throughout the year - community practitioner · 2017. 12. 14. · patients with known...

IN THIS ISSUE

COMMUNITYPRACTITIONER

The Journal of the Community Practitioners’ and Health Visitors’ Association

June 2010 Volume 83 Number 6 www.commprac.com www.unitetheunion.org/cphva

Throughoutthe year

Marmot: fairness and health

Presenting at conferences

Supporting breastfeeding

Mini-MEND: obesity preventionHPV vaccination: acceptance, side effects and screening intentions

Estimating the cost of a perinatalmental health protocol

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Gentle yet Strong

Eczmol 1% w/w Cream: Abbreviated Prescribing InformationPresentation: Please refer to the full Summary of Product Characteristics before prescribing. Indications: Eczmol 1% Cream is an antimicrobial emollient which can also be used as an alternative to soap in the management of dry and pruritic skin conditions including eczema and dermatitis. Dosage: For external use only. For adults, the elderly, infants and children. For application to the skin: Apply Eczmol to the affected areas as often as necessary. For use as a soap substitute: Eczmol may also be used as a cleanser in the bath or shower, or for other toiletry purposes, instead of ordinary soap or shower gel. Contraindications: Preparations containing chlorhexidine are contraindicated for patients who have previously shown a hypersensitivity reaction. However, such reactions are

uncommon. Do not use in cases of known sensitivity to any of the ingredients. Warnings and Precautions: For topical application only. Keep out of the eyes and ears and avoid contact with the brain and meninges. Hypersensitivity to some of the ingredients of Eczmol may be more common in patients with leg ulcer or stasis dermatitis. Eczmol should therefore be used in caution in these patients. Eczmol contains the ingredient cetostearyl alcohol which may cause local skin reactions (e.g. contact dermatitis). Adverse events (see SPC for full list): Irritative skin reactions can occasionally occur. Generalised allergic reactions to chlorhexidine have also been reported but are uncommon. Packaging size and price: 250ml HDPE bottle. £3.70. MA Number: Eczmol 1% w/w Cream PL06831/0242. Date of preparation: January 2010. Further

information available from the MA holder: Genus Pharmaceuticals Limited, Park View House, 65 London Road, Newbury, Berkshire, RG14 1JN. API.ECZ.V1

Adverse events should be reported. Reporting forms and information can be found at www.yellowcard.gov.uk. Adverse events should also be reported to Genus Pharmaceuticals on 01635 568400.

Date of preparation: March 2010ECZ0110659

ANtIMICRoBIAL EMoLLIENt AND SoAP SUBStItUtE

Eczmol contains 1% chlorhexidine gluconate which is highly active against Gram positive bacteria, especially Staph aureus, a clinically significant trigger factor in the pathogenesis of atopic eczema.

the gentle cream base spreads easily and evenly and is quickly absorbed into the skin.

1% chlorhexidine gluconate w/w cream

GENUS

A soothing cream with the antimicrobial power to deal with Staph aureus associated with atopic eczema.

CONTENTSCOMMENT3 Uncertain times

Gail CartmailUnite will continue to engage withministers on behalf of members

NEWS & FEATURES4 NEWS

14 Breastfeeding: supporting workthroughout the yearKin Ly Drawing attention to local servicesand raising public awareness

34 Fairness and health

Ros Godson Marmot Review: linking socialand health inequalities

36 Not blind to dangerMargaret CaldwellIdentifying corded window blindsin risk assessments

38 Tickling TastebudsAlison ShortA family eating course delivered byhealth visitors and adult learning

PROFESSIONALAll professional papers have been double-blind peer reviewed prior to publication

22 Estimated cost of a healthvisitor-led protocol for perinatalmental healthYemi Oluboyede, Anne Lewis,Irene Ilott, Chrysanthi Lekka

26 Mini-MEND: an obesity preventioninitiative in a children’s centreStephanie Hardy, Amanda Lowe,Anouch Unadkat, Val Thurtle

30 HPV vaccination: vaccineacceptance, side effects and screening intentions Virginia Paul-Ebhohimhen, Sara Huc, Helen Tissington, Ken Oates, Cameron Stark

CLINICAL40 Clinical papers

June ThompsonDisabled children more likely to live in povertyReliability of online medical adviceExtreme obesity in pregnancy

REGULARS

18 Research notesResearch ForumConference posters and papers

20 Letters

42 Your rights at workSiân ErringtonNew pay survey: be heard

44 Resources

48 Network

The journal of the Community Practitioners’and Health Visitors’ Association Transport House, 128 Theobald’s Road,London WC1X 8TNT: 020 3371 2006 F: 0870 731 5043

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© 2010 Community Practitioners’and Health Visitors’ AssociationISSN 1462-2815

Community Practitioner is indexed in theCumulative Index to Nursing and AlliedHealth Literature (CINAHL) and the AppliedSocial Science Index and Abstracts (ASSIA).

The views expressed do not necessarilyrepresent those of the editor nor of Unite/CPHVA. Paid advertisements carriedin the journal do not imply endorsement byUnite/CPHVA of the products.

GUIDE FOR CONTRIBUTORSCommunity Practitioner welcomesrelevant contributions. Articles onprofessional issues are double-blind peerreviewed and should be 2000 to 3500words. Author guidelines are availablefrom the editor. Submissions should bemade in electronic format by email to: [email protected]

COMMUNITYPRACTITIONERJUNE 2010: VOLUME 83, NUMBER 6

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SKIN-TELLIGENCE

Name of the Class I Medical Device: Balneum Cream.Ingredients: Urea 5 %, Ceramide 3, Aqua, Glycine Soya Oil,Propylene Glycol, Cetearyl Alcohol, Liquid Paraffin, Isohexadecane,Sodium Lactate, Lactic Acid, PEG-20 Stearate, Polysorbate 60,Squalane, Stearic Acid, Disodium EDTA, Lecithin, Tocopherol,Ascorbyl Palmitate, Hydrogenated Palm Glycerides Citrate. BalneumCream is free of fragrances, colourants and preservatives.Pharmaceutical form: Cream. White cream. Indications: For thesymptomatic relief of dry and very dry skin conditions. Dry and verydry skin is often associated with eczema, psoriasis and otherdermatological conditions in which the skin has low levels ofsubstances such as urea, ceramides and lipids. Balneum Creamcontains clinically proven ingredients such as urea, ceramide 3 andlipids. It is formulated to protect the skin, to maintain skinmoisturisation and to restore the impaired skin barrier in conditionsgiving rise to dry skin. Method of administration: Using cleanhands, apply the cream to the skin twice daily. Contraindications:Patients with known hypersensitivity to any of the ingredients.Warnings and precautions: For external use only. Do not use onbroken or inflamed skin. Caution should be exercised with

concomitant use of some medicated topicals. If the conditionworsens on usage or if patients experience side effects, discontinueuse and consult a Health Care Professional. Undesirable effects:Very few side effects have been reported; typically local skinreactions. Special precautions for storage: Do not store above25°C. Use within 6 months of first opening. Pack sizes: Available in50g (£2.80) and 500g (£9.80) pump dispensers. CE marking heldby: Almirall Hermal GmbH, Scholtzstraße 3, 21465 Reinbek,Germany. Distributed in the UK by: Almirall Ltd, 4 The Square,Stockley Park East, Uxbridge, UB11 1ET.

References: 1. Balneum Cream label. 2. Puschmann M et al.Clinical Experimental Evaluation of the Effectiveness and Tolerationof a Urea-Ceramide Combination in Dry Skin. Akt Dermatol 2000;26: 70-75. 3. Cork M, Danby S. Skin Barrier Breakdown:A Renaissance in Emollient Therapy. British Journal of Nursing 2009;18(14): 872-877.

Date of preparation:January 2010. UKSOY0450.

THE SCIENCE OF COMBINING TWO COMPONENTS IN ONE EMOLLIENTFOR THE IMPROVED RESTORATION OF DRY SKIN:

UREA 5% - a natural moisturising factor that is deficient in dry skin. Ureaacts as a humectant attracting and retaining water in the epidermis.1,2,3

CERAMIDE 3 - which is also deficient in dry skin, helps restore the skin’s naturalbarrier, reducing Trans Epidermal Water Loss.1,2

Urea 5% and ceramide 3

A D VA N C I N G E M O L L I E N T T H E R A P Y

NEWEMOLLIENT

CREAM

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COMMENT

The full extent of the new government’seconomic agenda will only truly becomeapparent with the emergency budget dueon 22 June. Already, the government hasannounced plans for £6billion of spendingcuts, and the implications for the healthservice have yet to be fully digested.

