UNISON welcomes the opportunity to respond to
the issues raised before the Petitions PE1198,
which were discussed before the Petitions Committee of the Scottish
Parliament on 18 November 2008.
UNISON represents around 50% of all Health Visitors
employed by Glasgow and Clyde NHS Board.
UNISON believes that the evidence presented can
be broadly identified as falling into three main areas.
- Consultation with staff, patients and other relevant
- The future of services as defined by NHSGGC
- Implementation of the review
The Health Visiting Review sits within a wider
agenda (improving children’s services) being driven by NHSGGC.
UNISON members are not opposed to changes in their service,
they are not opposed to the board refocusing services to provide
better, more effective services for the most vulnerable in society.
Unfortunately UNISON members do not believe that the direction
of travel being implemented by NHSGGC is in the best interests
of patients or their profession.
UNISON is disappointed at the lack of partnership
engagement and consultation around this issue. UNISON and sister
unions have been raising concerns with the board since mid 2006.
Recognised trade unions have raised grievances
throughout the process with lack of progress and trade union
tensions being raised with both Andy Kerr MSP and Nicola Sturgeon
MSP in their respective Ministerial roles during the 2007 and
2008, Accountability Review.
Despite this unusual approach, the matter remains
a significant point of tension between UNISON and NHSGGC.
UNISON is disappointed and concerned that NHSGGC
appear to have failed in their obligation to listen to and react
sensitively to the views of the community, staff side and other
health care professional partners.
Critically NHSGGC seem determined to ignore the
views of Health Visitors and are unwilling or unable to convince
this group of front line professionals that their overall proposals
make sense and are safe.
The Future of Services
UNISON members have a number of concerns related
to the proposed future of the Health Visiting Profession/ Service.
Primarily that concern is driven by their concern that the proposals
set out by NHSGGC will not lead to an improved service and will
in time de skill the profession.
Current proposals do not provide for a Universal
Model of Care. Critically the proposed direction of travel will
- lead to the removal of Health Visitor intervention with
- requires staff to determine whether a child is ‘at risk’
in the first 17 weeks of it’s life, because NHSGGC do not
value interaction with families who are not currently within
the Social Work system. UNISON members are genuinely concerned
that this approach will lead to system failure and increased
risk to children, because there will be no Health Visitor
‘contact’ which is critical in recognising subtle changes
that may affect a child safety – even in ‘low risk’ families,
- lead to increased generic working as other staff are used
to fill gaps which are deemed as ‘lower risk’ and that in
time this will lead to de-skilling of the profession.
- result in some child protection issues being ‘hidden’
if public perception begins to change as Health Visitors
begin to ‘integrate’ more with Social Work colleagues.
UNISON recognises that on paper, NHSGGC have begun
to move away from a service model based purely on ‘geographic
working’. However staff remain concerned that the employers
will push towards this model or worse try to develop a hybrid
at the earliest opportunity. In our members opinion this would
be a retrograde step leading to confusion within the profession
and with professional partners and families.
UNISON members accept that there is a need to
focus resource and intervention on those families who need it
most. However the Health Visiting Service has always been highly
professional and universal in the patient/ client group that
it interacts with. UNISON members are concerned that the proposal
as it stands represents a ‘lowest common denominator’ and fails
to recognise the founding principles and strengths of Health
Much of the benefit for patients/clients comes
on the ‘soft side’ of engagement with Health Visitors given
unrestricted access to families and young people, simply because
the service is universal and ‘everyone has a Health Visitor’.
These ‘soft’ engagements are difficult to measure, UNISON members
firmly believe that these engagements are effective but feel
that they are being punished, simply because they do not tick
lots of boxes.
Health Visitors work best with those families
who are not ‘at risk’ but may slide into risk if there is no
support. UNISON believes that the work of Health Visitors in
some of our most challenging communities has been critical in
ensuring that immunisation levels remain high in these areas.
Implementation of the Review
NHSGGC have failed to win over their staff, public
or partners on this issue. Irrespective of the disagreements
in direction of travel, there is a pressing need for agreement
on the methodology for implementation.
At present the view of NHSGGC remains that the
entire review should be driven on a CHCP by CHCP basis. Whilst
UNISON accepts that there is merit in developing local services
to meet specific local needs and challenges. UNISON does not
agree with this federal approach to staff consultation, engagement
and the redesign of services.
With no overall work force plan, little accurate
data and a clear unwillingness to listen to staff, service users
and partners it is no wonder that there is an increased level
of scepticism towards this approach.
In the paper headed Improving Children’s
Services from Dec 2006, the then Director of Planning
Catriona Renfrew, wrote that there had been “limited progress”
in the development of a “medium term workforce plan to deliver
the required pattern of services and systems of care.”
No such plan exists to date and yet NHSGGC seem
determined to press on with local implementation groups.
It is worth noting that to date NHSGGC have been
unable to provide details of how many Health Visitors they currently
employ, how many vacancies they hold and how many Health Visitors
have been employed in previous years – despite the information
being requested under the Freedom of Information.
Based on this evidence alone, it is little wonder
that UNISON members have little or no confidence that the Board’s
proposals are sensible, safe or indeed well thought out.
UNISON believes that any implementation should
be underpinned by an agreed workforce plan for the entire service
and that adopting a piecemeal approach across various CHP’s
and CHCP’s will put the profession and families at risk.
NHS Glasgow and Clyde
5 January 2009.