Select Committee on Health Minutes of Evidence

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 leadership;

    —  support and professional advice to its members;

    —  provision of education and training courses; and

    —  advocacy on behalf of its members.


  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 working.

  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.


  3.1  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.


  4.1  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.


  5.1  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 Service.


  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 some control/influence.

  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.


  7.1  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.

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