At the time of writing, health secretaryAndrew Lansley has the job of fulfilling thecoalition’s stated aim that ‘funding for theNHS should increase in real terms in eachyear of the Parliament, while recognisingthe impact this decision would have onother departments’. However, Lansley is alsolooking for so-called ‘efficiency savings’ –‘cuts’ to you and me. Unite would suggestthat the £20billion a year spent on the NHS

internal market to promote the privatesector Trojan Horse would be an excellentplace to start. Private finance initiatives –buying a hospital on a credit card over 30years – should be subject to an immediateinvestigation by the new Office for BudgetResponsibility. He needs to explain thedividing line between ‘frontline’ servicesdue to be safeguarded and the ‘back room’jobs apparently in line for the axe.

In opposition, David Cameron gave outmixed messages on Sure Start, initiallystating that they would be closed to releasefunds to restore health visitor numbers –the figure of 4200 new health visitors hasoften been quoted. However, the policychanged and there are fears that thecontinuation of Sure Start will herald‘means testing’, ending universal access.

Our health visitor and school nursemembers want to know how the coalitiongovernment will deliver more ‘feet on theground’. The latest NHS workforce figuresreveal that a full-time health visitor jobwas being lost every 35 hours. The silenceon school nurses remains deafening, andUnite/CPHVA will be campaigning for thenew government to fulfil the last one’spledge that every secondary school inEngland will have a qualified school nurse.

Expansion of ‘new independent andvoluntary sector providers’ will createconcerns among members, who reject thefragmentation of NHS services. These werehighlighted when it was disclosed that theConservative health team was funded by

the wife of the chairman of private health-care firm Care UK, which received almost£400million from the NHS last year forrunning GP surgeries, walk-in centres andout-of-hours services.

There will be a ‘review’ of public sectorpensions, and Unite will rigorously defendthe schemes against a ‘race to the bottom’.All public sector pension schemes havebeen subject to recent radical change,including capping employer’s contributionsand levelling the normal pension age to 65.

Unite did not campaign for the govern-ment we now have, but Unite will engagewith the new ministerial team to stronglypromote members’ interests.

Gail CartmailUnite assistant general secretary

Uncertain timesThe implications of the new government on the NHS are as yet unclear,but Unite will continue to engage with ministers on behalf of members

There are fears that the continuation of Sure Startwill herald ‘means testing’, ending universal access

EDITORIAL ADVISORY BOARDGaynor Kershaw (chair) Health visitor,Heywood, Middleton and Rochdale PCT

Obi Amadi Unite/CPHVA lead professional officer

Maggie Breen Macmillan clinical nursespecialist – children and young people,Royal Marsden Hospital NHS Trust, Sutton

Debbie Davison Health visitor, Surrey PCT

Toity Deave Research fellow, Centre forChild and Adolescent Health, Bristol

Wendy Deshpande Infant feeding co-ordinator, North West Locality, SurreyCommunity Health

Barbara Evans Unite/CPHVA CommunityNursery Nurse Forum chair

Gavin Fergie Unite/CPHVA professionalofficer for Scotland and Northern Ireland

Margaret Haughton-James School nurseteam leader and practice nurse, Lambeth PCT

Avril Jones Research health visitor, Gwent Healthcare NHS Trust

Kay Kane Independent nurse advisor,community nursing

Catherine Mackereth Public health lead –mental health and wellbeing, Sunderland Teaching PCT

Brenda Poulton Professor, Institute ofNursing Research and School of Nursing,County Antrim

Lesley Young-Murphy Acting director ofcommunity services and head of patientcare, North Tyneside PCT

EDITORIAL TEAMDanny Ratnaike [email protected]

Jane Appleton Professional [email protected]

Kin Ly Assistant [email protected]

T: 020 7878 2404 F: 020 7379 7155

HONORARY OFFICERSLord Victor Adebowale President

Angela Roberts Chair

Alison Higley Vice chair

PROFESSIONAL OFFICERST: 020 3371 2006

Obi Amadi Lead professional officer

Gill Devereaux Professional officer for Wales

Gavin Fergie Professional officer for Scotlandand Northern Ireland

Rosalind Godson Professional officer forschool health and public health

Dave Munday Professional officer

COMMUNICATIONSShaun Noble Communications [email protected]

LABOUR RELATIONSBarrie Brown Lead officer for nursing

Siân Errington Research/policy officer

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Privatisation threatUnite has raised concerns that the NHScould be subjected to increased privatisa-tion under the administration of the newlyelected Conservative-Liberal Democratcoalition government.

While Unite said it was too soon to assessthe impact that the new government willhave on health services, Unite assistantgeneral secretary Gail Cartmail stated:‘Both sides of the coalition have declaredsupport for opening up the NHS forfurther privatisation. This will add to thealready exorbitant cost of £20billion inannual transaction costs created by thepurchaser-provider split.’

In its pre-election manifesto, theConservative Party said that patients willbe able to choose their provider, whetherfrom the independent, voluntary orcommunity sectors, as long as it meetsNHS standards and prices.

At the same time, the Liberal Democratshad proposed reorganising health services,establishing elected local health boards toreplace primary care trusts, and allowingthem to commission services from a rangeof different types of provider on the statedbasis of a ‘level playing field in anycompetitive tendering’.

However, the Labour Party supported theNHS as the preferred provider of services,stating that the NHS would come first:

‘Where changes are needed, we will be fairto NHS services and staff and give them achance to improve, but where they fail todo so we will look to alternative provision.’

Increased efficiency savingsAlthough it is unclear how health servicesmay be affected by efficiency savings, it isclear that a number of cuts will be madewithin the public sector.

At the time of going to press, thecoalition government was drawing upplans of how it will make £6billion-worthof cuts in public spending to reduce thepublic deficit. It had also been implied thatthe NHS may need to make more savingsthan the £20billion that was proposedunder Labour in 2009.

In an interview on BBC Radio 4’s TodayProgramme, when the new secretary ofstate for health Andrew Lansley was askedwhether the figure of £20billion represent-ed the efficiency savings that the coalitiongovernment would be making on the NHS,he stated: ‘That implied something like a3% to 3.5% efficiency saving each year on

the NHS. Of course we may need to dothat, and we may need to do more becausewe have increases in demand in the NHSand the need to improve outcomes.’

Concerns over changesA number of changes implemented soonafter the new government took officeflagged up concerns. The Department forChildren, Schools and Families (DCSF) hasbeen renamed the Department forEducation, and Unite/CPHVA professionalofficer Dave Munday stated: ‘This is ashame and a regressive step. It has longbeen recognised by healthcareprofessionals working with babies andchildren that their needs can be ignored bygovernments, policy-makers andcommissioners. The DCSF made sure thatthis was reversed.’

ContactPoint has also been abolished,and Dave stated: ‘It was recommended byLord Laming that a national system bedeveloped to support the work of profes-sionals to ensure efficient record-keeping that reduces duplicationand keeps children safe. Althoughthis system may not have beenpopular among some members,they may feel that so much of theirvaluable time has been wasted andmay be concerned about how they willimplement Laming’s recommendation.’

NEWS

Increased threat of NHS privatisationAlthough it is unclear how health services will be affected by the proposed £6billion-worth of cuts to public spending,concerns have been expressed that the NHS could face more privatisation under the new coalition government

‘Both sides of the coalitionhave declared support foropening up the NHS for

further privatisation’

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Open Space fornational forum

NEWS

The Equality Act 2010 includes clauses that prohibit discrimi-nation against women who breastfeed in public, andUnite/CPHVA is encouraging members to actively supportbreastfeeding in public during National BreastfeedingAwareness Week (NBAW) on 21 to 27 June.

Unite/CPHVA lead professional officer Obi Amadi stated:‘The evidence we have regarding health benefits to women andtheir children makes it clear that it should be the natural andfirst choice for all. We know that not all women can do this

easily, therefore the information, support and teaching tosupport this is just so important. We all have a responsi-bility to look after our future populations and the rightof a woman to feed her baby in public should besupported and respected too.’

Last year’s NBAW theme ‘Breastfeeding: every day isgood for your baby’ is being renewed this year inwhat the Department of Health said was itscontinued commitment to support mothers in

sustaining breastfeeding. For NBAW information and resources, see:

www.breastfeeding.nhs.uk/en/fe/page.asp?n1=5&n2=13

Professional debates at the Unite/CPHVA Annual ProfessionalForum will be in the form of an Open Space debate this year,where emergent themes on the day of the forum meeting will beopen to professional discussion.

