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Fears health visitor supply could soon outstrip demand

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Health visitors qualifying next year could struggle to find jobs unless the rate at which new posts are being created increases, an investigation by Nursing Times suggests.

The research provides a snapshot of progress with the government’s health visiting strategy which aims to increase the number of health visitors by 4,200 over the next four years.

It reveals a major discord between the number of extra places on health visitor courses currently being funded by strategic health authorities and the actual number of health visiting jobs being created by primary care trusts.

Information obtained from about a quarter of primary care trusts reveals just under a third were not planning to create any extra health visiting posts this year or were still trying to find the money to do so.

For those that were funding more posts, the average increase per PCT was 3.5 posts – equivalent to a 6% increase. If this trend was repeated across all of England’s 152 PCT areas, this would mean an extra 532 posts being created.

However, the number of post registration health visitor traineeships being commissioned by SHAs has rocketed by 165% – from 545 in 2010-11 to 1,433 this year – in line with the government’s strategy.

If the funding of new posts continues to lag behind the creation of extra training posts at a similar pace next year, many newly qualified health visitors could find themselves without a job to go to when the qualify.

PCTs are expected to fund extra health visitors out of their existing budgets, which have remained about the same as last year, as well as money raised through efficiency savings. But many claim they do not have the extra money needed for the posts and some have questioned whether it is the best use of resources in the current financial climate.

A spokesman for NHS Bury said the PCT would only invest the £250,000 it had set aside for additional health visitors once it was convinced the new posts would pay for themselves and release savings “in excess” of the original investment.

In Rotherham, where the PCT plans to boost its health visitor workforce by 24 posts by 2015, there is funding for four new positions in 2011-12 but additional funding is needed for future years.

The union Unite, which represents many health visitors, called for PCTs to be given a ring fenced budget to spend on implementing the health visitor strategy and warned that lack of jobs to go to was already a problem in some areas. 

Unite lead professional officer and health visitor Obi Amadi said: “Unless the PCTs really do something I’m concerned some new health visitors will find they have no jobs to go to. We are hearing about students that haven’t got posts and can’t even get an interview.”

She added: “It’s regrettable because the Department of Health is supporting this.”

Senior health visitor advisor Cheryll Adams, who sits on the DH’s healthy child programme expert group, told Nursing Times there was a need for PCTs to recognise the benefits health visitors brought to children and families, and the money they could save society in the long term.

“It’s about winning hearts and minds,” she said. “In many areas, they fully understand the contribution of the health visitor, but in some areas they don’t and they’re more concerned with balancing the books in the short term.”

She added: “We have had a culture for five or six years or more where posts have been reduced and reduced. The same people making those cuts are now having to increase them. You can understand it’s a big cultural shift.”

David Stout, who is director of the PCT Network which represent managers, admitted it would be a “challenge” to afford the extra health visitor posts next year under continuing financial pressure for the NHS.

But he questioned whether employing more health visitors was the “best use of money if you’re struggling to fund cancer services or maternity services”.

Under the government’s NHS reform agenda, PCTs are due to be abolished in 2013 when responsibility for commissioning health visitor posts will pass to the NHS Commissioning Board. PCTs are currently merging into clusters to save management costs as they prepare for abolition.

A senior health visitor working in the midlands told Nursing Times the reorganisation had “created a lot of anxiety” but the profession was enthusiastic about the health visitor strategy.

Some PCTs are funding a significant increase in new posts (see table). NHS Norfolk, one of 30 early implementer sites for the strategy, is funding an extra eight posts in 2011-12 on top of its existing 100 strong workforce.

Its children’s services commissioner Helen Jackson admitted expanding the workforce was a “considerable financial pressure”, but said it was in line with the PCT’s priorities to improve outcomes for children.

Responding to the investigation’s findings, health minister Anne Milton said: “We take implementation of the coalition commitment on health visiting very seriously.

“Much work is underway and the Department will analyse SHA plans and address any gaps in service growth which may arise.  We will publish our first annual review of progress against the government’s ambition on health visiting in October this year.”

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Readers' comments (1)

  • I think you will find that the number of Health Visitors is going down in some areas as when Health Visitors have left post over the last year they are being replaced in post by level 5 staff nurses as a cost cutting tactic! There are currently very few posts being advertised for Health Vistors in the North West. Research has shown that Health Visitors are value for money, and that para-professionals do not deliver the same quality of service. The trend seems to be at the moment to advertise for "Family Nurse Partnership" at grade 7 whereby (with a caseload of 25) some families are being targetted and getting a good service, other universal families are getting little or nothing.

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