Community Practitioners' and Health Visitors' Association

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CPHVA Response to the Invitation to Comment on the document – `Shifting The Balance Of Power within The NHS: Securing Delivery`
1.0 Introduction
1.1 The CPHVA welcomes this opportunity to comment. We are pleased that the emphasis is about devolving power to frontline staff, but we see enormous potential for power to be devolved to PCT boardrooms unless the cultural change to facilitative and empowering management is achieved.
1.2 Innovative and facilitative clinical leadership at all levels in the new NHS organisations is required if frontline staff are to be motivated and empowered to change to deliver an improved service to the general public.
1.3 Our comments are confined mostly to primary care trusts and strategic health authorities, as these will have the most impact on our members.
2.0 Primary Care Trusts
2.1 The document, Shifting the Balance of Power within the NHS places a significant increase in the range of responsibilities they hold at present. Change management teams within PCTs might be of benefit to ensure that help is available at every level within the PCT to develop a culture which is confident about accepting and devolving authority. These change management teams could also work to create systems, which facilitate true partnership, and equity between clinical governance and corporate governance, between those involved in Public Health and health service delivery. We welcome staff involvement being built into managers’ objectives but would also urge that the ongoing professional development of staff is also a specific objective. Strong clinical leadership is vital both in the boardroom and outside it if professional confidence and skill is to be developed and maintained by front line health professionals.
2.2 Ready access to lifelong learning and to the most recent research findings to promote evidence-based practice must be seen as a priority for PCTs. Clinical supervision and annual performance reviews for frontline staff can no longer be seen as add-on extras. These activities again require the skills of good clinical leaders.
2.3 Increased emphasis on the involvement of the public in the planning of local health services and their evaluation is welcome. Community Practitioners and Health Visitors can contribute to this process because of their access to local communities and to families in their own home setting.
2.4 A major challenge for PCT Boards when allocating their directly received budget will be to balance acute need and the longer-term investment in health gain for their populations. This will be especially challenging when, as is the case in some city areas, only 50 per cent of those living in the PCT catchment area are registered with the GP practices within it. (For example, Derby City PCT.) This makes working in partnership with local social services, education and voluntary organisations difficult, as they do not share the same geographical population. PCTs might have to look at innovative ways of deploying their health visitors and others within the community nursing teams if their potential to impact on the health and personal empowerment of local communities is not lost.
3.0 Strategic Health Authorities
3.1 In principle, the CPHVA welcomes the reduction of the number of health authorities and their focus on the strategic direction of the NHS and the performance management of PCTs and NHS trusts.
3.2 We believe, however, that there are dangers in this increased performance management focus if, again, there is not a cultural shift in the discharge of this duty. PCTs already have a clear, strategic direction and quality agenda set for them from the centre with the NHS Plan, national service frameworks, local HIMPs and numerous other policy documents, such as Saving Lives and Making a Difference
3.3 PCTs will need the autonomy to decide HOW the desired outcomes from these policy documents are reached for their populations. They should not be told WHAT TO DO TO achieve them. This document, Shifting the Balance of Power must spell the end, once and for all within the NHS, of command and control management.
3.4 The CPHVA would also urge that the performance management process focus some of its attention on evaluating the impact that shifting the balance of power has had on increasing the involvement and development of front line staff.
3.5 The idea of a franchising route to establish the best management approaches to lead the SHAs is an interesting one. If named, chief executives’ teams are to be part of this franchising process; it is unfortunate for existing health authority directors, who are not working with a ‘winning’ chief executive.
3.6 The CPHVA would like assurances that all those presently working within health authorities and are facing huge disruptions to their working lives are offered the appropriate level of support and guidance to make the transition as painless as possible. The NHS cannot afford to lose a talented workforce through burnout and stress.
3.7 Innovative and facilitative clinical leadership must be clearly identified with a place on the SHA board and at all levels within the SHA. More than just medicine must be represented. This level of expertise must be available to advise PCTs and NHS trusts and will ensure facilitative clinical performance management of them.
3.8 The CPHVA welcomes the workforce planning and development role for the SHAs working closely with the workforce development confederations. It will obviously only produce the required workforce if PCTs and NHS trusts are well represented within this process.
4.0 Public Health
4.1 The new public health responsibilities of primary care trusts emphasise the importance of public health nurses, including health visitors and school nurses, in the newly structured service. Their role as ‘generalist’ public health practitioners working with individuals, families and communities is crucial to the PCT’s responsibility for improving the health of the community. Their functions include undertaking health needs assessment, surveillance, establishing and maintaining local partnerships and engaging the local communities.
4.2 The proposed public health networks and teams must include these grass roots public health practitioners. health visitors and school nurses have specialist knowledge in areas such as family support, child protection, homeless people, travellers and teenage health. This knowledge is essential to public health teams and they can act as consultants to all those within local public health networks. The development of the public health teams and networks should lead to the obvious next step of creating more public health nurse consultant posts around specialist areas of public health practice depending on local need.
4.3 The board level public health appointment should be open to all health professionals with the appropriate level of knowledge, skills and experience in public health. Primary care trusts must ensure that opportunities are provided for grassroots public health practitioners such as health visitors and school nurses to develop their public health practice to the level necessary to enable them to apply successfully for such board positions. As well as further academic qualifications opportunities could be offered to such practitioners to be seconded into public health departments or to shadow existing directors of public health.
5. Conclusion
5.1 The CPHVA is conscious that staff in the National Health Service have been subject to frequent organisational changes. The only justification for this significant change process is if, when the process is complete, the focus of the new board rooms is on the health needs of local populations and the needs of the front line professional staff to meet those needs in ways that are relevant and acceptable to them. This is an opportunity to complete the clinical governance circle with health professionals feeling confident to call the board to account for creating a suitable environment for high quality services to be delivered. Clear and overt systems should be in place for calling health professionals to account for the quality of their own practice.
5.2 In conclusion we would stress again the importance of having support freely available to all those 19,000 staff who face disruption to their working lives between now and April 2002/3.