27th October 2022
We are delighted to share a Voices Blog by Dr Karen Whittaker, Education and Workforce Lead at iHV, giving an update from our recent Practice Education Networking event which explored the opportunities and considerations for health visiting within the national plans to modernise professional regulation, including Advanced Clinical Practice.
Dr Karen Whittaker, Education and Workforce Lead, iHV
The iHV hosts regular Practice Education Networking events for its membership, to support the development of ideas surrounding educational practice for health visitors. These events provide the opportunity to hear from leaders within the profession and explore, through discussion, the issues pertinent to health visitor education and professional development. Attendees join from all parts of the UK and include health visitors involved in frontline service provision, those supporting and assessing students, team leads and university academics.
The recent event on 12 October welcomed Anne Trotter, Assistant Director of Education and Standards at the NMC, and a panel of experts from organisations representing SCPHN registrants from school nursing and occupational health nursing. Together the presenters provided a focus on the preparation and regulation of SCPHN practice.
Background Issues
Specialist Community Public Health Nursing is the title that health visitors, school nurses, occupational health nurses and public health nurses are required to use for registration with the Nursing and Midwifery Council (NMC), the independent regulator for nurses and midwives in the UK. In May 2022, the newly reviewed and updated standards of proficiency for SCPHN practice were approved by the NMC. These standards reflect what the public can expect SCPHN health visitors, school nurses, occupational health nurses and SCPHN public health nurses to know and be able to do in order to lead, collaborate, promote, protect and prevent ill health across the life course.
The newly published SCPHN standards also include field-specific standards for health visiting and introduce the requirement for all SCPHN educational curricula to be updated by September 2024. The process of course redevelopment will now begin and provides an exciting opportunity for academics, professionals, students and experts by experience to come together as partners to identify fresh approaches to the education of future SCPHN practitioners. This process is critical for getting the preparation of future health visitors right and ensuring their knowledge and skills are relevant to the needs of families and communities.
This period of educational development for SCPHN practice also coincides with the need to consider the future regulation of nurses and midwives, and specifically those registered as SCPHN practitioners. During 2021, the Department of Health and Social Care (DHSC) introduced a public consultation on regulating healthcare professionals as part of plans to modernise professional regulation and better protect patients and service users. The results of the consultation are yet to be published, but the proposals signal that the NMC register of nurses and midwives (currently in four parts) will soon be part of a wholescale programme of regulatory reform. In debating issues of professional preparation and regulation, SCPHNs should also be mindful of the parallel work on the development of multi-professional advanced practice credentials (also known as Advanced Clinical Practice (ACP)) in a range of specialised areas of health, including public health.
At the networking event, speakers invited attendees to consider some critical questions concerning:
- how to maximise the potential of SCPHN when working to the new standards of proficiency;
- whether the new standards could assist with improving workforce diversity;
- whether advanced practice should be regulated and what does this mean for SCPHNs;
- how the future register of SCPHNs should look, including how to display registrants’ qualifications on a public-facing register;
- meaningful regulation of post-registration qualifications and specifically how will people use the revalidation process to demonstrate they are up-to-date in meeting the new SCPHN standards.
The discussions within the breakout rooms revealed a continuum of perspectives on the value and purpose of the SCPHN part of the NMC register. Many felt concerned about a possible closure of the SCPHN part of the register. Some emphasised the value in specifying the boundaries of public health nursing as a specialist field of practice and distinct from other fields of nursing and midwifery. There was concern that, whilst workforce recruitment and retention is such a pressing issue, having the means to identify and acknowledge the unique contribution of health visitors, school nurses and occupational health nurses was felt to be crucial due to the impact on practitioners’ sense of professional recognition and identity. Others, in giving focus to issues of public protection, questioned whether registration as a SCPHN offered anything extra to an alternative option – registration as a nurse and annotation as a SCPHN-HV.
