Will health visiting survive?

Abstract

W hen I met district nurses and health visitors last week in Edinburgh, there was much discussion about our plans for the integration of acute and community health services and social care. There were questions and comments about the pace of change, the implications of such fundamental change for frontline staff and, most importantly, what it will mean for patients—how will it really improve services and outcomes of care? How will we ensure robust clinical governance and professional accountability? There were also questions about money and how health budgets would be ‘protected’ against the need to subsidise the rising demand for social care. It was a very interesting and stimulating session. I did my best of course to share our thinking and our progress in terms of agreeing how we will deal with such issues and to share my hopes about such a fundamental shift in the way we deliver our services, but one question stood out for me: ‘Will health visiting survive?’ This was as much a general question as one linked to health and social care integration. It certainly was not a question I was expecting, but the answer was easy: ‘Yes it must.’ Health visiting celebrated its 150th birthday last year and has as much to do now as it did when the profession was born, in terms of helping to improve the health of the population. The need for significant support for mothers and babies, as well as the more general public health agenda, means there is plenty for health visitors to do. We know so much more now about the importance of nurturing and good health care in the early years of life (as well as pre–birth) and we need to be applying it in practice for every child. Attempts not so long ago at national change in Scotland to review community nursing instigated more upset and concern among frontline practitioners than successful progress towards developing a confident community nursing workforce ready to face such challenges as integration. I hope that is well behind us and we can all move on. The policy context in Scotland does clearly hold a place for health visitors. This is evident in Modernising Nursing in the Community (www.mnic.nes.scot.nhs.uk), Health for All Children (‘Hall 4’) (Scottish Government, 2005 and 2011), Getting it Right for Every Child (GIRFEC) (2008) and The Early Years Framework (2009). The introduction of models of care developed and tested elsewhere, such as the Family Nurse Partnership (FNP), provides excellent evidence-based care and support to a specific group of clients—but not to all. Such programmes as FNP were not meant for all women and their families. The strength of health visiting is that it was and is meant for all women and their families, as part of the provision of universal services that underpins the NHS. Our current challenge across the UK is that, to Melanie Hornett Nurse Director NHS Lothian Health Board continue to provide a health visiting service to all, we do need to find different ways to deliver and sustain it. The demands placed on the service by health inequalities, the needs of vulnerable children and child protection issues, as well as the impact of parental substance misuse, to name but a few, continue to rise. Added to this, across Lothian we have a growing population. Routine work around parental support, developmental checks and immunisation is also considerable. The demands of the workload, especially around child protection, are often cited to me as reasons why it is hard to recruit and retain health visitors in certain areas. We know that the best care for children and their families comes from child-focused teams working together across professional and organisational boundaries and this brings me back to where I started—integration.