The Front-Line: Community Nursing, Policies of Community and Governmentality

Abstract

This chapter is concerned with three main issues: the current direction and meaning of policies which place the restoration of community and social inclusion at their centre; the vulnerable groups at whom these policies are directed; and the real lived experience of community nurses and health visitors who, as ever, are placed in the front-line of the administration of social order. Since the elections of the New Labour administrations in 1997 and 2001, policies have shown a continuation of former emphases on efficiency, value for money and economy but this has been coupled with a desire to tackle the causes of social exclusion. There has been in many respects a revival of public health, with the first appointment of a Minister of Public Health. This higher profile was carried in individual policy documents on the state of the nation’s health in England, Wales and Scotland. Interestingly, in all the documents the structural causes of ill health such as poverty, bad housing, unemployment, low income and lack of educational opportunities were focused upon as well as a recognition that personal circumstances and culture had an effect on lifestyles. This was a break with the almost sole fixation on personal risk and a ‘blaming the victim’ attitude which was prevalent in the The Health of the Nation (DoH 1992) document. But, as we shall see, the new direction of policies presents a puzzle for management and community practitioners, it requires a shift of focus and a corresponding cultural change.