#FindTheHV (in England): An update

Just over 3 weeks ago, on 19th Feb, I asked the wonderful social media world, and the health visitors who inhabit it, to help me in a quest. I wanted to find out where all the health visitors in England work. I outlined the reasons for this in another blog. I just wanted to give you a quick update as to the progress made!

By the 9th March, we had done it and cleared the first hurdle and found out who employed the health visitors in each English Council area. To make it easy for anyone who wanted to search the information, I also created a Google Sheet.

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The next stage in my quest? To ask each the 30 non-NHS organisations a few questions that would help with finding out the true picture of health visitor numbers in England. I sent these emails on Tuesday (13th Feb). Here’s the text of what I sent (NB. the line about the Freedom of Information Act was only included to Councils as the others aren’t required to provide information under the Act):

Dear Sir/Madam,
I am currently identifying how many health visitors there are in England. This information is already available for health visitors employed by NHS organisations (via NHS Digital). I am making requests of the other organisations that employ health visitors.
Please can you provide me with:
  • The number of health visitors that you employ? I have included the definition used by NHS Digital below, and I would be grateful if you could also use this definition. If you are unable to use this definition, please identify which definition you have used instead.
  • The date that you started providing the health visitor service?
  • The number of health visitors that were employed on the day of transfer?
If required, I’m asking for this information under the Freedom of Information Act.
I will be posting all the responses to my blog, where I hope people will be better able to scrutinise the number of health visitors in England. You can read some more background to this here (https://adaywithdave.wordpress.com/2018/02/19/help-i-need-somebodies-health-visitors-help/).
Dave Munday

…and here’s that very helpful NHS Digital definition:

Definition used by NHS Digital re. Health visitors (notes 28 and 29 from the nursing, midwifery and health visiting staff matrix of Occupation Code Manual)
28. Please ensure to code the following as Health Visitors: 
  • qualified nurses/midwives who also hold a qualification as a Registered Health Visitor under the Specialist Community Public Health Nursing part of the NMC Register working directly with children and families;
  • qualified and registered Health Visitors who perform specific activities such as providing breastfeeding advice to parents;
  • family nurses working within the Family Nurse Partnership Programme who are qualified and registered as Health Visitors;
  • Sure Start Children’s Centre qualified and registered named Health Visitors;
  • managers within a Health visiting team who hold a health visiting qualification and registration and are involved in clinical work or safeguarding.
29. Please ensure that the following employees are not coded as Health Visitors: 
  • any person working in a health visiting team who does not hold a qualification and registration as a Health Visitor;
  • any person who holds a qualification and registration as a Health Visitor but is not employed in a role where this is a requirement;
  • managers within a health visiting team who hold health visiting qualification and registration but are not involved in clinical work or safeguarding.
Please see below the general definition for ‘health visitor’ from the Occupation Code Manual:
Health Visitor:   An employee who holds a qualification as a Registered Health Visitor under the Specialist Community Public Health Nursing part of the NMC Register and who occupies a post where such a qualification is a requirement.  Not below Agenda for Change Band 6.
I’m now waiting for the responses. Councils should have to provide the data by mid-April, under the FoI Act. The others? Well lets see!
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Now don’t just let employers have all the fun! Make sure you give it a read.
Again, as I highlighted on Twitter, my favourite section is on safe staffing, including this line:
“publishing information about average caseloads for health visiting and school nursing within the organisation”
And as I said on Twitter, will this ensure that my quest won’t need to be repeated in the future? Again, lets see!
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Children and Young Peoples Mental Health Green Paper: A few responses

On Friday 2nd March, the Government closed it’s consultation on ‘Transforming Children and Young People’s Mental Health Provision: A Green Paper’. I’d suggest that anyone who reads the consultation questions themselves would agree with me that the consultation has been pretty flawed. In Unite’s response we argued:

It is concerning that the consultation process, alongside this green paper, is not sufficient to properly allow feedback on the significant omissions of the paper, with the questions asked showing evidence of implicit bias in favour of your preferred options. Unite asks that in future both departments make considerable more efforts to ensure that green paper consultations are much more meaningful. Unite have also included a copy of the response we have submitted online in appendix A. This full response must be read in conjunction with our online submission.

