A trust in the North West believes it is the first place in England to increase the number of home visits from health visitors from the statutory five to at least eight.
A newly-designed health visiting service, delivered by Blackpool Teaching Hospitals NHS Foundation Trust, will mean all families with new babies get eight home visits from before birth to the age of three – with the most vulnerable families being seen up to 30 times.
“We foresee parents receiving more support and attention from the one-to-one visits”
Health and local authority partners in Blackpool have also revised training for health visitors and changed the style of visits, so parents are encouraged to take the lead and discuss the issues that matter most to them, as part of the major restructure.
The changes have been made possible thanks to a £1m investment from Blackpool Better Start, a wider 10-year programme to improve outcomes for young children funded by the National Lottery and set up by the Big Lottery Fund.
The funding over three years from 2016 has been used to pay for a review of the current health visiting service, consultation on a new approach and the development and production of new tools for health visitors.
“I am proud of the health visiting workforce, who have embraced the changes”
The eight-visit model was one of three options chosen in consultation with staff, explained Merle Davies, director at Blackpool’s Centre for Early Childhood Development.
“By increasing the number of visits, we foresee parents receiving more support and attention from the one-to-one visits, as it will give parents the chance to discuss issues in more depth,” she said.
“This will help forge a trusting relationship and will encourages families to be more open and confident to discuss sensitive issues,” said Ms Davies.
She added: “It will also help the health visitors to identify concerns at an earlier stage and refer to additional sources of support.”
Under the new service, which launched this month, families will first be seen by their health visitor at around 28 weeks of pregnancy.
“That Blackpool is bucking the trend and investing is fantastic”
The next visit takes place any time up to 14 days after birth followed by home visit at weeks three to five. After that, visits occur at six to eight weeks, three to four months and nine to 12 months.
The final two visits are a developmental review at between two and two and a half, and a school readiness review at three and three and a half.
Prior to the review, staffing had been reduced by 3.6 and a number of posts were “lost due to natural wastage”.
The new service, which will be evaluated after the first 12 months, has not seen an increase in numbers but the level of community provision was reviewed, said Ms Davies.
“There hasn’t been an increase in the number of health visitors. So in order for them to deliver more visits we have reviewed the community offer,” she said. “We consulted extensively with staff regarding the activity in each level of the service offer.
Blackpool Better Start
“Drop-in child health clinics are available every weekday and antenatal education sessions continue to be commissioned as part of the community offer,” she said.
Ms Davies highlighted that the number of drop-in clinics and antenatal sessions had not been reduced.
The 57-strong team comprises health visitors – mainly at bands 6 and 7 – and band 5 and nursery nurses, with staff working a variety of hours.
In addition, Ms Davies said caseloads had not increased as a result of the review, with an average 150 per health visitor.
“Caseloads haven’t increased as a result of the review and are calculated using formulae that reflect the indices of deprivation in Blackpool,” she said.
While all families are entitled to the universal offer of eight visits, others will get more visits under Blackpool’s Universal Plus and Universal Partner Plus schemes for vulnerable families and those with additional needs.
Training for health visitors in the area has been revised and updated in the light of training needs assessment, with a new competency framework currently in development.
They will be trained in the use of new assessment tools, including a new speech and language assessment designed to better identify any issues a child may have, new ways to observe and assess newborn and young children’s progress and identify and support mums with depression.
The structure of visits has also been changed to ensure a greater focus on “collaborative working between health visitors and parents”, noted Ms Davies.
This will see health visitors deploy motivational interviewing techniques and use new resources for collaborative planning and “agenda matching” – a way of creating tailored plans based on each family’s strengths and needs that was core to the national Family Nurse Partnership programme.
“We have reviewed the content of every visit in the pathway and looked at the evidence base behind them,” said Ms Davies.
Pauline Tschobotko, head of the families division at Blackpool Teaching Hospitals, said she was proud of the way health visitors had responded.
“I am proud of the health visiting workforce, who have embraced the changes,” she said. “They have worked with families in Blackpool and Better Start to develop a service that should better meet the needs of our community.”
Cheryll Adams, executive director of the Institute of Health Visiting, said Blackpool was bucking the trend by investing in health visiting services against a backdrop of widespread cuts.
“Cuts to public health budgets in England have had a devastating effect on the services many health visitors can deliver and we have seen the growth of enormous differences in the quality of services up and down the country, which will serve to increase health inequalities,” said Ms Adams, who is on the Blackpool Better Start external advisory group.
“That Blackpool is bucking the trend and investing is fantastic,” she said. “They are also doing it within a framework of evaluation, so the effects will be measured.
“Without time to get to know families and to assess their needs over time it’s so much harder for the health visiting service to have an impact. They are often dealing with mental health challenges and much of their work is not a quick fix,” she added.
Meanwhile, yesterday, Labour pledged to introduce one extra mandatory home visit by health visitors while children are aged three to four months, if the party comes into power.
The policy commitment was unveiled on Thursday by shadow health secretary Jonathan Ashworth, who was speaking at a conference on breastfeeding at the Royal Society of Public Health in London.
At the same conference, new survey results were revealed suggesting that nearly one in three health visitors thought their ability to support breastfeeding mothers has reduced in recent years.
The survey of almost 800 health visitors, carried out by the Institute of Health Visiting, found 28% said their capacity to support new mums with breastfeeding had decreased in the past two years.