Review of Nursing in the Community (RONIC)
Bridget Hunter, UNISON Scotland's Lead Officer
for Nurses and Midwives identifies concerns over the new
role of community health nurse replacing the time-honoured
traditional roles of district nurse, health visitor, school
nurse, public health nurse and family health nurse.
Visible, Accessible and Integrated Care, the Review of
Nursing in the Community in Scotland was published on 14th
November 2006. This review was an action point from Delivering
for Health. Sponsored by Paul Martin, the then Chief Nursing
Officer for Scotland, it was considered that the demographic
changes and concern over workforce pressures meant that
the future provision of nursing services in the community
required to be updated.
The report proposed a generic community health nurse model
and identified four development sites: NHS Borders, Highland,
Lothian and Tayside, to test out the model over the two
years. In April 2008, we moved to the implementation phase
with the new role of Community Health Nurse (CHN) replacing
the time-honoured traditional roles of district nurse, health
visitor, school nurse, public health nurse and family health
nurse which many consider to be the ‘Jack of all trades
and master of none’.
Although the status of this project then reverted to pilots
in all four sites, concern has been raised by the nurses
and GP’s on the ground, not purely as a result of
the impending changes but also because the impact will produce
a reduction in the standard of service that is already available
to the people of Scotland. Although an evaluation group
was established to work up and submit a bid for external
contractors to assess the impacts of the process, and although
partnership involvement is in place in the four development
sites, many staff side members are concerned that their
fears are disregarded.
The main concerns are that:
- It will result in a diminution of the size and quality
pool of Scottish community nursing skills
- It has made many nurses consider leaving their lifelong
- It has resulted in a devaluation of the presently existing
- It will result in the fragmentation of the UK wide recognition
of those skills.
- The short term vision of amalgamation for longer fusion
of these designations is contrary to the conclusions in
the other UK countries who recommend expansion, enhancement
and strengthening of the present skills.
- It already has, and will continue to, cause skills inconsistency
throughout Scotland in different health board areas.
- It has allowed the unencumbered and unevaluated mushrooming
of schemes in the non-pilot sites.
- It is perceived by practitioners as having no clinical
improvement in practices for the benefits of the patient.
- It is a one way street with no way of back tracking
- There is no alternative strategy being tested to measure
- The baseline study identified that two thirds of community
staff did not support the generic role of CHN
- The NMC have been noticeably hesitant at accepting CHN
onto any specific part of the register for nursing
- The evaluation process is flawed as it can only measure
short term indicators and only over a period of six months.
- These short term indicators (such as detection rates
of post-natal depression, breast feeding or immunisation
rates, or smoking cessation) will have other influences
or variables which could contaminate the purity of outcome
- The evaluation process is flawed in that it can not
measure long term indicators which are vital in the assessment
of all community nursing.
The disenchantment so far has come purely from staff within
the pilot sites who are anxious that they are 1)not skilled
to perform across all of the other roles and, 2) did not
choose to do these duties.
Staff are not reassured that the training on offer will
fully skill them to raise their expertise to the level of
the experienced staff who presently deliver these roles
and equally they are not convinced that there will be sufficient
funds to backfill replacement staff for them to undertake
this level of training.
From the beginning one of the main concerns has been that
the elements of public health and prevention will, as a
matter of course, be relegated in priority against the pressing
needs of acute health. This goes against the fundamental
aims and objectives of the review and those stated in Better
Health, Better Care for the war on ill health prevention,
tackling health inequalities, substance misuse as well as
the early years strategy.
Lead Officer for Nurses and Midwives