Despite across-the-board cuts to children's services, the government's commitment to recruit 4,200 more health visitors remains intact. Public health minister Anne Milton reiterated the pledge in front of hundreds of health visitors at the Unite Community Practitioners' and Health Visitors' Association conference in Harrogate late last month.
But while her assurances were initially met with rapturous applause, concerns remain about the lack of detail that has been released about how this target will be met.
Milton admits the profession "has been eroded dramatically over the past decade", but the government is yet to reveal how it will tackle problems affecting the profession. The ageing workforce remains a concern, with NHS workforce statistics for 2008 showing 20 per cent of health visitors are aged over 55 and 40 per cent are over 50.
Unite national officer for health, Karen Reay, says: "Health visitors are already under pressure because of the shortage, what will be done about that? We've always said 4,200 is not enough - we need 8,000 just to stand still." But she admits that "anything that will put more health visitors into the field is obviously a good thing".
A Department of Health spokeswoman says better training options for returners and new recruits will be offered and a new training programme will be launched next year for health visitors to refresh and extend their community health skills.
Plans to boost the number of health visitors also include working with commissioners over the next year to ensure they do everything possible to retain and increase numbers in their locality; instructing providers to train more health visitors to fill the gaps; disseminating the new service vision for health visitors; creating a new commissioning framework around the service model; and encouraging experienced health visitors to welcome and mentor new students and returners.
Uncertain sector
But quite how this will be done is uncertain, especially at a time when there is little, if any, wriggle-room in commissioner budgets.
Reay says: "This is positive but how will health visitors be trained? What will be done about continuous evaluation and monitoring?"
The government's commitment to a national recruitment drive and the creation of a "shared identity" for the profession has also not had a particularly enthusiastic reception.
Reay, who used to work as a health visitor, says: "I remember when there were 300 to 400 people competing for every place. It really was a very well respected profession. But there has been a long-term decline which we have been fighting for a long time to turn around."
Unite's assistant general secretary for public services Gail Cartmail says the union's campaign for health visitors has "never given up the fight to revive the profession", arguing that the government should be concentrating on this rather than reinventing the wheel.
Cartmail also feels that more notice should be given to the campaign to return health visiting to statute to safeguard its future. The union argues that removing the title of health visitor from statute in the Nursing and Midwifery Order 2001 had a significant effect in reducing investment in the profession.
Reay adds: "We need a big push for regulation. Putting it back into statute is not the be-all and end-all but it could help. There is light here. We want to work with ministers to help achieve the goals."
Unanswered questions
While the government has continued to commit to increasing the number of health visitors to 4,200, there remains a lack of clarity over how this will be delivered. In particular:
- What will the shared identity of the health visiting profession look like?
- When will the recruitment campaign start and how will it be conducted?
- How will the government help to improve training and continued professional development opportunities for health visitors?
- Has the government dropped plans to examine a direct-entry route into the profession, in which students could train as health visitors without first having to train as a nurse or midwife?
