Analysis

Ambitious new curriculum redefines public health nursing standards

Institute of Health Visiting's recommended curriculum gives a ‘broad idea’ of what is expected of public health nurses

Institute of Health Visiting's recommended curriculum gives a ‘broad idea’ of what is expected of public health nurses


Picture: Tim George

The idea of providing public health nursing to children and families can be traced back to the 1860s, when the first incarnation of the health visitor emerged.

Since then health visitors, and later on school nurses, have been trained to work proactively with new mothers, babies, children and their wider families.

Unsurprisingly the role has evolved over the years. Properly training and equipping nurses to fulfil these jobs is an essential and complicated task.

The Nursing and Midwifery Council’s standards of proficiency for specialist community public health nursing (SCPHN) set out what nurses must achieve to go on this section of the register.

Knowledge, skills and attributes set out

These have provided the basis on which many courses have been developed. But they date back to 2004. The need for fresh evidence has led to six leading health organisations setting out a recommended curriculum for courses for these specialist nurses.

‘We see the curriculum as being targeted at everyone… It has a broad relevance’

Robert Nettleton, curriculum lead author

The 44-page document is the result of over two years of work by a stakeholder group coordinated by the Institute of Health Visiting and involving the trade union Unite, the National Forum of School Health Educators, the UK Standing Conference on SCPHN Education, the School and Public Health Nurses Association and the RCN.

It sets out the knowledge, skills and attributes a modern health visitor or school nurse needs to gain from the practical and theoretical elements of training. The range and breadth are huge. It calls for knowledge ranging from how modern technology can aid care delivery to detailed insights into how humans develop from the prenatal stage to adolescence.

Flexibility is essential

In terms of skills and attributes, it says nurses need to be good at relationship-building, negotiation, solution-finding and resolving conflict. Flexibility is also essential – whether it is the ability to shift focus between family members or to work across different organisational boundaries and settings.

Curriculum lead author Robert Nettleton is unapologetic about the ambition, saying the document demonstrates the ‘complexities and subtleties’ of these roles.

‘The rationale is good – although we have to be careful it’s not used as a cover for cuts’

Joy Murray, specialist community public health nursing programme leader

He says the curriculum intentionally stops short of a full syllabus, as that would have been ‘too complex’ given the variation in services between the devolved nations and increasingly in different parts of England.

Instead, he hopes it conveys a broad idea of what is needed based on the most recent evidence and professional consensus.

What a health visitor or school nurse needs

The curriculum sets out a range of knowledge, skills and attributes that health visitors and school nurses need to acquire and develop during their training. They include:

Knowledge

  • Human development, including nutrition, genetics, and social and emotional aspects of all life stages from prenatal to college years
  • How to implement as well as generate reliable and valid evidence through audit, evaluation and empirical research
  • Strong leadership and know-how to champion service quality, stimulate innovation and support change
  • Technology to support service delivery and care planning
  • Decision-making and assessment needed to diagnose and take action

Skills

  • Flexibility to shift focus between different family members and health needs
  • Ability to build relationships of trust
  • Empathetic communication
  • Interviewing, listening and questioning
  • Negotiation, solution-finding and conflict resolution to establish collaborative working with clients and other health professionals and agencies
  • Advocacy to give children and young people a voice

Attributes

  • Cultural humility and awareness
  • Self-reflection and awareness
  • Able to promote health and well-being in way that develops an individual’s own assets, potential and attributes
  • Able to work in non-routine-based work patterns and be responsive to emerging needs
  • Strong sense of professional identity, given the need to work across boundaries

 

Crucially, the curriculum says there is a need for flexibility to respond to the ‘emerging models of delivery’ as well as the introduction of apprenticeships, which may be extended to this field.

What happens next? 

Dr Nettleton hopes education providers will use it to review courses and says the Institute of Health Visiting will develop the work by showcasing best practice.

He also wants the Nursing and Midwifery Council to use the curriculum as it reviews the proficiency standards – something the regulator says it will do.

But he hopes the effect will stretch beyond this. ‘We see the curriculum as being targeted at everyone. It can help those thinking about studying – they don’t always know what it entails.’

Referring to staff who might wish to argue for extra training or protected time to enhance their skills or experience, he continues: ‘And it can help those who are working to articulate what the role involves and what they need from their employers. It has a broad relevance.’

University of the West of England SCPHN programme leader Joy Murray agrees it should have a wide appeal. She says education providers welcome the publication, saying they will be looking to ‘map’ their courses against it.

The senior lecturer, who until recently was chair of the UK Standing Conference on SCPHN Education, says the existing evidence base was ‘out of date’ and importantly this document recognises the need for a ‘more flexible workforce’ to create a seamless service from birth to the age of 19 where health visitors and school nurses can work across the age ranges.

Huge variation in courses

‘The rationale is good – although we have to be careful it’s not used as a cover for cuts. The workforce is in a bit of a crisis.’

‘We’re concerned that the skills mix is being diluted too much in places’

Sharon White, chief executive of the School and Public Health Nurses Association

It is a point taken up by School and Public Health Nurses Association chief executive Sharon White.

Ms White says the curriculum is much needed as there is a ‘huge amount of variation’ between courses and it establishes ‘what good looks like’, which is important given the drop in numbers working across both fields.

‘Random models’

‘We’re concerned that the skills mix is being diluted too much in places – nursery nurses and staff nurses are being asked to take on complex care when they shouldn’t.’

She also cites what she describes as ‘random models', with health visitors taking on primary responsibility for children up to the age of seven and generic adolescent health teams developed to act as a substitute for school nurses.

‘We’re not against innovation. But we have to be careful it’s not taken too far, just to make savings.’

‘We need more money to provide jobs’

The past three years have seen health visitor and school nurse numbers fall in England – the number of health visitors is down 24% and school nurses down 6% in terms of full-time equivalents.

This has coincided with commissioning responsibility becoming firmly embedded in local government.

The Local Government Association (LGA) says some of the fall may be related to staff being employed by non-NHS bodies, which means they are not always counted in the official figures.

But it acknowledges there are shortfalls, particularly in health visitors. It says that between 2015 and 2019 the amount of funding councils have obtained from the government for public health has been cut by £500 million in cash terms.

LGA community well-being board chairman Ian Hudspeth says these cuts must be reversed if councils are to be able to invest. He says: ‘Funding has simply not kept pace.’


Nick Evans is a health journalist

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