26th-30th September is #HVweek – or for those of you not living in a world of hashtags, Health Visiting Week. Celebrating Health Visiting in 2016.
Now, let me stop you there. I know, you’ve already started to think about all of the ways in which health visitors drive you crazy. Ways in which they have let you down. Ways in which they have upset the women with whom you work. But let me make very clear one of the reasons this happens:
Health Visiting is a universal service for children between the ages of 0 and 5.
That’s right, a health visitor is provided for every single child in this country, either from birth or whilst still in the womb, until they reach 5 years of age, at which point care passes to the school nursing team.
That’s a lot of children. And a lot of parents. And a lot of carers. A lot of family situations, and a lot of challenges. A lot of safeguarding. A lot of infant feeding. A lot of ensuring that children are developing as they should, or being provided with the support that they need. A lot of maternal mental health care. A lot of nutritional advice. A lot of domestic abuse, and a lot of frightening situations.
What do we not have a lot of? Health visitors.
I am the first, the very first, to pull up HVs when their advice is not evidence-based. When their approach is unhelpful. When their compassion is lacking or the ethical standards of their profession in question. I am no apologist for the health visiting service. What’s that phrase, “some of my best friends are health visitors”? I certainly do count among my friends some amazing women who support families in the UK via their health visiting role, and I have so much admiration for them. And one of the reasons I admire them is that they are the health visitors who welcome the feedback, who want to discuss it and be creative in their solutions to it, and who then want to find out more!
The conversations I have had, and sometimes the arguments I have had, with health visitors over the last few years have been stimulating, thought-provoking, humbling, and enlightening, as well as at times frustrating.
Poster presentation following online discussions between mothers & HVs – for more information please see the HVe-COP newsletter
I really want to continue to have those conversations. I really hope that next year there is an #HVweek too. I want to be able to provide feedback on health visiting services for many years to come. But this may not be possible. Because health visiting services are under threat.
You may not have got on well with your health visitor. You may not have felt that you needed one. You may have been frustrated by some of the advice they gave. But I hope you do not believe that all of the 0-5s in this country will get along just fine without a healthcare professional to check in on them. I hope you don’t think that GPs have the time, experience, knowledge or desire to take on that role, because if you do you are living in a fantasy land. Even in a world where every family had a postnatal doula (and that is a world in which I would love to live) that would still fall incredibly short of the work that health visitors do.
In case you are unsure, this is what health visitors do:
A more detailed discussion can be found in this blog by now newly-qualified health visitor, Jenny Harmer.
Well, that’s what they used to do. That is what I was confident telling people they did, up until October 2015. Nearly a year ago, commissioning for health visiting services moved to local authorities. Since then, cuts have been drastic. Some LAs have suggested dropping health visiting services altogether. Some health visiting services have been moved to private providers. And you can be certain that there are nowhere near enough health visitors to do everything we want them to do, everything we think they should do, and everything they so very much want to do for families.
So this #HVweek I urge you to get behind health visitors. Make it clear that we, as parents, value them. We know that they’re not perfect, they know that they’re not perfect, but continuing to strive to improve an imperfect but vital service is where I want to be. I dread the day when there is no service to call upon, no one supporting new families, no one seeing almost every new child (apart from the children of families who decline the service) to try to spot those crucial early signs of abuse, neglect and trauma.
My own health visitor was, and is, a marvel. She has supported my family for over 5 years, and I know she is there, at the end of the phone, whenever I need her until my youngest is 5. Mine is far from an isolated experience. Let me finish with some quotations from women of my acquaintance describing their positive experience with their HVs:
“My health visitor sees me weekly and has done pretty much since number 3 was born 6 months ago. He weighs her, gives advice about all 3 kids that are under 4, referred me to mental health team, CBT, sorted my prescriptions out with my GP, took me to get my daughter’s tongue tie cut as I had no one else to come with me or watch the other 2 kids, he also explains to my husband about post natal depression/psychosis, he discusses my mood and intrusive thoughts and coping mechanisms, he gives me hope and he listens to me and I never feel judged or rushed. He also writes prescriptions for my kids, listens to their chests if I’m worried about a chest infection, he talks to and plays with the kids, advises about weaning, sleep, behavioural management of my 3 year old. I don’t know what we’d do without him. I would never have got help for my PND/psychosis and would probably have never told anyone else that I didn’t think my daughter was mine and was planning an overdose.”
“[I was helped by] an amazing health visitor I met through my local sure start breastfeeding group. She was amazing and noticed my daughter had a sub mucous cleft palate and referred us in to specialist support.”
“I love my health visitor! She’s fantastic, she never forces things onto you and if I’ve had a problem she’s helped me with it, she’s lovely, so down to earth, more like a friend really.”
“I had a really lovely HV and she agreed that my little one was definitely crying for more than the reason the doc said ‘babies just cry’ – she encouraged me to get her tongue tie cut and totally changed my baby girl!”
“Nothing ever seems silly to ask them, am happy to ask anything and they take it seriously. Have had a lot of support from the nursery nurse working with HVs about sleep, and they’ve been to visit me at home. They were very good at supporting me with my first son when he wasn’t gaining much weight.”
“My HV really listens, isn’t afraid to ask difficult questions about how I’m feeling and tailors her advice to each mum rather than just generic off an info sheet advice. She’s lovely but sadly far too stretched so the service they offer has been cut down. Such a shame as you can see how much more stressed everyone is.”
“Being a first time mum I thought I was doing everything wrong, my lovely health visitor gave me a lot of reassurance.”
“My HV has helped me a lot with my anxiety & being a first time mother & coping! She’s the one who said she could refer me to psychological services & I allowed her to. She’s been supportive, she will call me out of the blue to see how I am, she’ll come around for a chat to see how things are going. If she hadn’t have visited me at home, I don’t think I would have took that step to reach out for support. Especially as the HVs I see at the children’s centre are different/people I have never met.”
“[My health visitor told me] rest is the only other job apart from looking after baby that you should be doing. It was good to hear this from a professional, I’m dreadful and never slow down or do “me time” and after 2nd baby I was ill for a constant 11 months, she tried hard to make me slow down.”
“I was told by a health visitor that I was a good mum and doing my best for my baby. That gave me so much confidence.”
“When I was diagnosed with PND and felt like my baby should be taken away from me [my health visitor told me] “There isn’t a single person in the world that is capable of loving and caring for your baby better than you are. You are his mother and that is everything”. It was said in the most inspiring way, without pressure or judgement.”
Let’s make sure that this #HVweek local commissioners understand the importance of the health visiting service. And that they never forget it.
Helen Calvert
September 2016
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Heartmummy Musings 
Thank you Helen, timely piece on the unique role of Health Visiting and their universal offer 0-5. There needs to be a high level intervention to bolster funding for preventative services to survive, let alone to flourish as LA budgets and consequently financial envelopes for commissioning are slashed.
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