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THE JOURNAL OF THE COMMUNITY PRACTITIONERS’ AND HEALTH VISITORS’ ASSOCIATION
FEBRUARY 2019
COMMUNITYPRACTITIONER.CO.UK
+
DARK TIMES
TACKLING CHILD
SLEEP DISORDERS
‘BIOLOGICAL CHAOS’
SPOT THE SIGNS
OF ENCEPHALITIS
COUNTRY LIFE
ARE CPs ISOLATED
IN RURAL SETTINGS?
A clear picture of health-visiting services
across the four UK countries
COVER_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 1 30/01/2019 13:23
p02.CPFEB2019.indd 2 28/01/2019 15:35
CONTENTS February 2019 | Vol 92 | No 1
30 COVER STORY
24
Encephalitis:
inflammation of the
brain may be rare but
it can be deadly
28
When nurses
hang up their
uniforms and
become HVs
14
Stepping in to
Ste
ssafeguard
42 children
hildr online
Rural practice: the view
from the countryside
38
A bad night?
Sleep disorders in
children increase
NEWS 14 BIG STORY 20 THE BIG QUESTION PRACTICE
How can CPs help Why is it important that
6 NEWS IN NUMBERS safeguard children and members find the time 22 24 HOURS WITH...
Your at-a-glance guide their data in a world to complete our Debbie Fawcett,
that is increasingly readership survey? specialist health visitor
8 PUBLIC HEALTH LATEST lived online? The journal’s team at for homeless families
A look at what’s new Redactive respond
OPINION 24 CLINICAL
10 PROFESSIONAL UPDATE 21 RIGHTS AT WORK A brain under siege:
Your round-up of 18 FEEDBACK Unite national officer when encephalitis strikes
professional news Crunching caseload Colenzo Jarrett-Thorpe
numbers, data protection asks if the NHS long- 28 THE RIGHT MOVE?
12 GLOBAL RESEARCH and the Named Person, term plan is just another What motivates nurses
Recent findings from and HVs named in the pledge to be broken by to become HVs and what
around the world New Year’s Honours list the government skills do they need?
3
COMMUNITY PRACTITIONER | FEBRUARY 2019
CONTENTS_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 3 30/01/2019 15:14
9 #CPHVA19
9
EARLY BIRD DEADLINE
28TH JUNE
16-17 October 2019,
Harrogate International Centre
Book now:
p04.CPFEB2019.indd 4 28/01/2019 15:35
WELCOME
FEATURES
30 COVER STORY
We shine a light on the reality of
practice across the four nations and
look at the unique challenges faced
by health-visiting services
from Emma and Aviva
38 WAKING UP TO THE CHILD A warm welcome back from your New Year break… It’s only the second month of
SLEEP CRISIS 2019, and already there is movement afoot in health and social care, with the January
Healthy sleep patterns are key to release of the NHS long-term plan. Unite national officer for health Colenzo Jarrett-
child health and wellbeing, but Thorpe looks at what the plan means for you now and moving forward on page 21.
sleep problems are on the rise and Meanwhile, on page 30, we shine a light on health visiting in the UK - what is the
support can be patchy true picture of practice, the real challenges and demands in the four UK countries
among budget cuts, workforce capacity issues and commissioning problems? And
42 THE LAY OF THE LAND how is all this taking its toll on you as dedicated HVs who want to provide the best
What approaches do CPs take to possible service, and on the families and children you serve? Are there any quick
caring for families and what extra answers, and what is the best way forward? Some of you have already contributed
skills do they need to work in rural your views (thank you), but we would love to hear what others think of the issues
and remote settings? reported - perhaps you have aspects to add, or maybe it sounds all too familiar.
Some of the latest topical issues affecting CPs in this month’s journal include the
digital footprint of the children you care for (page 14), the current sleep crisis among
RESEARCH young people (page 38),
and the realities of being
45 PSYCHOLOGICAL SUPPORT a CP in rural parts of the
FOR RAPID RESPONSE STAFF UK (page 42).
Coping and recharging strategies A year on from the redesign
following the death of a child and refresh of your journal,
we have devised an online
readership survey so that
PROFESSIONAL PAUSE you can tell us exactly what
you think (find out how on
48 THE BUILDING BLOCKS page 17). We look forward
OF LEARNING to hearing from you. Until
Kirsten Asmussen of the EIF next month...
advises on aiding early years JOIN CONVERSATION
OIN THE CO
ONVERSATION
cognitive development
aviva@
communitypractitioner.co.uk facebook.com/CommPrac twitter.com/CommPrac
Non-member subscription rates Editorial team Printed by Warners
Individual (UK) £135.45 Managing editor Emma Godfrey
Individual (rest of world) £156.45 Deputy editor Aviva Attias © 2018 Community Practitioners’ and
Health Visitors’ Association
Institution (UK) £156.45 aviva@communitypractitioner.co.uk ISSN 1462-2815
Institution (rest of world) £208.95 Content sub-editor James Hundleby
Subscription enquiries may be made to The views expressed do not necessarily
Unite-CPHVA Professional editor Jillian Taylor represent those of the editor nor of
Existing Unite-CPHVA members with Community Practitioner subscriptions Senior designer Nicholas Daley Unite-CPHVA.
queries relating to their membership Redactive Publishing Ltd Picture editor Charlie Hedges
PO Box 35 Paid advertisements in the journal do
should contact 0845 850 4242 or see Advertising not imply endorsement of the products
unitetheunion.org/contact_us.aspx for Robertsbridge TN32 5WN or services advertised.
01580 883844 Senior sales executive Joanna Holmes
further details. Any Unite-CPHVA member wishing to
cp@c-cms.com joanna.holmes@redactive.co.uk
To join Unite-CPHVA, see 020 7880 6231 change their contact details must get
unitetheunion.org The journal is published on behalf of in touch with their local Unite office.
Unite-CPHVA by Redactive Media Group, Production
Unite-CPHVA is based at 78 Chamber Street, London E1 8BL Production director Jane Easterman Recycle your magazine’s plastic
128 Theobald’s Road London WC1X 8TN 020 7880 6200 wrap – check your local LDPE
Unite health sector officers
020 3371 2006 facilities to find out how.
