Trailblazer sites unveil rejuvenated health visiting services

The pledge to recruit an additional 4,200 health visitors by 2015 was one of the coalition government’s first commitments to children and families.

A detailed implementation plan setting out how the promise would be fulfilled was published last year, after which 20 “early implementer sites” were selected to lead the way in the government’s drive to overhaul the health visiting service.

The sites were given a deadline of April 2012 to have launched the four-tier service model, designed to rejuvenate health visiting. These four tiers of provision – community, universal, universal plus and universal partnership plus – were constructed to cater to families with varying levels of need, from basic antenatal care to complex perinatal mental health problems.

The sites have met the deadline and the government is now preparing to launch a second round of early implementer areas.

Dave Munday, professional officer at the Community Practitioners’ and Health Visitors’ Association (CPHVA), says his members are positive about the level of progress made so far, although the speed of health visitor expansion is “varied across the regions”. The Department of Health (DH) itself has predicted a dip in health visitor numbers, before any increase, because of the length of time it takes to train new recruits.

“We’re telling members that even though it feels incredibly pressurised at the moment, they have to hold their nerve for the next few months, when the first new students start coming out,” Munday says.

He believes the government’s plans are mobilising professionals to improve the way they work with families. But he is cautious about the next two years of the health visiting drive. So far, strategic health authorities (SHAs) have played an important role in overseeing health visitor recruitment and taking responsibility for the introduction of the new service, he says.

But the NHS reforms mean that SHAs will be abolished next year. “I’m really concerned about who will make sure that the health visitor plan is moving forward on a regional level when the SHAs cease to exist,” he says.

Munday adds that CPHVA is worried about broader changes to the NHS. “Numerous children’s services are being privatised; either being turned into social enterprises or run by private companies,” he says. “That has big implications for information sharing, for example. In a way, health visitors are being cushioned from this over the next two years because of the implementation plan. Come 2015, it will be interesting to see where it goes.”

Partnership working with wider children’s services will be vital to the success of the health visitor expansion, which advocates increased integration between health visitors and children’s centres.

But Munday warns that health visitors are working alongside local authorities that are enduring massive cuts. “If local authority services are stripped right back, the additional health visiting staff aren’t going to be able to work on early intervention,” he says. “They will get gobbled up dealing with crises and child protection cases.”

This is an issue that will need to be addressed locally, as responsibility for public health shifts to councils and the NHS becomes increasingly devolved.

Here, three of the early implementer sites outline how they are taking on the challenges.


Jenny Gilmour, service manager, children and families, Solent NHS Trust

“As an early implementer site, we have met our local strategic health authority targets for recruiting health- ?visiting students and have agreed funding to double health visitor posts in Portsmouth by 2014/15.

"We have not seen a big increase in health visitor numbers as yet, so existing staff have done really well to embrace the new health-visiting service offer, and have been taking part in training to help them step up to the new service delivery.

"A large part of the work we are doing is about defining what health visitor services will look like in Portsmouth based on local needs and the four new levels of service: community, universal, universal plus and universal partnership plus. Community services involve health visitors supporting local early years provision; universal refers to health visitors making sure all children get the essential immunisations, health and development checks; universal plus means local health-visiting teams providing additional support for problems such as postnatal depression; and the fourth tier, universal partnership plus, is for families with more complex needs.

"Input from the strategic health authority, as well as other early implementer sites and the Department of Health (DH), has helped us move the health visitor implementation plan agenda on in Portsmouth. The Family Nurse Partnership implementation team at the DH has supported us to learn about the programme before rolling it out in Portsmouth, with plans to expand next year.

"In terms of improving services, we are piloting a new way of delivering the health and development review to be used as part of our universal two-year-olds health check, which is designed to improve the experience for families.

"We are also piloting a parenting programme called Preparation for Birth and Beyond, in partnership with local midwifery services in children’s centres.

"We are increasing our use of text messaging as a means of communicating with families and are developing mobile phone apps for use by parents. For example, we already have a school nursing app that parents can download. It offers?information about common illnesses and ailments and tells parents whether or not they should send their child to school and when to seek medical advice.

"As part of our pre-birth-to-five strategy in Portsmouth, we are working closely with early years and wider children’s services to integrate our provision and link our work into the emerging health and wellbeing boards.”