National Health Service

This essay discusses some of the oppertuities and challenges facing Health visitors today, It outlines changes, strategies and plans commisioned by the National Health Service (NHS), Department Of Health (DOH) and the Government to ensure families have a positive start. The aim is to strengthen the Health Visiting team and provide continued care using communication, information sharing and multi disciplinary team work.

Looking at the positive side of Community Health Visiting and the oppertunities it provides for the public, is extremely eye opening to the possibilities it offers the community. Health visiting is a universal service, providing help and support to all families who are expecting their first child, or already have young children. Because everyone recieves a primary visit, there is not the stigma attached to a health visitor appointment like there is to a social worker appointment. Because of this it is easier to engage with families and build relationships. Throughout Britain the rate of poverty and the lack of good solid education is rife in the underprivilidged areas. A good Community Health Visiting team can implement big changes in Health and Wellbeing as well as attitudes and understanding. Following the completion of training the Health Visitor is able to utilise resources such as Sure Start children’s centres.

These centres introduced in 2003 are invaluable in providing a base where interprofessional teams can access vulnerable families and introduce them to many opportunities including, health promotion, education, advice and support. They offer the opportunity for Community teams to supervise play and interactions, enabling them to identify needs and establish early recognition where there is a risk of deterioration to an individual or a family’s health or social wellbeing. The team are able to provide the support required in ensuring that every child achieves the five outcomes introduced in the ‘Every Child Matters’ agenda. The centres also provide a base for interprofessional communication, enabling practitioners to make referrals to many different agencies for example to CAMHS or to propose the need for a CAF referral.

The Healthy Child Programme updated edition in 2009 discusses the importance of the early identification of need and risk, as do the papers Safeguarding Children and Working Together. The need to put preventative measures in place early to ensure vulnerable adults and children are kept safe, are fundamental to enable communities to achieve the six policy objectives recommended in the Marmot Review ‘Fair Society, Healthy Lives’. The Health Visiting team are instrumental in supporting and educating families from pregnancy until school age when the school nursing team take over. Confidential sharing of information is vital in ensuring continuation of care. The need for a good Health visiting team for new parents is invaluable, from being able to support breastfeeding and weaning to advising on good positioning and the risks of sudden infant death syndrome.

The proposals in the ‘Health Visitor Implementation Plan’ to expand and strengthen health visiting services, along with the important new investment through Department of Health budgets to provide 4,200 extra health visitors by 2015, should enable stronger links with local health services such as the Sure Start children centres, social services, family support workers, GP’s and many more. By increasing the number of Health Visitors, communities will benefit greatly from being able to access the support they need to recognise their strengths and improve their confidence giving their children the best start in life. The challenges faced by Community Health Visitors can include a negative opinnion of their role by the public.This highlights the importance of using interpersonal skills to build relationships.They will have to face predujice and will need to overcome bias and religious barriers. The decline in the number of Health Visitors has increased due to retirement, lack of training and financial restraints. This has meant the workload for the remaining teams has increased. As the numbers of substance abusers and homelessness continue to rise, the role of the Health Visitor can be challenging.

Refereals and child protection issues will need to be addressed which will require excellent observation and communication skills. In such a diverse populated community communication can cause misunderstandings and confusion following visits of a nebulous and intricate nature. Religion can also have an impact on health and wellbeing and may influence families to live in a way that is seen to be detrimental to the development of their children. Tactful and non judgemental support will be vital in this situation, and a good baseline knowledge of different religious needs. Cultural differences and gaining access to properties to visit families may also play a part in the challenges that Health visitors face on a daily basis. It may take time for a trusting relationship to form.

A family’s or an individuals attitude influenced by social, parental, environmental or educational factors may take time to change, so the Health visitor will need to be patient and understanding. It may even be neccesary to enlist a translator to assess an individual families needs. The Health Visitor often lone works and needs to have a safe lone working system in place to maintain their own safety. Another consideration of lone working is professional accountability. When making decissions regarding the family’s wellbeing, or offering advice and guidance it is vital that one’s recommendations can be supported by evidenced based knowledge. So conntinued study is also essential. Funding from the PCT may also restrict the services one is able to provide, in a socially deprived area a Health Visitor may see the need to run a parenting programme, or a mother and toddler group and require funding for equipment aswell as necesary helpers. This is a challenge all health care professionals face and the lengthy process of getting the funding approved, could be frustrating.

The role of the Health visitor can be a very rewarding one, empowering families to make informed choices and helping families make independent decisions resulting in changes to their lifestyles, ultimately improving health awareness in the community. The DOH have launched a campaighn to promote breastfeeding in the UK and are commissioning PCT’s to increase breast feeding awareness and reduce inequalities. The aim is to icrease the numbers of mothers breast feeding resulting in improved health in infants and children and a reduction in health inequalities. Following this, advice and teaching on weaning and healthy eating can be given to continue in providing the best nutritional start for the infants. This could be challenging esspecially for families effected by povety and inadequate housing. The local Government and the NHS began to address the ‘Health Gap’ in 2000, the aim was to reduce the gap by pooling agencies and providing
support to the most vulnerable.

The DOH have also introduced Whooping cough vaccines for pregnant woman so that their newborns are temporarily covered instead of waiting for the normal vaccine at two months old. This has come about due to the increase in cases of infants having contracted the diseaese this year, resulting in nine infant deaths. This early prevention can then be followed up in the community by the standard childhood immunisations. Providing families with current information regarding immunisations and other health care issues can be provided by Health Visitors at initial visits and baby clinics.

There are times when the role of Health Visitor can be enjoyable and fullfilling but there will be times when it will be stressful. 1 in 4 individuals in the uk suffer from mental health problems within their lifetime, and working with these individuals requires coping strategies and lots of support on both sides. Intervention is a very important part of the Health Visitors role and referrals and follow up appointments may be neccesary. Due to the area specialised, new mothers with post natal depression can be a real factor in the day to day role of any community health worker. Having the opportunity to reflect on stressful situatiions will be invaluable. Setting up postnatal depression support groups and using the Edinborough post natal depression scale and ensuring these vulnerable women get the support they need can be time consuming. Being pro active and using ones innovative ideas can be tiring and may well be difficult to introduce.

One of the key roles of a Health Visitor identified by the Department of Health in 1999 was leadership. When developing an effective leadership role, Health Visitors will need to employ evidence-based problem-solving strategies which will enable them to lead a team of professionals or formulate a plan of action at multi disciplinary meetings. Thus ensuring the health needs of family’s are met for example when child abuse is suspected.

The NICE guidelines, ‘when to suspect child maltreatment’ recommendation, outlines how essential communication is, and discusses some of the potential obstacles a Health visitor may encounter. When recognising and responding to any form of abuse or neglect the Health visitor will be involved in complex decision- making processes and may face anger from the family. The NHS ‘Zero Tolerance Campaign’ has developed government initiatives to support staff working in areas of high risk. Adopting good coping mechanisms and writing reflective and accurate reports will help ensure one receives the required support from managers and colleagues.

In conclusion the role of a Health visitor is fulfilling and rewarding. A determined person with a positive attitude will be able to work towards overcoming the challenges faced. Because it is a financially driven service provided by the government, it is important that proof of the effectiveness of the service is achieved by auditing, and from the service users themselves. This will ensure continued support and more Health visitors. This will reduce workloads and make it possible to reach more people above core services ie: primary visit, 8-week check and 8-month check. By working with other agencies such as children’s centers there is more of a chance to deliver health promotion to more families, and by continuing to build relationships by being sensitive to their individual needs Health visitors will continue to break down barriers.