Editorial advisory board National officers Jacalyn Williams and
Community Practitioner Karen Adams Obi Amadi Lucretia Baptiste Colenzo Jarrett-Thorpe
Unite-CPHVA members receive the journal Mandy Brimble Victoria Button Toity Deave Lead professional officers Obi Amadi
free. Non-members and institutions may Barbara Evans Gavin Fergie Elaine Haycock- Jane Beach Gavin Fergie Dave Munday
subscribe to receive it. Stuart Sarah Reddington-Bowes Janet Taylor and Ethel Rodrigues
5
COMMUNITY PRACTITIONER | FEBRUARY 2019
EDITORIAL_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 5 30/01/2019 13:19
NEWS
NEWS IN NUMBERS
13
deaths and 6 cases of heart disease would be prevented if 1000
people moved from a low-fibre to a high-fibre diet. Low fibre is
defined as less than 15g and high as 25g to 29g each day
Mental health patients
who miss 2 or more GP
appointments within the
space of a year are
8x
more likely to die than those
who miss none
Of those who missed
appointments in Scotland,
32.1%
were addicted to alcohol
and drugs. Among those
who subsequently died, the
average age of death was 49
1 in 10
men are affected by £30m
postnatal depression a year is needed to meet
during the first the demand for medical
year after birth in students in Northern Ireland.
Scotland, and are to A report found that at least
be helped in a new 100 more medical students
initiative, How Are are needed a year to meet
You, Dad? the demand for doctors
6
COMMUNITY PRACTITIONER | FEBRUARY 2019
6-7 NEWS In Numbers_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 6 30/01/2019 13:19
NEWS
1.8m
prescriptions for antibiotics were written in
Northern Ireland last year. That is about 1 per
person living in the province – the highest rates
in the UK. Antibiotic resistance could lead to 10
million people dying each year around the world
£7.1m
additional funding is to be
made available to improve Cutting the speed limit to
20
the mental health of
children and young people
in Wales. £1.4m is also being
invested in mental health
in-reach support for schools
mph
70%
in all urban areas could help
counter Scotland’s obesity
epidemic, by encouraging
more families to get outdoors
with their youngsters and
take part in physical activities,
of all food and drink says the RCPCH
26%
products in prominent
locations in the
supermarket (such as
aisle ends) contribute
significantly to children’s
sugar and calorie intake of Scottish youngsters
aged 2 to 15 are at risk
of being overweight
ISTOCK
Find links to relevant reports and surveys highlighted in the news stories at bit.ly/CP_news_in_numbers
7
COMMUNITY PRACTITIONER | FEBRUARY 2019
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NEWS
PUBLIC HEALTH LATEST KEY
NEW GUIDANCE ON OBESITY IN PREGNANCY
Video
outcome for both
o DURING PREGNANCY, WOMEN
mother and baby,
m SHOULD FOCUS ON EATING HEALTHILY
the RCOG has said.
th
DDuring pregnancy,
AND BE SUPPORTED WITH ADVICE ON
DIET AND THE RISKS OF OBESITY Report
tthey should focus on
eating healthily and
e
be supported with
b
advice on diet and
a why it is crucial there health spending, we know
the risks of obesity. are support services that providing these
Latest UK figures available for anyone services is becoming Campaign
show that around wanting to manage their increasingly difficult, so we
22% of pregnant weight, especially couples hope that the publication
women are obese, wanting to start or expand of this new guidance acts
28% are overweight their family. as the catalyst needed to
and 47% are within ‘With cuts to public reverse these cuts.’
Poll
The Royal College of a normal range.
Obstetricians and Responding to the OVERWEIGHT AND OBESITY IN PREGNANT WOMEN
Gynaecologists (RCOG) publication, Dr Max
has published new
clinical guidance on
Davie, officer for health
promotion at the Royal
47%
NORMAL
obesity management College of Paediatrics Website
RANGE
before, during and
after pregnancy.
and Child Health, said:
‘Overweight parents are 22%
OBESE
28
Women who are obese much more likely to have
should be supported overweight children, and %
in losing weight before they as a family are more OVERWEIGHT Government
conception and between likely to suffer from life- website
pregnancies to ensure changing conditions such bit.ly/UK_RCOG_obesity
the healthiest possible as type 2 diabetes. That’s
£4M TO DRIVE CAMHS RECRUITMENT
Another 80 staff in child and and the Convention of Scottish Local
adolescent mental health services Authorities to review CAMHS published
(CAMHS) will be recruited in Scotland its delivery plan for improving services.
following a £4m investment. It recommended preventing young
The new staff – psychologists, people being referred to specialist care
nurses, allied health professionals and by default, treating more in primary and
administration workers – will help reduce community-based care, and providing
pressure on CAMHS and support new more information on what to expect
services, said mental health minister from CAMHS and how the system works.
Clare Haughey.
The funding comes as a taskforce bit.ly/SCT_recruitment
ISTOCK
appointed by the Scottish Government
8
COMMUNITY PRACTITIONER | FEBRUARY 2019
8-9 NEWS Public Heal_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 8 29/01/2019 18:14
NEWS
PHW CELEBRATES A YEAR OF RESEARCH SUCCESS
Nearly
in external income was generated BREASTFEEDING
CRUCIAL FOR
to support PHW research INFANT DENTAL
HEALTH, SAYS PHE
Public Health England
Public Health Wales (PHW) has published include breaking the generational cycle of (PHE) has highlighted how
its Research and development report crime, mental health support and training important breastfeeding
2017-18, highlighting the depth and breadth for secondary school teachers, and adverse is in protecting infant
of its work. childhood experiences and resilience. dental health.
Achievements include 77 academic Dr Alisha Davies, head of research and It says that dental teams
publications, 20 active research projects development division at PHW, said: ‘Our work should continue to support
in any single month and nearly £1m in external cuts across policy agendas and engages a wide and encourage mothers to
income generated to support research. range of partners. breastfeed, that not being
PHW also secured a £6.8m Home Office ‘By generating new knowledge and seeking breastfed is associated with
grant to develop the Early Action Together to answer big questions, our research plays a an increased risk of infectious
programme with criminal justice partners, fundamental role in achieving PHW’s vision for morbidity, and breastfeeding
and has been recognised as a World Health a healthier future for Wales.’ up to 12 months of age is
Organization Collaborating Centre on associated with a decreased
Investment for Health and Wellbeing. bit.ly/WAL_PHW_research risk of tooth decay.