Unite/CPHVA chair Angela Roberts stated: ‘We want toencourage as many people from professional forums to attend.Attendees will participate in developing ideas that professionalofficers and the National Professional Committee can takeforward. The Open Space methodology is a way of developingemergent themes, rather than asking members in advance whatissues they would like us to take forward this year.’

The forum will take place on the first day of the annual profes-sional conference, which will be held on 20 to 22 October at theHarrogate International Centre (see page 13).

Olivia Giles, founder of the charity 500 Miles that providessupport to amputees in Malawi and Zambia, will present theNick Robin Memorial Lecture at this year’s conference. She willbe telling her personal story about how contracting meningococ-cal septicaemia resulted in quadruple amputation, and how thisfuelled her determination to set up 500 Miles.

Other speakers include Policy Studies Institute senior researchfellow and author of Cultural competence in family supportFatima Husain, and NHS Harrow health visitor and domesticviolence lead Tanya Dennis.

To book a place, see: www.neilstewartassociates.com/sh269

Call to supportbreastfeeding in public

June 2010 Volume 83 Number 6 COMMUNITY PRACTITIONER 5

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Take part in new payand conditions survey

Welsh child povertystrategy consultation

Unite, along with other unionsincluding the RCN, RCM andUnison, is conducting a new surveyto ask staff about their pay andworking conditions, during a timewhen inflation is at 4.4% and cutsto public expenditure could impacton public sector staff pay.

In an e-bulletin to activists, Unitenational officer Karen Reay stated: ‘For this survey to carryweight, we need as many people as possible to complete it – astrong survey, clearly giving the views of NHS staff on pay,workload, morale and training, will be of assistance in not onlyputting forward the strongest possible evidence to the NHS PayReview Body, but in campaigning politically for a fair payincrease to be implemented.’

She added: ‘Completing the survey is the first step in fightingagainst more years of pay cuts in real terms for NHS staff.

The survey asks staff about their pay, morale, workload,experiences at work, access to training and their work-lifebalance. To take part, see: www.surveymonkey.com/s/9B57NNXand see pages 42 and 43 for further information.

The Welsh Assembly Government (WAG) has launched aconsultation on its child poverty strategy.

Unite/CPHVA professional officer Gill Devereaux stated:‘It is vital that members respond to the consultation – theyare frontline practitioners working with many families whoare living in poverty and will know how best to adviseWAG on how to effectively implement the strategy.’

She added: ‘The situation in Wales is that there arearound 200 000 children living in poverty and notenough jobs because of a massive recession. We have anew UK-wide government and so we are not yet clearabout funding for the region or for implementingthis strategy.’

The consultation is seeking views on areas such asthe best way to integrate local multi-agency support forfamilies living in poverty, and whether its delivery plan willenable the government to achieve its aims.

The consultation deadline is 12 August. To respond to it,please see: www.wales.gov.uk/consultations/childrenandyoungpeople/cpstrategy

In Scotland, a longitudinal study on child poverty hasfound three in 10 children to be income poor in any oneyear, while one in four three- to four-year-olds and one infive five- to six-year-olds were persistently poor.

The study began in 2005 with one cohort of 5217children aged nought to one year and another of 2859children aged two to three years.

The report details findings from data collected in 2008 to2009, when the birth cohort was aged three to four yearsand the child cohort five to six years.

Unite has raised concerns that the integration of primary caretrusts (PCTs) with acute or mental health services could meancuts to primary and community services.

Unite national officer Karen Reay stressed that the only way thatvertical integration could work is if funds are ring-fenced. Shestated: ‘Vertical integration of PCTs with acute or mental healthtrusts raises great concerns among our members. We have beenhere before in the 80s – community and public health serviceswere seen as the most disposable, services were cut and subsumedinto the acute sector.’

She added: ‘We need to have a very progressive and activecommunity health service, fit for purpose to deliver a high qualitypreventative health service. If trusts merge vertically, it is essentialthat the funding is ring-fenced and that community health staffare able to fully influence the direction and delivery of servicesrequired. This must be on an evidence- and needs-based assess-ment of the specific community’s health needs.’

An Independent Nurse poll of 121 respondents found that 72%believed vertical integration could harm patient care and 74%were concerned that the move could lead to job cuts.

Integration concerns

NEWS


Cervical screening:continued need despiteHPV vaccinationsDespite questions being raised over the continued long-termcost effectiveness of cervical screening, Unite/CPHVA hasemphasised the importance of continuing to screen womenuntil more is known.

Unite/CPHVA professional officer Ros Godson stressed: ‘We donot know how long the human papilloma virus (HPV) vaccineremains active. We have to continue screening women forcervical cancer because a majority of sexually active people havenot had the vaccine. We are still to find out the efficacy of theHPV vaccine, and whether any new strains of HPV develop thatthis immunisation cannot address. All research regarding thisover the next 40 years will determine how long we need toscreen women.’

In a presentation at a Royal Marsden Hospital event for GPs,consultant gynaecological surgeon Thomas Ind had warned thatscreening would ‘not be cost effective in the background of animmunisation programme’, adding that ‘vaccines may result inabandonment of the Papanicolau [cervical smear] test, thereforea higher rate of cancers’.

Ros Godson noted: ‘The lack of women turning up for cervicalscreening has been a concern long before the HPV vaccine camealong. There is also a social grading issue. Those in lower socio-economic groups present themselves much less for screening thanthose in higher socio-economic groups. As long as we target theright groups of people for screening and the right and appropri-ate types of resources, then we may see an increase in the numberof people turning up for cervical screening appointments.’

Epidemiology professor Jack Cuzick, who conducted a studylooking at both cytology and HPV testing methods, alsosuggested that HPV testing should be used instead: ‘Using HPVtesting as the primary screening method for cervical cancerwould not only mean women could be screened less often, but itwould also mean efficiency savings for the NHS.’

He added: ‘There is now an overwhelming case for moving toHPV as the primary screening test for women 30 and over anddemonstration projects should start for this now.’

His study, published in the British Journal of Cancer, tested twosamples taken from 11 000 women. One was screened usingconventional cytology methods and the other by testing forHPV. HPV testing was very accurate in identifying early signs ofcervical cancer, and detected more serious abnormalities thanthe current cytology screening in women aged 30 and over.

However, in research reported in this issue of the journal (seepages 30 to 33), the importance of promoting awareness andattendance of cervical screening has been emphasised, particu-larly (but not only) among those who decline HPV vaccination.

For further information on nappy rash prevention and treatment, visit www.morhulin.co.uk. The site contains a section dedicated to healthcare professionals, where an educational leaflet containing nappy rash advice can be downloaded or ordered to distribute in your surgery. Additional leaflets can be requested free of charge by simply visiting www.leaflets2U.co.uk.

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1 www.nhs.uk

Always read the label

A First Choice Treatment For Nappy Rash

Nappy rash is a common skin condition experienced by most babies. As the first point of contact for new parents, community practitioners are ideally placed to offer valuable advice on both prevention and treatment.

Morhulin is a dual action nappy rash cream containing zinc oxide, a known barrier cream1, enhanced with the natural benefit of cod liver oil, which promotes the healing of wounds, whilst soothing and moisturising the skin. Cod Liver Oil also contains Vitamin A which contributes to its healing effects.

Morhulin is available in 50g and retails at £2.99

NEWS


New ministerialappointments

New health and education ministers have been appointed tothe new coalition government.

Unite/CPHVA lead professional officer Obi Amadi stated:‘We will continue to work with the government to improveour members’ working conditions, public services and thehealth of the population, and plan to meet with the newgovernment soon.’

South Cambridgeshire MP Andrew Lansley is the newhealth secretary, while other new health ministers includeConservative MP for Guildford Anne Milton, formerConservative spokesman for health and social services EarlHowe, Conservative MP for Chelmsford Simon Burns andLiberal Democrat MP for Sutton and Cheam Paul Burstow.

The former Conservative shadow secretary for children,schools and families Michael Gove has been appointed asthe new education secretary. Other newly appointededucation ministers include Conservative MP for BognorRegis and Littlehampton Nick Gibb, Liberal Democrat MPfor Brent Central Sarah Teather and Conservative MP forthe East Worthing and Shoreham Tim Loughton.

The pay survey takes no longer than 10 minutes tocomplete and is completely anonymous – be sure to take

part by 8 June. See: www.unitetheunion.org/health

Make your voice heard!


IN BRIEF...

