Health visitors could in future be based in accident and emergency departments under plans being proposed by a senior nurse in London.
Dame Donna Kinnair, clinical director of emergency medicine at Barking, Havering and Redbridge University Hospitals Trust, said the move would tap into the public’s popularity with seeking access to healthcare via A&E.
It could help establish contact with anxious parents that regularly turned up at A&E for support and advice, rather than treatment, and therefore ultimately reduce pressure on hard-pressed emergency departments.
She told Nursing Times she was seeking discussions about the idea with the Department of Health.
“One of the things is people will say hospitals are for sick people but, actually, if you were really worried about your child at eight at night where would you go?”
Dame Donna, a health visitor by background, said parents were already visiting her emergency department during out of the hours periods, when most community-based staff did not currently work, to seek advice on looking after their young children.
She said that introducing health visitors into emergency departments would meet the needs of those parents who wanted reassurances during the evenings and night about their infants, on matters such as feeding and minor rashes.
It is hoped the plans could be trialed within a year at a busy A&E department, she told Nursing Times.
Dame Donna said the system should not see health visitors functioning as an emergency service for parents and their babies. However, she admitted that a balance might have to be struck between how much time was spent advising patients and redirecting them.
She acknowledged that the proposals may appear controversial to some, including GPs who “often want health visitors just working for them”. There could also be reluctance to provide the service within a hospital, which is seen as a providing a service for ill patients, she said.
“But it’s about meeting the needs of the population,” said Dame Donna. “One of the things is people will say hospitals are for sick people but, actually, if you were really worried about your child at eight at night where would you go?”
Cheryll Adams, director of the Institute of Health Visiting, said the small-scale use of health visitors in emergency departments in the past had been very successful. It could be a solution to the increasing numbers of inappropriate attendances at A&E departments by families that want help, she told Nursing Times.
“We have to turn this around because it’s a very expensive business if they have to go through the full A&E triage system,” said Ms Adams.
The idea was previously tried at Portsmouth Hospitals Trust. Ms Adams said: “It was very successful because the health visitor could support the department with patients that had health visitor issues and also could help around safeguarding issues.
“A lot of health nursing staff don’t have an awful lot of training around the under-fives so there was an element of informal training by the health visitors that went on for nurses and doctors as well,” she said.
The College of Emergency Medicine said it recognised the idea’s potential and would support a trial to evaluate a hands-on health visitor role, but only in selected emergency departments.
“Health visitors and other health professionals have the potential to play a strong role in reducing the burden on emergency departments”
Department of Health
A spokeswoman for the college said it recognised that in many emergency departments – particularly in large cities – parents brought children into the department for only minor illnesses.
However, she said the college believed that the service might only prove beneficial in a small number of areas where primary care facilities were not co-located near to emergency departments.
“Where a primary care centre is co-located with the emergency departments, these cases can be seen by those experienced staff, who are usually nurse practitioners and doctors (usually GPs) and have the skills to give reassure and give advice, and provide a holistic consultation,” she said.
“Where primary care facilities are not co-located to the emergency department, a health visitor based in the emergency department may provide valuable to parents,” she added.
A Department of Health spokesman said: “Health visitors and other health professionals have the potential to play a strong role in reducing the burden on emergency departments. We welcome proposals on innovative ways to achieve this.”
Dame Donna was an adviser to Lord Laming during his inquiry into the death of Victoria Climbié. She was made a dame in the 2008 Queen’s birthday honours list.