Project areas also highlighted in the report Further advice for dental
teams can be found in
Health matters: child dental
health (2017), which states:
‘Health professionals, such as
CHILDREN EXCEED HEALTHY SUGAR LIMIT BY AGE 10 midwives and health visitors,
should support and encourage
The average versions of yoghurts, search ‘Change4Life’ women to breastfeed.
child has already juice drinks and online to help ‘Creating the right
exceeded the cereals, for example. them find lower environment to promote
maximum sugar On average, sugar options. this is crucial. The Unicef
intake recommended children consume Popular brands will UK Baby Friendly Initiative
for an 18-year-old by eight excess sugar display the ‘Good provides a robust evidence-
the time they turn 10, cubes a day – around Choice’ badge based framework to develop
says Public Health 2800 a year. online, in-store and a whole-systems approach
England. Now it has Families are throughout their to breastfeeding.’
launched a new encouraged to look advertising for Unicef said it welcomed
campaign to help for the Change4Life healthier options, the statement and urged
families cut back ‘Good Choice’ and customers UK governments to
on sugar. badge in shops, can also find recognise breastfeeding in
Change4Life is download the free these options all other relevant policies,
encouraging parents Food Scanner app or in supermarkets. including sustainability.
to ‘make a swap
when you next shop’, bit.ly/PHE_dental_
bit.ly/ENG_sugar_swap health
choosing healthier
9
COMMUNITY PRACTITIONER
COMMUNITY | DECEMBER
PRACTITIONER | FEBRUARY
/ JANUARY
2019 2019
8-9 NEWS Public Heal_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 9 29/01/2019 18:15
NEWS
PROFESSIONAL UPDATE
Starting ‘Increasing
investment in
salary of health visiting
£32,222 is one crucial
way to support
children’s cognitive
development’
‘RED BOOK’ AND HVs BUMPED UP TO PREPARE DISADVANTAGED
MATERNITY RECORDS BAND 7 ARE PAID £5K YOUNG CHILDREN FOR
ARE GOING DIGITAL MORE THAN REST OF UK SCHOOL, HVs TOLD
The child health record New health visitors will Health visitors should
‘red book’ is going be paid ‘significantly play a greater role in
digital, along with maternity records, more’ than their counterparts in preparing disadvantaged young
under new plans to modernise England, Wales and Northern Ireland, children for school, says a new
neonatal and maternity services. under a new deal negotiated by report from the Early Intervention
The Department of Health and healthcare unions. Foundation (EIF).
Social Care has announced its aim to Those choosing to work in Scotland The EIF called for a greater
improve safety, quality and continuity will now start on Band 7, with a focus on boosting the cognitive
of care, backed by a funding increase starting salary of £33,222. Health skills of disadvantaged children at
of £20.5bn every year by 2023-24 for visitors in other areas usually start an early age. It says health visitors
the NHS in England. at Band 6, with starting salaries of should be backed by investment
Further plans include improving around £28,050. to ensure they can provide
accommodation for critically ill It is hoped the change will boost intensive home-visiting support
newborns, making physiotherapy for the number of health visitors by for low-income families during
women who experience incontinence attracting more skilled nurses. their children’s first two years.
after childbirth more widely available, Gavin Fergie, Unite’s lead The report points to evidence
and asking all maternity services to professional officer for health in that shows by the age of three,
offer an accredited evidence-based Scotland, said: ‘Unite is pleased that middle- and upper-income
infant-feeding programme, such as the higher banding is a recognition children have a vocabulary at
the Unicef Baby Friendly Initiative. of the professional dedication and least twice the size of their low-
Matt Hancock, secretary of state quality of service provided by health income peers.
for health, said: ‘Each child will now visitors in Scotland.’ EIF chief executive Jo
be able to start life using the best But he added that the re-banding Casebourne said: ‘Increasing
of modern technology – in a way ‘must not come at the expense of investment in health visiting is
that’s easier for parents and fit for other colleagues in the wider health one crucial way to support
ALAMY / ISTOCK
the future.’ sector and result in future cuts’. children’s cognitive development.’
bit.ly/ENG_digital_records bit.ly/SCT_Band_7 bit.ly/UK_EIF_report
10
COMMUNITY PRACTITIONER | FEBRUARY 2019
10 -11 NEWS Professiona_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 10 29/01/2019 18:16NEWS
£
8%
of those surveyed knew
that co-sleeping on a
sofa or armchair was a
main risk factor for SIDS
£7m
STAFF TRAINING NHS STAFF BECOME REDUCE THE RISK OF
BUDGET INCREASES FOR ‘CORPORATE PARENTS’ SUDDEN INFANT DEATH
FIFTH YEAR IN A ROW TO VULNERABLE YOUNG SYNDROME, SAYS PHA
The Welsh Government A new ‘corporate The Public Health
is to increase its parenting’ training Agency (PHA) is calling
investment in education and resource has been launched for NHS for greater awareness of sudden
training for healthcare professionals workers to help them understand infant death syndrome (SIDS) after
in the next financial year by £7m their duty to promote the interests of a new survey found many adults
– its fifth consecutive annual rise. young people who are or have been didn’t know about the risk factors.
Overall, it will invest £114m in in care. Only 4% of respondents were
education and training places to Developed by NHS Education aware of the messages of the 1990s
support a range of roles including for Scotland (NES) and charity ‘Back to Sleep’ campaign.
health visitors, nurses and midwives. Who Cares? Scotland, the resource Emily Roberts, designated nurse
However, it will not mean an increase describes the legal duties of for safeguarding children at the
in training places for nurses. corporate parenting for young PHA, said: ‘We need to increase
Since 2014, there has been a 68% people up to the age of 26, everyone’s knowledge, including
increase in overall nurse training identifies negative effects that ‘care among relatives and friends who
places. Health visitor training places experience’ can have on wellbeing, may help out with childcare, of the
have increased by 88%, and a 43% and encourages staff to think about risk factors for sudden infant death.’
increase in midwifery training places how they could further promote the She said that only 8% of
last year will be maintained. interests of these young people. respondents knew that co-sleeping
The new money is intended to Judy Thomson, corporate on a sofa or armchair was a risk
support advanced practice/extended parenting lead at NES, said: factor for SIDS, and just 5% knew
skills programmes and healthcare ‘It’s about doing the things that that a baby sleeping in a different
support worker development. parents would: paying attention, room to its parents for the first six
Health secretary Vaughan Gething appreciating when they need extra months could have an impact.
