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'Health visitors must show leadership to deliver vision'


Cheryll Adams is optimistic that the government’s plan to increase health visitor numbers will be delivered

For several years I have felt despair as I watched the number of health visitors plummet. With this comes a marked reduction in the scope and quality of preventive services for children, families and communities.

How could this happen at a time when there was such a growth of significant evidence to prove that what happens to you as a young child has a strong influence on your future health and happiness?

While at first sight the government’s plan to increase the number of health visitors by 4,200 by 2015 can seem ambitious, I am optimistic it will be delivered. This pledge has now been strengthened by the government’s creation of the health visitor task force to oversee the plans. The committee is made up of 15 members and led by the former assistant chief nurse Dame Elizabeth Fradd.

But there are also other reasons for my optimism. First, the fall in health visitor numbers accompanied by a rising birth rate over the past few years has led to a plethora of anecdotal evidence showing that fewer children are ready for school, an increase in inappropriate attendances by pre-school children at accident and emergency departments and GP surgeries, and developmental delays. The UNICEF league table for child health and wellbeing put the UK at the bottom of 21 industrialised countries. Any government would want to reverse this situation.

The driver for the increase in staff is the understanding by the government that investing in the first two years of a child’s life leads to significant gains, not only to the child’s health in later life, but also to the fiscal spend in terms of less use of the NHS, less crime and antisocial behaviour, and more productivity through more success in relationships and in the workplace.

This policy view is longer term than the normal cycles of NHS expenditure, which is one of the reasons it is not sitting comfortably with some commissioners and providers. However, the evidence is clear, by investing early in children’s lives, there will be marked advantages to the country’s health, and to the economy later. Put like that, it may be easier to understand the investment, though at first sight it can seem out of step with budget restraints. Indeed this policy, if fully implemented, should in a few years help ease those constraints.

The fact that some NHS managers have been reluctant to respond to the requirement from the operating framework to recruit more health visitors using the money added to their baseline allocation, is disappointing and worrying for the students recently recruited. It is hoped that the new task force will address this issue. Where cost savings must be identified, the value added by a properly resourced health visitor service may not be properly understood. Many may be unaware of the relatively new research into the importance of positive emotional stimuli and the right nutrition in infancy to secure positive health outcomes in later life, including the incidence of long-term conditions.

As their professional resource increases, health visitors must demonstrate leadership to articulate and deliver the new vision for their services.

Never before has the profession had such powerful support from policy. The next generation must benefit from better resourced services. Health visitors will have new skills for working with families and will be able to build and sustain partnerships with agencies and within communities. As a result, more children will reach their potential in adult life and I remain confident the country will be rewarded with improved health and social outcomes, including savings in NHS expenditure.

Cheryll Adams is independent adviser in health visiting and community and public health policy and practice


Readers' comments (2)

  • I think you are talking "pie in the sky" as a qualified Health Visitor (who only qualified in 2008) I am currently debating whether to bother renewing my NMC status as I am being asked to act not as a Health Visitor but to only perform birth visits and Child Protection. This is not what I trained for and I am losing my skills to assess development etc due to this. I know of a large number of Health Visitors who are leaving the profession due to this pressure.
    Health Visitors are being asked to be accountable and managing teams of staff nurses (quite often being employed when HV's have left due to retirement and moving to other Pct's) and nursery nurses whilst remaing on a level 6 pay.
    I value to work undertaken by my skill mix but this should be in addition to a Health Visitor assessment not instead of. In the North West of England on the NHS jobs site there are only 4 positons being advertised currently! does this look like a drive to recruit health visitors, I think not.

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  • The role has been impoverished and so have the education programmes, where HV students are taught alongside wholly unrelated nursing roles on the basis that they all work in community services.

    First step has to be the return of the proper register, then rebuilding education that's fit for practice needs. Post basic catch up courses will be required for disadvantaged practitioners and Return to Practice for those coming back in.

    We can do it, but the register is essential & DH needs to wise up to SHA and trust b*llsh*it about recruitment figures and challenge them. Ringfencing funds would help prevent the extra funding being used dishonestly.

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