I was at the CPHVA conference last week. The CPHVA is part of Unite, and organises community nurses – health visitors, school nurses, nursery nurses and some district nurses. It was a great event, with some really exciting presentations and discussion. There were sessions on the straight union issues around cuts, privatisation, social enterprise companies and so on, but also some excellent sessions around social inequality, child protection, infant mental health and the like.
It was good to meet members who combined passionate commitment about their jobs with a deep concern for the future of the NHS. I obviously raised the reasons I’m standing for the Unite National Executive – for a union that fights hard for the NHS, for a union that puts support for its members before support for Gordon Brown, and a union that’s run by its members not a handful of senior officials.
The question of lay control is particularly important in the CPHVA. The CPHVA has a dual role of trade union and professional body, but this has not been well understood in Amicus. At a time when community nursing is under attack, and we urgently need a strong voice in defence of high quality services and the staff who provide them, it’s unacceptable that the autonomy and influence of the CPHVA have been eroded.
I talked to CPHVA members about my experience on the Amicus NEC over the last four years, and what I hope to achieve on the Unite Executive. It was brilliant to get support from so many people.
The conference was a sharp reminder of how professional issues and trade union issues go hand in hand for many health workers. Community nursing has been seen as a soft touch when it comes to cuts. There’s nothing particularly glamorous or media friendly about dressing leg ulcers, or even about promoting children’s health in the community. NHS bosses can cut services like this without getting a particularly bad press.
For these staff, the issues are obviously partly about their own workloads and their own stress levels – but staff are also absolutely committed to maintaining the quality of the services they provide. For health visitors, ‘universality’ is an important principle, with core services available to every family. In the brave new world of the reformed NHS, universal services have gone in many areas, or been replaced with a service that offers virtually nothing. Some health visitors report caseloads of as many as 1000 children! How can you know and support and develop a relationship with that many families? The claim from managers is that ‘vulnerable families’ receive intensive services. This is fine in principle, and in some areas there is high quality and properly resourced targeted work going on. In other places, though, targeted work has been used as cover to cut core services. The reality is that without universality, many vulnerable families will never be identified in the first place, and will be left unsupported.
Another issue is ‘skill mix’. Again, in principle, there’s nothing wrong with this. It’s great when health visitors or district nurses can offer a better and expanded service by working with nursery nurses or community staff nurses. The challenge is that skill mix in practice is being driven by a lack of resources. Experienced specialist staff are being replaced with staff with different or lesser qualifications. The risks to patients or clients increase, all staff members work under a higher level of stress, and it’s always the frontline staff – not the bosses – who are scapegoated when something goes wrong.
Some of these issues are very complex. That’s why the CPHVA, with its dual identity, works well. This is a part of Unite that is valuable, and that must be protected going forward. Members of the CPHVA need effective representation – but so do the children and families who depend on their support.