said: ‘This record level of funding will support and removing the barriers She also urged parents to ‘talk to
support the highest ever number of that can get in the way of them your health visitor, who can provide
training opportunities in Wales.’ achieving their full potential.’ practical advice’.
bit.ly/WAL_education_spending bit.ly/SCT_corporate_parenting bit.ly/NI_PHA_SIDS
11
COMMUNITY PRACTITIONER | FEBRUARY 2018
2019
10 -11 NEWS Professiona_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 11 29/01/2019 18:16NEWS
For more
information on
these studies, visit
GLOBAL RESEARCH the bit.ly links
CANADA
MOST BABIES DON’T SLEEP
THROUGH THE NIGHT
Research has shown that most healthy
babies aren’t sleeping through the night
– even at one year old.
Investigators found that at six months
of age, 38% of typically developing
infants were not yet sleeping at least six
hours at a stretch at night and 57% weren't
sleeping eight hours. At 12 months old, 28%
of infants weren't yet sleeping six hours straight at
night, and 43% weren't staying asleep eight hours.
The study, published in Pediatrics, also found no
association between infants who didn't sleep for
six or eight consecutive hours and problems with
psychomotor and mental development.
Babies who didn't sleep through had a
significantly higher rate of breastfeeding.
Researcher Marie-Hélène Pennestri said: ‘Our
findings suggest parents might benefit from more
education about the normal development of – and
wide variability in – infants’ sleep-wake cycles.’
bit.ly/P_sleeping
USA
AUGUST BABIES MORE LIKELY TO BE
DIAGNOSED WITH ADHD AT SCHOOL
USA Children who start school as the youngest in their year are
far more likely to be diagnosed with ADHD, scientists say.
PROBIOTICS DON’T HELP CHILDREN WITH A study from Harvard University, published in The
ACUTE GASTROENTERITIS New England Journal of Medicine, shows that, in those
A study across 10 paediatric A&E departments found that giving states where the cut-off date for school enrolment is
probiotics to children with gastroenteritis did not help their recovery. 1 September, children born in August are 30% more
Researchers enrolled more than 900 children aged between three likely to receive an ADHD diagnosis compared with
months and four years with a diagnosis of acute gastroenteritis. They those born in September enrolled in the same grade.
were randomly assigned a course of either a probiotic or a placebo. Among the 407,000 elementary school children
Results published in The New England Journal of Medicine showed studied, no such differences were observed in states
no difference in length of vomiting or diarrhoea with or without with different cut-off dates.
probiotic use. A second study, run in Canada using a ‘Our findings suggest the possibility that large
different probiotic strain, showed similar results. numbers of kids are being overdiagnosed and
Study leader Dr David Schnadower said: ‘Because overtreated for ADHD because
of the popularity of probiotics, it was important to they happen to be relatively
make sure their use is worth the cost. In this instance, immature,’ said study lead author
probiotics added no measurable benefit.’ Timothy Layton.
bit.ly/NEJM_probiotics
bit.ly/NEJM_ADHD
12
COMMUNITY PRACTITIONER | FEBRUARY 2019
12-13 NEWS Global Rese_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 12 29/01/2019 18:16NEWS
UK
BMI REMAINS USEFUL GAUGE OF OBESITY
The body mass index (BMI) remains useful on 230 different traits Our study asked
for assessing obesity and health, despite relevant to metabolism and how useful it really is for
criticism that it cannot distinguish fat future heart disease risk. detecting the health effects of obesity
from lean mass, a study suggests. The study, published in the Journal by pitching it against more objective
Researchers examined body scans of the American College of Cardiology, body scan measures.
from 2840 young people aged 10 to showed that higher BMI had similar ‘We found that […] simple BMI gives
18 from Bristol’s Children of the 90s effects to higher total and trunk fat, very similar answers to more detailed
population study, comparing BMI findings reflecting a close overlap between measures. This is good news since
BMI is widely measured and costs
with more precise measures of body fat. the measures.
virtually nothing.’
They studied the effects of total fat, Bristol University’s Dr Joshua Bell, who
as well as fat in the trunk, arms and legs, led the study, said: ‘BMI is often criticised. bit.ly/JACC_BMI
UK
POSTNATAL DEPRESSION
RISK FAR HIGHER IN
MOTHERS OF BOYS
The odds of developing postnatal
depression (PND) increased by up to
79% when mothers had baby boys
rather than girls.
Researchers from the University of
Kent, using data from 296 women, also
found that women whose births had
complications were 174% more likely to
experience PND compared with women
SWITZERLAND who had no complications.
Lead authors Dr Sarah Johns and
NOSE BACTERIA MAY Dr Sarah Myers set out to discover
DICTATE SPEED OF BABIES’ any relationship between the sex of
RECOVERY FROM THEIR FIRST COLD infants and PND, because of the known
Babies with a wide variety of different bacteria living in link between inflammatory immune
their noses tend to recover more quickly from their first response and the development of
respiratory virus compared with those who have less depressive symptoms.
variety, say researchers. A pregnancy with a male fetus
The study, published in ERJ Open Research, offers and birth complications have both
clues as to why some babies recover quickly from their previously been linked with increased
first cough or cold, while others suffer for longer. inflammation yet, until this study,
Dr Roland Neumann from University Children's published in Social Science &
Hospital of Basel said: ‘The respiratory tract is home Medicine, the relationships
to a wide variety of bacteria, and we are beginning with PND were unclear.
to understand that the types and numbers of these Dr Johns said the finding ‘gives
bacteria can influence our respiratory health.’ health practitioners two new and
The study cannot explain the link, and researcher
ISTOCK / SHUTTERSTOCK
easy ways to identify women
Professor Urs Frey adds: ‘We do not yet know what who would particularly benefit
combination of bacteria would be “ideal”, and this from additional support in the
would need to be known before we understand how first few weeks and months’.
we might manipulate it.’
bit.ly/SSM_PND
bit.ly/ERJ_bacteria
13
COMMUNITY PRACTITIONER | FEBRUARY 2019
12-13 NEWS Global Rese_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 13 29/01/2019 18:16NEWS
h
hildren’s digital footprints – the body
C of information that exists on the internet
o
as a result of online activity relating to
them – are now vast. By the time they
th
reach the age of 13, the average child
re
will have had 1300 photos and videos of them posted to
social media by their parents. And children between 11
and 16 will themselves post on social media on average
26 times a day – which means by the age of 18 they
are likely to have posted 70,000 times (Office of the
Children’s Commissioner, 2018).
