News Insight: Health visitor drive faces barriers
Ross Watson
Monday, March 8, 2010
Shadow families minister Maria Miller last week sketched out her party's plans to boost health visiting numbers.
The Conservative pledge to increase the number of health visitors by 4,200 represents one of the party's longest-standing promises. But reforming a diminishing workforce that has been a victim to sharply increasing caseloads may also prove to be one of its greatest challenges.
Shadow families minister Maria Miller last week proposed her party would focus on enticing qualified professionals back to practise and simplify the career path from midwifery to health visiting.
But Sarah Cowley, professor of community practice development at King's College London, believes that while there are some professionals who may be willing to return to practise, the means of doing so are ever decreasing.
Lack of uptake
"Return to health visiting practise courses mostly closed down because of lack of uptake," she says. "It is now hard to find employers that will sponsor students, provide practice and pay university fees," she says. "What is needed is probably one university running a course in each local region."
But even if all the current courses were fully subscribed, says Cowley, this would only produce 15 recruits a year for each region, a far cry from the numbers needed to meet the Tory pledge.
Add to this the complexities of the midwife registration scheme and the real extent of the challenge facing the profession begins to emerge.
To be a health visitor, candidates have to first train as a nurse or midwife and register with the Nursing & Midwifery Council (NMC). But under the Nursing and Midwifery Order 2001, midwives wishing to remain on the register have to continue practising midwifery - making it difficult to take up a health visiting position.
This means employers paying for return-to-practise courses may be forced to fund training in midwifery as well as health visiting.
While Miller wants to review this process to encourage more midwives into health visiting, Jon Skewes, director of employment relations at the Royal College of Midwifery, warns of "robbing one profession to boost the other".
He says Miller should be aware that midwifery is a workforce facing crippling shortages of its own with the Conservatives already signed up to the current government commitment of boosting the number of midwives by 3,000 before 2012.
Skewes is also sceptical about trained midwives wanting to sidestep into health visiting roles.
"Midwives and health visitors are broadly paid the same. But midwives have a title that is legally protected and midwifery is increasingly becoming a direct-entry profession. People train in midwifery because they want to be midwives," he says.
But one of the greatest challenges for the profession is trying to retain the current workforce with increasingly worse conditions.
Maggie Fisher left the NHS last year to become a supporting health visitor for website Netmums. Towards the end of her career she was dealing with more than twice the recommended 250-baby caseload advised by the NMC.
She could not form proper relationships with families, instead just visiting them once before the birth to make a decision if the child may be vulnerable. Families deemed less vulnerable were handed over to less qualified staff, she says.
"Practitioners are so worried there will be a death or child protection case they have not picked up," she says. "Even with the vulnerable families we can't offer the service required. There needs to be a task force set up for health visiting, like they did with social work." Fisher would consider a return to practise, but only in exchange for guaranteed case numbers and a golden handshake back into the profession.
Spiralling workload
Anne Clare Whiteside stopped practising as a health visitor 14 months ago. She says she "no longer felt safe to practise" for fear of overlooking a potential child protection case due to her ever-increasing workload.
Whiteside believes a different ethos among primary care trusts is required to tackle the diminishing numbers. "People drift in and out of vulnerability and we need to be there for everyone," she adds.
The current government says it is already acting on concerns: "Strategic health authorities and PCTs will now have to publish health visitor numbers and caseloads and significantly more health visitors are currently in training than in recent years," claims a Department of Health spokeswoman.
But while Miller is confident the Tories can entice more people to fill much needed health visitor roles, for those who have already had a taste of the profession, it may be too late.
CAREER PATH: The route to health visiting
- The title of health visitor was removed from statute in the Nursing and Midwifery Order 2001
- The order instructed that the only way to become a health visitor is to be trained as a nurse or midwife; all health visitors must also be registered as a nurse or midwife
- In order to stay on the register, health visitors must prove their competence to practise by working for at least 450 hours every three years in those other fields, be it nursing or midwifery
- This means that any health visitor who trained as a midwife must also work as a midwife for 450 hours over three years. The same does not apply to health visitors who trained as nurses, because the Nursing and Midwifery Council claims health visiting and nursing demonstrate the same skills