Reflections on the Consequences of Change.

I’ve been reflecting on the past few months and how so many changes to what I have been accustomed to have taken place.
The big picture is of course Brexit and Trump, each has exposed the worse in us and feelings at least on one side of the argument of anger, concern and profound disappointment.

Personally the widespread cuts to public health budgets and consequently health visiting and school nursing services has compounded this ‘winter of our discontent’.

Currently I am busy campaigning in my local area, initially in an attempt to stop and now to challenge the implementation a new 0-19 service. This includes a health visiting service which has been reduced by almost 25% and a already depleted school nursing service further reduced by 4%.

Posters created for the consultation phase of the campaign.

with thanks to Dave Munday UNTE/CPHVA/MHNA LPO

The trust and local authority responsible for these changes were the same ones that up until my departure from the NHS some four years ago I had been working as a part of and closely with. Indeed my leadership and service improvement roles were predicated on successful collaborative working across those two organisations and ensuring that children young people and their families were at the centre of everything we did – do these cuts represent this? particularly as apparently service user views were not sought as part of the remodelling exercise.

Disregard for staff expertise when the tendering process was taking place in addition to  an absence of participation in the development of the service transformation plan has led to a situation where a demotivated and demoralised workforce are now not engaged in the changes taking place around and to their practice.

Of course I appreciate the pressure on public health budgets which local authorities (strapped for resources as a result of funding cuts from central government) have in turn  passed on to organisations tendering to provide health visiting, school nursing and associated programmes such as family nurse partnership. However the reductions highlighted above which have been introduced in my area, do not, in my view represent a safe level of service provision and will undoubtably  adversely impact on the children young people and families and well as compromise the practitoners who are required to deliver this new service.

The campaign continues, supporting staff as they struggle with poor communication, inadequate planning, lack of engagement in a process that they neither agree with or understand.

Please take a look at our Facebook  and Twitter pages which seeks to keep them informed and connected.





As a former colleague of many of the staff Im involved in supporting in my role as local branch chair of the CPHVA , this quote on leadership has resonance for me in describing the current situation. The tender for this service was secured the consequences of that are profoundly worrying as the changes are introduced.



A great piece on the challenges to health visiting services facing and dealing with cuts around the country.

Jen the HV

Am sure there is a clever analogy/political statement that could be made between the lack of posts on this blog and the plummet in moral (echoed by the drop in HV numbers) of the last 12 months.

I revalidated last month – 18 years since I first registered as an RN(child) and have realised how that time and experience has broadened my shoulders, built my resilience and enabled me to adapt in my transition from student to independent health visitor.I’m not alone in finding the job not quite what I signed up for, and feeling like any element of seeking health needs and building communities has been replaced by hitting targets and keeping commissioners happy while they congratulate our teams by slashing budgets further often with a side order of cutting or downgrading roles.

My fab friend Su highlightedThe issues she faces in Staffordshire, but it feels one…

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Blog for #HVweek

A Health Visiting Perspective

In 2011 at the start of the ‘Health Visitor Implementation Plan: A Call to Action’, I recall feeling both excited but also a little concerned. Whilst welcoming this commitment designed to bolster and invigorate a flagging service I felt a tinge of anxiety and scepticism encapsulated as follows:

What about my school nursing colleagues asked to do more with no additional resources?

Would the emphasis on strengthening health visiting be at the cost of other members of their skill mix teams notably Community Nursery Nurses and support staff?

And perhaps most importantly how would this programme the changes and investments be sustained?

As we celebrate health visiting 125 years young and a successful #HVweek lets us reflect that despite the investment and service transformation that occurred as a result of the call to action health visiting in many area is facing difficulties.

Commissioning has now passed to Local Authorities Public Health Departments. Colleagues in many provider organisations are deeply concerned about the level of service they are required to draw up in the light of diminishing financial envelopes arising from reduced funding available to local authorities with whom they are now engaged.

One of the successes of the implementation plan was the Early Implementer Sites, which aimed to transform service delivery and embed the new service model. This evidenced based programme was motivational as it inspired local leaders to improve their local service offer and measure these successes and how they contributed to overall improved outcomes for children and families.

The opportunity to recruit and train new health visitors was welcomed although training places have now been reduced and recruitment in many areas has ceased altogether. This seems a disappointing and somewhat worrying development in light of the age demographic of the current health-visiting workforce. The potential loss of newly trained staff who, unable to secure health visiting posts are returning to previous nursing roles in effect depriving health visiting of enthusiastic motivated new practitioners in addition financial investment of providing the training both in terms of the academic preparation and practical placement.