Call for School Nurse Forum membersThe Unite/CPHVA School Nurse Forum islooking to recruit school nurse members inScotland, Northern Ireland, West Midlands,East Midlands and Eastern regions, which arecurrently under represented. For further information, please contact SchoolNurse Forum chair Denise Hopkins on email:[email protected]

Pre-registration consultation responseUnite/CPHVA’s response to the NMCStandards for pre-registration nurseeducation consultation is available fordownload. To access a copy, please see:www.unitetheunion.com/sectors/health_sector/professional_groups__assoc/cphva/cphva_education.aspx

Preventing outdoor injury consultation The National Institute for Health and ClinicalExcellence (NICE) has published a consulta-tion on its draft guidance on preventingunintentional injuries in outdoor play areasamong under-15s. Individuals and organisa-tions wishing to respond must be registeredas a NICE stakeholder, and the consultationdeadline is 13 July 2010. To access theconsultation documents and for further infor-mation, please see: www.nice.org.uk, click on‘Consultation’ and then ‘Preventing uninten-tional injuries among under 15s: outdoor playand leisure: draft guidance consultation’.

World Cup reading toolkitThe National Literacy Trust has published afootball World Cup resource for literacyprofessionals to help them promote readingamong children. The resource includes ideasfor activities and games that schools, librariesand learning centres can use to encouragereading, including tips for organising activitiessuch as the ‘World Cup library treasure hunt’,‘The football reading game’ and ‘World Cupbingo.’ To access the resource, please see: www.literacytrust.org.uk/worldcup and clickon ‘World Cup toolkit’.

Protecting children against violenceThe Council of Europe has published guidelineson developing a Europe-wide national strategyto protect children from violence. The guidelinesrecommend setting up child-friendly servicesand strengthening international co-operation.See: www.coe.int/t/transversalprojects/children/News/Guidelines/Recommendation CM A4 protection ofchildren _ENG_BD.pdf


Swine flu costs mean PCT cutsResearch by GP newspaper has found that thecost of responding to the influenza A/H1N1v(swine flu) pandemic has resulted in 16% of 107respondent primary care trusts (PCTs) cuttingother healthcare services.

Unite Health Sector lead officer for nursingBarrie Brown stated: ‘While thepreparations for the potentialpandemic were an absolutepriority, and PCTs and the NHSmade all the necessary arrange-ments, this should not have led toservice cuts elsewhere. This was anational priority and fundingshould have been availablecentrally, but the issue of widevariations in the costs for PCTsneeds to be followed up by

strategic health authorities.’The research suggested that PCTs spent

£340 000 on average in responding to thepandemic. Specifically on costs of equipment,staff and communications, 9% of the 56 PCTsthat provided details spent more than £600 000,

while 4% spent £500 000 or less.A freedom of information request for this

was sent out to all PCTs, to which NHSBarnsley responded: ‘These costs have beenmanaged by achieving savings elsewherewithin the organisation, and this will apply toany costs incurred in 2010 to 2011.’

Four other trusts acknowledged that cutswould need to be made to recoup costs,including NHS Berkshire West, NHS Easternand Coastal Kent, NHS Peterborough andNHS West Essex.

New health informatics chair

NEWS

NHS East Riding ofYorkshire health visitor SuDavis has been appointedas the new chair of theUnite/CPHVA HealthInformatics AdvisoryGroup (HIAG).

Su stated: ‘I am reallyexcited about being the chair of the HIAG – a collective group of very experienced andknowledgeable practitioners in the field ofhealth informatics. I am very keen to networkwith other like-minded people and hope that

my energy and enthusiasm will help toencourage other members to becomeinvolved with the HIAG.’

Su has been a health visitor in Hull and EastYorkshire for 15 years. She is currentlyworking in East Yorkshire as a children andyoung people’s clinical lead for SystmOne, aprimary care service computer system forinformation sharing and recording of patienthealth records.

She has facilitated the implementation of thesystem across health visiting, school nursingand special school nursing.

Su Davis

Scottish health election pilotsHealth board elections in Scotland will takeplace in two pilot sites NHS Fife and NHSDumfries and Galloway on 10 June, and youngpeople aged 16 and 17 years will also have theright to vote.

Unite/CPHVA professional officer Gavin Fergiestated: ‘This age group can sometimes be amissed part of the population when it comes toprovisional service, so anything that canencourage 16- to 17-year-olds to engage in thefuture of health boards is a very good idea. If weengage with this group appropriately, forinstance going through the Scottish YouthParliament, then hopefully we will get the righttype of response.’

Scottish health secretary Nicola Sturgeonstated: ‘I would urge those under 18 who canvote in these pilot elections to get informed onlocal health issues, and cast their vote.’

She added: ‘We want an NHS that is trulymutual, where patients are not just partners intheir own care but where local communities areat the heart of local decision-making.’

In NHS Fife, 12 of the 25 people on the boardwill be elected non-executive members, with 12appointed members and one local authoritymember. In NHS Dumfries and Galloway, 10 ofthe 21 board members will be elected, with 10appointed members and one member from alocal authority.


1817401 RCM Midwives JournalBleed size 216mm wide x 286mm highTrim size 210mm wide x 280mm highType area 178mm wide x 248mm high

there’smothercarein all our bathtimes

mothercareall we knownew baby toiletriesWe couldn’t ask babies their opinions. So we did the next best thing, consulting an independent panel of mums and midwives. The result is All We Know, a range of baby toiletries designed to gently and safely care for baby’s skin.

If you would like to receive a free travel pack of our new baby toiletries and a free step-by-step guide to bathing, please send an email to [email protected] with your name, professional title, full address and postcode.

IN BRIEF...

Neonatal jaundice guidanceNew National Institute for Health and ClinicalExcellence guidance has been published onneonatal jaundice. The guidance recommendsthat visual inspection should not be relied onalone to identify possible jaundice innewborns. To access the guidance, pleasesee: www.nice.org.uk/CG98

Members to inform consultationsUnite/CPHVA is calling on members who havespecific knowledge and competencies inissues relating to obesity, tuberculosis,enuresis, accident prevention and personal,social, health and economic education tohelp inform forthcoming consultationsplanned by the National Institute for Healthand Clinical Excellence. To get involved, please contact Ros Godsonon email: [email protected]

Food Dudes gets gold medalFood Dudes, an initiative to encourage andmaintain healthy eating habits in children, wasawarded the gold medal at the chief medicalofficer’s Public Health Awards 2010. Theproject was set up in Wolverhampton tocombat high rates of childhood obesity byincreasing and sustaining the consumption offruit and vegetables among four- to 11-year-olds. For further information on the project,please see: ww.fooddudes.co.uk/fda-around-the-world

New Welsh helpline for childrenThe Welsh Assembly Government haslaunched a free helpline for children andyoung people in Wales. Advisers will eitherprovide information themselves or transferchildren to an independent professionaladvocate. The new helpline, called Meic, willwork alongside ChildLine and in its initialstage, the helpline will be available sevendays a week between 12pm and 8pm, beforebecoming a 24-hour service. To contactMeic, Tel: 0808 8023456 or text: 84001.

Male lower urinary tract symptomsThe National Institute for Health and ClinicalExcellence has published guidance on theeffective management of lower urinary tractsymptoms (LUTS). The guidance recommendsthat men who have LUTS should have accessto care that can help with their emotionaland physical conditions, and any relevantpsychological, sexual and social issues. To access a copy, please see:www.nice.org.uk/CG97

NEWS

Welsh minimum

alcohol pricingHealth minister Edwina Hart has raised theprospect that Wales will seek the power toimpose a minimum price on alcohol ifWestminster does not act on this issue.

Edwina Hart stated in a written statement: ‘Ifwe do not see the action we want at UK levelvery soon, then the time will come when we seekmore powers to act ourselves.’

She added: ‘We do not have specific figures forWales, but this evidence suggests that after 10years, a minimum unit price of between 40p and50p could reduce the number of alcohol-relateddeaths in Wales by 20% to 25%. This wouldequate to 200 to 250 fewer deaths per year after10 years.’

Unite/CPHVA professional officer GillDevereaux responded: ‘This is notjust a pricing issue, we need a culturalchange in attitudes toward alcoholconsumption. A good way ofachieving this is through education –and the earlier the better. The maincohort of problems is in youngchildren, and so we need to interveneas early as possible.’

Child protection cases on the riseAccording to research conducted for theAssociation of Directors of Children’s Services,child protection referrals to social services haverisen by over 20% in two years.

Heather Wood, a PhD student at BournemouthUniversity who is working on risk assessmenttools used to assess child protection cases, stated:‘The Peter Connelly (“Baby P”) case and cases ofchild deaths from abuse and neglect in Doncastermay have led to a cautious re-consideration ofcurrent child protection cases nationally, leadingto a rise in the numbers being taken to court forcare orders and an increased tendency to providealternative foster care.’

