As health visiting suffers a recruitment crisis, unprepared staff are being asked to work with vulnerable families. This raises child welfare concerns, say Yvonne Crome and Val Thurtle
While the public sector prepares for severe financial constraints, the health visiting service is already at a low point. Cutbacks in resources, poor workforce planning and insufficient recruitment to educational programmes mean that in many areas practitioners cannot provide the service needed.
But it is not morally acceptable for those of us working as health visitors and educators to allow continual plugging of gaps in the service by staff inadequately prepared for their role.
Health visitors are highly skilled and trained to provide a public health service, with an emphasis on prevention. The Laming Inquiry into the death of Victoria Climbié emphasised how important health visitors are to protect children. The emphasis was on highly trained, skilled professionals, not nurses without any further training.
While there is concern about child maltreatment, there are also claims that many children are starting school with a range of undiagnosed developmental problems. Early intervention and preventing child maltreatment from poor parenting is vital to improve children’s outcomes in later life. The loss of dedicated health visitors is linked to a marked rise in mental health problems in children.
At a time when there are concerns about child health, the number of qualified health visitors is at its lowest ebb, with a drop of nearly 13% in whole time equivalents since 1998. The DH recognises the need for more qualified health visitors but action is slow to follow. Health visitor vacancies continue to be filled with nurses and nursery nurses, a source of particular concern for safeguarding children.
Skill mix does have its place within health visiting teams; nursery nurses have expertise in child management and mental health nurses’ skills are often beneficial. Nonetheless, workers coming into a health visiting team should be appropriately educated and prepared.
Nurse education does not prepare newly qualified nurses for preventive child and family public health work. Community staff nurses and nursery nurses are not currently prepared to work with children and their families to promote resilience and positive health. To expect them to work with extremely vulnerable families, deal with child and family mental health problems and child abuse in an over-stretched service is an experiment with people’s lives that we cannot afford.
The loss of dedicated health visitors is linked to a marked rise in mental health problems in children
All staff in health visitor teams should be systematically prepared through suitable educational programmes so they share the ethos of prevention and health promotion as well as partnership and community development.
If the government is committed to ensuring that “every child matters” then it must demonstrate its commitment to health visiting. The DH should make it a priority to ensure that strategic health authorities have enough qualified health visitors. There is also a need for a clear strategy for educating health visitors.
As Nursing and Midwifery Council registered practitioners we are accountable for actions and omissions in our practice; in health visiting this is currently questionable. Hence we feel the need to speak out. The NMC must recognise that health visiting is a unique occupational group and that nursing skills are not automatically transferable. It needs to consider whether having a mix of staff unprepared in family public health protects the public.
The health visiting service is being delivered by staff who are inappropriately prepared, or barely delivered at all. This leads to inequality, something health visiting, public health and this government has sought to address. It is now time for action before the demise of the service is permanent and we can only look back and reflect on what has been lost.
AUTHORS Yvonne Crome and Val Thurtle are senior lecturers at Anglia Ruskin University and the University of Greenwich respectively, and members of the United Kingdom Standing Conference on Public Health Nurse Education