Our colleagues in school nursing did benefit from their own call to action but lacking central funding has been challenging to implement.

Skill mix within health visiting teams was subjected in many areas to recruitment freezes and even dis- investment and health visitors felt that improving their position and ability to deliver the new service model should not be at the expense of their team members who support them in this endeavour.

Returning to the question of sustainability of the successes of the call to action programme will they wither on the vine? After this week when I witnessed at first hand, passion and enthusiasm to preserve and ensure our profession flourishes despite the very many challenges it faces.


Call to Action: The Health Visitor Implementation Plan

Health visitor programme: early implementer case studies

Being A Patient





Last week I suffered a rather undignified trip and subsequent fall in a car park – I fell on my out stretched right hand and I knew that I was in trouble.

A Good Samaritan came to my rescue checking I had no loss of consciousness or that I needed an ambulance. He provided my daughter and I with a chair and an ice pack wrapped in a j cloth from a coffee shop for my wrist whilst we waited for my husband to rescue us.

Later on arrival at the Emergency department our combined intelligence eventually mastered the self-check in, we took our seats and waited….

The area was packed; it seemed like whole families accompanying individuals waiting to be seen, seating was limited and uncomfortable and we were in proximity to others with only marginal preservation of personal space. Ordinarily as on the tube in London for example I can cope reasonable well, on this occasion as I was in pain and contemplating the need for x-rays and a pot I felt vulnerable to inadvertent knocks.

When we were seen, the Nurse Practitioner was friendly and efficient and I was directed to x-ray where the radiographer was also friendly and reassuring. Both these interactions helped me to relax. I was given an appointment for fracture clinic and a temporary splint. The clerk informed us that I had the last appointment for the clinic next day and we left the department which was still heaving at the seams “its always like this Monday and Tuesdays”she remarked as no-one can get an appointment with their GP.

Next day I arrived at fracture clinic to discover my appointment was for the following day, as per the letter I had been given but not checked, relying instead on the comments of the clerk, felt somewhat foolish and £5 poorer from the car park charge.

My actual appointment the following day featured another busy waiting area and the seemingly obligatory delay in being seen despite an appointment time, the chairs were comfy though!

The Consultant was friendly, charming and explained the x-ray pictures and the need for a below elbow pot.

A further short wait and then I was called into the plaster room.

This final experience inspired this blog

I was shown into the department and greeted with “Hello my name is Annette how are you feeling Angela?”

Annette explained the procedure and applied the plaster ensuring I was comfortable throughout she gave a full verbal explanation of post procedure care and a comprehensive patient information leaflet to take home.


I was familiar with ‘hello my name is…’  campaign created by the inspirational Dr Kate Granger although the hospital I was attending was not signed up.

As I health professional whilst I understand the system, being a recipient of it was anxiety provoking part in due to the pain I was experiencing but also that feeling of vulnerability. The health professionals I encountered demonstrated compassion and skill in our interactions and on reflecting this episode of care certainly fulfilled Kate’s core values for the campaign

  • Effective communication
  • The little things matter
  • No decision about me without me
  • See me, not my disease

Here’s my feedback tweet on the experience

One week on I am managing reasonably well although one-handed typing takes forever and no baking for me for a while sadly.




Busy, but time to step up!


I was minded to start blogging, I forgot how busy my life was and it appears I haven’t made time for the blogging never mind the reflective health visitor stuff!
So, I’m feeling reflective.

The pace of change in health visiting over the past few years has been hectic, traumatic at times and stressful, but have the rewards promised been delivered?
Health visitors welcomed standards and national recognition but the next phase is not certain at all.
We, as with our School nurse colleagues transfer to Local Authority Commissioning this year. We have worked hard to ensure commissioners were ready for us and know what we do, how we respond to populations and need. Lots of good standards have been written down but sadly this is where I fear the wheels fall off.
Government cuts have hit Local Authorities. Hard. The honeymoon period has been short for our school nurses…

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Reflections on the 2016 CPHVA Awards

One week ago I was sat having lunch next to a delightful elderly lady, the mother of a CPHVA stalwart, and a very recently retired Safeguarding Specialist from Manchester. The occasion was the CPHVA Awards 2016, which I was attending as a guest for the  second consecutive year. These awards celebrate the practise of community nursing and the recipients are nominated by their peers.


