There are enormous problems within the health visiting profession, and more generally in community nursing.
In England, cost cutting has led to sharp reductions in the provision of a universal health visiting service, leaving very many children at risk. ‘Skill mix’ is fine when its used to extend and develop services, but far more often is being used crudely to cut costs and reduce service quality. The vital preventative and public health roles of health visitors are very much under threat. The CPHVA has its work cut out – from a trade union and a professional perspective – to defend its members and the services they provide.
Like a lot of people, I’d thought that the NHS in Scotland was in relatively good shape. I was shocked to learn the details of the Scottish proposals for community nursing. There is a real horror story in the making in Scotland – driven by the same resource issues as the cuts in England, but a proposal that goes for a ‘big bang’ approach to dumbing down services.
The last Labour Government led a review of community nursing. The SNP used to be fiercely critical of the proposals, but have changed tack now they are in power. The plans are clearly driven by cutting costs and covering up a shortage of staff. The intention is to take the separate and distinct professional roles of health visitors, school nurses and district nurses and roll them into a single ‘community nurse’ function. This is meant to start as soon as April 2008, although there is apparent secrecy (or total lack of planning) around how existing staff will be retrained and supported in taking on totally different roles.
This is just mad. It’s like telling a Cardiac Consultant that they have to be a Paediatrician and an Oncologist and an ENT specialist as well. It makes no sense at all. Health visitors and school nurses are skilled professionals. Both play a vital role in health promotion, supporting individual children, and in preventing and detecting child abuse. They are specialists in their own areas of work. The role of District Nurses – equally specialist and valuable – is a totally different one of supporting sick, disabled or terminally ill adults in living with dignity in their own homes.
If these proposals go ahead, it will be the most vulnerable people who suffer: very young children, parents who are struggling to cope, ‘at risk’ school age children, and the adults who are least able to have a voice and fight their corner.
The CPHVA has carried out a survey of its members in Scotland. These members are rightly furious. Their anger isn’t just about their own jobs – it’s about the threat of a social model of care being replaced with a medical model, about the loss of a meaningful public health role, and about the enormous damage to the people they work with.
One health visitor summed it up nicely: “The proposals are a disaster in the making. Staff will be deskilled. There will be less time to provide support for vulnerable children and families. This is a cost cutting exercise that will be detrimental to children and to society as a whole”.
The Union is working hard to reverse the proposals. There is still time for this insanity to be stopped.