Careers Special: Health visiting set for revival

Health visiting is one of the few children's professions earmarked for a recruitment drive in these austere times. The coalition government has pledged to recruit 4,200 extra health visitors over the next four years.

This increase in numbers is desperately needed, given the dwindling staff numbers and increasing caseloads faced by those in the profession.

Norma Dudley, a specialist early intervention health visitor who supports families with premature babies in London, says she feels "very encouraged" by the coalition's pledge to boost the numbers entering the sector.

"Health visiting can have enormous positive benefits for families, but at present many do not have the capacity to give sufficient time to respond to all the needs they perceive. There are simply not enough of us to go round," she says.

The government has yet to set out its plans as to how the 4,200 extra positions will be filled, but Dudley, who is also chair of the health visitor union CPHVA/Unite in London, hopes that this recruitment drive will not be "just a one-off exercise, but a sustained, regular training programme", with targets for increasing numbers each year.

An ambitious target

The Conservative Party, while in opposition, said little about meeting this ambitious target other than there would be a drive to encourage former health visitors to return to the profession and for midwives to switch discipline.

Gail Adams, head of nursing at Unison, is sceptical about whether this will be enough and says the government needs to do more to help other children's professionals move into the profession. She suggests a change in regulation may be needed to enable those from outside nursing to join the ranks of health visitors.

Currently, health visitors have to be registered nurses or midwives and be regulated by the Nursing and Midwifery Council. It would be time-consuming to recruit from outside nursing. Someone not currently trained would need to undertake around three years nursing training followed by a further year to 18 months of health visiting training.

Direct-entry profession

"If the government is serious about filling these roles, it may have to consider a legal change to make it a direct-entry profession and remove the requirement to be a registered nurse or midwife," Adams says. She accepts such a move would be controversial and could spark fears that the profession has been dumbed down. It would also leave question marks about regulations and standards since health visitors without such a background would not be subject to the Nursing and Midwifery Council guidelines.

Fiona Smith, the Royal College of Nursing's adviser on children and young people's nursing, wants to see the requirement for nurse training continue, adding: "there is a real benefit for health visitors having a nursing background in terms of the specialist health skills they acquire."

While conceding that several years' training represents a major commitment, Smith believes other children's professionals should not be put off joining the sector. "It is a broad profession, looking at a wide range of family support such as support with postnatal depression, public health promotion and the chance to specialise in areas such as working with traveller families," she says. "The job requires broad knowledge from its recruits and those with experience of supporting families will have a distinct advantage."

Dudley is an example of how a health visitor's broad experience can be put to good use. Although she trained as an adult and paediatric nurse before becoming a health visitor, she also has a background in nursery work, a degree in sociology and spent time as a research assistant at the Institute of Psychiatry.

"Many of my colleagues were multi-skilled and multi-trained before they started health visitor training," she says. "It is a profession that builds on the skills and experience of the practitioner. Nothing is wasted."

Dudley adds that despite sometimes feeling frustrated by her heavy caseload, the job gives her immense satisfaction. She takes particular joy in helping mothers repair the parenting bond that can be damaged by long periods of hospitalisation. "If the correct support and therapeutic work is provided early on to foster a good attachment and prevent postnatal depression, this can have a hugely beneficial effect on the baby's future health and the whole family," she says.

HEALTH VISITORS: THE FACTS

• Most health visitor roles pay between £25,400 to £34,100 a year
• Team leader and specialist health visitors can earn £30,400 to £40,100 a year
• One in four health visitors has a caseload of more than 500 children and one in five has a caseload of more than 1,000
• Latest figures show there were around 9,000 health visitors in 2007, 13 per cent less than in 1998
• The average age of health visitors in the UK is 46

Source: Royal College of Nursing, CPHVA/Unite