More than £500m is to be invested in recruiting and training extra health visitors under plans set out in the government’s public health white paper.
However, there are concerns it may not be enough to persuade nurses from other sectors to take on the challenging role and the Department of Health may have to pay above the odds in order to meet its target.
Figures contained in an impact assessment published alongside last week’s public health white paper Healthy Lives, Healthy People reveal £577m has been earmarked to help the government meet its commitment to recruit and train an extra 4,200 health visitors by 2014-15.
The figures imply the DH is planning each extra health visitor will cost the NHS an average £40,000 a year – covering their salary, pension costs and other associated costs of employment.
The total £577m pot, which is separate from the estimated £4bn public health budget, includes £4m to fund a recruitment drive; £101m to train qualified nurses as health visitors; and £130m to train replacement nurses.
Royal College of Nursing head of employment relations Josie Irwin is sceptical that many nurses can be persuaded to become health visitors, particularly against the backdrop of a changing provider landscape . Anyone entering the profession today cannot be sure who they will ultimately be employed by.
She said: “Of the total nursing workforce health visitors tend to be the most fed up group of nursing staff, largely because of the stress of working in child protection… and the heavy workload.
“There is an uncertainty in the new landscape. People won’t just go and work for [new providers] particularly not if the health providers aren’t part of the NHS and there are less generous pay and conditions.”
The small print in the impact assessment says estimates for the paybill and training costs have erred on the larger side “to reflect the fact that such a large workforce expansion may accrue larger unit costs than the trend”. This suggests the DH fears it may have to pay health visitors more than the usual band 6 or 7 to meet the target.
King’s Fund chief economist John Appleby said: “In terms of the paybill, on the face of it, it does look like they’re assuming this expansion in staff would require paying staff more.”
The impact assessment predicts the extra headcount will include around 239 former health visitors, whom the DH hopes to tempt back to practice with a range of incentives including “flexible retirement”.
Unite national officer for health Karen Reay, herself a former health visitor, questioned how effective the plan to recruit former health visitors back into the profession would be.
“You may get some coming back into practice that have left but the number isn’t going to be enough to plug the gap,” she said.
Ms Irwin is also unconvinced the DH will succeed in recruiting former health visitors back into the workforce. “Our previous experience of trying to attract nurses back to practice when they have left has not been particularly good and I wonder if that figure is realistic,” she said.
However, a scheme supported by NHS London encouraging former staff to return has recruited 60 former health visitors to a refresher course since it began in September.
NHS London chief nurse Trish Morris-Thompson said the region had also seen a 40 per cent increase in applications for traditional nurse conversion to health visitor courses this year, compared with last year.
The white paper talks about introducing “more flexible and cost effective training routes which meet the Nursing and Midwifery Council standards” and also reveals the DH is developing a “new vision” for school nurses and reiterates the commitment to doubling the capacity of the Family Nurse Partnership programme.
As Nursing Times has previously reported, there are concerns the new training routes could “dumb down” the role of health visitors.
The white paper also reveals that responsibility for health visitors will be passed through a number of organisations over the coming months. It says the DH will lead the commissioning of health visitor “workforce development” at first and later pass that to the national commissioning board. However, from 2015-16 the responsibility for commissioning health visitors will transfer to local councils.