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'Lincolnshire’s health visitors are taking a stand on a local problem of national significance'

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Later this month, a group of around 40 health visitors in Lincolnshire are set to stage a series of planned strikes over pay and the “erosion” of their role.

Making such a stand is unusual to say the least for clinical staff, but is probably unprecedented for health visitors – though they have always had strong union support down the years.

Normally when I receive a press release about a strike ballot it turns out to be an indicative ballot – an initial vote about whether to hold an actual vote for industrial action.

It is a tactic often used in disputes to ratchet up the pressure on employers to meet the demands of those behind the ballot. But this was not the case in Lincolnshire.

As reported by Nursing Times last week, 44 of the 58 health visitors employed by Lincolnshire County Council voted in favour of a series of strikes, starting with a 48-hour stoppage on 15 July.

What has driven them to take this measure? The county council has withheld annual pay rises for staff who transferred over from the NHS in October 2017 but who chose to remain on Agenda for Change, rather than move to the council’s contract.

As a result, Unite claims that its health visitor members in Lincolnshire have lost more than £2,000 a year since the transfer.

The union also says the council has split the health visitor role into two levels with level 2 only available to those on the council contract.

The health visitors on level 1 had “specialist elements” of the role removed, which limited their scope of practice and made it more in line with a staff nurse position, according to Unite.

In response, the county council has said its pay scales reflect Agenda for Change pay and are “in fact, slightly higher”, and that its job descriptions are in line with those set by the regulator.

By its very nature, this is a local dispute about a specific set of circumstances. But there is a national message here that needs national attention. Lincolnshire isn’t alone in trying to balance shrinking budgets by cutting health visitor services; last month we reported that Suffolk County Council had announced plans to cut 31 posts – 25% of its health visitor workforce.

As has been well documented over recent years, health visitors have come under increasing pressure with a decline in staff numbers since the targets in the Health Visitor Implementation Plan expired.

In England, the number of health visitors has slumped from around 10,000 in 2015, when councils took over the responsibility for commissioning health visitors, to around 8,000 at present.

This has a negative effect on both health visitors and the children and families they care for. Fears have been raised that rising caseloads mean the role is becoming more about safeguarding than public health. In Suffolk, for example, it is proposed that nurses will carry out three of the five mother-and-baby health checks currently undertaken by health visitors, and that health visitors will prioritise vulnerable families.

“Please also spare a thought for those planning to go on strike – which takes real courage”

Health visitors have already voiced fears of a child tragedy occurring; in an Institute of Health Visiting survey last year, many reported rising caseloads, high levels of stress and were worried they would not be able to help children in need due to stretched services.

Ordering health visitors to prioritise vulnerable families increases this risk as many families needing additional support are identified during the five health checks.

When funded and used properly, health visitors play a vital role in ensuring that all children have the best possible start in life. We cannot afford to lose any more health visitors – or the services they provide; national and local government must take note or risk storing up problems down the line.

And please also spare a thought for those planning to go on strike – which takes real courage.

Health professionals are generally reluctant to strike because of its impact on their patients. However, it also opens them up to criticism from colleagues, the public and media, puts them at risk of being branded troublemakers by their employers.

Whatever the outcome of the dispute, the action by Lincolnshire’s health visitors should shine a much-needed light on the parlous state of the profession. Let’s hope it deters other councils from considering similar tactics or simply failing to invest in this precious resource.

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