She added: ‘Another interpretation might bethat the lack of early identification of childsafeguarding needs has resulted in some casesbeing more serious when referred. This couldreflect a lack of early identification and preven-tative services. Home visiting is the only way topick up detailed information. Health visitors canask probing questions around issues such as

domestic abuse and child safeguarding, but withmassive caseloads of more than 500, the oppor-tunities for interaction are reduced.’

Unite/CPHVA lead professional officer ObiAmadi stressed: ‘In some areas, health visitorshave been commissioned to do assessmentswithin 45 minutes. Commissioners need tounderstand that more flexibility around homevisits needs to be given in order to allowthorough assessments.’

The research compared data from 105 localauthorities in the period October to December2007 with figures for the same quarter in 2009. ■ Initial contacts, in which a child is first

brought to the attention of social workers, hasincreased by 24.6% (from 155 921 to 194 286)

■ Referrals for further investigation increased by16.5% (from 74 722 to 87 026)

■ Section 47 enquiries, where professionalsinvestigate concerns that a child is sufferingfrom or is at risk of significant harm, haveincreased by 20.3% (10 371 to 12 575).


Change4Life

BME focusAs part of its Change4Lifeblack and minority ethnic(BME) activity, theDepartment of Health hasdeveloped a toolkit to helppromote healthy eating andlifestyles among BME people.

The toolkit includes resources such as postersand flyers in English, Urdu and Bengali. Inaddition, an information pack has beencompiled for BME families that includesEnglish/Urdu and English/Bengali informationbooklets with healthy traditional recipes.

Since the launch of Change4Life in Wales,8500 families there have returned applicationforms to receive their personalised action planfor a healthier lifestyle, and 500 organisationsthat work with children and families havesigned up to support the campaign.

The campaign was launched in Wales inMarch, but has not been introduced inNorthern Ireland or Scotland.

To access the Change4Life BME toolkit, andrelated resources, see: www.dh.gov.uk/en/MediaCentre/Currentcampaigns/Change4Life


NEWS


Member’s corner

Newly inducted Queen’s NursesFive members have been awarded the title of Queen’s Nurse,and certificates were presented by Dame Donna Kinnair, NHSSouthwark director of commissioning and nursing.

One of the newly inducted Queen’s Nurses was infantfeeding co-ordinator Sharon Breward MBE. She stated: ‘I wasdeeply honoured to be made a Queen’s Nurse. I hope that myaward will help highlight to others the importance of us allworking together to strive to establish a first-class infantfeeding service for new mothers and their babies. I amcontinually inspired by the mothers with whom I work andwish to pay tribute to the mothers who took the time tonominate me for the award.’

Specialist health visitor for homeless families MaxineJenkins was also awarded the title. She stated: ‘I was veryproud to receive the title of Queen’s Nurse, but most impor-tantly I was really pleased to be offered an opportunity tofurther develop my nursing skills through the extra trainingand networking with other Queen’s Nurses that I now haveopportunity to participate in.’

Other newly inducted Queen’s Nurses include locality leadco-ordinator Frances Allen and health visitors Alex Dudleyand Anne Hobbs. At the Queen’s Nursing Institute ceremony,Dame Donna Kinnair stated: ‘These nurses are the way of thefuture of nursing people in their own homes and communi-ties, with a huge responsibility for delivering good care.’

From left to right, Donna Kinnair with Maxine Jenkins, Sharon Breward, Frances Allen, Alex Dudley and Anne Hobbs

For more on pay and the pay survey, see pages 42 and 43


Unite/CPHVA Annual Professional Conference 2010Healthy Family, Healthy ChildWednesday 20 - Friday 22 October 2010 Harrogate International Centre, Harrogate

The Unite/CPHVA Annual Professional Conference is a vital opportunity for you and your colleagues to hear the very latest developments in best practice in primary care and public health. The conference themes for this year are:

• Economicanddemographicimpactsonpractitioners

• Sustainingpositivechangeinthecommunity–flourishing, not failing families

• Sustainingpositivechange–influencingthefuture

Register today and join a speaker panel of high-level policy makers and opinion formers at what is expected to be a very topical and lively debate.

www.neilstewartassociates.com/sh269

To register for updates about the agenda and speaker line-up visit the website.

For enquiries call Dino Dionissiou on 020 7324 4357 or email [email protected]

Speakers include:

Angela Mawle Chief Executive,

UK Public Health Association

George Hosking Founder, Chief Executive and

Research Co-ordinator, WAVE Trust

Rosemary Kennedy Chief Nursing Officer for Wales

Martin Bradley Chief Nursing Officer for Northern Ireland

Ros Moore Chief Nursing Officer for Scotland

Dame Christine Beasley DBE Chief Nursing Officer for England

Keynote speakers:

Lord Victor Adebowale President, CPHVA

Professor Laura Serrant-Green Professor of Community and Public Health,

University of Lincoln

Dr Mike Grady Senior Research Associate;

Member of the Marmot Review Team

National Breastfeeding Awareness Week(NBAW) takes place on 21 to 27 June, andmany practitioners in all four countries ofthe UK will be organising events focusingon this year’s theme ‘Breastfeeding: everyday is good for your baby’. Many practi-tioners see NBAW as a good way to raiseawareness of the benefits of breastfeedingand draw press attention to local supportgroups for mothers, though on-going,year-round initiatives are needed toincrease and sustain breastfeeding rates.

Using NBAW as a focusCaithness Breast Friends is an onlinenetworking website in Scotland that putslocal breastfeeding mothers in touch witheach other so that they can support each

other with breastfeeding. In the past, theorganisation has set up a stall in Thurso topromote its service during NBAW.

Caithness Breast Friends founder FionaMatthews states: ‘We were not onlytargeting mothers but grandmothers andthe extended family so that they could helppromote breastfeeding as something that issocially acceptable. In the Highlands,mothers are generally too shy to breastfeedin public and that is one of the biggestbarriers that we have here.’

She adds: ‘I am not sure that NBAWdirectly helps breastfeeding rates, but itcertainly helps to increase awareness ofthis type of support for mothers in thearea. Generally, it is a good idea to have aweek devoted to promoting breastfeeding.If NBAW did not exist, there would not bethe incentive to organise such events. Inthat respect, it is worthwhile. Also, the

local press does pick up on these activi-ties, and in some ways the press

coverage can be more useful thanthe event itself for highlighting

what is on offer for breastfeed-ing mothers.’

Fiona suggests that eventsshould encourage moreinteraction to be moreengaging: ‘Generally, peoplewho came to the stall werethose who were already

getting breastfeedingsupport or who have been

involved in a similar supportgroup, so we were not reaching

out to new people. It would havebeen beneficial to have different

events that were more participatory, suchas a breastfeeding picnic. The events that wehave planned for this year’s NBAW willcertainly be more participatory.’

Engaging the public and the mediaJanet Calvert, regional breastfeeding co-ordinator at Northern Ireland’s Public

On-going, year-roundinitiatives are needed to

increase and sustainbreastfeeding rates

PHO

TOLI

BR

ARY

Breastfeeding: supportingwork throughout the year

NEWS FEATURE

National Breastfeeding Awareness Week is useful in drawing attention to localservices and providing a focus for the public and the mediaKin Ly

Assistant editor


10-11 CP June10 News feature.qxd:12-13 CP Feb 09 News_NEWv6.qxd 19/5/10 15:47 Page 10

Health Agency (PHA), emphasises howNBAW is valuable in helping to raiseawareness: ‘It is difficult to measure theimpact that NBAW has on increasing andsustaining breastfeeding rates – there areso many factors that are involved in thedecision to breastfeed and continuingwith it – but I do think it is an opportuni-ty for those who work so hard in thestatutory and voluntary services to try andimprove awareness of breastfeeding. Itdoes give valuable focus. If we all celebrateit at one time, it can be reported innational and local media and there is stillvalue in that.’

The PHA has previously organised anNBAW pampering event for breastfeedingmothers, which offered reflexology, shortpresentations and opportunities to meetpeer supporters. Janet states: ‘If we go bythe number of attendees and feedbackfrom the women who attended, it is clearthat there is real potential to engage andhelp them to realise that there is supportfor them.’

In Sutton and Merton last year, a numberof roadshows were held for NBAW. Theevents were helpful in engaging the localpopulation and providing information onhealth benefits.

Infant feeding advisor Sue Taylor, whoworks for Epsom and St Helier UniversityHospital NHS Trust and Sutton andMerton Primary Care Trust, states: ‘Weconnected with the public by invitingthem to fill out a quiz in return for a raffleticket for a prize draw. The quiz askedquestions such as “Would breastfeedingreduce the risk of ovarian cancer?” “Doyou know how long breastmilk can bekept out for?” and “What is in breast-milk?” Before drawing the winning tickets,we provided the answers to the quiz, andeveryone was astonished at the answers.This got them talking about the healthbenefits of breastfeeding. We got supportfrom Debenhams, Mothercare and gardencentres for the prizes.’