But it is not just social media. A new report from the
Office of the Children’s Commissioner for England
– Who knows what about me? – explores how huge amounts information that could put them
of children’s data are collected through the screens they at risk of bullying or abuse, but the
watch, the websites and apps they access, through smart report warns that this generation will
speakers, tracking watches, school databases, classroom be at an increased risk of identity
apps, biometric data in schools, retail loyalty schemes, theft and fraud as they grow up.
travel passes and medical records. Their data profile could influence the
Even the youngest children are not exempt, thanks to adverts they are targeted with, and
a new wave of internet-connected interactive toys aimed even whether they are offered a job,
at children as young as three. Last year, two million voice insurance or credit in the future.
messages gathered by CloudPets – app-connected cuddly Aside from this, there is the matter
toys which allow children and their family members to of a child’s right to freedom and
share recorded messages via the internet – were found to independence, and the question of
be stored unprotected online. how these children can understand
their right to privacy, when they and
DIGITISED FROM BIRTH others share personal information
As the report points out, this is the first generation to be so readily.
‘digitised’ from birth, growing a vast digital footprint that As Anne Longfield, the children’s
has the potential to shape their lives now, and as they commissioner for England,
mature, in ways which neither they, nor the adults around emphasises: ‘We simply do not know
them, can fully appreciate. what the consequences of all this
Not only can these bodies of data reveal personal information about our children will
be. In the light of this uncertainty,
should we be happy to continue
Today, the average child’s forever collecting and sharing
children’s data?’
digital footprint is broader Work certainly needs to be done
than ever. What do in policy and education, and action
taken by companies producing these
community practitioners toys and apps.
need to know when it The report makes a number of
recommendations to that effect,
comes to advising parents including calling for clearer
and helping to packaging on products that capture
information about children, and new
safeguard children? lessons in schools to help children
FOLLOW THE 14
COMMUNITY PRACTITIONER | FEBRUARY 2019
14-16 NEWS Big Story_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 14 29/01/2019 18:20NEWS
understand how and why their data Too often we find the child hasn’t
is collected. even been asked, or if they have
A spokesman for the Information expressed a negative feeling about TOP 10 TIPS FOR STAYING
Commissioner’s Office (ICO) says it, been ignored. SAFE ONLINE
that its forthcoming age-appropriate ‘Nobody should be saying parents
design code for providers of websites, mustn’t post anything – that’s FOR CHILDREN
games and apps will be ‘a key step unrealistic and frankly silly, but 1. Stop and think when you’re about to share
in ensuring that providers of online again the dialogue with children some personal information.
services take their responsibilities to about this is crucial. Practitioners 2. Read the Digital 5 a dayy guide if you
the children who use their services have that trickiest of tasks to make spend lots of time online and on social
seriously, and design their products judgement calls about this, and the media at bit.ly/CCE_5_a_day
with children best thing is to 3. Look through terms and conditions to
in mind’. start with some see what data is collected when you use
But what ‘CPs ARE IN A kind of dialogue websites and gadgets at bit.ly/CCE_TandCs
can be done on with the parent.’ 4. Mute smart speakers when you don’t want
KEY POSITION TO them to listen to you.
an individual Anne accepts
level? What do EDUCATE AROUND that tackling 5. Talk to an adult you trust if you are
practitioners need SAFE USE OF THE parents’ personal worried about someone else knowing
to know? And choices is harder something about you.
INTERNET, DATA
how can they best than clear-cut
advise parents PROTECTION AND safeguarding FOR PARENTS/CARERS
6. Don’t post photos and videos which reveal
navigating this EXPLOITATION’ issues. ‘Often just
personal information about your children.
unfamiliar territory? outlining who
owns an image, 7. Change the default passwords on all the
‘THE TRICKIEST how many people gadgets your children use.
OF TASKS’ can see it, what it might say about 8. Make sure the gadgets you buy your
From sharing birthday messages that the child that possibly hasn’t been children are genuine. Counterfeit versions
show a child’s date of birth, to ‘first considered and, it won’t surprise can be even less secure.
day at school’ photos, which often you that I say this, what the child’s 9. Watch out for security updates and install
reveal a child’s location or identity view about it is, will often at least them as soon as you are prompted.
through details such as school logos get parents thinking a bit more 10. Talk to organisations that hold
and street signs, the potential to about the issue.’ information on your child about what
unwittingly create risks is huge. She continues: ‘Advise families information they collect and why.
Anne says: ‘Oversharing by parents to think about who and for what
can be a problem on lots of levels. reason they are giving their data
FOOTPRINTS 15
COMMUNITY PRACTITIONER | FEBRUARY 2019
14-16 NEWS Big Story_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 15 29/01/2019 18:20NEWS
around children is adults talking to other adults about
what another set of adults should do for children,’ she
says. ‘That should be the end of the process, with the start
cutting out all those adults and just talking with children.
‘We have found giving advice is fine, but providing
frameworks for children and adults to have their own
discussions about something is actually more effective.’
