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A new vision for health visiting

The new vision for health visiting in England is a great opportunity to improve health outcomes for children, families and communities. Jacque Gerrard, Pauline Watts and Rona McCandlish take a look.

Midwives magazine: Issue 5 :: 2011


Most midwives will have worked in partnership with health visitors. Some midwives may even have been health visitors at some point, and if so will probably understand the key role they play and how they can help children and families stay healthy. 

There has been a national decline in the number of health visitors and, as a result, many families have missed out on the valuable skills and advice they provide. Staff who remain have to juggle busy, demanding caseloads. Anecdotally, this has been noticed by midwives who hand over care to a health visitor at discharge.

However, the research shows that the positive parenting and good health behaviours taught by health visitors and midwives have an enormous influence on children’s life chances and health outcomes. More than that, a number of reviews in fields from neuroscience to public health (Tickell, 2011; Field, 2010; Marmot, 2010) have underlined the need to make sure that parents and children get the help they need during those crucial first years.

So the news that the government has begun to focus on rejuvenating the health visiting profession is timely and most welcome. A new vision for health visiting was published in February 2011 (DH, 2011a) and an extra 4200 health visitors will be recruited in England by 2015.

New vision for health visiting
This new vision enhances the role of health visitors and places them at the heart of developing and providing services for families in the community. The aim is to make sure that all families get the support they need, from the routine health checks and inoculations as part of the Healthy Child Programme, to more in-depth help and support if needed.
The new offer to families (see box) places specific responsibilities on health visitors and the teams they work in. They will:
✲ Deliver universal child and family health services through children’s centres (The Healthy Child Programme)
✲ Lead health improvement through children’s centres, on subjects such as healthy eating, accident prevention and emotional wellbeing
✲ Help families stay in touch with wider sources of support through children’s centres, including from the community and other parents
✲ Be leaders of child health locally, including fostering partnerships between GPs, midwives and children’s centres.

It will be up to health visitors themselves to establish exactly how these services will be provided locally. Some areas are already quite close to providing such a service and 20 of these have been set up as ‘early implementer sites’. They will offer the new service by April 2012.

Over the next three years, all other areas will move towards providing a similar service, incorporating the best practice and lessons learned from the early implementer sites (DH, 2011b).

More on the way
The number of health visitors is going to rise to provide all the different parts of the new service and so SHAs are starting a three-year programme of recruitment. The aim is to increase the workforce by 4200 – that’s an extra 50% on top of current numbers. 

The number of training places for health visiting is going to almost double this September and SHAs are also encouraging ex-health visitors to return to the profession. Over the next two years, you should start to see many more new health visiting colleagues in early years teams.

What does the new role mean for midwives?
Health visitors are going to play a central role in co-ordinating local services for families to develop a range of services for parents. To do this, they will work in partnership with midwives locally and with health and social care professionals in GP practices and Sure Start centres.

The DH has held country-wide roadshows talking about the new plan. Health visitors have highlighted that working with midwives at the right time during a woman’s pregnancy and in the postnatal period is key to maximising the benefits of health visiting for families. They have also said that a shared pathway for antenatal and postnatal care would be a valuable tool to take forward partnership working and deliver quality outcomes. The DH is now working with health visitors and midwives to develop such a pathway.

Collaborative working will have benefits for families – by helping to build strong relationships during pregnancy and the first few weeks after birth and in planning future contact with families.

The plans for health visiting value the particular contributions midwives make to the health of families and whole communities and will mean midwives and health visitors working together in even closer partnership to improve on health outcomes. 


The offer to families
The new vision for health visiting offers four levels of service to all families:

Your community:
Includes a range of services, including Sure Start services and those that parents and others in the community provide for themselves. Health visitors will work to develop these services and make sure women and their families know about them.

Universal services:
The health visitor and their team provide the Healthy Child Programme to ensure a healthy start for babies, children and families (for example immunisations, health and development checks), support for parents and access to a range of community services and resources.

Universal plus:
Gives a rapid response from the health visiting team when specific expert help is needed, for example with postnatal depression, a sleepless baby, weaning or answering any concerns about parenting.

Universal partnership plus:
Provides ongoing support from the health visiting team plus a range of local services working together – and with women and families – to deal with more complex issues over a period of time. These include services from Sure Start children’s centres, and other community services including charities or family nurses.

To find out more, please read the Health visitor implementation plan 2011-15.



Authors
Jacque Gerrard is RCM UK Board for England director. Pauline Watts is the professional officer (health visiting) at the DH and Rona McCandlish is the DH midwifery professional advisor.