I’m aware of a number of organisations that went ‘off-piste’ and submitted their own responses ignoring the questions. I thought it might be helpful to collate the ones I’m aware of. If you know of any I’ve missed, let me know in the comments below or on Twitter:

People in mental health crisis deserve a #RecoverySpace


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Today I’m off to Parliament to participate in the launch of ‘Recovery space: Minimising the financial harm caused by mental health crisis’. It’s a new report from the excellent team at the Money and Mental Health Policy Institute. I say excellent as I feel privileged to have worked with them on a few of their campaigns previously including their successful #StopTheCharge campaign.

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This time the Institute have put their focus on the Government’s ‘Breathing Space’ scheme. This scheme aims to give people in problem debt a window without fees or charges, and where they won’t be pursued by creditors if they seek debt advice. But this won’t support the tens of thousands of people in mental health crisis who are too unwell to either manage their finances alone, or to seek debt advice.

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The #RecoverySpace campaign launched alongside the report today is calling on the Government to extend the Breathing Space scheme to allow people in mental health crisis space to recover. We at Unite/MHNA are supporting them and back their call for #RecoverySpace.

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The campaign makes 5 asks:

The Government should:

  • Extend the proposed Breathing Space scheme to everyone receiving NHS support for a mental health crisis
  • Expand existing benefits easement to people in mental health crisis, ensuring people are not expected to meet conditionality requirements.

Healthcare services should:

  • Routinely screen for financial difficulties, and make provision for this within care, crisis and relapse prevention plans
  • Develop referral pathways to appropriate bene t and debt advice for people recovering from a mental health crisis.

Essential services firms should

  • Freeze interest, charges and enforcement action for a time limited period upon notification by a mental health professional that a person is experiencing a mental health crisis.

I’ll be tweeting from the launch so please follow along if you want to know more. More importantly though, if you want to add your name alongside mine to the campaign, visit the campaign website and sign the letter to Rt. Hon. Philip Hammond MP.

Help, I need somebodies [health visitors] help!

For those that follow me in some way shape or form (maybe on Twitter, on this blog or down the street) you may know that I take an unhealthy interest in stats from NHS Digital. Normally this will be focused on two passions, either mental health nurses or health visitors.

One of the problems with watching the health visitor stats on NHS Digital is that it only records the numbers of health visitors that work for NHS employers. Although this will make up the vast majority, it is not the full picture. For a while I’ve been wanting to get this full picture.

health visitors - oct 2017 nhs stat

My first thought is to do it the traditional way. This involves finding the list of councils and then contacting each council to ask who provides the health visitor service that they commission. Once I’ve got this information, I’d then like to find out how many health visitors each employer employes.


As I’ve got a long train journey ahead, I want to try a different approach and see if it works to cut out some (or maybe most) of the first bit out. I’m therefore asking the Twitterverse (or at least health visitors inhabiting it) to let me know which organisation they work for and which local authority this service covers. I’ll be updating this blog with the details that I hear back so everyone can join in the fun.

Originally I had a list on this blog that I was updating. I’ve now transferred this to a Google Sheet that can be accessed here: Google Sheet.


2018 marks the 70th anniversary of the NHS. A land mark that we at Unite want to celebrate throughout the year. As part of these celebrations we’ll be focusing on different professions that make up our membership. Our mental health nurse members, via the Mental Health Nurses Association (MHNA), have picked October as their month to celebrate, to coincide with World Mental Health Day on 10th October.

It’s not just about the 70th year of the NHS however! Last year we talked to our members, mental health nurse non-members, students, educationalists, managers, service users, charities, parliamentarians and many others about the amazing profession that is mental health nursing, and how we can work to develop its future, promote the profession and highlight its work. A number of reviews and reports have said how important this work is and our members agree.

Therefore, we’re working on #MHnursingFuture and we want as many of you as possible to join in. As a start to this, we want to sign up supporters to the campaign. It’s early days but we want as many people as possible to help shape the campaign.

Supporters can be individuals, healthcare organisations, charities, groups and anyone else we’ve missed out.

If you’re an organisation/group, we’ll add you to our #MHnursingFuture website (so please send us a logo and details of your website and social media pages) which we will be setting up soon. If you’d like to sign up, email me.

How much does it cost to be a supporter?

Absolutely nothing! But we do want supporters to support and we’ll be in touch, with our suggestions on what you can do. You may have some great ideas too so let us know your thoughts and any plans you’d like to develop (especially for October 2018!).

Although there’s lots that we’ll be doing in 2018 to campaign about things that we’re concerned about at Unite in Health, this won’t be a part of #MHnursingFuture. This campaign is about celebrating and promoting the good bits. Unite the union is also affiliated to the Labour Party, however this isn’t just about one political party. We won’t limit our invitations to be involved.