On the latter point, the DHSC (2021) noted in the consultation on regulatory reform that:
“160. An annotation is a note against a registrant’s entry on a register which provides additional information, over and above that required for basic registration, such as specifying their scope of practice, an area of expertise or restrictions on their practice or registration. The NMC, GPhC, PSNI and HCPC currently annotate their registers to indicate their registrants’ prescribing status. Annotation of the register will allow the regulators to indicate where registrants hold specialist qualifications rather than holding separate registers or specialist lists.”
In considering the question of meaningful registration through demonstrating currency of qualification, some of the network discussions gave consideration to multiple workforce issues and impacts of staffing shortfalls. Such shortfalls were noted as an obvious problem for service delivery, but also for recruitment given the difficulty in making available sufficient numbers of qualified practitioners able to supervise and assess student SCPHNs. The impact of which was felt to be unhelpful to improving workforce diversity. It was acknowledged that recruitment and retention concerns are sometimes addressed using ‘grow your own’ models, where there is explicit investment in talent spotting and support for career pathways. Indeed, some attendees noted pockets of success in this regard. Unfortunately, few of these models have been formally evaluated, something that is certainly needed so that the mechanisms of change for workforce improvements can be fully understood and model translation can support wider dissemination of helpful approaches. Overall, workforce challenges were identified as far reaching, impacting on public safety and the ability of SCPHNs to work across their full scope of practice, which was seen as a threat to meaningful registration.
Final thoughts
For modern day health visitors, the biggest change to professional registration came some 20 years ago, when the Nurses, Midwives and Health Visitors Act 1997 was updated by The Nursing and Midwifery Order 2001, that came into force in February 2002. This, in effect, removed the title ‘Registered Health Visitor’ from statute law. With the formation of the SCPHN part of the NMC register in 2004, those undertaking qualification as a health visitor, like others completing educational programmes as school nurses and occupational health nurses, have on qualification been registered as SCPHNs, with their specified area of practice noted. In effect, the health visitor qualification is annotated as part of the SCPHN registration. In addition, to be a SCPHN registrant, candidates must have a primary registration as a nurse or midwife and thereby complete the SCPHN course as a post-registration qualification. This means that the SCPHN register is, for some, an anomaly, as other post-registration nursing and midwifery qualifications programmes of study do not result in separate registration. However, the breadth of SCPHN’s public health orientation to practice does not sit easily as an advanced form of any specific field of nursing (adult, child, mental health or learning disabilities) or midwifery. As a result, this anomaly has provided separate registration for SCPHNs and thereby formal acknowledgment of this scope and orientation to practice as distinct from both nursing and midwifery.
Next steps
This short networking event was a starting point for an important conversation on the future of health visiting regulation and career progression within the ACP framework. To move forward, we must continue the conversation. What is the vision for health visiting in the future? Collectively and individually by area of practice, SCPHNs must be clear about how their practice demonstrates specialist expertise. Further, there is a need to set out what the levels of SCPHN practice look like, including advanced practice for public health. In answering these questions, there is also a need to set out a clear career structure within health visiting. Without such a structure, localised efforts to address recruitment and retention may only offer limited improvements to staffing shortages, and may deepen variation between areas. Let us keep these conversations going.
To support the readiness of the health visiting profession for the future developments already discussed, the iHV has been proactive in reaching out and speaking with policy makers, providers of health visiting and other health and social care services, commissioners, educationalists and parents’ interest groups. We are working on a position statement with respect to skill mix in health visiting, and an extension of this work will consider potential career frameworks with defined levels of practice. We have collaborated with other SCPHN leaders to produce a response to the developing ACP credentials in public health and will be specifically following this up with regard to advanced health visitor practice.
For individuals, we recommend contributing to conversations through joining professional networking and learning events and, where possible, take an active role in joining local Higher Education Institution efforts to design the new SCPHN educational programmes. This is not a piece of work that educational providers can do alone and it will be by working together that there will be real opportunity to discover how to shape the future.
Dr Karen Whittaker, Education and Workforce Lead at iHV
