If you read my post on Health Visiting – Quality and Quantity you will know that the mothers in my Facebook group have plenty to say about health visiting services. Good and bad, the feedback comes thick and fast every week, so much so that I contacted various senior health visitors to discuss the trends I was seeing.
But if I ask my group whether they have personally provided this feedback to their health visitors or trusts most of them will say no. Why is this the case? Sure, a lot of it will be the usual social media rants and whinges that we see all the time, and doesn’t actually warrant a call to a team leader. But I frequently see posts where the health visiting team in question would really benefit from being told about the perceived problems, the poor quality of advice, the difficulties families are facing and so on. Yet trying to convince mums to provide feedback is very difficult. Why should this be the case?
Health Visitor Advisor to the Department of Health Andrea Johns asked me to find out from the group what they felt were the barriers to providing feedback. I will give you a flavour here of their response:
“I didn’t complain about mine as I knew it would be likely I’d still see her at clinic. I didn’t want there to be any awkwardness / receive more negative attitude as a result of a complaint.”
“I think the problem is that no one really knows who you can complain to.”
“I complained about mine and was told there was nothing I could do as it would be recorded as a personality clash. I can’t remember the exact wording of the conversation but I was essentially told my request would have to be referred to management (leaving a mark on the health visitor’s record) and would likely be put down as a personality clash. They just advised me to go to the baby clinic if I had questions.”
“Had it been any other service or an every day situation like being served in a restaurant I wouldn’t put up with poor service and would say something. But when it comes to HVs I found I suddenly lost my voice. It felt like questioning them would lead to questioning of you and you as a mother. If they had a very clear and well set out feedback system (for positive and negative feedback) that was highlighted from the beginning I think it would help to make the whole system seem more transparent and make it easier. Maybe even something online? It would also make it easier for people to quickly raise an issue without feeling they have to talk to the people involved directly themselves?”
“I haven’t complained as you’re stuck with them for 5 years so it would be quite embarrassing!”
“I realise that they are under staffed which I think stops me from complaining. Like others I depend on the internet for advice nowadays or the GP as I just find it’s less stressful.”
There is so much confusion about the role of health visitors and by whom they are supervised. It is even news to a lot of mums that HVs are registered nurses. Of course, even when this is well known, a complaint to the NMC seems extreme! But is it made clear to families how and where they can provide feedback on health visiting services – feedback in general and complaints specifically?
Fortunately I have absolutely no complaint about my health visiting team, and I have provided positive feedback to them directly on a number of occasions. But let’s say I wanted to mention that I had been unhappy with something my HV had said to me. Not even a complaint as such, just a concern. Putting aside the contacts I have and the things I know now, where would I have looked as a first time mum?
Well, I may have Googled Sale Moor Health Visitors. And if I had the top link would have been this
This takes me to the Trafford Council website where I am told the following:
Now I know that Joan is the team leader. But that is not made clear on this information. And it is certainly not made clear that you could use her email address to provide feedback about the team. But is this the webpage the team would like you to be directed to? Let’s see if there is a better link than the one at the top…..
No, there isn’t. The other links are to news reports about awards the team has won, and to the local GP surgeries. There might be something on the next page, but I don’t know of many people who search past one page of Google. Added to this is the fact that when my eldest was born I didn’t know that my health visitor was from the Sale Moor team. I only registered that information fairly recently. So in all honesty I would have Googled Trafford Health Visitors. And I would have got this:
Even less informative. Now I’m not suggesting that all health visiting teams should suddenly spend the huge amounts of time they don’t have building fantastic websites and employing search engine optimisation experts. What I am saying is that if my team is typical it is not obvious to whom feedback should be addressed.
The second issue is of course what will happen if feedback is provided. What will be the repercussions? What is the standard procedure for dealing with feedback and complaints? What if there is only one health visitor in your area? And is the team leader likely to welcome feedback or will you just be creating problems for yourself in providing it?
The consensus on my group was that feedback should be gathered online, simply and anonymously. This comment summarises the general feeling:
“I think a feedback survey, one that has one-word answers but also gives you the space to elaborate if you need to, but so that you can remain anonymous as well. And for them to be given at standard times throughout the age of your little ones, as I realise everyone differs in the amount of times they would see their HV. So like once your little one is 1 month then 6 months etc. And to do it online, that way the NHS are saving costs with postage but also it’s a lot quicker for the parents to fill out. It personally takes me ages to get round to filling out a survey by hand and then posting it (will sit on my kitchen table for weeks!) But I think online you’re more likely to just do it when you’re having a browsing session. Also make sure the survey would allow you to put the positives on there as well. Even though I’ve had negative experiences I also know there are a lot of good HVs out there as well.”
I know that some areas are piloting systems very like that described above and I hope these are rolled out nationwide. In the meantime, it would be fantastic if every team could provide clear information about how to provide feedback (positive and negative), how to complain, and what the procedure will be if you do. With health visitors working alone, certainly when it comes to home visits, there is not the informal peer supervision you get with so many other healthcare providers. This is why gathering honest feedback from families is so crucial – and hopefully relatively simple to achieve.