Abstract
This study aimed to explore the extent to which health visitors who trained and qualified in both Greater London and the South West of England between September 2011 and January 2016 were employed in health visiting posts and have remained in the profession. In 2011, the UK Government launched the Health Visitor Implementation Plan 'A Call to Action' (Department of Health, 2011) to develop the health visitor workforce by training 4200 health visitors over a four-year period. By April 2015, 4000 additional health visitors were trained, but the total workforce has since fallen back to pre-Implementation Plan size. Data were collected using a survey, completed online by participants. All participants had undertaken a health visitor education programme at one of two participating universities. The survey was distributed in January 2017 and completed by 180 individuals. Quantitative data were analysed using SPSS; association was assessed using individual chi-square tests or Fisher's exact test. Free-text responses were thematically analysed. Most (153; 87%) participants were still working as health visitors. Length of time spent working in the community prior to completing health visitor training was associated with staying in the role ( χ2 (with Fisher's exact test = 7.998, P = .027). Current pay was associated with attrition from the health visitor workforce ( χ2 (with Fisher's exact test) = 67.559, P < .001.). The majority who had left the health visitor role were on higher pay bands in their new post compared to those that had stayed (12; 60%). Bronfenbrenner's (1979) theory of socio-ecological development was used as a framework to interpret the results. While participants made an active choice to join the profession, leaving was influenced more by factors outside their control. To influence health visitor retention, both local and strategic changes are required.
Highlights
A strong health workforce is highlighted by World Health Organization (2017) as one of the building blocks of an effective health system
In England, the public health nursing workforce consists of health visitors (HVs), school nurses and occupational health nurses
The findings indicate that in order to influence recently qualified HVs to remain in the profession, both local and strategic changes may be required
Summary
A strong health workforce is highlighted by World Health Organization (2017) as one of the building blocks of an effective health system. HVs work with pre-school children and families to promote healthy lifestyles and prevent illness. They are nurses or midwives who have undertaken a further year of study to gain a specialist public health qualification. These areas for development were intended to collectively strengthen the health visiting service over a four-year period and led to unprecedented student numbers in the one-year educational programmes in higher education institutes that equip nurses and midwives to become HVs, whilst innovative practice and new service models influenced the way both established and newly qualified HVs worked. Investment was part of a complex picture of UK National Health Service (NHS) transformation and economic reform including radical changes to the structure of the NHS and public health services
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