In Focus: Health Visitor Implementation Plan

Tuesday, July 10, 2012

Pilot areas have reported breakthroughs in joint working. Image: Gary Manhine
Pilot areas have reported breakthroughs in joint working. Image: Gary Manhine

Insight: A healthy start in life is essential
By Anne Longfield

The evidence is clear – the first months of life are pivotal to the healthy development of the child with long lasting consequences. Advances in neuroscience and genetics mean that we now know that damage may never be overcome – all reasons why the Healthy Child Programme is being given such a priority by government, with a substantial extension of the health visiting role to make it happen.

The move fits well with the broader agenda of early intervention and prevention that is increasingly the focus of local delivery. The universal service with targeted support for vulnerable babies, children and families has much to offer those seeking to remodel wider children’s services, with hopes high for the potential of a renewed level of engagement between health and local government through new health and wellbeing boards that are already well on their way.

The Health Visitor Implementation Plan is at the forefront of these changes with a significant programme of recruitment and workforce development. Aiming to rejuvenate the health visitor service, the plan also reinforces the importance of the wider relationship between professionals and services – particularly children’s centres – acknowledging the value of working together to support wider outcomes for children and families.

Anne Longfield is chief executive of 4Children

In depth: Optimism grows for health visitor programme
For those outside the profession, it is not necessarily clear what the Health Visitor Implementation Plan means in practice or how they can get involved. Within the national framework there are local variations in delivery with many early years staff reporting a reduction of health visiting staff rather than an expansion over the past year. Early feedback from the 26 early implementer sites added further worries, as wider children’s service staff struggled to find their way into strategic discussions in their area.

However, there are distinct signs that the mood is changing, with new levels of optimism and collaboration developing on the ground.

Officials in charge of health visitor numbers always maintained that a net fall in numbers was expected while new health visitors worked through their training – a position that seemed to defy reality as budgets were slashed. But it is a new emphasis on strategic collaboration now becoming apparent that is likely to make the big difference. Those working in areas such as Blackpool, Bristol and areas of London report significant breakthroughs in partnership working: joint planning around antenatal and early years’ services; the beginnings of real engagement around early intervention; joint working on forthcoming two-and-a-half-year-old progress checks and the prospect of joint commissioning if health and wellbeing boards are done right.

There is also good progress in some areas that have historically struggled to build good relationships. For instance, Merton in south London has increased contact and identification and assessment needs of vulnerable children and their families as part of its early implementation plan, as well as driving an increased take-up of early help and evidence-based parenting programmes. Along with making efforts to improve cross-agency working and sharing of good practice across the borough and beyond, there is huge optimism for the future too.

Despite some persistent challenges – such as the shift from universal to targeted services and implementing standardised tools for the two-year progress check, as well as developing robust measures for tracking children through the early years and across partners – there are exciting plans for further integration with children’s centres’ targeted services and raising the profile of the project to influence commissioning.

Local examples such as these are growing ever richer. It may be that the ministerial commitment to joined-up working across health and education and the evidence base for early intervention are coming together to finally inform priorities on the ground.

In Figures

increase in number of health visitors by April 2015 targeted by the government
(Source: Department of Health)

estimated additional health visitors to be trained over the period to 2015 to achieve 4,200 target
(Source: Department of Health)

number of health visitors as of March 2012
(Source: NHS Workforce statistics)

annual change in number of health visitors as of March 2011
(Source: NHS Workforce statistics)

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