And while she finds that children in the UK are ‘actually
pretty savvy about safety issues and often well advised
on what to do and not do to stay safe’, there is a need to
address other issues which ‘don’t really come under the
b
banner of safety’.
away, and if CPs are collecting it, just EDU
EDUCATING CHILDREN – AND OURSELVES
be transparent about what it’s for and d ‘We neneed them to learn that things you wouldn’t do
what will be done with it.’ in rreal life are not appropriate in a digital sense, that it
doesn’t make them lesser people if their photos don’t
THE ROLE OF CPs get hundreds of likes, that sending people vicious
Safeguarding expert Michelle messages direct to maybe their bedroom late at night is
Moseley, CPHVA Executive member not behaviour that can or should be tolerated – asking
for Wales, believes that CPs ‘are in themselves always “Do I want to post this?” and “Who am
a key position to educate parents I really talking to?”’
and children around safe use off the Anne doesn’t want to see children online shut up in
exual
internet, data protection and sexual ‘some digital backyard’. ‘But we need them to be armed
exploitation’. with the tools to explore both safely, and confident in
One step is making parents more the knowledge that they know what’s what and how to
aware of the steps they can take to handle it without upsetting their overall wellbeing.’
protect their children online. ‘There As the report says, educating children ‘early and
is no need to place children's photos com
comprehensively about the many ways in which
on social media, faces can be blacked their ddata might be used is an important way to foster
out,’ she explains. ‘Practitioners digita
digital resilience and to help rebalance the power
can advise parents to have high be
between children and those that gather or use their
security settings – this is available personal information’.
on all platforms. But, with these digital natives far more at home in this
‘They need to be aware of the risksks space than the adults around them, perhapserha we must first
themselves, access training and look take steps to better educate ourselves..
at appropriate resources; the Child
Exploitation and Online Protectiontion
(CEOP) unit (ceop.police.uk) has a
whole range of appropriate resources
for children and parents.’ FURTHER GUIDANCE
And if a practitioner is uneasy Parentzone offers a free online
about how a parent posts on social safety guide to digital family life
media, especially if they feel it is at parentzone.org.uk
exploiting the child in some way, ThinkUKnow raises awareness of
even unintentionally, she urges online child abuse and exploitation
o
them to ‘address it with the parent, at thinkuknow.co.uk
provide evidence-based advice and
Childline offers children advice on
assess whether this has been taken
taking care of their digital footprint
on board’.
at bit.ly/childline_digital_footprint
But perhaps parents and
practitioners should not expectt to
have all the answers. There is a lot
they can learn from engaging with For references, visit
and talking with children, says Anne. bit.ly/CP_news_big_story
‘Too often, our public debate
16
COMMUNITY PRACTITIONER | FEBRUARY 2019
14-16 NEWS Big Story_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 16 30/01/2019 13:20OPINION
WOIFNTWO
ONE
£M5&0S S
C HER
VOU
Readership survey 2019
It’s been two years, but it’s that time again
when we ask readers for their invaluable
feedback on their professional
onal journal.
Community Practitioner was redesigned 12 months
ago, just part of the process of evolution that has
made it the journal it is today. Some significant
and impactful changes were made, offering
members an improved reader journey, even
more news-driven and relevant content, regular
columns and insightful articles. Peer-reviewed
research is still positioned within the publication’ss
pages, as is the latest research news. But what
do you think about your professional journal?
We would really like to know.
Does the content work for you?
Is it interesting and useful?
What would you like to read about?
Do you like the present design?
How important is the research
element of the journal?
By taking a few moments to complete the online
survey – see right for the link – you’ll play an
instrumental role in shaping the future of your
publication. We want the journal to be the best it
can be, with the most informative and relevant ACCESS THE SURVEY
content, and the most appealing design. To do this,,
we need your input. And you could be in with the
at bit.ly/CP_survey_2019
chance of winning one of two £50 M&S vouchers, The deadline is 28 February
if you fill in your details at the end of the survey.
17
COMMUNITY PRACTITIONER | FEBRUARY 2019
17 Opinion Readersh_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 17 30/01/2019 13:20OPINION
FEEDBACK
ARE HV CASELOADS
ADDING UP?
As one member crunches caseload numbers, another
looks at data protection and the Named Person, and we
highlight the HVs named in the New Year’s Honours list.
I read with interest Dave Munday’s Caseload
crunch article in November 2018’s journal. His
article outlined the changes in health visitor
staffing numbers following the end of the
Health Visitor Implementation Plan and the
transfer of commissioning to local authorities
in October 2015.
The article quotes the number of children
on the average whole-time equivalent
(WTE) caseload and compares it with the
250 children per WTE caseload benchmark
recommended by Unite-CPHVA. The
article reported health visitor caseloads in
Worcestershire of 514. The methodology used
to calculate the current average caseload is
inaccurate for Worcestershire as we monitor
active caseloads and work within integrated
skill-mixed teams.
As all health visitors will know, there is
a rich mix of needs within each caseload
from those children and families requiring
a Universal approach, to those requiring children, approximately 6% require some predominantly universal the caseload
intensive support at a system level. All additional support (Universal Plus) and size is 231 children per WTE.
children within Worcestershire receive 3% require intensive support (Universal Enabling health visitors to safely support
a public health service guided by the Partnership Plus). children and families is essential to ensuring
Healthy Child Programme up to the age Worcestershire Health and Care NHS the best possible outcomes for the child and
of 27 months. At this stage, if their needs Trust health visitor caseloads are monitored family, and therefore I would not support
are assessed as being Universal they are no on a monthly basis by the service, taking a caseload in excess of 500, which – as the
longer considered ‘active’ on the caseload. into account the needs of the children article states – is more than double the
Should their needs change, they will be and families. The average caseload for our recommended number.
reinstated on the caseload and receive a registered health visitors is 217 children
Universal Plus or Universal Partnership per WTE. In locations where there are Sally-Anne Osborne is service delivery unit
Plus service. Based on our current caseload, significantly higher levels of need, the lead for children, young people and families
this accounts for 91% of children under average caseload size is 207 children and specialist primary care, Worcestershire
the age of five years. Of the remaining per WTE, and where the needs are Health and Care NHS Trust.
18
COMMUNITY PRACTITIONER | FEBRUARY 2019
18-19 feedback_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 18 30/01/2019 15:15OPINION
IT’S AN HONOUR
In the 2019 New Year’s
Honours list, Ruth Oshikanlu,
health visitor, parenting
expert and author, has been
appointed as a member
of the order of the British
Empire (MBE) for services to
community nursing, children
and families, and named an
ambassador for the health-
visiting profession.
Gail Powell, senior nurse and
professional lead for health
visiting at the Aneurin Bevan
Local Health Board, was also
awarded an MBE for services
to health visiting.
