Health visiting needs a shot in the arm
Ravi Chandiramani
Tuesday, March 24, 2009
Health visiting as a profession has reached a crossroads. Numbers are at their lowest for 14 years, falling by 10 per cent in the past three years alone (see p9).
Severe caseloads - with 40 per cent of health visitors handling more than 500 children, and 20 per cent more than 1,000 - is a major part of the problem. A dearth of children's social workers is forcing many to focus their work away from preventative health services and on child protection.
And yet surveys suggest health visitors are among the occupational groups in the children's workforce most trusted by families. Moreover, they are effective. Evaluations of Sure Start show that those programmes led by health visitors tend to perform better. The planned expansion of family nurse partnerships to target vulnerable families will increase demand.
There's now a consensus that something has to be done to bolster the profession. The Conservatives have for some time pledged to create more than 4,200 extra posts. Lord Laming in his report called for "immediate action to address the numbers, confidence and competence of health visitors". Health Secretary Alan Johnson duly obliged, kicking off a programme of action. A summit in May will flesh out its proposals.
The government's programme should focus its energies on two matters. First, it should refine the remit of the profession. Here, it must realise the knack of a good health visitor is the ability to form trusting relationships with families, to get under the skin of problems and tease out their health needs.
Health visitors require the maturity to knock on every door, from caravans to stately homes. Skilled visitors help not only those more deprived families and young children in obvious need, but also middle-class families where the wellbeing of parent and child might be just as at risk. If health problems are to be identified early and nipped in the bud, these functions of relationship building must be protected. It will also make the profession attractive to existing and would-be recruits.
Which brings us to the second issue: workforce development. A stronger career framework - with more training, routes to entry and progression, and clear salary bandings - is essential to the very health of the profession. Deputy chief nursing officer Viv Bennett's seeming urgency on this matter is encouraging (see p4). Health visiting will be 150 years old in 2012. A robust and confident health visiting service must be restored by then.
