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Analysis - Do health visitors have a future?

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Health visiting in England could be key in the shift to more preventative care but there are serious concerns the role is to be phased out.

Louise Tweddell reports

Health secretary Alan Johnson, in his Labour Party conference speech last year, acknowledged there needed to be more health visitors to tackle public health issues in deprived communities.

This, combined with a range of family-friendly policies and an emphasis on prevention rather than treatment, should mean that health visitors could have every reason to feel secure.

But was this just lip service from Mr Johnson?

Scratch the surface, and the evidence seems to point in a different direction. In fact, looking at key changes in this area of nursing in recent years, it could be argued that health visiting is slowly disappearing. Some key stakeholders believe there is a plot afoot to secretly chip away at health visiting until it is no longer tenable.

The government has so far done nothing to specifically address the decline in health visitor workforce figures, which over the past 10 years have dropped by around 1,000
whole-time equivalent posts.

NHS Information Centre data alone shows that there were 320 fewer health visitors working in 2007 than in 2006, a decrease from 9,376 to 9,056.

Angela Mawle, chief executive of the UK Public Health Association and chairperson of its special interest group on health visiting and public health, said: ‘I think the government
has been quite happy to allow this to happen. And, if there is a plan to erode the profession, commissioners are doing the job for them because health visitors are seen as expensive.’

The average salary for a health visitor is around £32,000 per year, based on an Agenda for Change rate near the top of band 6.

Ms Mawle added that it was difficult to prove the worth of health visitors in the strict cost-benefit ways favoured by health service commissioners. ‘It is a problem that you can’t measure their outcomes, especially when you have a government that is driven by targets – it is a real difficulty,’ she said.

It is now eight months since Mr Johnson’s speech, and there has been no sign of a recruitment drive for health visitors. More worryingly, the man charged with reviewing the future direction of the NHS, junior health minister Lord Darzi, is apparently unaware of any problem.

As NT revealed this month, Lord Darzi was surprised to hear of the health visitor workforce shortage when it was highlighted to him during a private meeting of Labour Party backbenchers (NT News, 8 April, p5).

But that is not the whole story. In contrast to the lack of activity around health visitor recruitment, there has been an enthusiastic response to alternative initiatives.

There have been plans to invest in the Family Nurse Partnership Programme, a US model that targets young mothers and vulnerable children.

And last October ministers welcomed the radical proposals of Facing the Future, a government-commissioned review of health visiting by the Queen’s Nursing Institute. These recommended that health visitors lead multi-professional teams, targeting vulnerable families and moving away from the traditional role of providing cradle to grave care in the community.

Such moves have been described as weakening the health visitor role. ‘We have seen it be slowly dismantled and other staff being brought in to take on the role,’ said Cheryll Adams, acting lead professional officer of Unite/CPHVA. ‘Really you have to ask what is going on and where certain people want to take the profession.’

Ms Mawle added: ‘There are not even enough health visitors to manage the teams, which, if they were serious about Facing the Future, they would have addressed.’

Another recent concern for the profession was the reversal of the 2001 vote, which allowed specialist community health nurses to sit solely on the third part of the register.

This, together with a planned change to the Nursing and Midwifery Order 2001, replacing the word ‘registrant’ with ‘nurse and midwife’ has seen the union Unite/CPHVA call for the term health visitor to be reinstated in the statute to protect the future of the specialism (NT News, 25 March, p4).

Ms Adams said: ‘We need to get legal protection for the sake of the future of the profession to make it more difficult for it to be pushed to one side, which is what seems to be the direction things are currently being taken in.

‘I think things took a turn for the worse when the Council for the Education and Training of Health Visitors was abolished before the 1980s but the removal of the title was key to the profession being where it is now,’ she added.

She maintains that union members should have been consulted over the NMC’s decision to reverse the 2001 vote. ‘What is this all about and what is going on here? It opens the door for the profession to be diluted even further and its imperative we get a guarantee this is not going to happen,’ she warned.

Ms Mawle added: ‘I think [the government] is planning to remove the profession. It is difficult to say what exactly is going on really but since health visiting was removed from the register there seems to be that message.’

But not all are in agreement. Yvonne Sawbridge, a qualified health visitor and vice-chairperson of the NHS Alliance, thinks the profession is merely being moved to suit the changing needs of the population and the NHS.

‘The profession is becoming more polarised, in that we are working in a business world of targets and efficiencies. The tasks that are associated with health visiting, which was always cradle to the grave, are more difficult to pin down.

However, she dismissed any deliberate attempts to do away with health visiting. ‘I don’t think there is a plan to get the profession out,’ she said.

‘Health visitors may be in smaller numbers but it may also be that they have been taken into different roles, the service is about children and communities and public health needs, and not about the number of health visitors,’ she said.

Although sympathetic to the current workforce difficulties, Ms Sawbridge added that a lot of the current concerns were simply about re-branding.

‘It is more about professional pride of being regulated as a health visitor and what that pride stands for,’ she said. ‘That energy needs to be used appropriately and put towards the difference you are trying to make.

‘Health visiting is a really valuable profession and has lots to offer but you need to look at what it can offer in a more measured way rather than a knee-jerk reaction,’ she said.

In Scotland health visiting already looks set to be consigned to history. The role is likely to be abolished in favour of a generic community nurse post. The devolved government will make a decision after assessing a pilot scheme on the new role.

What lies in store for the future of health visiting in England remains to be seen. Lord Darzi’s review, due to be published in July, should reveal more.

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