Examination of Witnesses (Questions 480
- 483)
THURSDAY 14 DECEMBER 2000
DR IONA
HEATH, CBE, DR
GRAHAM ARCHARD,
PROFESSOR CHRIS
DRINKWATER, CBE, DR
PHILLIP CROWLEY,
MS PAT
JACKSON AND
MS OBI
AMADI
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.
Chairman
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.
Chairman
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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