Editorial
‘It was Florence Nightingale who was quick to appreciate that health visiting was different to nursing’
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VARIETY IS THE SPICE OF LIFE
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The role of the health visitor is varied and that is a good thing, but it does complicate our image. Health visiting has been around for a long time, but its starting point is generally accepted as being the first formal appointment of a paid health visitor in 1862. This role had grown out of what were referred to in Victorian times as ‘sanitary visitors’. These were women who voluntarily visited the homes of families and provided health promotion and education 14 JCN 2014, Vol 28, No 5
some of the key issues that have replaced poor sanitation as our current focus.
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hat is a health visitor? What do they do? Indulge me for a moment and reflect on your immediate response to that question. Weighing babies was in there, wasn’t it? Don’t worry, you’re not alone — I recently asked a random sample of service users and healthcare professionals the same question and ‘weighing babies’ also featured highly in their perception of the health visitor’s role. Few could explain the role succinctly and most struggled to quantify exactly what it is we do. Indeed, my own health visitor colleagues had trouble explaining their jobs as they represent so many things to so many people.
It was Florence Nightingale who was quick to appreciate that health visiting — with its focus on health promotion and education at an individual, family and community level — was different to nursing. With the distinction clear in her mind, Nightingale was instrumental in establishing the first health visitor training in 1891.
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Melita Walker is a professional development officer perinatal mental health (iHV) and health visitor, City Healthcare Partnership CIC, Hull
in order to address the high infant mortality rates associated with poor sanitation and diet, and overcrowding
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There’s so much more to health visiting than weighing babies
It has been a requirement in the UK since 1945 that health visitors are already qualified nurses or midwives. Training has evolved and today becoming a health visitor involves specialist post-registration training in public health, over one or two years at level 6 or above. Since its very inception the role of the health visitor has developed in response to the ever-shifting challenges of public health. The details of our work may be different to that of our forbearers, but the underlying philosophy of working to address health inequalities and improve health on an individual, family and community level remains. Mental health, drug and alcohol use, domestic violence, attachment and bonding, the transition to parenthood, and obesity are just
FAMILY VALUES
Although the role of the health visitor includes health promotion and addressing health inequalities at a population level, we are currently focused (like the very first health visitors) on families with children under five. Advances in neurosciences along with an increased awareness about how a baby’s earliest moments influence their lifelong wellbeing, has led to extra investment and a resurgence of health visiting recently. The amazing research on attachment and bonding, infant mental health and perinatal mental health offers health visitors an exciting and unique opportunity to really make a difference. We know that early intervention and supporting families in the transition to parenthood is the foundation of a healthy society — as part of the wider primary care team we are confident we can deliver on this. Through the ‘healthy child programme’ (HCP), health visitors are tasked with ensuring that extra investment delivers high-quality services for all children, families and communities (universal services), with more targeted personalised care (progressive services) for those with additional needs and risks. In practice, this means that every family has contact with a health visitor — initially antenatally and then at regular intervals following the birth. This is our
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We are also looking at how the baby is handled, the quality of attachment and the responsiveness of the caregiver to the child’s needs, as well as considering the parents’ emotional and physical health. Simultaneously, we will be monitoring the baby for weight gain, which encourages continued breastfeeding and all the associated benefits that this brings. To see the delight of parents for whom the baby’s weight gain means their sleepless nights have been worthwhile is payment enough.
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Writing this editorial has been a great opportunity to reflect on the role of the health visitor. The profession is facing more changes, with services once again being transferred to local authorities in October 2015. However, with change comes opportunity as well as uncertainty.
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How does this work in practice? Well, when a baby is brought to a child health clinic or weighed in the home, for example, a health visitor is actually using a ‘top-to-toe’ health assessment to check for a multitude of possible issues, including a wide range of potential physical problems. Growth is plotted and interpreted, not only to detect potential physical disorders, but also to monitor safeguarding concerns.
Health visitors have always been active in influencing policy and campaigning for better services, and, during this next transition, I believe that it is vital that we demonstrate our value through providing measurable outcomes and contributing to the future NHS and social care landscape. Health visitors are highly skilled... and just for the record, yes, we do weigh babies! JCN
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ROLE CONFUSION
But, let’s take a minute to explore this popular perception. Can it really be true that a health visitor is paid at band 6 or 7 merely to read a baby’s weight from a set of scales? Of course not. In reality, being a health visitor is about providing added value.
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All of these issues can impact on health. In order to address the wider determinants of health and well-being, it is essential that as health visitors we have effective working relationships with our partners in care across the full range of services. From just one contact I may refer to social services, psychological services, a children’s centre, housing, smoking cessation, dietician and the community nursing team.
‘Writing this editorial has been a great opportunity to reflect on the role of the health visitor’
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Holistic assessment of a family may unearth a vast range of health and wellbeing issues. When I first introduce myself to a family, I clarify my role by saying that I am there to work in partnership with them to help them get the best quality of life possible for their child and themselves. I go on to say that quality of life is affected by many things — housing, relationships, emotional health, social inclusion, physical health and financial circumstances, to name a few.
One colleague said that she felt there was a danger of limiting our abilities by trying too hard to explain what is both an ‘art and a science’, and not simply a taskorientated profession. However, there was general consensus that families often feel we are there to ‘weigh babies’.
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core service and at each contact a holistic assessment of the whole family’s health and wellbeing is undertaken, with those who are vulnerable or have additional needs being seen much more frequently.
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Why then, if we have thousands of contacts with the public every year, is our role so vague? This question caused some passionate debate within my team. One comment was that until the recent re-investment in health visiting, we have been swamped, managing large caseloads and finding ourselves predominantly engaged in safeguarding and tackling the effects of health inequalities rather than the root causes.
There was an acknowledgment that having extra investment, commitment from government, clinically intelligent leadership and professional support from organisations such as Public Health England, Health Education England and the Institute of Health Visiting (iHV) are helpful in raising the profile of the important role we play.
Worth the weight: health visitors in Hull practise their baby-monitoring skills.
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