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January 2009


UNISON welcomes the opportunity to respond to the issues raised before the Petitions PE1198, PE1199 and PE1200 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 partners
  • 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 older people,

  • 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 Visiting.

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.

Matt McLaughlin
Regional Organiser
UNISON Scotland
NHS Glasgow and Clyde

5 January 2009.


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