For this year’s NBAW, Caithness BreastFriends will be adopting an early interven-tion approach – its infant feeding advisorswill be visiting a number of primaryschools in the area to talk to childrenabout the benefits of breastfeeding.

Fiona states: ‘Last year, a colleague ofours did a presentation in a number ofschools that really engaged the children.The aim was to allay any misconceptions

that they may have of breastfeeding, andto try and promote the idea that it isnormal to breastfeed. There was also aposter competition, where the childrenwere asked to make a poster thatpromoted breastfeeding. Because of thesuccess of this, we are hoping to do thisfor this year’s NBAW.’

Need for year-round workSue stresses the importance of workthroughout the year in improving breast-feeding rates: ‘NBAW will only help tobring issues to the forefront – it does whatit sets out to do, to encourage practition-ers to raise awareness. As a trust we are

completely committed to promotingbreastfeeding, and we are working towardachieving UNICEF Baby FriendlyInitiative status. We promote breastfeedingall year round. We keep staff up to datewith the most accurate, evidence-basedresearch and ensure that our clients havethe right information.’

She adds: ‘In Sutton and Merton, weoffer a walk-in antenatal class, and allpregnant women have my phone number.In the community, there is a volunteerpeer support programme. I am workingclosely with the peer supporters and wewill be going through the process ofgetting them checked through theCriminal Records Bureau.’

Fiona Matthews says that CaithnessBreast Friends is working with theNational Childbirth Trust to develop peersupporters: ‘We are hoping that the peersupport programme will make a hugedifference to breastfeeding rates. The NHSis massively understaffed. Although infantfeeding advisors follow all the rightprotocols and have done all the training,they do not have the time to follow up.’

She adds: ‘The idea is that the trainedpeer supporters will contact motherswithin 48 hours of them giving birth. Wewill provide them with all the informationand more importantly the emotionalsupport. We are not trying to push peoplewho do not want to breastfeed into it, butwe are hoping that by encouraging the

peer supporters to make contact withmothers within the first few weeks ofgiving birth that they may not give upbreastfeeding when they may ordinarilyhave done.’

NBAW as a springboardIn addition to raising awareness of breast-feeding and local services, NBAW can alsobe used as a springboard for new initia-tives that continue to work throughoutthe year.

For example, the Breastfeeding WelcomeScheme was launched in Wales duringNBAW last year, with the aim of encour-aging businesses to promote and welcomebreastfeeding on their premises. Since itslaunch, a further 200 venues have signedup to the scheme all over Wales, bringingthe total to nearly 350, including restau-rants and cafes as well as tourist attrac-tions like the Wales Millennium Centre.

In addition, funding was announced todevelop an Agored Cymru (formerlyknown as Open College Network) coursein breastfeeding peer support. The aimwas to ensure that peer support trainingacross Wales is consistent, and a newbadge has been produced to identifyqualified breastfeeding peer supporters.

Agored Cymru co-ordinator MariaDowden states: ‘The introduction of thebreastfeeding support course and theaward demonstrates a fine example ofpartnership working between the healthboards, national and local voluntarybreastfeeding organisations, the WelshAssembly Government and Agored inencouraging and recognising the achieve-ment of breastfeeding peer supporters intheir work toward supporting, protectingand promoting breastfeeding.’

NBAW is clearly an opportunity forpractitioners to promote the healthbenefits of breastfeeding. While activitiesand events held during this week cannotexpect to result directly in immediateincreases in breastfeeding initiation orcontinuation rates, they can be helpful indrawing attention to on-going localservices and new initiatives.

NBAW can also be used as a springboard for new

initiatives that continue towork throughout the year


NEWS FEATURE

Further informationFor further information about NBAW 2010 and to access Department of Health resources, please see: www.breastfeeding.nhs.uk/en/fe/page.asp?n1=5&n2=13

10-11 CP June10 News feature.qxd:12-13 CP Feb 09 News_NEWv6.qxd 19/5/10 15:47 Page 11

Silent Night

The most widely used infant colic treatment in the UK2

Effectively relieves wind, infant colic and griping pain

Clinically proven to reduce the frequency and severity of crying attacks associated with infant colic1

Suitable to use from birth onwards

Sugar, alcohol and colourant free

Easy to administer - comes with an integrated convenient-to-use plastic dropper

References: 1. Sethi K.S. & Sethi J.K. Simethicone in the Management of Infant Colic. The Practitioner 1988; 232:508. 2. IRI Value and Volume Sales 52 w/e 20th February 2010.

Please refer to Summary of Product Characteristics before prescribing. Presentation: An orange-fl avoured, colourless, translucent suspension. Each ml contains 40mg simeticone. Indications: An antifl atulent for the relief of griping pain, colic or wind due to swallowed air. Dosage: Infants - one dropper full 20mg (0.5ml) administered before each feed. If necessary this may be increased to two droppers full 40mg (1ml). Treatment with Infacol may provide a progressive improvement in symptoms over several days. Contra-indications: None stated. Warnings and Precautions: If symptoms persist, seek medical advice. Side Effects: None stated. Legal Category: GSL. Package Quantities: 50ml plastic bottle fi tted with a plastic dropper and evoprene teat. Basic NHS Cost: £2.26. Marketing Authorisation Holder and Number: Forest Laboratories UK Limited, Bourne

Road, Bexley, Kent, DA5 1NX, UK PL0108/0100 and PA 100/41/1. Date of Preparation: October 2009. For further information, or to request a copy of the Summary of Product Characteristics (SPC), please contact: Forest Laboratories UK Limited, Riverbridge House, Anchor Boulevard, Crossways Business Park, Dartford, Kent DA2 6SL. Tel: +44 (0) 1322 421800

Information about adverse event reporting can be found at www.yellowcard.gov.uk Adverse events should

also be reported to Forest Laboratories UK Ltd. Tel: +44 (0) 1322 421800

contains simeticone

06037 Infacol Advertorial DPS 297x420mm.indd 1-2Untitled-1 1 19/05/2010 14:48

contains simeticone

October 2009. For further information, or to request a copy of the Summary of Product Characteristics (SPC), please contact: Forest Laboratories UK Limited, Riverbridge House, Anchor Boulevard, Crossways Business Park, Dartford, Kent DA2 6SL. Tel: +44 (0) 1322 421800

The strongest baby bond Each year the Infacol Baby Bonding Award celebrates exceptional partnerships between healthcare professionals and those parents who have struggled to bond with their baby. From hundreds of moving stories sent in by parents from around the UK, the judges gave this year’s Baby Bonding Award to Dr Richard Dawson, from Westcliffe Medical Centre in Shipley, West Yorkshire. His caring approach, professionalism and patience helped new mum Zoe Swift fi ght depression and form a strong bond with her baby.

www.infacol.co.uk

Infacol, the UK’s No.1 selling infant colic treatmentFor over 13 years Infacol has maintained its position as the most widely used infant colic treatment in the UK.

First sold in pharmacies in 1987, Infacol was made more widely available through grocery outlets ten years later.

The clinically proven active ingredient simeticone works as an anti-fl atulent, helping small trapped air bubbles in the digestive system join together to form larger bubbles that are released as wind.

The success of Infacol has been recognised by many awards, including the Practical Parenting Award, and the Mother and Baby gold award for the best healthcare product.

Mum Zoe Swift, William Roper from Infacol and Dr Richard Dawson

18/5/10 10:05:34Untitled-1 1 19/05/2010 14:49

There are two basic ways to make a presentation at a conference –by poster or paper. In a poster presentation, information isvisually delivered using text, diagrams and pictures. Peopleattending conferences will view posters during breaks in theconference programme, and often the poster presenter will standby their poster to answer questions about their presentation. In apaper presentation (also known as an oralpresentation), information is primarilydelivered by speaking to an audience.

When preparing a presentation, be sure toread and then strictly adhere to conferenceguidelines, such as the size of posters or theduration of paper sessions. It is alsoimportant to consider who is likely to attend the conference –will they be practitioners, managers or researchers? Develop yourpresentation with this audience in mind, ensuring that thecontent meets their needs. Aim to keep your message simple,concise and relevant. To ensure that the presentation is focused,in the introduction briefly inform your audience about the areasthat you intend to cover, and at the end of the presentationprovide a concise review of its content.

