Re: Nursing Standard and the NMHVC ?

September 27, 2001

Dear Senate,

The following is the letter I just emailed to the NS, as a non health

visitor and non-school nurse. Because it is a bit long for a letter,

I am doubtful that they will print it, but I add it to your debate as

a tribute to many valued colleagues.

Woody.

CHANGE - A LIBERATING EXPERIENCE.

In the policy debate on health visiting as a distinctive profession, I

am neither a nurse nor a heath visitor, but I have researched the role

development and effectiveness of both populations of practitioners in

many settings. For example in attempting to offer an evidence-based

view, since 1991 I have been directly involved in at least 18 research

or development projects on health visiting in 4 areas of England and

contributed to the Health Technology Assessment review of the

effectiveness of home visiting for child health. I was the Head of

R & D for the community trust in Cambridge when its health visiting

services disappeared, first for older people and then for children. I

am currently in a Public Health department which is at the forefront

of identifying and co-ordinating health visitors' expertise within the

wider public health and inequalities agenda of our most disadvantaged

neighbourhoods. Along with a very diverse range of community

practitioners, I am involved in continuing professional development

and postgraduate degree courses for health visitors aiming " to

demonstrate competency through education and practice " ( & Rote,

26 September).

The key construct in the professional identity and function of nursing

is " caring " , just as the pre-NHS and Community Care Act 1990 basis

of social work used to be " relationship " . When I first began

researching health visiting, I thought there were some parallels with

the case management function of some CPNs and with the palliative care

co-ordination function of Macmillan Nurses (think: planning a life

after birth vs planning a life before a death). However, by 1998 I

had to abandon such crude parallels because they totally failed to

predict the impact of two events, the Cambridge cutbacks and the green

paper Our Healthier Nation. Next I speculated that health visiting

might be akin to occupational health nursing and school nursing, two

specialities whose contribution to population health I most

enthusiastically value. Unfortunately for this hypothesis, while I can

observe close parallels in the way various health visitors work with

different clients (frail elders, gypsy travellers, refugees) the way

they interact with service users is easily distinguishable from the

way occupational health or school nurses care (even when they are

relating to the same clientele, e.g. children with special eductional

needs). If one was designing from scratch a new community profession

(as our seminar group discussed at Community Care Live 2000) then some

of the tasks currently done around child protection or the

prioritisation of client needs are shared in common with social

workers - some new hybrid practitioner might cover these in the

future. However, I suggest contemporary readers do a thought

experiment; imagine your feelings as you say aloud " The Health Visitor

is coming round this morning " or " The Social Worker is coming round

this morning " . The perceptions of service users appear to differ

between those two professional " visits " .

Well. What do, say, a homeless man with TB, parents struggling to

raise toddlers in an unsafe environment, battered women in a domestic

violence group, a family unable to cope with granny's physical and

mental deterioration, or residents in a poor estate trying to organise

a food co-operative, experience when a skilled health visitor enters

their territory on their terms ? A professional skilled in promoting

change. Dorothy in the Wizard of Oz " unsticks " the Tin Man with his

own oil can. Certain public health professionals, often equipped

with only sturdy shoes and cardigans, seek out people who would be

trapped in their own environment, and they unstick them. As Robbie

Coltrane says in the TV ad, " it's a liberating experience " .

Woody Caan

Senior public health specialist in R & D

Barking and Havering Health Authority.

> This week's Nursing Standard (26 September page 20) published a

short

> debate on the future of health visiting, with Mark &

Rote

> making one case re NMC and Daly offering an alternative view.

>

> The Editor invites readers to " Let us know where you stand in the

> debate " . You can email letters to colin.parish@r...

>

> In the period of MayDay activities, the NS remained silent for a

long

> time (until they began running items about divisions within the

> CPHVA). This could be an ideal opportunity for Senate membes to air

> your views on the nature and worth of health visiting, whether or

not

> you belong to the RCN.

>

> A good tip (as an Editor): better for 3 people to send in short

> letters each making one distinct point, than 1 person sending a long

> letter making three points, as far as publishing goes.

September 27, 2001

Dear Woody, Liked your letter and found it refreshingly quirky.It certainly

does add to the debate.I am interested in the work you have done with regard

to an evidence based view and wonder if we could discuss further.I find the

whole evidence basis for health care rather obstructive being a believer in

humanitarianism and not giving a jot about cost.I know this makes me a

target for charges in respect of wastage of public money but I sincerely

support the principle of help and support where it is needed even if it

doesn't lead to a measurable outcome.Maybe this is a reflection of my