Also on our table is my ‘twitter friend’ Karen Whittaker who later picked up an award for her colleague, Cath Coucill, for Lecturer of the Year.It was lovely to finally meet Karen in person.

At last year’s celebration I felt very proud of my profession and after enjoying an excellent lunch including a rather delicious deconstructed Banoffee Pie, the presentations  began with a real buzz of anticipation in the room amongst the guests.


The citations outlined fantastic contributions and dedications to the care of children, young people and their families by Health Visitors, School Nurses, Community Nursery Nurses and Specialists etc. I was delighted when Jo Fee, whom I sat next to, was presented with the Leader of the Year award; I suggested that the award should have pride of place on her mantlepiece.

I was thrilled when Jenny Harmer was named student of the Year, a real rising   Unknown.png for sure.


In order to share the success of the winners I was busy on social media tweeting and retweeting, sharing their achievement to a wider audience. The final award announced on the day to an as yet unsuspecting recipient began. Gavin Fergie, Professional Officer, began the citation for the winner of Advocate of the Year awarded ‘to an organisation or individual deemed to have offered positive support and encouragement to the professional disciplines within CPHVA’. I was impressed by the quotes Gavin was reading out and then I realised they were about me!. Apparently my face was a picture as I raised my head in amazement realised I would be receiving the warm applause and acknowledgement of my peers and many friends in the room.

I managed to tell a couple of ancedotes in an attempt to reflect my involvement with CPHVA over many years and of course to thank the Professional Officer Team who decide on the recipient.Cfh0aRgWQAQsJQ_.jpg

That smile lasted for the rest of the day and reappeared every time I received any of the numerous messages on Facebook and Twitter.

I have just completed an official duty as Advocate of the Year by speaking live via telephone to BCB Radio in Bradford, proudly promoting the fantastic work of health visiting and school nursing services across the UK.

On my mantlepiece#proud




Campaign to End Physical Punishment of Children in the Home

I was concerned to read recently that a high court judge in the family division stated ‘that authorities need to make allowances for a “cultural context” in cases involving parents who physical punish their children’. Mrs. Justice Pauffley made the comments in a High Court ruling of a man from India accused of slapping his son. The NSPCC responded that practice in different communities within the UK were not an acceptable excuse for “child abuse taking place in this country”.

According to the Council of Europe 28 European countries now have laws in place that completely ban smacking including physical punishment in the home Louise Arbour, former United Nations High Commissioner for Human Rights stated:

“Violence against children is a violation of their human rights, a disturbing reality of our societies… No such thing as a ‘reasonable’ level of violence is acceptable. Legalised violence against children in one context risks tolerance of violence more generally’’. Furthermore an outright ban on smacking children including in the home involving parents and their children should be introduced in the UK, the United Nations has recommended. In a report, the UN’s Human Rights Committee (UNHRC) urged the government to “put an end to corporal punishment in all settings, including the home”, and instead focus on encouraging “non-violent discipline”.


In England and Wales physical discipline is currently illegal in schools, nurseries and child-minding settings, as well as in children’s homes and secure establishments, but ‘light’ punishment in the home is not included. When the law was last reviewed in 2007, it was not changed as legislators decided not to criminalise parents for giving a “mild smack” as a form of “reasonable punishment”.

The UNHCR committee: “remains concerned” that corporal punishment was not “fully outlawed”, and said it was particularly worried that “reasonable punishment” could be used as a legal defense in any subsequent criminal proceedings.

It added that recent surveys found an increasing number of parents were using “alternative” forms of discipline, and said the government was working to try to ensure the trend continues. Health Visitors are well positioned to discuss appropriate discipline within a positive parenting framework. As the UNHCR further points out “Governments should encourage non-violent forms of discipline as alternatives to corporal punishment, and conduct public information campaigns to raise awareness about its harmful effects”.

The Children Are Unbeatable! Alliance campaigns in the UK for the abolition of all forms of physical punishment and for the promotion of positive discipline.

The alliance lobbies hard to find opportunities to raise this issue in the Westminster Parliament and the devolved assembly in Wales.

This issue is present in community practice and as such in fulfilling the principles of health visiting

  • Search for health needs;
  • Stimulate an awareness of health needs;
  • Influence policies affecting health;
  • Facilitate health-enhancing activities

(Council for the Education and Training of Health Visitors, 1977)

Health Visitors should challenge the status quo and work alongside UK organisations pushing for change in line with the unequivocal position outlined by the United Nations.

Please see

Angela Lewis

Independent Consultant Public Health Nursing Practice