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'Is health visiting facing turbulent and chaotic times ahead?'

Rita Newland
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Three years after the end of the Health Visitor Implementation Plan, the health visitor profession is in turbulent times.

Workforce numbers have already plummeted and will continue to fall as available funds for education and training dramatically decrease from September 2019.

Health visitors are the only professionals providing a universal service to safeguard all children under five. Health visitor education and training, also known as the Specialist Community Public Health Nursing (SCPHN) is a post initial registration course, which must recruit people who are already employed as registered nurses or midwives.

Currently, it is unique in that it provides successful applicants with a fully funded course and a salary. Furthermore, the sponsoring organisation does not pay either cost and can therefore meet the Nursing and Midwifery Council requirements for student health visitors to be supernumerary during the intensive 52-week course.

However, from September 2019, it is anticipated that health visitor education and training will join other health and care professions to help the government meet its 3 million target for new apprenticeships by 2020.

This marks a significant change for the profession; not only because the source of funding will move from the Health to the Education Department, but also because the apprenticeship model only funds tuition costs, leaving employers to pay the salary costs. The absence of salary support will make it extremely difficult for NHS trusts to fund sufficient people to undertake the course.

“Workforce intelligence in England indicates that the number of students undertaking health visiting courses has reduced year on year”

Experience from the health visitor implementation plan has shown that employment alone will not create an adequate workforce. Workforce intelligence in England indicates that the number of students undertaking health visiting courses has reduced year on year since 2015 and continues to fall. This means that England will be unable to sustain the required health visitor workforce. 

Furthermore, the introduction of the apprenticeship as the main source of funding is excluded from England’s strategic workforce plan.

Indeed the Health and Care Workforce Strategy for England only uses the term “health visitor” twice in its 142 pages; despite it being promoted as a document which informs the NHS workforce requirements for the next 10 years. There is also a dearth of information in the draft strategy about how the workforce will meet the needs of children and families or the early intervention and prevention agenda in the next 10 years.

As we move forward with the development of the apprenticeship standard, the conversations that I hear focus on the desired content of the course and the changes that should be incorporated into course content from September 2019. However, I suggest that the important questions are much more fundamental.

We should be asking if and how the apprenticeship funding model will provide the workforce needed in the next 10 years to meet the agenda for children and family healthcare, early intervention and prevention. We should also be challenging the wisdom of introducing such a major change in the absence of evidence-based transition arrangements, which will enable us to replenish a decreasing but much-needed workforce.

“Health visiting is in turbulent and chaotic times”

In the fullness of time we may find that the apprenticeship funding model is sufficient to meet the demands of the health visitor workforce; however, the evidence to provide assurance for this does not currently exist.

Health visiting is in turbulent and chaotic times. Not only is the health visitor profession excluded from England’s 10-year workforce strategy, but the current dataset does not consider health visitors as a distinct profession. This means that available data is unable to inform the current workforce position.

It is therefore not possible to assure children and families in England that the universal health visitor service will be sufficient to safeguard all children under five.

Rita Newland is fellow at Institute of Health Visiting

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