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Exclusive: Top nurse calls for health visitors to be based in A&E


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?”

Donna Kinnair

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.

Donna Kinnair

Donna Kinnair

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.

Cheryll Adams

Cheryll 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.


Readers' comments (2)

  • I am a Hv with 20 years plus experience of handling babies/young children in clinics at home etc and feel very confident in spotting unwell children. As with my other mature HV colleagues! the majority of us are either Paed or MW trained also so we draw on those skills of acute medicine from our ward experience. The current relaunch of HV numbers has resulted in a mix bag of backgrounds so many individuals are just at first base clinically. I feel it was a retrograde step to have almost direct entry HV's as you really need experience relevant to HV to function competently. This is a good idea in prinicple as on our patch numerous families, particularly from abroad use AE inappropriately. But we would need to be paid better than we are now. Band 6 is too low for the responsibilities we have already, especially for those of us in patches with lots of SG. Also I would not expect to be the doctor's hand maiden!

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  • I am an advanced emergency nurse practitioner with many years experience in ED.

    Is it expected that HV's would see the child before triaging, therefore avoiding the expensive full triaging system?
    If so, would these patients be 'sieved' by HV's when booking in? This is the only way I can see their presence making a difference. Otherwise, if the children are triaged and then referred to the HV, this would not be helping much at all. If the triage nurse is worth her salt, she/he would re-direct appropriate patient's to OOH or back to the GP after reassuring anyway.

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