Make it easy for your audience to engage with your message.Posters should be easy to read quickly and visually arresting. Youmay decide to supplement an oral presentation with audiovisualaids. These should not detract from your message, so keep visualaids unfussy and simple. Connect with your audience by keepinggood eye contact and speaking at a natural pace – avoid simply

reading your presentation out. Remember tokeep to time and allow people the opportunityto ask you questions about your message.Consider providing an email address or othercontact details at the end so that delegates cancontact you after the conference.

The best way to control excessive nerves is toprepare your presentation well in advance and to rehearse youroral presentation. If possible, ask for some presentation feedbackfrom people who are not wholly familiar with your subject – ifthey can understand your message, then the conference delegateswill too. As you make your presentation, relax, smile, be confidentand enjoy the opportunity to discuss something that is importantto you. Your audience will then relate to your enthusiasm andpositive attitude.


The best way to controlexcessive nerves is to

prepare your presentationwell in advance

RESEARCH NOTES

The Research Forum provides tips and advice for people who are preparing

and delivering conference presentations through posters or papers

Conference posters and papers

Guidelines for authorsArticles are considered for publication on theunderstanding that they are not being offered to anyother journal and have not been published or acceptedelsewhere. All manuscripts should be submitted, with fullauthor contact details, directly to the editor DannyRatnaike, by email: [email protected] as an Microsoft Word document on disk toCommunity Practitioner, Ten Alps Publishing, 1 NewOxford Street, London, WC1A 1NU. Authors should keepa copy of the material they submit.

Presentation and house styleThe first page should contain the followinginformation only: title of article, first name andsurname of author(s), qualifications, details ofposition held, number of words in article.Spelling should conform to that of Chamber’s TwentiethCentury Dictionary. Where either ‘s’ or ‘z’ can be used,please use ‘s’, eg organisation. Numerals one to nineshould be written out, 10 and over typed as figures.Percent should be written as %. Full stops should not beused to indicate abbreviations: eg, ie, DH. Unfamiliarterms should be spelt out in full when first usedfollowed by the abbreviation in brackets. Quotationmarks should be single, except for quotes within quotes.Capital letters should not be used for terms like healthvisitor or nurse. Please do not underline headings or anywords except those you want printed in italics.

Article content and lengthArticles need to be written with our readership in mind:health visitors, school, practice and district nurses andcommunity nursery nurses. We welcome inclusion ofrelevant figures, tables and images, though original workon paper is submitted at the owner’s risk. Electronicimages should be at least 300dpi resolution.

Professional papers should be between 2000 and3500 words in length, and are subject to double-blindpeer review following submission. Longer articles canbe submitted for consideration and may be publishedin two parts. They should begin with an abstract of150 to 200 words, and up to five key words thataccurately reflect the article’s subject and focus. Research articles should be arranged in the usualorder of introduction, study aim/purpose, methodincluding ethical approval, results, discussion,implications and recommendations, conclusion,references and acknowledgements.

Clinical updates are usually 1400 words in length,should be referenced and review management issueswithin a particular clinical area.

Other features are 700 or 1400 words in length (oneor two printed pages) and their content should bediscussed with the editor prior to submission.

ReferencesPlease check that allreferences are complete andaccurate prior to submission.References should be set out in theVancouver style and should not exceed 35 in number.

EditingThe editor reserves the customary right to style andshorten material accepted for publication.

PublicationThe editor reserves the customary right to determine thepriority and time of publication. Due to the largenumber of articles received, publication may bedelayed, although every effort is made to publish withinnine months of acceptance. Authors of articles willl receive one complimentary copyof the journal following their publication.

Danny Ratnaike editor Tel: 020 7878 2404E: [email protected]

Jane Appleton professional editor Tel: 01865 482606E: [email protected]

18 CP Jun 10 ResNotes.qxd:Layout 1 19/5/10 16:31 Page 18

Applications are invited for the MacQueen Award 2010, which this year willrecognise excellence in leadership in public health that demonstratesinnovation and new ways of working in public health.

The winner will receive £3000 in recognition of their personal achievementto enable further development, dissemination and publication of their work.A ticket and expenses (travel and accommodation) will also be provided toattend the Unite/CPHVA Annual Professional Conference in Harrogate on 20 to 22 October 2010.

The winner will be supported in submitting a report on their project forpublication in Community Practitioner. The project should:

■ Demonstrate innovation in leadership■ Be either on-going or recently completed■ Show evidence of evaluation and the difference it has made.

All applicants should demonstrate:

■ How they have motivated colleagues and/or clients to influence changeand provide independent evidence of this with their application

■ How they will disseminate or communicate their work to colleagues andthe wider health community.

All CPHVA members are eligible and welcome to apply. Please contact Kitty Lamb, chair of the Professional AdvisoryCommittee on email: [email protected] – the closing date is 1 September 2010. Short-listed applicants will benotified on 10 September and interviews will be held in London on 16 September (travel expenses will be recompensed).

CPHVA Education and Development TrustMacQueen Award 2010 for Excellence in Leadership

Last year’s winner Deborah Rountree (third from left)receiving her MacQueen Award at the Unite/CPHVAAnnual Professional Conference 2009, with (left toright) Lord Victor Adebowale, Jane Dauncey andDeborah’s colleague Diane Gray

PATR

ICK

TR

OLL

OPE

The trust was created to fulfil the wishes of Dr IanMacQueen, who was medical officer of health inAberdeen and a vice president and trustee of whatwas then the Health Visitors’ Association (HVA).

Dr MacQueen believed passionately in the contribu-tion that health visitors make to the health of apopulation, especially in public health, and he wishedto support this work and also reward individual healthvisitors for work that demonstrated excellence.

In 1978, he informed the HVA general secretary ofhis plans to make a major bequest that would beactivated following his and his wife’s deaths, and theCPHVA received £198 325 in 1997. He asked thatawards be given for excellence in practice, education

and leadership. He also said that moneycould be used to support the development ofpractice, hence a recent decision to supportspecial interest groups (SIGs). The trust

became live in 1997 and the first awardswere made in 1999. The trust’s name was

changed by a members’ vote in 2004, since theprevious title (CPHVA Charitable Trust) did not

adequately describe its purpose.

Also in 2004, a special award was created to thankLady Limerick for her many years as president of theCPHVA. Members raised £4000 that was used for anaward for excellence in research, and this has beenincluded in the awards cycle since then. For thisyear’s MacQueen Award (see above) the trust isencouraging applications from nursery nurses, schoolnurses and district nurses as well as health visitors.

The MacQueen Travel Bursary for Public Health Abroadwas launched this year to provide £1000 toward travelthat demonstrates a link to public health, and thewinner will be announced at the annual conference inOctober. This replaced the bursary for overseas workgiven once in 2008 to Tracey Young for school healthwork in Uganda. Keep your eyes peeled for news of nextyear’s bursary, which will be advertised later this yearon the Unite/CPHVA website and in this journal.

This year, SIGs were invited to apply for non-recurringfunding to support their work. The trust’s ProfessionalAdvisory Committee also plans to follow up previousMacQueen Award winners to assess the impact it hashad on them and how prize money was spent. Watchout for news on both of these in Community Practitioner.

Trusting in the futureMore about the CPHVA Education and Development Trust

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LETTERS


Family Nurse Partnership and health inequalities

We read in the April edition of the journal Maggie Fisher’sremarks about her concerns about the Family NursePartnership (FNP) in England and Scotland, and do not agreethat FNP contributes to health inequalities – instead, it is partof the package of proportionate universalism.1 Some familiesin the UK need a greater share of the service to get some of thesame outcomes for their health.

We believe that we are contributing to the Healthy Childprogramme and that our role falls within the progressiveservices offered to those with additional risks and needs.2

Teenage parents have a 60% higher risk of infant mortality,increased risks of a low birthweight, are three times more likelyto suffer with postnatal depression, and have a higher risk ofliving in poverty.3 This is why this vulnerable client group needsa different service to help meet their and their children’s needs.

FNP has a strong evidence base and the young people we areworking with like this service and want their friends to have afamily nurse. This is a powerful message, and as a powerfulunion we should be listening to the views of these young peopleand representing their views.

Lucy Love Family nurse supervisor, Leeds

On behalf of supervisors for the FNP randomised controlled trial sites

I have been lucky to spend time with our members who work inthe FNP schemes, being able to discuss with them their views ontheir progress. One of the messages that I have always tried to getacross from these meetings when speaking to members who arenot lucky to have witnessed FNP first hand is the vocal supportthat family nurses provide to health visitors.

We are aware that in some areas, health visitors have to facesome of the most challenging of situations, with caseloads well inexcess of Lord Laming’s recommendations. In this climate, it canbe difficult to then not feel frustration and sometimes despair atsuch a difference.