Want to know more, sign up and/or tell us what you think? Email me.

A few examples of what we’re planning:

  • Social media resources from service users, carers, mental health nurses and others about the benefit mental health nurses bring and why people should consider becoming mental health nurses.
  • Our October/November Mental Health Nursing journal (#MHNjournal) will be a special edition focused on the last 70 years of mental health nursing. If you want to write an article, get in touch.
  • A free mental health nurse conference in London on either 2nd or 3rd October.
  • A free mental health nurse conference in Edinburgh on 31st October.
  • Resources from charities focused on how they can support the work that mental health nurses do and how mental health nurses can help them.
  • We’re supporting Nursing In Practice with 3 free conferences with specific mental health streams, in Glasgow, London and Birmingham, but we’ll be taking the #MHnursingFuture message to many more of their free events throughout 2018.

Mental Health Nursing journal February/March 2018 – Lead professional officer update

This update featured in the February/March 2018 Mental Health Nursing journal (Vol 38 #1)

This year is the 70th anniversary of the founding of the NHS. To celebrate, each month Unite in Health is celebrating one or more of the professions that make up our organisation. The MHNA OPC has chosen October as mental health nursing month. This makes perfect sense for at least two reasons: it coincides with World Mental Health Day on 10 October and it gives us more time to put plans in place. We’re hoping to hold conferences in London (at the beginning of the month) and Edinburgh (possibly on 31 October, so save the date).

While you’ve got your diaries out, I’m also really pleased to announce that we are continuing our partnership with Nursing In Practice to deliver mental health streams at three of their events in 2018. These start with their Scottish event in Glasgow on 6 March, followed by returning to their London and Birmingham events later in the year. Nursing in Practice offers a great way to get some free CPD, and not just in these locations, and I recommend that you take a look at their website to look at where they will be visiting.

We have submitted evidence to the House of Commons Health Committee Nursing Workforce inquiry. The committee launched its final report on 26 January. It was good to see its call for the government to increase the number of nurses ‘at scale and pace’ and that it again highlighted the problems that different parts of our nursing family face, including those of mental health nurses. In my response to the report I highlighted my frustrations that it did not take up our recommendations to work towards safer staffing, especially in mental health services [I also wrote a blog on the report].

As an example of the benefits we would see from such legislation, in the same week of the committee’s report, the Care Quality Commission, in their report ‘Mental Health Act – The rise in the use of the MHA to detain people in England’, highlighted that “Some of the factors at play in the rising rates of detention, both nationally and locally, are also signs of a healthcare system under considerable strain. Detentions under the Act can be influenced by gaps in support and provision in the system.”

The independent review of the Mental Health Act continues. We submitted a response to the call for evidence and we’re currently working with the RCN to develop a survey for mental health nurses. We’ll share the link via our social media pages and in an email with members. Please help us to get this survey out far and wide. The review is also looking for responses to a service user survey. Please help them by visiting the review website and sharing the link with your networks.

In other consultation news, we’re currently formulating our response to the government’s green paper on children’s mental health. As we’ve reported in this months news feature, we believe the green paper is nowhere near ‘bold’ enough, a claim that it makes in its conclusion. I’ve written a blog that helps with some background and thoughts. If you want to contribute your thoughts, on this or any other issue, please get in touch.

Since my last update, I’ve attended a few different meetings and events. These include the Mental Health and Smoking Partnership. See p14 for an update on this group.

On a similar theme, I also attended the launch of the NHS Smokefree pledge. If you’re interested in these or other events I attend on behalf of MHNA, take a look here. I’ve included Twitter moments that hopefully give you a flavour of what went on.

In my last update I mentioned our [Evri Anagnostara, Hollie Roblin and I] meeting with Jeremy Corbyn. One issue we raised was increasing his ministerial team on mental health.

We originally argued for a minister with a focused responsibility for mental health. Recently this brief was widened to also cover social care, when Barabara Keeley took up the role. We were therefore really pleased to welcome Paula Sherriff to her new [shadow] ministerial role focusing on mental health. I had my first meeting with her the week after she was appointed and really look forward to working with her into the future.

I’ve also been busy over the last few months working to improve our e-MHN journal offering. I’ll be sending emails to members in February to update you on a new way to access your journal from PocketMags. We hope that it makes your access even easier than before.