DATA SAFEGUARDING AND THE NAMED PERSON
The GIRFEC [Getting it right for every information-sharing without consent
child] Practice Development Panel has is likely to remain at the level of
been meeting regularly since early 2018 ‘safeguarding’ the child’s wellbeing.
to support the development of a binding If practitioners cannot share or receive
code of practice in relation to information information without consent to promote
sharing by and with Named Persons. and support (that is, enhance) the child’s
While all involved believe in the GIRFEC wellbeing, there seems little ‘added value’
principles of providing early help and to the Named Person role in legislation
support to children and families who without a very real concern of only
need it, Unite-CPHVA aims to ensure damaging the health visitors’ relationship
that information-sharing by practitioners with families by stigma creep.
is lawful and in accordance with data
protection regulation, human rights and the Annette Holliday is a health visitor
common law of confidentiality. It is equally and Unite-CPHVA Executive
concerning and frustrating that lawful member for Scotland.
WHAT DO YOU THINK? The following are just a few of the topics that we hope to cover in the
next few issues of the journal. If you would like to suggest an aspect of a topic that we should
explore, if you have expertise in any of the areas, or if you would like to be interviewed on
ALAMY / ISTOCK
a subject, please get in touch. Future topics will include Brexit, the anti-vaccine movement,
tongue-tie, bereavement, foodbanks, and autism. And, as always, if you would like to
comment on any of our published articles, email aviva@communitypractitioner.co.uk,
tweet us @CommPrac, or reach us at facebook.com/CommPrac
19
COMMUNITY PRACTITIONER | FEBRUARY 2019
18-19 feedback_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 19 30/01/2019 15:15OPINION
THIS MONTH WE ASK
THE BIG Why is it crucial that
members find the time to
complete the CP readership
QUESTI ? N survey? The journal’s team
at Redactive respond.
JO MARSH NICHOLAS DALEY AVIVA ATTIAS
Director Senior designer Deputy editor
A
hank you to aking content is always visually s you know,
T those who’ve
already taken
the time to participate
T part in
the online
readership survey
engaging, with interesting
imagery and colours, as well
as layout designs that are easy
we gave
Community
Practitioner a bit of a
in the latest readership survey is very important. Your to navigate and that simplifies makeover this time last year.
about Community Practitioner. feedback helps to shape the complex language of data The aim was to keep providing
If you haven’t yet, then please the way your journal looks. and sensitive topics into an all the content you enjoyed,
take a moment to respond. Your answers ensure that the understandable format. but in clearer sections, with a
Your answers to these questions greater focus on practice, plus
will be used to help develop more member voices and some
the brand and identify areas brand new formats. We’ve had
you think may benefit from EMMA GODFREY lots of positive feedback so far,
improvement. You do not have Managing editor but we want to ensure your
to answer all the questions, but professional journal continues
the more answers you provide, to serve both your personal and
the more robust our survey. We here’s just version online for example – professional needs in the best
would like to broaden the range
of advertising in Community
Practitioner and exhibitors at
T under three
weeks left
to take part in the
a change you were keen for
us to make in the last survey.
If you think we should be
way it can. So your feedback
is vital. While you can get in
touch at any point, we have
Unite-CPHVA events like the journal’s readership survey doing it differently, we’d like crafted a number of questions to
annual professional conference. and I would like to urge to know. The design of the cover all aspects of the journal
With your feedback and insight, as many of you as possible journal has changed, even in our readership survey.
we can approach new brands to take a few moments to the size – all improvements Please take a few moments out
to increase the diversity of respond. I understand how we’ve made with you in of your busy schedules to let
advertisers in the title. Your busy you all are and that mind and to enhance your us know what you think. We
answers will be treated in we’re asking you to complete reading experience. If we look forward to hearing your
strict confidence, but they are yet another questionnaire, are getting right, or we’re thoughts, as always.
necessary to help provide key but your input is invaluable. not, we want your thoughts.
information to attract a wider We’ve made some changes And you could be in with the
commercial market to help to the journal since the last chance of winning one of two To take part in the
sustain the viability of these survey and we want to know £50 M&S vouchers - just a survey, visit bit.ly/
CPHVA member benefits. Thank what you think. The research small thanks for your time. CP_survey_2019
you for your help and good luck now consists of shorter I look forward to reading The deadline is
in the prize draw. summaries with the full your opinions. 28 February.
20
COMMUNITY PRACTITIONER | FEBRUARY 2019
20 OPINION Big Ques_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 20 29/01/2019 18:22OPINION
RIGHTS
AT WORK
A ROAD TO NOWHERE?
Colenzo Jarrett-Thorpe, Unite national
officer for health, takes us through the
reaction to the NHS long-term plan from
Unite and community practitioners.
anuary saw the launch of to local government in October 2015, UNITE HEALTH
J the NHS long-term plan
for England following the
government’s commitment
last year to increase levels of spending on
the number of health visitors in England
had fallen by almost 25% at August
2018, and school nurses by almost 20%.
There are consequences to this fall in
SURVEY RESULTS
Both 80% of HV and
school nurse respondents
the NHS until 2023-24 by £20bn. numbers, judging by the feeling of health frequently or always work
Community practitioners should visitors and school nurses taking part in through their breaks.
note the following: the proposal to last November’s Unite health members’ Compared with the
create a children and young people’s pay survey. previous year, 76% of
transformation programme, which should Some of the salient points that indicate school nurses and 80% of
underpin the plan to expand and invest in why they are feeling under pressure HVs believe that morale is
access to community-based mental health or leaving the service and not being worse or a lot worse. This
services; improving the responsiveness of replaced, can be seen in Unite health compares with 73% across
community health crisis response services; survey results, right. all respondents.
and a proposed £4.5bn new investment The NHS long-term plan must tackle the When asked why this is the
to fund multidisciplinary teams aligned issues of why so many skilled and dedicated case, the leading answer
with new primary care networks based on professionals are leaving, and prevent from HV respondents was
neighbouring GP practices. this, as well as investing in the CPs of the an increase in workplace
The long-term future. So much of stress (87%), and the
plan is high on the funding that has leading answer from
ambition and been earmarked for school nurse respondents
aspiration, but investment in our (77%) was dissatisfaction
low on detail and public health services with the quality of care
THE LONG-
the mechanics is simply replacing they feel they are able
of how it is TERM PLAN the funds that have to provide.
possible to meet IS HIGH ON been systematically 83% of HV respondents
these ambitions removed over the frequently reported
in the spaghetti
AMBITION last nine years. Does staffing shortages in their
junction of AND the plan signal a department or working
confusion ASPIRATION, bright new future for area in the last 12 months,
and chaos in the NHS or does it with 65% of school nurse
the English
BUT LOW ON merely add to the list respondents frequently
NHS structure. DETAIL AND of this government’s reporting staff shortages.