My approach has rather been to value the benefits that FNPbrings, the support it offers to some of our most disadvantagedfamilies in England (and soon in Scotland), but never to see thatit should be a question of either one or the other, because in thatcase Maggie’s comments would be quite correct. Some organisa-tions are racing to cut back on services, even though this is quitecontrary to the guidance issued by government in needing toincrease the number of health visitors.

One of the worries about what is next for FNP may well mirrorthe current crisis in health visiting, where in the drive to save aquick quid, community public health will be seen as that areathat can face the cuts first, and so these services that were soneeded when Wanless said we need to get people fully engaged tomake health care more cost effective will be ignored. In thisregard, I have already supported several of the FNP schemes inensuring that the staff are paid the correct grading and that thereis no inappropriate grade mix.

Dave MundayUnite Health Sector professional officer

1 Strategic Review of Health Inequalities in England post-2010: the Marmot

Review. Fair society, healthy lives. London: The Marmot Review, 2010.

2 Department of Health. Healthy Child programme: pregnancy and the first five years

of life. London: Department of Health, 2009.

3 Department for Children, Schools and Families, Department of Health. Teenage

pregnancy strategy: beyond 2010. London: Department for Children, Schools and

Families, 2010.

Breastfeeding and CMPAI was interested to see the clinical updateon cow’s milk protein allergy (CMPA) inthe May issue of the journal.

While reading the article, I was struck bythe absence of any reference to the factthat for many babies this is an avoidabledisorder. In clinical practice, I have comeacross many mothers who have reportedscenarios where it is clear that if theirbreastfeeding had been better supported,they would not have introduced the infantformula that then caused their baby todevelop CMPA.

Indeed, the case study provided withinthe article details a mother who had beentold to stop breastfeeding by her GPbecause of the need to take medication. Inthese types of situation, stopping breast-feeding is often unnecessary. With the useof alternative information sources such asProfessor Tom Hale’s Medications andmother’s milk1 or the BreastfeedingNetwork’s drugs information helpline,2 analternative plan of care can usually beproffered, with the result that breastfeed-ing can continue for the benefit of boththe mother and baby.

In such circumstances, health visitorshave an important role in acting as theadvocate for mother and baby, so that therisks of stopping breastfeeding are factoredinto the decision-making process.

Sharon Breward RHV and lactation consultant, North Wales

1 Hale TW. Medications and mother’s milk. Amarillo,

Texas: Pharmasoft Medical, 2008.

2 Breastfeeding Network. What is the Drugs in

Breastmilk Helpline? Available at:

www.breastfeedingnetwork.org.uk/

drugs-in-breastmilk.html (accessed 17 May 2010).

Say something!We welcome letters of up to 300 words – send them to the editor, marking themclearly as being for publication, either via email to: [email protected] or by post to: Community Practitioner, Ten Alps Creative, One New Oxford Street, London, WC1A 1NU.

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PROFESSIONAL


IntroductionProtocols: common quality assurance toolsOver the last decade, government policy hasemphasised quality, safety and the need toreduce unacceptable variations in practiceand outcomes.1 One way of achieving this isthrough formalising and standardising careprocesses by making explicit ‘who shoulddo what, when, how and why’ in documentssuch as protocols, care pathways or clinicalguidelines. These documents are producedby professional associations, nationalbodies such as the National Institute forHealth and Clinical Excellence (NICE) andby local services. They are referred to asevidence based when they synthesise bestavailable research into practice recommen-dations, reflecting the embedded researchmodel of getting evidence into practice.2

A recent survey suggests that protocols,care pathways and clinical guidelines arecentral to the work of the many nurses,midwives and health visitors in the NHS.3

The findings from a national survey with2711 respondents revealed how commonthese documents are, and the contributionthese staff groups make to local develop-ments. One in five (19.8%) reported leadingthe development process to a great extent,and almost half (49%) had contributed tothe process. Over half of the respondentsworking in hospital and primary carereported using clinical guidelines, and athird used protocols in these settings. Therewas a similar pattern across specialities, withmore than 50% using guidelines in women’shealth, mental health, primary care andcommunity care. Over 60% reported usingthese documents all or most of the time forhealth screening, assessment, interventions,patient education and discharge.

Resource use costs of developing protocolsThe pervasiveness of protocols, carepathways and clinical guidelines raisesquestions about their clinical and cost effec-tiveness in supporting quality health care,especially in the current financial climate.One question relates to the opportunitycost of development, implementation, auditand sustainability. Such resource use costs

include staff time attending meetings andappraising the literature, implementationcosts of staff training, and resources neededto audit and update the documentation.

Anecdotal evidence suggests that thedevelopment process is time and labourintensive. However, costs are rarely consid-ered or quantified in national guidance orreports about local developments. An inter-pretative review of UK literature found thatcost was not mentioned in official guidanceabout how to develop local, protocol-basedcare and was rarely noted in papers.4 Theguidance5 estimated that the developmentprocess would take between three and sixmonths, but in the 10 papers that reportedduration this ranged from six months tothree years, with an average of 15 months.

A systematic literature review of the effec-tiveness and efficiency of guideline dissem-ination and implementation strategiesfound that only four papers (1.7%)reported costs of development, dissemina-tion and implementation.6 This finding wasreplicated in a recent review of economicevaluations.3 Although 16 studies werefound that contained data about develop-ment and implementation costs, it was notpossible to summarise their magnitude andnature due to differing costing methodsand inconsistent reporting. Inconsistencywas evident in methods used to gathercosting information – some studies lookedat the consequences of standardised careand typically reported total costs. However.others reported a single aspect of care thatwas the focus of the protocol, such as acqui-sition costs of drugs. In addition, differentdegrees of detail about resource use made itdifficult to make direct comparisons.3

A locally developed protocolThe research presented in this paper soughtto address this knowledge gap by investigat-ing the resource use costs associated with awell established, health visitor-led protocolfor perinatal mental health. This protocolaimed to provide women with the opportu-nity to have their mental health needsidentified and assessed and be offeredeffective support, advice and treatment.

Yemi Oluboyede MSc, BANational Institute for Health Research research fellow,Institute of Health Sciences, University of Leeds

Anne Lewis MSc, BNurs, RGN, RHV, NDNCert Clinical leadership and quality manager, NHS Central Lancashire

Irene Ilott PhD, FCOT, MEd, BAKnowledge translation project lead, Sheffield Teaching Hospitals NHS Foundation Trust

Chrysanthi Lekka PhD, MSc, BAHuman and organisational factors specialist, Health and Safety Laboratory

AbstractAnecdotally, protocols, care pathways and clinicalguidelines are time consuming to develop andsustain, but there is little research about the actualcosts of their development, use and audit. This is anotable gap considering the pervasiveness of suchdocuments that are intended to reduce unacceptablevariations in practice by standardising care processes. A case study research design was used to calculatethe resource use costs of a protocol for perinatalmental health, part of the core programme for healthvisitors in a primary care trust in the west of England.The methods were in-depth interviews with the opera-tional lead for the protocol (a health visitor) anddocumentary analysis.The total estimated cost of staff time over a five-yearperiod (2004 to 2008) was £73 598, comprising£36 162 (49%) for development and £37 436 (51%)for implementation. Although these are best estimatesdependent upon retrospective data, they indicate theopportunity cost of staff time for a single protocol inone trust over five years. When new protocols, care pathways or clinical guide-lines are proposed, the costs need to be consideredand weighed against the benefits of engaging frontlinestaff in service improvements.

Key wordsProtocols, economic analysis, health visitors, perinatal mental health

Community Practitioner, 2010; 83(6): 22-5.

Estimated cost of a health visitor-ledprotocol for perinatal mental health

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PROFESSIONAL

The case study was based in a primarycare trust (PCT) in the west of England thathad been established for 18 months,following the merger of three smaller trusts.It served a population of 450 000 thatincluded multicultural communities livingin urban and rural areas, and combinedprovider and commissioning functions.The PCT then employed over 100 whole-time equivalent (WTE) health visitors,though this was reduced after a majorservice review and modernisation that wason-going during the study period (Januaryto March 2008). Most health visitors werebased in health centres or communityclinics, with a few in GP surgeries.

The perinatal mental health protocol illus-trated the dynamic, iterative developmentprocess. It was instigated in the late 1990s bya core group of health visitors with a specialinterest in mental health and a child protec-tion nurse. The need for a protocol emergedas a result of a benchmarking questionnairethat showed variation in the identificationof maternal depression and no commonapproach to treatment. The protocol

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