Professions within a profession failed

Today the House of Commons Health Committee have published their report on the nursing workforce inquiry. This brings to an end, a long process for the committee, which started last September. I’ve been involved with that process, contributing to the writing of the Unite in Health written evidence, supporting a colleague with their appearance in front of the committee to give oral evidence and following other aspects of the work. There’s a huge amount of material that can be shifted through on the inquiries website, including the final report which runs to 55 pages in length.

There are 17 conclusions and recommendations, across the 5 topics;

  1. Retention – keeping the current workforce
  2. New nurses
  3. Nursing associates
  4. Nurses from overseas, and
  5. Workforce planning

There’s worthy stuff in there, but before I look at some of this I wanted to address one of the big issues; nurses have been spectacularly failed by the current government, and here’s why…

Listening to Jeremy Hunt speak, he focuses on talking about the increase in ward nurses. A recent tweet he shared highlighted that in 1 year, there were ‘800 more nurses on wards’. There is truth in that statistic. In fact looking at the total number of nurses and health visitors in the NHS, we’ve seen a 2.2% increase in their number since 2010.

With all these figures you’ve got to remember that over a similar time period, the population in England has increased by 2.6 million, or 5%, so even a 2.2% increase is really a 2.8% ‘real terms’ cut.

Looking at adult nurses, the picture unusually shows one of an actual real terms increase. Their number has increased by 6.5% since May 2010 (before considering that population growth I’ve mentioned above).

When you go a little further down the NHS Digital spreadsheet however, things don’t look anywhere near as ‘marginally getting better’.

Community health nurses, well they’ve gone down by 14.7%…

Learning disability nurses, down by a staggering 37.4%….

School nurses, down by 20.1%….

And although health visitors have seen a 5.9% increase, since their transfer from NHS to local authority commissioning, they’ve been cut in the NHS by 19.0%.

For mental health nurses, their number have reduced by 11.4%.

All these are despite warm words about the importance of community services, early intervention, mental health, et al. Is enough being done to alter their steep downward trajectories? Again, although we’re told there is, I think the proof is sorely lacking.

And these cuts to staff have great and grave impact on patients and service users. For example earlier this week, the Care Quality Commission, in their report, ‘Mental Health Act – The rise in the use of the MHA to detain people in England‘ identified that a growing number of people were being detained under the Mental Health Act due, in part, to gaps in support and provision.

The calamitous decision to remove NHS student bursaries for new students has seen a marked decline in the number of people putting themselves forward to run the education gauntlet. What’s even more perverse about this is that the report makes clear that this decision has impacted the choices made by those in older age groups, and in their graph on page 21, they show how these groups, aged 30 or over, make up a larger percentage of two of the nursing fields that are facing some of the worst drops in numbers, 39% in learning disability nursing and 40% in mental health (62).

The report talks about monitoring the bursary issue ‘very closely’ (71). As a colleague, Jane Beach says however, “…we don’t have the luxury of waiting another year to know how this will play out. The evidence of nursing shortages from NHS Digital is already stark and alarming”.

Thinking on Jane’s point about the luxury of time, as I’ve shown above, the cuts to many professions in nursing have been significant, constant and going back 7+ years. This long period of failing the professions means that the response now should be more immediate and have a greater impact. As in many things, I have no confidence that the Government will take the necessary action.

One area that our Mental Health Nurses Association have argued for is to have safer staffing legislation. Unfortunately the report does not make a recommendation on this. It should have.

Another recommendation that Unite made was to look to improve public protection by better protecting the nurse title. As Prof. Alison Leary uncovered in her recent research, the current situation is not fit for purpose. Again the report is silent.

One area that the report does encourage is more accurate data collection (115). This would be excellent. As I was reading this through I noticed an answer to a Parliamentary Question from Sir Nicholas Soames (MP), answered by Jackie Doyle-Price (MP), which suggests we’re heading in the wrong direction. When asked about health visitor numbers, the answer is now, one the one hand ‘we don’t know’ and on the other a misleading response given about ‘800 new training places being made available in 2016/17’. This is misleading as, was reported by Nicola Merrifield in the Nursing Times, one third of these courses places were left vacant.

There’s more that could be said about the report and its recommendations, for example I’ve not even got started on the issues of pay and retention rates. I’m getting tired though, as I’ve just got back from the NHS rally in London. As this report is on the nursing workforce, I wanted to give the final words to Siobhan, a specialist nurse, who spoke at the #NHSrally, as they seem fitting:

“Our NHS is not beyond repair… I believe it is our countries greatest achievement. We must and we will defend it”.