If Health Visiting is Important, Why Are We Pursuing the Idea of Community Health Nurses?

IN YOUR article of November 21, “Why a healthy beginning is crucial”, the Chief Medical Officer, Dr Harry Burns, rightly emphasises the critical importance of providing intensive support and intervention during pregnancy and early infancy as a means of reducing widening health inequalities in Scotland.

The latest evidence from American randomised controlled trials suggests that intensive nurse-led interventions lead to improved prenatal health, fewer childhood injuries and improved school readiness for children born to mothers with low psychological resources. As almost one-third of children in Scotland live in a lowincome household, one could be forgiven for thinking there would be a substantial investment in providing specialised health- visiting services to deliver these evidence-based programmes of support and intervention. It therefore beggars belief that, far from investing in more health visitors, the recent review of community nursing in Scotland, Nursing in the Community, has recommended making the traditional health visitors, school nurses and district nursing roles obsolete and creating in their place a new generalist community health nurse with a strong chronic-disease-management remit, who will not only unblock your catheter but will apparently perform the role of the health visitor and dispense vital parental support.

It is not rocket science to work out that the disease-management remit of this new community health nurse in terms of administering insulin to diabetic patients and chemotherapy to patients who are seriously ill will always take priority over the childhealth remit, which will be inevitably compromised as a result. Fortunately, other important players appear to have recognised this and have acted accordingly. Greater Glasgow and Clyde appear to agree with the benefits of early intervention and have distanced themselves from the new community health nurse model – and, in marked contrast, see health visitors as key players in tackling health inequalities. Fortunately, Greater Glasgow and Clyde’s refusal to sign up to this puts the future of the new model in doubt, as it leaves the rather intriguing scenario of this policy being implemented throughout every health board in Scotland apart from the biggest in the country. The English review of health visiting has also rejected the community health nurse model and is committed to tackling health inequalities by investing in health visiting.

In spite of fierce criticism from the academic community, health visitors, district nurses and school nurses, the community health nurse project appears to be being rushed through to implementation stage in four health boards next year. It is not too late for Nicola Sturgeon to keep her election pledge and call a halt to this model – and take a lead from her English counterpart, Alan Johnson, by investing in training 1000 new health visitors and midwives by 2009.

Robert Hoskins, Lecturer, Nursing and Health Care, University of Glasgow.

DRHARRY Burns is quoted in your article as acknowledging the need for, and benefits of, early intervention and support in reducing inequalities in health. A recent review of health visiting in England noted the essential part played by health visitors in tackling inequalities in health and in promoting and protecting public health.

It is unfortunate that policymakers in Scotland appear to take a very different view, exploring the potential of a “model” which will replace health visitors, district nurses and school nurses with a new community health nurse. In a preelection statement, a spokesperson said that “the SNP believe that the discreet roles must continue and are committed to doubling the number of school nurses to deliver public heath plans ? The SNP would not wish to continue with the Nursing in the Community model as it stands”. Despite this, resources continue to be spent developing this new “job”.

Perhaps the SNP administration should reconsider and divert those resources into enabling health visitors to achieve the aims sought by Dr Burns, namely the reduction of inequality in health.

Dr Dorothy Ferguson Head of Division of Community Health, Glasgow Caledonian University.

Originally published by Newsquest Media Group.

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