Policy: Reconnecting health visiting and public health

Abstract

Prevention and public health are the basis of the work of health visitors. How can the wider public health community work with health visitors to make best use of this valuable front line public health resource?In 2012, in addition to all the other celebrations, the first 150 years of health visiting was celebrated and the new Institute of Health Visiting (www.ihv.org.uk) was launched. The history of health visiting roots the profession in the work of home visitors, employed by the Ladies Branch of the Manchester and Salford Sanitary Association to visit women and children in slum areas of Manchester and Salford to promote hygiene and health in the home.1 The existence of this and many other associations was in itself a reflection of the growing concern with public health during the early and mid 19th century, which focused on issues around industrialization and infectious diseases, epitomized by the work of John Snow whose bicentenary is celebrated this year.While the practice of health visiting may go back to 1862, it was not until 19772 that the underpinning philosophy of health visiting practice was fully articulated in the four principles of health visiting:* The search for health needs* The stimulation of an awareness of health needs* The influence on policies affecting health* The facilitation of health enhancing activities3These principles identify the health visitor as a preventive, public health worker working both with individuals, families and communities and acting to influence the wider public health context. The principles form the basis for the Nursing and Midwifery Council (NMC) approved health visiting programmes, which led to registration of health visitors as Specialist Community Public Health Nurses (Health Visitor) on the third part of the NMC register. Health visiting programmes also make use of the Public Health Skills and Competencies4 but the time is probably long overdue for the competencies for health visitor education to be based more clearly on these generic public health skills and competencies. If this was the case then the critical role of the health visitor as a Band 6 or 7 practitioner in public health might be more clearly seen by the wider family of public health practitioners.The launch and subsequent implementation of the Health Visitor Implementation Plan 2011-15 A Call to Action5 in England has led to a re-energizing of health visiting and health visitors in England and throughout the UK.6 The plan initiated the new four-level health visiting service for families: community; universal; universal plus and universal partnership plus, all informed by attention to safeguarding and child protection concerns. The reality of implementation, within the context of an ongoing programme to raise the numbers of health visitors from a historically low base, has been a focus, by commissioners, on commissioning and monitoring achievement of the activity in the three service areas (universal, universal plus and universal partnership plus). Reporting has focused on achievement of activities, for example the new birth visit at 10 to 14 days, monitoring of breast feeding at initiation and continuation, and management of vulnerable families and children at risk.A task-focused counting of contacts and activities does not, however, sit well with the 'opportunity' identified in the Call to Action for health visitors to: 'promote community capacity building to enable families and communities to build on their strengths to develop new ways for providing services as part of the Big Society'.This type of statement acknowledges that the health of the community is dependent on multiple factors which may be impacted by interdisciplinary and community collaboration. …