HC 1048-III Health CommitteeWritten evidence from the Queen’s Nursing Institute (PH 174)


1. The Queen’s Nursing Institute (QNI) is the national charity concerned with the quality of nursing care patients receive in their own homes. We aim to improve care by funding nurse-led improvement projects, and inspiring nurses through the example of our Queen’s Nurses. We also aim to influence policies that impact on the quality of care patients receive. The QNI does not have a membership base: this response reflects the expertise from our community nurse forum—which has more than 1,000 members.

2. The QNI welcomes the opportunity to respond to the Health Committee’s inquiry on the Public Health reforms. Our submission addresses the questions most relevant to community nursing, and also showcasing examples of public health innovation led by community nurses. The QNI would of course be very pleased to meet with members of the Committee to discuss these issues further.

Workforce, Education and Training

3. Improving the public’s health is a key role for all community nurses. Working closely with GPs, local social services and health promotion teams, community nurses share health information to encourage healthy lifestyles, help to deliver preventative services to help young people stop smoking, assist hard-to-reach groups access outreach services, and support falls prevention programme for older people.

4. The QNI believes that the delivery of the vision in the Public Health White Paper, of a service which empowers people to makes changes that will make a difference to their lives, is dependent on the skills, knowledge and engagement of community nurses, midwives, health visitors and AHPs, in addition to new, targeted, flexible programmes. There is no alternative workforce to deliver these services and programmes.

5. Disappointingly, the framework for healthcare workforce education and training lacks focus on improving the capabilities in public health. We are relatively clear about the direction of structural reforms, but the framework has failed to convince us of the future reform direction of the competencies of healthcare professionals in a public health setting. Public health needs to be better taught to all nurses so that they understand the complexity i.e. it’s not just about epidemiology or social marketing. We believe there is a huge opportunity to use nurses, health visitors and midwives to improve the health of the population if the workforce issues are addressed early on.

Health Education—The Importance of School Nurses

6. Health education should be part of the national school curriculum. The National PSHE continuing professional development (CPD) programme should be the foundation going forward. Currently the programme provides community nurses and teachers with the opportunity to gain recognition and accreditation of their experience in teaching personal, social and health education (PSHE) and to develop their knowledge, understanding and teaching and learning skills in the delivery of PSHE in schools and other settings. It has been running for six years and around 10,000 teachers, community nurses and other professionals have undertaken the programme. The programme is an important area of the curriculum that helps children and young people grow and develop as individuals and as members of families and communities.

7. The health perspective within the education curriculum needs to be supported by skilled health professionals. Specifically, School Nurses are essential within the school health team and have the capacity to increase the access to healthcare for children and young people both within educational settings and outside traditional settings. Examples of further refinement to the current programme include:

Sexual Health, using the “building backwards” approach to personal hygiene in younger years and valuing self, gives structure to sexual and relationship education and should include the importance of using inclusive language thereby supporting a sensitive approach.

Emotional Health including short term psycho-social interventions will help address prevention of mental health problems identified in Healthy Lives, Healthy People.

Preventing uptake of smoking and the health risks of drug and alcohol are also necessary discussion areas.

A critical success factor in progressing health education will be partnership working. The opportunity for health education to be situated within the Public Health Service will give greater opportunities for integration with education and social services for children and families which encompass the wider determinants of a school child’s health.

Commissioning Nurse led Services—Health Promotion and Public Health

8. Modern healthcare services are increasingly nurse-led in response to changing healthcare needs. Since 1990, the QNI has funded hundreds of projects led by community nurses, midwives or health visitors, which set up new services or improved ways of working. The following examples illustrate the ability of community nurses to influence behaviour change and that their achievements in public health have a visible and measurable impact at individual and community levels.

9. Health Literacy Project for Travellers (Pregnancy) - Hackney London—This project engaged with the Traveller and Gypsy community to improve their experience of accessing and using maternity and health services during pregnancy, ante-natal care and childbirth. The project, through consultation, with the Traveller community identified the issues and concerns Travellers have about accessing mainstream health services, particularly for pregnancy and childbirth services. As a result materials were developed to increase knowledge, confidence and health literacy. As this group has the highest rate of maternal and baby deaths in the country, such initiatives can ultimately save lives.

10. “What if” Project – Cornwall—“What If” is a life survival skills project, aimed at young people, their parents/carers and the community. The project brought together education, health and police agencies to tackle “real life” issues that affect every member of society through six life skills workshop days covering domestic abuse, sexual health, substance misuse, emotional wellbeing and healthy eating. The project also developed an interactive resource which included comprehensive lesson plans and a DVD for professionals which enabled the life skills programme to be delivered in other environments. This project showed that equipping young people with the skills to help keep themselves and others stay safe makes real differences to their lives and also the wider community. The success of this project has spread across the region with the teaching package and DVD made available to all the schools in Cornwall with strong interest for national dissemination.

11. Smoke Free Homes Project—Kirklees—This project set up a support service for parents of infants and children with breathing problems to help the parents to stop smoking in the home. The parents often express an interest to stop smoking but were unable to access the support for a variety of reasons. This project brought together the services of respiratory nurses and the Stop Smoking Service and succeeded in reducing the number of children admitted to hospital. More and more families are being referred to the service by other health professionals.

12. Stop That Shake, Babies Break—West Midlands—This was an innovative project equipping young people with vital life skills, via an audio visual teaching experience, on the cause, consequences, risks and prevention factors around “Shaken Baby Syndrome”. The project team took the teaching tool out to a variety of educational establishments within the Tamworth locality. Students viewed the experience as extremely valuable improving their understanding around “Shaken Baby Syndrome, specifically: how it affects infants physically, mentally and developmentally; the circumstances which could lead to shaken baby attack; the types of coping mechanisms that need to be employed as a prevention behaviour; and the support networks available for further support in positive parenting. The DVD has already been adopted by Heart of Birmingham PHSE training department and is being adopted into school curriculum for 6th Form pupils. The project was presented in Atlanta Georgia USA at the Eleventh International Conference on Shaken Baby Syndrome/Abusive Head Trauma. The project has also been submitted to National Foundation for Educational Research as best practice evidence.

13. Parenting In Pictures – Hasting—This project supported the development of positive parenting skills for young parents especially those at risk of social exclusion. A photographic resource called “Parenting in Pictures” was produced using the young people themselves as actors. These scenarios covered preparing for a baby, managing money, breast feeding and dealing with emotional or relationship changes. The resource is now being used by multiple agencies such as education, social services and health as well as young Peer Educators within school sexual health programmes and parenting awareness sessions.

14. In summary, the QNI believes that nurses, midwives and health visitors are a ready-made workforce capable of having a positive impact on public health - there is no other workforce to rely on. We also believe that more attention needs to be paid to the inclusion of public health teaching in all nursing courses, if new generations of nurses are to have these competencies.

June 2011

Prepared 28th November 2011