Following MECHANICS broken pledges? 80% of HVs and 75% of
the transfer of school nurse respondents
commissioning of See more results have raised concerns
0 to 5 community from the survey in regarding safe staffing
ISTOCK
health services our cover story on levels, compared with 62%
from the NHS page 30. of all respondents.
21
COMMUNITY PRACTITIONER | FEBRUARY 2019
21 OPINION Rights @_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 21 29/01/2019 18:23PRACTICE
24
HOURS
WITH
DEBBIE
FAWCETT
Debbie is a specialist HV for
homeless families at Central London
n
Community Healthcare NHS
Trust and a Queen’s Nurse.
MY ALARM GOES OFF AT… signpost them severall years MY PR
PROUDEST
6.30am, but I’m usually the last to services before being ACHIEVEMENT IS… the
one to leave for work. So I take and local offered more support from management and
advantage of a quiet house and support. permanent recognition of the specialist role
respond to emails on my laptop. housing. Lack by commissioners, which led to
My role means I’m in contact A VISIT of stability can a team of two! My colleague
with a range of statutory and CAN impact on a parent’s Nicola Ford joined me last
voluntary colleagues, from social INVOLVE… addressing emotional wellbeing August and we hope to continue
services, schools and housing to and signposting issues such as and decision-making. to develop our role. The most
charities offering support. housing, benefits, domestic challenging part of my job
violence, mental health, drug THE BEST PART OF MY is knowing that as soon as a
I AM RESPONSIBLE FOR… or alcohol use, as well as the JOB IS… knowing I can family are re-housed, another
families living in temporary practicalities of finding a school, make a difference. I am in a family will move in, and this
accommodation units, including GP and children’s centre. There unique position to recognise will continue until the current
B&Bs, women’s refuges, young are many barriers to accessing challenges and offer emotional housing shortage is addressed.
mothers’ accommodation and services when homeless, not support as well as practical
private units for families placed least that every time a family strategies. I love being able OUTSIDE OF WORK…
by housing authorities, and moves, referrals may close due to visit families in their I enjoy walking my dog, which
traveller communities moving to address or GP changes. temporary accommodation also gives me the opportunity
through and on fixed sites. and getting to know each one. to reflect and enjoy the
PARENTING ADVICE It’s very rewarding to be part countryside. I tend to head off
I AIM TO… meet every new NEEDS TO REFLECT… of their journey, and I often to bed around 11pm.
family on arrival. Families the home environment get calls after they’ve moved
dealing with homelessness face families are placed in. Families telling me about their
many stresses, and maximising presenting as homeless at new homes. I can also
engagement means being flexible their local council are often advocate for individual
and responsive. The initial contact placed in a studio flat with families as well as raise
ISTOCK
is an opportunity to assess the limited facilities, far from awareness of the impact
family’s current needs, and to familiar social networks, for of homelessness.
22
COMMUNITY PRACTITIONER | FEBRUARY 2019
PRACTICE 24 Hour_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 22 30/01/2019 13:21SECTION NAME
NEW
H
HOW
OW DO YOU DO IT?
1 Visit the journal website at
communitypractitioner.co.uk/cpd
and log on.
2 Choose which category most interests
Do you need more support
su
upport iin
n you or you feel would be the most
Are
achieving your CPD goals?? A re you beneficial, click on this and then choose
which specific module appeals.
interested in a streamlined online 3 Read the content, scrolling down to the
solution? Then read on… references at the end.
4 Click on the blue and white box ‘Click
As part of our commitment to expanding these as more companies
here & complete CPD module’ and a
you, and the desire to evolve our and organisations get involved.
separate window will open.
support of you and your work, We know that continuing
we’ve launched an online, journal- professional development is crucial 5 Answer the five multiple-choice
affiliated CPD hub. for all practitioners in your growth questions given.
In partnering with some of and learning throughout your 6 Complete your details and a certificate
the leading healthcare brands, career, and we are acutely aware will be emailed to you to confirm your
we’ve generated some interesting, of the requirements of the NMC’s completion of the module.
insightful and informative courses revalidation process too (see 7 Add the certificate to your portfolio.
aimed to expand your knowledge bit.ly/NMC_revalidation). So this
and broaden your skill-set in will go some way to supporting
relation to your core job role and you in that. If you complete You can, of course,
responsibilities. At the moment, the interactive self-assessment complete as many modules
the courses fall into six categories questions at the end of the course, as you wish. They are free to
– behaviour, child development, you will receive a certificate to add all Unite-CPHVA members.
conditions, mental health, nutrition to your professional portfolio. What Look out for alerts in your inbox when new
and safeguarding – but we will be could be simpler than that? modules become available.
23
COMMUNITY PRACTITIONER | MONTH 2018
CPD_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 23 29/01/2019 18:37A BRAIN
CLINICAL
Encephalitis
may be rare,
UNDER but when it
strikes it can be
devastating,
SIEGE
and even
deadly –
especially for
children and
young people,
writes journalist
John Windell.
ncephalitis is not a
E
common condition:
according to the
Encephalitis Society
(2017), the UK
sees around 6000 cases in a typical
year. The global figures are more
alarming, with some 4.3 million cases
a year leading to 150,000 deaths,
indicating just how devastating
encephalitis can be (GBD 2015
Disease and Injury Incidence and
Prevalence Collaborators, 2016; GBD
2015 Mortality and Causes of Death
Collaborators, 2016).
Put simply, encephalitis is an
inflammation of the brain. It has a
range of triggers, although in most
cases the cause is a viral infection
that finds its way into the brain.
These viruses tend to be routine
varieties, such as herpes simplex
or those responsible for measles,
rubella and chickenpox. Most of the
time, these trigger an infection that
manifests itself in the symptoms
of the primary condition, such as
feeling poorly or developing a rash,
which the body takes a few days to
deal with. But on occasions, the virus
GETTY
manages to cross the blood-brain
barrier and infect the central nervous
24
COMMUNITY PRACTITIONER | FEBRUARY 2019
24-26 PRACTICE Clinica_COMMUNITY PRACTITIONER FEB 2019_Community Practitioner Magazine 24 30/01/2019 13:22You can also read
