Health visitors: five key changes
Dr Robert Nettleton
Tuesday, September 25, 2018
Blueprint for the future of health visiting sets out how practitioners can best support young families.
The Institute of Health Visiting has produced recommendations aimed at stabilising the effective contribution of the profession to child and family health - set within the context of the wider health and social care system and in a fragmented commissioning environment.
Health visiting has become practically invisible in the NHS landscape because its concern is children and their families.
The overwhelming concern of the NHS and wider health and social care system is on managing demand to cope with pressures in adult health services and managing falling budgets in social care for the elderly.
There needs to be an equivalent sense of collective urgency to focus on the health and wellbeing of children and families as a critical public health issue, and in doing so creating the environment for reduced spending on health needs in later life.
Health visiting in England received investment in recruiting 4,000 more health visitors and the development of the service from 2011 to 2015. That has now stalled and even reversed in many areas, largely due to the pressures of cuts to public health grant and on local authority budgets. NHS data shows the number of health visitors has fallen at ar least 20 per cent since 2015, while public health budgets have shrunk 20 per cent.
A potential to recover and build on the gains of the first half of this decade comes from Simon Stevens, chief executive of NHS England, who announced a new 10-year plan for the NHS to be published later in the year.
The plan promises a "renewed focus on children's services, and prevention and inequality as they affect children", as well as the prioritising of mental health, providing an opportunity for supporting family and infant mental health.
These new NHS priorities align fully with the intended work undertaken by health visitors at the heart of child and family public health services and as leaders in delivery of the Healthy Child Programme for families and children from before birth to five years of age.
There is a gap between knowledge of what affects child and family health, and how services are commissioned and organised to implement this knowledge.
What is required is that services are organised around the holistic needs of children and families in the circumstances where they live, not the organisations themselves.
Health visiting is a crucial service as well as a vital social connector between every family with a pre-school child, statutory and voluntary health and social care services, and other community assets and resources.
The IHV's position statement - Health Visiting and the NHS in the Next 10 Years - makes five key recommendations that cover the service model, governance, workforce and clinical leadership of health visiting. These are:
1. Build on the principle of proportionate universalism to tackle inequalities and shift the curve of demand on services, as set out in 2010's Marmot Review.
Children's services, especially in times of austerity, tend to be "targeted" to greatest need and "universal' services tend to be defined in terms of "offer". But best evidence proposes that the non-stigmatising health visiting approach of actively engaging with every family from the antenatal period onwards is what effectively identifies health needs as a basis for a proportionate range of preventative support.
This can include but is inadequately defined by "early help". Without protecting this service model, we will perpetuate failure of demand management.
2. Support health visitors to lead the delivery of the Healthy Child Programme with partner agencies - with strengthened joint governance mandated within a national quality framework for systems-based practice for child and family public health.
The fragmentation of health visiting from other child health services needs to be underpinned by a wider and more robust governance to replicate the priorities of integration and sustainability to transform child public health with the same urgency as is given to adult health and social care. This needs clinical governance as well as joint commissioning.
3. Provide a health visiting service sufficiently well staffed, trained and supported to deliver a form of provision through which all children's and families' health needs and resilience can be reviewed and facilitated at key developmental phases and transitions.
4. Resource health visitors to take a specific lead for infant and perinatal mental health; oral health; promoting good nutrition; improving the home learning environment and, with it, speech, language and communication skills of pre-school children; and for addressing child safety for the first 1,001 days.
5. Ensure that health visitors take a lead for supporting the health needs of the most marginalised and vulnerable children whether as a result of poverty, social exclusion, chronic ill health, special needs or other cause.
- By Dr Robert Nettleton, education lead, Institute of Health Visiting
FURTHER READING
Health Visiting and the NHS in the Next 10 Years, IHV, September 2018
Review of mandation for the universal health visiting service, March 2017, DHSC
Fair Society, Healthy Lives: The Marmot review of health inequalities, 2010