left with a child in need as social services are unable to take on the case until the child has evidence of significant harm.

  Children going into care and returning home—liaison between social services and health.

  Adults with long term illnesses.

  Adults with disabilities.

  Fostering.

  Adoption.

  Health visitors are often asked for health reports to present to court.

FAMILIES WITH MENTAL HEALTH PROBLEMS

  Health visitors have an increasing role with families where one or more members have mild to moderate mental illness.

DAY CARE

  Health visitors are the second biggest referral to daycare after parents themselves.

  Children or adolescents with mental health problems. Links with education, welfare and or social services.

  Domestic violence inter agency forum.

STATEMENTING OF SPECIAL NEEDS FOR CHILDREN UNDER 5 YEARS

  Dysfunctional families—multiagency working with housing, social services and health. The key worker may not be the one with the most contact.

INFLUENCING FACTORS

—  The effectiveness of joint worker depends on networking and building relationships

—  There is some difficulty in the interpretation between social care and health care, eg bathing

—  Some of the contact is through advising clients to seek help from social services

  Examples of social needs identified by health visitors—see A month in the life of a health visitor page 5 [1].

HEALTH
Chronic problems like eczema etc	13%
Dietary	73%
Behaviour	38%
Speech	8%
Parents' health	30%
Mother's mental health/post-natal depression	37%
Access to health services	12%
Safety	37%
Immunisation	22%
Smoking	24%
Mental health/depression	4%
Dental care	16%
SOCIAL
Child abuse	17%
Day-care	12%
Neglect of any type	17%
Housing	56%
Voluntary service support	8%
Bereavement	7%
Marital breakdown	26%
Children's playing	15%
Education/nursery	11%
Drugs/alcohol	8%
Financial	22%
Others	53%

  Difficulties arise when there are exaggerated expectations of each others roles.

  When the assessment of family needs do not agree there is conflict between the agencies leading to difficulties for the client.

BENEFITS OF JOINT WORKING BETWEEN SOCIAL SERVICES AND PRIMARY HEALTH NURSES:

  Nurses are perceived as less threatening by clients.

  Able to facilitate positive social service work with the family.

  Health visitors and school nurses are a universal service to all families and have data on health, not only for individuals but of whole communities which can inform social services planning.

  Community nursing can be used as a consultancy service across multiagency services.

  Health visitors, being the expert on children's health, nutrition, behaviour, and relationships, can advise on appropriate help when this deviates from the normal.

March 1998

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Prepared 10 August 1998