Rosalind Godson believes cost cutting and poor training will put families at risk
The Department of Health has pledged to recruit an extra 4,200 health visitors. This would obviously be wonderful as the current ones are exhausted because of the heavy caseloads and increased responsibility they are carrying.
Some areas have resorted to offering pay up to band 7 to attract applicants. However, this is just “robbing Peter to pay Paul”. We calculate that 8,000 more health visitors will need to be recruited over the next five years, taking account of jobs already lost, natural wastage and the fact that some will go on further training to do family nurse partnership jobs.
Currently health visitor training places are commissioned by strategic health authorities. Over the time of this parliament, that responsibility will move via the NHS Commissioning Board to local authorities. There is a possibility that universities and potential students will be confused about the application process, and that this will put people off. It will be important to make sure there is not a mismatch between training places and available jobs.
Applicants need to be nurses or midwives and do an additional year’s training (two years part time) at university. The government is exploring “flexible training options” with the Nursing and Midwifery Council - these may involve staff nurses working alongside nurses in the community to encourage them to apply, and a greater use of accreditation for prior (experiential) learning.
Unite and the Community Practitioners and Health Visitors’ Association will resist any attempt at lowering training standards because, if anything, the professional level of expertise needed to do the job is increasing. We are, of course, happy to work with the NMC to make sure that health visitor training covers contemporary issues. In addition, there is a lack of health visitor practice teachers - as there are no significant plans to remedy this, it may be difficult for trusts to commit to training places if they cannot meet NMC requirements.
Part of the coalition government’s calculation is that some “lapsed” health visitors will be attracted back to the profession. Although this may be possible where management is supportive and forward thinking, the truth is that many health visitors in their 50s are looking forward to retiring before anything happens to their pensions, as the stress of the job, coupled with seemingly constant local reorganisation, has sapped commitment.
Health visitors are not just advanced nurses, they are experienced public health professionals who are skilled in holistic assessment. Their role is to offer a universal service to families with children to detect and prevent health problems. They recognise hidden, as well as visible, needs and develop a therapeutic relationship with families, building on their strengths, so they can identify issues that may profoundly affect a child’s wellbeing, such as maternal postnatal depression, domestic violence or substance abuse. These problems cross social divides.
Unfortunately, owing to cost cutting and, in some areas, skill mix, staff without suitable training are being used to fill the gaps inappropriately. Furthermore, in some areas, techniques without an evidence base, such as postal questionnaires and phone conversations, are being used to identify problems. While there are flaws in these processes, which hit the headlines when child abuse is missed, the real sadness is the neglected families who struggle on daily without support, and the communities who need a health champion.