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Time to show health visiting the door

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VOL: 97, ISSUE: 28, PAGE NO: 35

Sally Gooch MSc BA RGN RHV

Let's knock it on the head and finally accept that, like lamplighters, health visiting has had its day. But it is the role that is redundant, not the people. There is, and always will be, work for health visitors because the NHS badly needs their intellects and labour.

Let's knock it on the head and finally accept that, like lamplighters, health visiting has had its day. But it is the role that is redundant, not the people. There is, and always will be, work for health visitors because the NHS badly needs their intellects and labour.

Like all the health professions, health visitors need to raise their game. They have to stop doing other people's jobs and say no to practices that do not improve the health of the population enough for the investment to be worthwhile. And they have to stop whingeing about how useful they could be if only ...

Despite Shirley Goodwin's best efforts, from her seminal paper Whither Health Visiting? to her sterling work in opening up public health training and practice to non-medical health professionals, health visiting is, with many notable, small-scale exceptions, a waste of NHS money.

Apart from pen-pushing, health visitors do one or more of the following:

- Monitor child health;

- Assess the health needs of individual adults (mostly mothers) and family groups;

- Support vulnerable individuals and family groups;

- Develop the capacity of communities to improve their health;

- Try to reduce the burden of illness through public health activities.

The balance of what they do tends to be determined by two factors: what previous health visitors did in that area and what they like doing. This is no basis for modern health services. The government must act.

Health visitors are seldom used to their full potential. Babies' weights, hearing and developmental progress do not need to be checked by someone as broadly educated or as expensive as a health visitor. Being clear about the competencies involved in these tasks would be a better way of determining who should do them and what clinical supervision and case management is required.

If, say, midwives took full responsibility for maternal and infant health, the farce of the midwife meeting the health visitor on the doorstep would end. Health visitors and midwives have had scandalously little impact on the nation's breastfeeding rates. The sooner the government diverts these resources into community development initiatives to improve support for breastfeeding babies, the better.

I am not, of course, suggesting that work with families and individuals in distress or in need of protection is not necessary. But many health visitors spend too much time on people they cannot help.

Indisputably, building up communities' capacity to improve their own health is what government, public agencies and health professions must now focus on. Health visitors seem incapable of rising to the challenge. Even with a fair policy wind prevailing for public health, practice is in the doldrums. In my view, permanently becalmed and beyond rescue.

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